1
PN COMPREHENSIVE PREDICTORComplete 180-Question
Practice Examination Original NCLEX-PN Style Questions
with Detailed Rationales
SECTION 1: FUNDAMENTALS OF NURSING
QUESTION 1
A practical nurse is caring for a client who is 2 days postoperative following
abdominal surgery. Which finding should the nurse report to the healthcare
provider immediately?
A) Incisional pain rated 4 on a 0-10 scale
B) Serosanguineous drainage on the surgical dressing
C) Temperature of 101.8°F (38.8°C) with purulent wound drainage
D) Bowel sounds absent in all four quadrants
CORRECT ANSWER: C
RATIONALE: A temperature of 101.8°F with purulent (pus-like) wound drainage is
highly suggestive of a surgical site infection and requires IMMEDIATE notification
of the healthcare provider. Surgical site infections typically present 2-4 days
postoperatively with fever, purulent drainage, redness, warmth, and increasing
pain at the incision site. This is a serious postoperative complication that can
progress to sepsis if untreated. The provider will likely order wound cultures, CBC,
and possibly initiate antibiotics. Incisional pain rated 4/10 is an expected finding 2
days postoperatively—it should be managed with prescribed analgesics but is not
an emergency. Serosanguineous drainage (pink-tinged, thin) on the dressing is
expected in the first few postoperative days. Absent bowel sounds are an
expected finding in the first 24-72 hours after abdominal surgery due to
anesthesia and bowel manipulation; bowel sounds typically return gradually. The
nurse should continue to monitor and promote return of bowel function
(ambulation, NPO until bowel sounds return).
QUESTION 2
pg. 1
,2
The practical nurse is preparing to administer an intramuscular injection to a 6-
month-old infant. Which site should the nurse select?
A) Deltoid muscle
B) Dorsogluteal muscle
C) Vastus lateralis muscle
D) Ventrogluteal muscle
CORRECT ANSWER: C
RATIONALE: The vastus lateralis muscle is the preferred IM injection site for
infants under 7 months of age. It is the largest and most well-developed muscle in
infants, located on the anterior lateral thigh. It has few major blood vessels and
nerves, making it the safest site for this age group. The deltoid muscle is not
adequately developed in infants and cannot accommodate the volume of most
infant immunizations. The dorsogluteal muscle is contraindicated in children
under 3 years because the muscle is not well developed and the sciatic nerve is at
significant risk of injury. The ventrogluteal muscle can be used in children older
than 7 months, but for young infants, the vastus lateralis remains the site of
choice. The needle length for an infant IM injection is typically 5/8 to 1 inch, and
the maximum volume is 1 mL. The nurse should use appropriate comfort
measures such as oral sucrose solution and non-nutritive sucking during the
injection.
QUESTION 3
A client is receiving continuous tube feeding via a nasogastric tube. Which nursing
action is essential to prevent aspiration?
A) Keeping the head of the bed elevated at least 30-45 degrees
B) Checking gastric residual volume every 8 hours
C) Flushing the tube with 30 mL of water every 4 hours
D) Changing the tube feeding bag and tubing every 48 hours
CORRECT ANSWER: A
RATIONALE: Keeping the head of the bed elevated at least 30-45 degrees during
continuous tube feeding is the MOST IMPORTANT intervention to prevent
pg. 2
,3
aspiration. This semi-Fowler's position uses gravity to prevent the reflux of
formula from the stomach into the esophagus and airways. The head of bed
should remain elevated for at least 30-60 minutes after intermittent feedings as
well. Aspiration pneumonia is one of the most serious complications of enteral
feeding. Gastric residual volume should be checked every 4-6 hours during
continuous feeding (not every 8 hours) to assess tolerance and gastric emptying.
Flushing the tube with water every 4 hours maintains tube patency but does not
directly prevent aspiration. Changing the feeding bag and tubing every 24 hours
(not 48 hours) reduces bacterial contamination but is not the primary
intervention to prevent aspiration. Additional aspiration prevention measures
include: verifying tube placement before each feeding and every 4-6 hours during
continuous feeding, and assessing for signs of intolerance (abdominal distention,
nausea, vomiting).
QUESTION 4
The nurse is caring for a client with a stage 2 pressure injury on the sacrum.
Which finding is characteristic of a stage 2 pressure injury?
A) Non-blanchable erythema of intact skin
B) Partial-thickness skin loss with exposed dermis, appearing as a shallow open
ulcer with a red-pink wound bed
C) Full-thickness skin loss with visible subcutaneous fat
D) Full-thickness tissue loss with exposed bone, tendon, or muscle
CORRECT ANSWER: B
RATIONALE: A stage 2 pressure injury is characterized by PARTIAL-THICKNESS skin
loss with exposed dermis. The wound bed is viable, pink or red, and moist. It may
present as an intact or ruptured serum-filled blister. Adipose (fat) tissue is NOT
visible in stage 2—if fat is visible, the wound is at least stage 3. Stage 1: NON-
BLANCHABLE erythema of intact skin (option A). The skin may be warm, firm, or
painful compared to adjacent tissue. Stage 3: Full-thickness skin loss with visible
subcutaneous fat (option C). Slough or eschar may be present. Tunneling and
undermining may be present. Fascia, muscle, tendon, ligament, cartilage, and
bone are NOT exposed. Stage 4: Full-thickness skin and tissue loss with exposed
pg. 3
, 4
or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone (option D).
Unstageable: Full-thickness skin and tissue loss covered by slough or eschar,
preventing visualization of the wound depth. Treatment of stage 2 pressure injury
includes: gentle cleansing with normal saline, application of a moisture-retentive
dressing (hydrocolloid, foam), offloading pressure with repositioning and support
surfaces, and maintaining adequate nutrition and hydration.
QUESTION 5
A nurse is teaching a client about preventing urinary tract infections. Which
statement by the client indicates understanding?
A) "I should take bubble baths regularly to keep the perineal area clean."
B) "I will wipe from front to back after using the bathroom."
C) "Drinking less water will decrease the need to urinate and reduce infection
risk."
D) "I should hold my urine as long as possible to strengthen my bladder."
CORRECT ANSWER: B
RATIONALE: Wiping from FRONT to BACK (urethra toward anus) prevents the
introduction of bacteria from the anal area into the urethra, reducing the risk of
urinary tract infection. This is a fundamental prevention strategy that should be
taught to all clients, especially females who are at higher risk due to the shorter
urethra. Bubble baths, perfumed soaps, and feminine hygiene sprays should be
AVOIDED because they can irritate the urethra and disrupt the normal flora.
Drinking PLENTY of fluids (water, cranberry juice) dilutes urine and flushes
bacteria from the urinary tract—decreased fluid intake increases infection risk by
concentrating urine and reducing urinary frequency. Voiding when the urge
occurs (not "holding it") prevents bacterial stasis and multiplication in the
bladder. Other UTI prevention strategies include: wearing cotton underwear,
avoiding tight-fitting pants, voiding before and after sexual activity, and
completing the full course of prescribed antibiotics for any diagnosed UTI.
QUESTION 6
pg. 4
PN COMPREHENSIVE PREDICTORComplete 180-Question
Practice Examination Original NCLEX-PN Style Questions
with Detailed Rationales
SECTION 1: FUNDAMENTALS OF NURSING
QUESTION 1
A practical nurse is caring for a client who is 2 days postoperative following
abdominal surgery. Which finding should the nurse report to the healthcare
provider immediately?
A) Incisional pain rated 4 on a 0-10 scale
B) Serosanguineous drainage on the surgical dressing
C) Temperature of 101.8°F (38.8°C) with purulent wound drainage
D) Bowel sounds absent in all four quadrants
CORRECT ANSWER: C
RATIONALE: A temperature of 101.8°F with purulent (pus-like) wound drainage is
highly suggestive of a surgical site infection and requires IMMEDIATE notification
of the healthcare provider. Surgical site infections typically present 2-4 days
postoperatively with fever, purulent drainage, redness, warmth, and increasing
pain at the incision site. This is a serious postoperative complication that can
progress to sepsis if untreated. The provider will likely order wound cultures, CBC,
and possibly initiate antibiotics. Incisional pain rated 4/10 is an expected finding 2
days postoperatively—it should be managed with prescribed analgesics but is not
an emergency. Serosanguineous drainage (pink-tinged, thin) on the dressing is
expected in the first few postoperative days. Absent bowel sounds are an
expected finding in the first 24-72 hours after abdominal surgery due to
anesthesia and bowel manipulation; bowel sounds typically return gradually. The
nurse should continue to monitor and promote return of bowel function
(ambulation, NPO until bowel sounds return).
QUESTION 2
pg. 1
,2
The practical nurse is preparing to administer an intramuscular injection to a 6-
month-old infant. Which site should the nurse select?
A) Deltoid muscle
B) Dorsogluteal muscle
C) Vastus lateralis muscle
D) Ventrogluteal muscle
CORRECT ANSWER: C
RATIONALE: The vastus lateralis muscle is the preferred IM injection site for
infants under 7 months of age. It is the largest and most well-developed muscle in
infants, located on the anterior lateral thigh. It has few major blood vessels and
nerves, making it the safest site for this age group. The deltoid muscle is not
adequately developed in infants and cannot accommodate the volume of most
infant immunizations. The dorsogluteal muscle is contraindicated in children
under 3 years because the muscle is not well developed and the sciatic nerve is at
significant risk of injury. The ventrogluteal muscle can be used in children older
than 7 months, but for young infants, the vastus lateralis remains the site of
choice. The needle length for an infant IM injection is typically 5/8 to 1 inch, and
the maximum volume is 1 mL. The nurse should use appropriate comfort
measures such as oral sucrose solution and non-nutritive sucking during the
injection.
QUESTION 3
A client is receiving continuous tube feeding via a nasogastric tube. Which nursing
action is essential to prevent aspiration?
A) Keeping the head of the bed elevated at least 30-45 degrees
B) Checking gastric residual volume every 8 hours
C) Flushing the tube with 30 mL of water every 4 hours
D) Changing the tube feeding bag and tubing every 48 hours
CORRECT ANSWER: A
RATIONALE: Keeping the head of the bed elevated at least 30-45 degrees during
continuous tube feeding is the MOST IMPORTANT intervention to prevent
pg. 2
,3
aspiration. This semi-Fowler's position uses gravity to prevent the reflux of
formula from the stomach into the esophagus and airways. The head of bed
should remain elevated for at least 30-60 minutes after intermittent feedings as
well. Aspiration pneumonia is one of the most serious complications of enteral
feeding. Gastric residual volume should be checked every 4-6 hours during
continuous feeding (not every 8 hours) to assess tolerance and gastric emptying.
Flushing the tube with water every 4 hours maintains tube patency but does not
directly prevent aspiration. Changing the feeding bag and tubing every 24 hours
(not 48 hours) reduces bacterial contamination but is not the primary
intervention to prevent aspiration. Additional aspiration prevention measures
include: verifying tube placement before each feeding and every 4-6 hours during
continuous feeding, and assessing for signs of intolerance (abdominal distention,
nausea, vomiting).
QUESTION 4
The nurse is caring for a client with a stage 2 pressure injury on the sacrum.
Which finding is characteristic of a stage 2 pressure injury?
A) Non-blanchable erythema of intact skin
B) Partial-thickness skin loss with exposed dermis, appearing as a shallow open
ulcer with a red-pink wound bed
C) Full-thickness skin loss with visible subcutaneous fat
D) Full-thickness tissue loss with exposed bone, tendon, or muscle
CORRECT ANSWER: B
RATIONALE: A stage 2 pressure injury is characterized by PARTIAL-THICKNESS skin
loss with exposed dermis. The wound bed is viable, pink or red, and moist. It may
present as an intact or ruptured serum-filled blister. Adipose (fat) tissue is NOT
visible in stage 2—if fat is visible, the wound is at least stage 3. Stage 1: NON-
BLANCHABLE erythema of intact skin (option A). The skin may be warm, firm, or
painful compared to adjacent tissue. Stage 3: Full-thickness skin loss with visible
subcutaneous fat (option C). Slough or eschar may be present. Tunneling and
undermining may be present. Fascia, muscle, tendon, ligament, cartilage, and
bone are NOT exposed. Stage 4: Full-thickness skin and tissue loss with exposed
pg. 3
, 4
or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone (option D).
Unstageable: Full-thickness skin and tissue loss covered by slough or eschar,
preventing visualization of the wound depth. Treatment of stage 2 pressure injury
includes: gentle cleansing with normal saline, application of a moisture-retentive
dressing (hydrocolloid, foam), offloading pressure with repositioning and support
surfaces, and maintaining adequate nutrition and hydration.
QUESTION 5
A nurse is teaching a client about preventing urinary tract infections. Which
statement by the client indicates understanding?
A) "I should take bubble baths regularly to keep the perineal area clean."
B) "I will wipe from front to back after using the bathroom."
C) "Drinking less water will decrease the need to urinate and reduce infection
risk."
D) "I should hold my urine as long as possible to strengthen my bladder."
CORRECT ANSWER: B
RATIONALE: Wiping from FRONT to BACK (urethra toward anus) prevents the
introduction of bacteria from the anal area into the urethra, reducing the risk of
urinary tract infection. This is a fundamental prevention strategy that should be
taught to all clients, especially females who are at higher risk due to the shorter
urethra. Bubble baths, perfumed soaps, and feminine hygiene sprays should be
AVOIDED because they can irritate the urethra and disrupt the normal flora.
Drinking PLENTY of fluids (water, cranberry juice) dilutes urine and flushes
bacteria from the urinary tract—decreased fluid intake increases infection risk by
concentrating urine and reducing urinary frequency. Voiding when the urge
occurs (not "holding it") prevents bacterial stasis and multiplication in the
bladder. Other UTI prevention strategies include: wearing cotton underwear,
avoiding tight-fitting pants, voiding before and after sexual activity, and
completing the full course of prescribed antibiotics for any diagnosed UTI.
QUESTION 6
pg. 4
