NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
The nurse in an inpatient mental health unit is caring for a 43-year-old client.
History
Admission:
The client comes to the inpatient psychiatric facility for an evaluation. The client is having distressing nightmares, flashbacks, and feelings of being "on edge" since a severe motor vehicle collision 6 months ago that resulted in the death of the client's sibling. The client blames self for the sibling's death and verbalizes feelings of guilt. The client reports an inability to sleep well and being quick to anger, both of which led to job loss and the client seeking help. The client reports a loss of interest in previously enjoyed activities, such as working out and interacting with friends. The client has started smoking cigarettes daily since the collision and typically consumes ≥4 alcoholic beverages per day. Mental status examination reveals an irritable, guarded, and easily distracted mood. The client's appearance is well- kept, and grooming and hygiene are appropriate. The client’s speech is hyperverbal yet coherent, and thought process is organized. The client admits to feelings of hopelessness after the death of the sibling. The client reports occasionally seeing "shadows" but no visual hallucinations. The client has no homicidal ideations or history of violence toward others.
Vital signs: P 78, RR 17, BP 132/78.
Nurses' Notes
Inpatient - Mental Health Unit
2100:
Client appears anxious and withdrawn, and states, "I am afraid to sleep at night because I get nightmares about my sibling." The client would not elaborate on the content of the nightmares.
1200:
Client attended the first session of cognitive-behavioral therapy.
1300:
Client was observed yelling at peers in the day room because someone changed the television channel. The client is irritable with poor impulse control.
1700: Client appears to be having a panic attack and was found shaking in the room in tears after waking up from a nightmare. The client reports heart palpitations and appears diaphoretic.
Vital signs: P 112/min, RR 20, BP 155/98.
Question 1 of 5
During the acute phase of a panic attack, the nurse should..... and........
Correct Answer: A,D
Rationale: During a panic attack, staying with the client (
A) provides safety and support, and reassuring them of their safety (
D) helps reduce anxiety. Privacy (
B), discussing triggers (
C), teaching (E), or offering a phone (F) are not appropriate during the acute phase.
Extract:
The nurse is caring for a 25-year-old female client.
History and Physical
Body System
General
Client reports jitteriness, anxiety, and palpitations for the past 2 months. Fine hand tremor is noted. Client reports insomnia for approximately 1 week.
Integumentary
Client is diaphoretic.
Eye, Ear, Nose, andThroat (EENT)
Exophthalmos is noted. Goiter is present.
Gastrointestinal
Client reports 10 lb (4.5 kg) weight loss over the past month. Bowel sounds are normoactive. Client reports diarrhea for the past few days.
Reproductive
Last menstrual period was 3 months ago.
Vital Signs
T 99.2 F (37.3 C)
P 164
RR 22
BP 156/92
Question 2 of 5
For each finding below, click to specify if the finding is consistent with the disease process of hyperthyroidism or hypothyroidism. Each finding may support more than one disease process. Note: Each column must have at least one response option selected.
| Finding | Hyperthyroidism | Hypothyroidism |
|---|---|---|
| Weight gain | ||
| Tachycardia | ||
| Constipation | ||
| Exophthalmos | ||
| Heat intolerance | ||
| Fine hand tremor |
Correct Answer: A: Hypothyroidism, B: Hyperthyroidism, C: Hypothyroidism, D: Hyperthyroidism, E: Hyperthyroidism, F: Hyperthyroidism
Rationale: Hyperthyroidism is characterized by increased metabolic rate, leading to tachycardia, exophthalmos, heat intolerance, and fine hand tremor. Hypothyroidism, with a decreased metabolic rate, is associated with weight gain and constipation.
Extract:
The nurse in the emergency department is caring for a 62-year-old client.
History and Physical
Neurological
The client is alert and oriented to time, place, person, and situation; the client reports sudden-onset right-sided facial drooping, speech is slurred; positive right-sided arm drift is seen
Eye, Ear, Nose, and Throat (EENT)
Bilateral pupils are equal, round, and reactive to light and accommodation
Pulmonary
Vital signs: RR 16, SpO, 95% on room air, lung sounds are clear bilaterally
Cardiovascular
Vital signs: T 99 F (37.2 C), P 86, BP 166/90; S1 and S2 are heard on auscultation; no murmurs are noted; the client has a history of hypertension
Musculoskeletal
Right-sided lower extremity weakness is seen
Endocrine
The client has diabetes mellitus
Psychosocial
The client reports drinking one glass of wine each evening with dinner, no tobacco use, and a history of major depression; the client takes sertraline.
Laboratory Results
During Admission
Blood Chemistry.
Glucose: 72 mg/dL (4.0 mmol/L)
Sodium: 133 mEq/L (133 mEq/L)
Chloride: 101 mEq/L (101 mmol/L)
Potassium: 3.7 mEq/L (3.7 mmol/L)
Laboratory Test and Reference Range
Blood Chemistry.
Glucose 74-106 mg/dL (4.1-5.9 mmol/L)
Sodium 136-145 mEq/L (136-145 mmol/L)
Chloride 98-106 mEq/L(98-106 mmol/L)
Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L
Diagnostic Results
Admission
CT scan of the head without contrast
1830:
No areas of hemorrhage are noted
Question 3 of 5
Based on the clinical data, which condition should the nurse suspect?
Correct Answer: C
Rationale: Sudden-onset right-sided facial drooping, slurred speech, arm drift, and leg weakness, with a non-hemorrhagic CT scan, strongly suggest ischemic stroke (
C). Bell palsy (
A) typically involves only facial weakness. Guillain-Barré (
B) presents with ascending paralysis. Seizure disorder (
D) lacks seizure activity in the history.
Extract:
The nurse in an inpatient mental health unit is caring for a 43-year-old client.
History
Admission:
The client comes to the inpatient psychiatric facility for an evaluation. The client is having distressing nightmares, flashbacks, and feelings of being "on edge" since a severe motor vehicle collision 6 months ago that resulted in the death of the client's sibling. The client blames self for the sibling's death and verbalizes feelings of guilt. The client reports an inability to sleep well and being quick to anger, both of which led to job loss and the client seeking help. The client reports a loss of interest in previously enjoyed activities, such as working out and interacting with friends. The client has started smoking cigarettes daily since the collision and typically consumes ≥4 alcoholic beverages per day. Mental status examination reveals an irritable, guarded, and easily distracted mood. The client's appearance is well- kept, and grooming and hygiene are appropriate. The client’s speech is hyperverbal yet coherent, and thought process is organized. The client admits to feelings of hopelessness after the death of the sibling. The client reports occasionally seeing "shadows" but no visual hallucinations. The client has no homicidal ideations or history of violence toward others.
Vital signs: P 78, RR 17, BP 132/78.
Nurses' Notes
Inpatient - Mental Health Unit
2100:
Client appears anxious and withdrawn, and states, "I am afraid to sleep at night because I get nightmares about my sibling." The client would not elaborate on the content of the nightmares.
Question 4 of 5
For each potential intervention, click to specify if the intervention is appropriate or not appropriate for the care of the client.
| Potential Intervention | Appropriate | Not Appropriate |
|---|---|---|
| Provide the client privacy during flashbacks | ||
| Help the client identify available support systems | ||
| Directly ask if the client is having thoughts of self-harm | ||
| Determine the client's ability to perform activities of daily living | ||
| Reinforce the use of progressive muscle relaxation for anxiety | ||
| Avoid discussion of the traumatic event when speaking to the client |
Correct Answer: B,C,E
Rationale: Appropriate interventions include identifying support systems (
B), directly assessing for self-harm (
C), and using relaxation techniques (E). Providing privacy during flashbacks (
A) may increase distress, assessing ADLs (
D) is less urgent, and avoiding discussion of the trauma (F) may hinder therapeutic progress.
Extract:
The nurse is caring for a 25-year-old female client.
History and Physical
Body System
General
Client reports jitteriness, anxiety, and palpitations for the past 2 months. Fine hand tremor is noted. Client reports insomnia for approximately 1 week.
Integumentary
Client is diaphoretic.
Eye, Ear, Nose, andThroat (EENT)
Exophthalmos is noted. Goiter is present.
Gastrointestinal
Client reports 10 lb (4.5 kg) weight loss over the past month. Bowel sounds are normoactive. Client reports diarrhea for the past few days.
Reproductive
Last menstrual period was 3 months ago.
Vital Signs
T 99.2 F (37.3 C)
P 164
RR 22
BP 156/92
Question 5 of 5
The nurse is reinforcing client teaching about home precautions following the first dose of RAI. For each nurse statement, click to specify whether the statement is appropriate or not appropriate to include in the teaching.
| Nurse Statement | Appropriate | Not Appropriate |
|---|---|---|
| Avoid sharing utensils with your spouse. | ||
| It is safe to hold your child 2 hours after treatment. | ||
| Delay pregnancy attempts for the next 4-6 months. | ||
| Wash your clothes separately from those of others. | ||
| You should sleep in a separate bedroom for 1-2 weeks. |
Correct Answer: A,C,D,E
Rationale: A: Appropriate, as RAI can contaminate utensils, posing a radiation risk to others. B: Not appropriate, as close contact with children should be limited for several days post-RAI to minimize radiation exposure. C: Appropriate, as RAI can affect fertility and fetal health, requiring a delay in pregnancy. D: Appropriate, as washing clothes separately reduces the risk of radiation exposure to others. E: Appropriate, as sleeping separately minimizes radiation exposure to household members.