Free NCLEX-PN practice questions

1. A. Notify the registered nurse immediately and stay with the clientCorrect

   Correct. A competent adult has the right to leave against medical advice, but the discussion of risks, the provider notification, and the AMA documentation are coordinated by the registered nurse and provider. The practical nurse reports promptly and keeps the client safe in the meantime.

2. B. Explain that the client cannot leave until the antibiotic course is finished

   Incorrect. Telling an alert, oriented adult they are not permitted to leave misstates their rights and could be construed as false imprisonment. Refusing treatment is the client’s choice once the risks have been explained.

3. C. Remove the intravenous catheter so the client can leave safely

   Incorrect. Acting on the request before the registered nurse and provider are involved skips the risk discussion and documentation the client is entitled to, and may leave a serious infection untreated without anyone having explained the consequences.

4. D. Ask a security officer to wait outside the room

   Incorrect. There is no threat to safety here — only a client exercising a right. Involving security is intimidating and escalates a situation that calls for communication.

Educational objective: A client who wants to leave against medical advice is reported to the registered nurse at once; the practical nurse does not block the client, nor act on the request before the risk discussion has happened.

1. A. Washing hands with soap and water after removing glovesCorrect

   Correct. C. difficile spores are not killed by alcohol-based hand rub; only the mechanical action of soap and running water removes them. Gloves reduce contamination but do not replace hand washing after they come off.

2. B. Using alcohol-based hand rub before and after every contact

   Incorrect. Alcohol rub is the standard for most organisms, but it does not inactivate C. difficile spores, so relying on it here leaves the spores on the hands and carries them to the next client.

3. C. Wearing a surgical mask whenever entering the room

   Incorrect. C. difficile spreads by the fecal–oral route via contaminated hands and surfaces, not through respiratory droplets, so a mask adds nothing to transmission control.

4. D. Placing the client in a negative-pressure isolation room

   Incorrect. Negative-pressure rooms are for airborne pathogens such as tuberculosis. Contact precautions with a private room or cohorting are the correct level for C. difficile.

Educational objective: Alcohol-based hand rub does not kill C. difficile spores — hand washing with soap and water after glove removal is the single most important measure on contact precautions for this organism.

1. A. "I will lay the baby on their stomach to sleep so they do not choke if they spit up."Correct

   Correct — this needs correcting. Prone sleeping is the strongest modifiable risk factor for sudden infant death. Healthy newborns are placed on their back for every sleep; their airway reflexes protect them if they spit up.

2. B. "The crib will have a firm mattress with a fitted sheet and nothing else in it."

   Incorrect — this is right. A firm, flat sleep surface with no pillows, blankets, bumpers, or soft toys is exactly what safe-sleep guidance recommends.

3. C. "The baby will sleep in a bassinet in our room for the first several months."

   Incorrect — this is right. Room-sharing without bed-sharing lowers the risk of sudden infant death and makes night feeding easier.

4. D. "I will offer a pacifier at nap time and bedtime once breastfeeding is established."

   Incorrect — this is right. Pacifier use at sleep times is associated with a reduced risk of sudden infant death; waiting until breastfeeding is established is the usual advice.

Educational objective: Reinforce safe-sleep teaching: back to sleep for every sleep, on a firm bare surface, room-sharing without bed-sharing — and recognise the prone-sleeping misconception as the statement that needs correcting.

1. A. "Tell me more about how you are feeling about what the doctors said."Correct

   Correct. An open-ended invitation lets the client express what the news means to them without being confronted. Denial is a normal early response to a devastating diagnosis, and exploring it respects where the client is.

2. B. "The test results are quite clear. It is important that you accept them."

   Incorrect. Confronting denial head-on strips away a coping mechanism the client is not ready to give up and closes the conversation rather than opening it.

3. C. "Try not to worry — a positive attitude makes a real difference."

   Incorrect. False reassurance dismisses the client’s situation and implies their feelings are not worth discussing. It is a non-therapeutic block to communication.

4. D. "I will ask the chaplain to come and talk with you this afternoon."

   Incorrect. Referring the client on before hearing them out changes the subject and may not be what the client wants. Spiritual support can be offered later, once the client has been listened to.

Educational objective: Meet denial with an open-ended, non-confrontational response that invites the client to talk; avoid confronting the denial, offering false reassurance, or changing the subject.

1. A. Hold the dose and report the findings to the registered nurseCorrect

   Correct. Beta-blockers slow the heart rate, and a pulse below 60 is the conventional hold parameter. Holding and reporting is within practical-nurse scope; the decision to give, hold permanently, or contact the provider for a dose change belongs to the registered nurse and provider.

2. B. Give the dose as ordered, since the client has no symptoms

   Incorrect. Absence of symptoms does not make the dose safe. Giving a beta-blocker on a pulse of 52 risks symptomatic bradycardia and hypotension that were entirely avoidable.

3. C. Give half the dose and recheck the pulse in one hour

   Incorrect. Altering a prescribed dose is a prescribing decision. A nurse may hold a medication on a safety parameter but never change the amount ordered.

4. D. Give the dose and place the client on continuous cardiac monitoring

   Incorrect. Monitoring does not prevent the drug from lowering a heart rate that is already too low, and initiating continuous monitoring is not the practical nurse’s decision to make independently.

Educational objective: Check the apical pulse before a beta-blocker, hold the dose when it is below 60 beats per minute, and report to the registered nurse — never alter the ordered dose.

1. A. Give 4 ounces of fruit juice and recheck the blood glucose in 15 minutesCorrect

   Correct. A conscious client who can swallow is treated with about 15 grams of fast-acting carbohydrate, then rechecked in 15 minutes and re-treated if still below 70 mg/dL. This is the standard hypoglycaemia protocol and squarely within practical-nurse scope to carry out.

2. B. Notify the registered nurse and wait for direction before treating

   Incorrect. Hypoglycaemia is treated immediately; the registered nurse is informed, but delaying the carbohydrate while waiting risks the client losing consciousness. Reporting follows treatment here rather than preceding it.

3. C. Administer the ordered subcutaneous glucagon

   Incorrect. Glucagon is for a client who cannot safely take oral carbohydrate — unconscious, seizing, or unable to swallow. This client can swallow, so oral treatment is faster and preferred.

4. D. Offer a peanut-butter sandwich and a glass of milk

   Incorrect. Protein and fat slow carbohydrate absorption, so a mixed snack raises the glucose too slowly for an acute low. A complex snack is appropriate afterwards, once the glucose is back above 70 mg/dL and the next meal is more than an hour away.

Educational objective: Treat hypoglycaemia in a conscious client who can swallow with 15 grams of fast-acting carbohydrate, recheck in 15 minutes, and reserve glucagon for the client who cannot take anything by mouth.