Advanced NCLEX-PN Multiple Choice
Questions (MCQs) with Answers and
Explanations for Practical Nursing Licensure
Examinations
1. A nurse is caring for a client with chronic heart failure who suddenly develops dyspnea,
bilateral crackles, and oxygen saturation of 86% on room air. Which action should the
nurse implement first?
A. Administer prescribed furosemide
B. Obtain a 12-lead electrocardiogram
C. Notify the healthcare provider
D. Position the client in high Fowler's position and administer oxygen as prescribed
Explanation: Airway and breathing take priority. Positioning the client upright improves
ventilation and reduces venous return, while supplemental oxygen addresses hypoxemia.
2. A client with type 1 diabetes mellitus becomes confused and diaphoretic. Fingerstick
glucose is 48 mg/dL. Which intervention is most appropriate if the client is conscious and
able to swallow?
A. Administer regular insulin
B. Restrict oral intake
C. Obtain a urine specimen
D. Provide 15 g of rapid-acting carbohydrate
Explanation: Conscious clients with symptomatic hypoglycemia should receive 15 g of fast-
acting carbohydrates and have glucose reassessed after approximately 15 minutes.
3. Which finding in a postoperative client requires immediate intervention?
A. Pain rating of 6 on a 0-to-10 scale
B. Temperature of 99.1°F (37.3°C)
C. Urine output of 40 mL/hr
, D. Sudden onset of shortness of breath and chest pain
Explanation: Acute chest pain with dyspnea may indicate pulmonary embolism and constitutes a
medical emergency.
4. A nurse is caring for a client receiving warfarin therapy. Which laboratory value should
be monitored most closely?
A. Hemoglobin A1c
B. Serum potassium
C. Blood urea nitrogen
D. International normalized ratio (INR)
Explanation: INR reflects the anticoagulant effect of warfarin and guides dosage adjustments.
5. A client with bacterial meningitis is admitted to the medical unit. Which precaution is
appropriate?
A. Protective precautions
B. Standard precautions only
C. Contact precautions
D. Droplet precautions
Explanation: Bacterial meningitis is transmitted through respiratory droplets, requiring droplet
isolation.
6. A nurse assesses a client receiving intravenous morphine and notes a respiratory rate of 8
breaths/min. Which action is the priority?
A. Encourage fluid intake
B. Reassess in one hour
C. Place the client in Trendelenburg position
D. Administer naloxone as prescribed
Explanation: Respiratory depression is a serious opioid complication and requires prompt
reversal with naloxone.
Questions (MCQs) with Answers and
Explanations for Practical Nursing Licensure
Examinations
1. A nurse is caring for a client with chronic heart failure who suddenly develops dyspnea,
bilateral crackles, and oxygen saturation of 86% on room air. Which action should the
nurse implement first?
A. Administer prescribed furosemide
B. Obtain a 12-lead electrocardiogram
C. Notify the healthcare provider
D. Position the client in high Fowler's position and administer oxygen as prescribed
Explanation: Airway and breathing take priority. Positioning the client upright improves
ventilation and reduces venous return, while supplemental oxygen addresses hypoxemia.
2. A client with type 1 diabetes mellitus becomes confused and diaphoretic. Fingerstick
glucose is 48 mg/dL. Which intervention is most appropriate if the client is conscious and
able to swallow?
A. Administer regular insulin
B. Restrict oral intake
C. Obtain a urine specimen
D. Provide 15 g of rapid-acting carbohydrate
Explanation: Conscious clients with symptomatic hypoglycemia should receive 15 g of fast-
acting carbohydrates and have glucose reassessed after approximately 15 minutes.
3. Which finding in a postoperative client requires immediate intervention?
A. Pain rating of 6 on a 0-to-10 scale
B. Temperature of 99.1°F (37.3°C)
C. Urine output of 40 mL/hr
, D. Sudden onset of shortness of breath and chest pain
Explanation: Acute chest pain with dyspnea may indicate pulmonary embolism and constitutes a
medical emergency.
4. A nurse is caring for a client receiving warfarin therapy. Which laboratory value should
be monitored most closely?
A. Hemoglobin A1c
B. Serum potassium
C. Blood urea nitrogen
D. International normalized ratio (INR)
Explanation: INR reflects the anticoagulant effect of warfarin and guides dosage adjustments.
5. A client with bacterial meningitis is admitted to the medical unit. Which precaution is
appropriate?
A. Protective precautions
B. Standard precautions only
C. Contact precautions
D. Droplet precautions
Explanation: Bacterial meningitis is transmitted through respiratory droplets, requiring droplet
isolation.
6. A nurse assesses a client receiving intravenous morphine and notes a respiratory rate of 8
breaths/min. Which action is the priority?
A. Encourage fluid intake
B. Reassess in one hour
C. Place the client in Trendelenburg position
D. Administer naloxone as prescribed
Explanation: Respiratory depression is a serious opioid complication and requires prompt
reversal with naloxone.
