NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
The nurse is caring for a 16-year-old client. History and Physical
Body System, Finding
General,
Client is brought to the emergency department due to nausea, vomiting, and abdominal pain that began 24 hr
ago. Client has type 1 diabetes mellitus and usually takes insulin. Parents state that the client was at an
overnight camp for the past 4 days and are unsure of how much insulin the client has been taking.
Neurological,
Client is lethargic but arousable to voice. The pupils are equal, round, and reactive to light and accommodation.
Integumentary,
Mucous membranes are dry, skin turgor is poor.
Pulmonary,
Vital signs are RR 36 and SpOz 95% on room air. Lung sounds are clear to auscultation. Deep respirations and a
fruity odor on the breath are noted.
Cardiovascular,
Vital signs are T 98.4 F (36.9 C), P 110, and BP 98/58. Pulses are 3+ on all extremities, and capillary refill time is
4 sec.
Gastrointestinal Normoactive bowel sounds are heard in all 4 quadrants; the abdomen is nontender.
Genitourinary,
Client voided dark yellow urine.
Endocrine,
Client is prescribed levothyroxine daily for hypothyroidism and has missed one dose of levothyroxine.
Psychosocial,
Parents state that the client has been sad and slightly withdrawn for the past 2 weeks after ending a romantic relationship.
Laboratory Results
Laboratory Test and Reference Range, 1000, 1600
Blood Chemistry.
Glucose (random)
≤200 mg/dL
(≤11.1 mmol/L),
504 mg/dL
(28.0 mmol/L),
164 mg/dL
(9.1 mmol/L)
Sodium
136-145 mEq/L
(136-145 mmol/L),
133 mEq/L
(133 mmol/L),
135 mEq/L
(135 mmol/L)
Chloride
98-106 mEq/L
(98-106 mmol/L),
101 mEq/L
(101 mmol/L),
102 mEq/L
(102 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
5.6 mEq/L
(5.6 mmol/L),
3.2 mEq/L
(3.2 mmol/L)
Arterial Blood Gases
Arterial pH
7.35-7.45
(7.35-7.45),
7.20
(7.20),
7.31
(7.31)
HCOg
21-28 mEq/L
(21-28 mmol/L),
13 mEq/L
(13 mmol/L),
18 mEq/L
(18 mmol/L)
PaCO,
35-45 mm Hg
(4.66-5.98 kPa),
30 mm Hg
(3.99 KPa),
32 mm Hg
(4.26 kPa)
PaO,
80-100 mm Hg
(10.64-13.33 KPa),
90 mm Hg
(11.97 kPa),
90 mm Hg
(11.97 kPa)
Question 1 of 5
Complete the following sentence by choosing from the lists of options. The nurse should first address the client's -------followed by the client's --------------
Correct Answer: A,D
Rationale: Hyperglycemia in diabetic ketoacidosis (DK
A) causes osmotic diuresis that leads to severe dehydration. When hyperglycemia exceeds the
renal threshold of glucose absorption, glucosuria (excretion of glucose in urine) occurs. Water loss is increased due to osmotic diuresis
induced by glucosuria, and extreme dehydration, hypotension, and decreased organ perfusion occur.
The priority intervention in DKA is to initiate an IV fluid bolus with 0.9% sodium chloride followed by insulin administration to lower serum
glucose levels. Rapid fluid resuscitation should occur before insulin infusion because insulin shifts water, potassium, and glucose into the
cells, worsening extracellular dehydration and electrolyte imbalances.
Therefore, for clients with DKA, the nurse should first address
hypovolemia followed by hyperglycemia.
Extract:
The nurse is caring for a 20-year-old female client.
Nurses' Notes
Urgent Care Clinic
0845: The parent brought the client to the clinic due to vomiting and weakness. The parent states that the client has experienced
sore throat and nasal congestion for the past week. The client has had 4 episodes of emesis during the past 24 hours and
diffuse, constant abdominal pain. The parent also reports that the client has had increased thirst and urine output over the
past 2 months.
The client's last menstrual period ended approximately 6 weeks ago with no abnormalities. Pregnancy status is unknown. The
client does not take any medications and does not use tobacco, alcohol, or recreational substances. Family history includes
hypertension and diabetes mellitus.
The client appears drowsy and is oriented to person and time only. The abdomen is soft without rigidity or rebound
tenderness, and bowel sounds are normal. No blood is present in emesis. Respirations are rapid and deep. Breath sounds
are clear.
Vital signs are T 98.8 F (37.1 C), P 128, RR 30, and BP 88/60 mm Hg.
Finger-stick blood glucose level is 600 mg/dL (33.3 mmol/L).
Question 2 of 5
Complete the following sentence by choosing from the lists of options. Based on the clinical findings, the client is most at risk for--------------------- as evidenced by the client's------------------------
Correct Answer: C,A
Rationale: The client's findings are most aligned with diabetic ketoacidosis (DK
A). When there is a lack of insulin to transport glucose into cells, glucose
accumulates, creating an osmotic gradient that leads to diuresis (polyuria) and fluid loss. If the hyperglycemia persists, the process continues
and the fluid volume deficit decreases cardiac output and perfusion to vital organs (hypotension). The heart rate increases (tachycardia)
to compensate for the decrease in cardiac output. Without immediate treatment, compensatory mechanisms eventually fail, and the client is
at risk for developing life-threatening hypovolemic shock
Extract:
History and Physical
Body System Findings
General
The client comes to the emergency department with fatigue, shortness of breath, dry cough, and
exertional dyspnea for 1 week; the client is homeless; medical history includes chronic heart failure,
uncontrolled hypertension, coronary artery disease, and type 2 diabetes mellitus
Pulmonary
Vital signs: RR 22, SpO, 88% on room air, the client is dyspneic but can speak in full sentences;
lung auscultation reveals decreased breath sounds at the lung bases and bilateral crackles; the
client reports smoking 1 pack of cigarettes per day for 35 years; the client was hospitalized for
pneumonia 6 months ago
Cardiovascular
Vital signs: T 99 F (37.2 C), P 90, BP 170/100; continuous cardiac monitor shows sinus rhythm with
occasional premature ventricular contractions; S1, S2, and S3 are heard on auscultation; bilateral
lower extremity pitting edema is noted
Question 3 of 5
Select below the 5 findings that are most concerning.
Correct Answer: B,D,E
Rationale: The client comes to the emergency department with fatigue, shortness of breath, dry cough, and
exertional dyspnea for 1 week; the client is homeless; medical history includes chronic heart
failure, uncontrolled hypertension, coronary artery disease, and type 2 diabetes mellitus
Vital signs: RR 22, SpOz 88% on room air; the client is dyspneic but can speak in full
sentences; lung auscultation reveals decreased breath sounds at the lung bases and bilateral
crackles; the client reports smoking 1 pack of cigarettes per day for 35 years; the client was
hospitalized for pneumonia 6 months ago
Vital signs: T 99 F (37.2
C), P 90, BP 170/100; continuous cardiac monitor shows sinus rhythm
with occasional premature ventricular contractions; S1, S2, and S3 are heard on auscultation;
bilateral lower extremity pitting edema is noted
Extract:
The nurse is caring for a 16-year-old client. History and Physical
Body System, Finding
General,
Client is brought to the emergency department due to nausea, vomiting, and abdominal pain that began 24 hr
ago. Client has type 1 diabetes mellitus and usually takes insulin. Parents state that the client was at an
overnight camp for the past 4 days and are unsure of how much insulin the client has been taking.
Neurological,
Client is lethargic but arousable to voice. The pupils are equal, round, and reactive to light and accommodation.
Integumentary,
Mucous membranes are dry, skin turgor is poor.
Pulmonary,
Vital signs are RR 36 and SpOz 95% on room air. Lung sounds are clear to auscultation. Deep respirations and a
fruity odor on the breath are noted.
Cardiovascular,
Vital signs are T 98.4 F (36.9 C), P 110, and BP 98/58. Pulses are 3+ on all extremities, and capillary refill time is
4 sec.
Gastrointestinal Normoactive bowel sounds are heard in all 4 quadrants; the abdomen is nontender.
Genitourinary,
Client voided dark yellow urine.
Endocrine,
Client is prescribed levothyroxine daily for hypothyroidism and has missed one dose of levothyroxine.
Psychosocial,
Parents state that the client has been sad and slightly withdrawn for the past 2 weeks after ending a romantic relationship.
Laboratory Results
Laboratory Test and Reference Range, 1000, 1600
Blood Chemistry.
Glucose (random)
≤200 mg/dL
(≤11.1 mmol/L),
504 mg/dL
(28.0 mmol/L),
164 mg/dL
(9.1 mmol/L)
Sodium
136-145 mEq/L
(136-145 mmol/L),
133 mEq/L
(133 mmol/L),
135 mEq/L
(135 mmol/L)
Chloride
98-106 mEq/L
(98-106 mmol/L),
101 mEq/L
(101 mmol/L),
102 mEq/L
(102 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
5.6 mEq/L
(5.6 mmol/L),
3.2 mEq/L
(3.2 mmol/L)
Arterial Blood Gases
Arterial pH
7.35-7.45
(7.35-7.45),
7.20
(7.20),
7.31
(7.31)
HCOg
21-28 mEq/L
(21-28 mmol/L),
13 mEq/L
(13 mmol/L),
18 mEq/L
(18 mmol/L)
PaCO,
35-45 mm Hg
(4.66-5.98 kPa),
30 mm Hg
(3.99 KPa),
32 mm Hg
(4.26 kPa)
PaO,
80-100 mm Hg
(10.64-13.33 KPa),
90 mm Hg
(11.97 kPa),
90 mm Hg
(11.97 kPa)
Question 4 of 5
The nurse is planning care with the registered nurse. For each potential prescription, click to specify if the prescription is expected or unexpected for the initial care of the client.
| Potential Prescription | Expected | Unexpected |
|---|---|---|
| Continuous cardiac monitoring | ||
| Frequent electrolyte monitoring | ||
| Continuous regular insulin IV infusion | ||
| Hourly finger-stick blood glucose checks | ||
| Nebulized albuterol breathing treatments | ||
| 5% dextrose in 0.9% sodium chloride IV infusion |
Correct Answer:
Rationale: The priority intervention for diabetic ketoacidosis (DK
A) is fluid resuscitation to restore fluid volume and increase organ perfusion. Fluid
resuscitation also treats hypovolemic shock and normalizes electrolyte and blood glucose levels via hemodilution. When planning initial care
for a client with DKA, prescriptions that would be expected include:
• Continuous cardiac monitoring due to the risk for dyshythmias caused by potassium imbalances
• Frequent electrolyte monitoring to assess for electrolyte imbalances from rapid fluid and electrolyte shifts that occur with IV fluid and
insulin administration
• Continuous regular insulin IV infusion of a short-acting insulin used to transport blood glucose into the cells to treat hyperglycemia
and stop ketosis (Glucose levels should be lowered slowly because a rapid decrease in glucose can cause cerebral edema.)
• Hourly finger-stick blood glucose to titrate the insulin dose and monitor glucose levels
Unexpected prescriptions for the initial care of a client with DKA include:
• Albuterol, a beta-adrenergic agonist used to prevent/treat bronchospasm that has the additional effect of decreasing serum potassium
levels. Because the client with DKA is already at risk for hypokalemia due to net potassium deficiency, albuterol increases the client's
risk for dysrhythmias.
• 5% dextrose in 0.9% sodium chloride IV infusion, a sugar-containing solution used to increase blood glucose levels, which would
worsen hyperglycemia
Extract:
Nurses' Notes
Outpatient Clinic
Initial
visit
The child recently started attending a new preschool and hit a teacher during lunch. The parent says, "My
child has never been aggressive before but has always been particular about food."
The client was born at full term without complications and has no significant medical history. The child
started babbling at age 6 months, and the parent reports that the first words were spoken around age 12
months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color.
The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are
normal, and the client is tracking adequately on growth curves.
During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow
the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back
and forth when the health care provider comes near.
Question 5 of 5
Select below the client findings that are most concerning.
Correct Answer: B,D,E
Rationale: When caring for a child, the nurse should be alert for abnormal developmental findings, including possible behavior,
communication, and/or sensory impairments. Autism spectrum disorder (AS
D), a neurodevelopmental condition, is usually
apparent by age 3. It is characterized by impaired social skills and interpersonal communication, increased or decreased
reactivity to sensory input, and restricted activities and interests (eg, unusual obsession with certain toys,
stacking/organizing by colors).
Some children may experience developmental regression, which involves losing previously acquired language and/or social
skills; this regression is a red flag for ASD. Other concerning findings include delayed speech (eg, lack of 3-word sentences
by age 3 years, deficiency in social-emotional reciprocity (eg, poor eye contact), and repetitive patterns of behavior (eg,
rocking back and forth, organizing toys by color).