NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
Nurses' Notes
Initial Clinic Visit
1100:
The client has experienced enuresis at night for the past 2 weeks and frequently requests to use the
bathroom while at school. The client was previously toilet trained with no nighttime bed wetting for 6 months;
the client recently relocated to a new home and school where the client lives with parents.
The parent reports that the client has recently demonstrated fatigue, irritability, and multiple behavioral
outbursts that resemble past temper tantrums. The client frequently reports feeling thirsty. No dysuria or
urinary hesitancy is reported.
Weight and height were in the 40th percentiles at the previous visit a year ago. Growth charts today show
the client's weight in the 20th percentile and height in the 40th percentile.
The client appears tired and irritable. Dry mucous membranes are noted with no increased work of
breathing. The lungs are clear to auscultation bilaterally. No cardiac murmur is heard.
Question 1 of 5
For each client finding below, click to specify if the finding is consistent with the disease process of behavior regression,diabetes mellitus, or urinary tract infection. Each finding may support more than one disease process.
Correct Answer:
Rationale: Behavior regression is the return to a previous behavior as an act of coping. This may be caused by a stressful event (eg,
new school, parental divorce, relocation). Clinical findings may include withdrawal or the return of previous behaviors that
resemble toddlerhood (eg, temper tantrums [fatigue, irritability], nocturnal enuresis).
Diabetes mellitus (DM) is a metabolic disorder characterized by insulin deficiency (type 1 DM) or resistance (type 2 DM),
which leads to increased blood glucose levels (ie, hyperglycemia) and signs of cellular starvation (eg, fatigue, irritability,
weight loss) from decreased glucose use. Glucose increases the osmolality of blood, which pulls water into the intravascular
space and leads to excessive urination (eg, urinary frequency, nocturnal enuresis). As the kidneys excrete excess glucose,
the body loses water, resulting in hypovolemia and signs of dehydration (eg, increased thirst [polydipsial, dry mucous
membranes).
A urinary tract infection is an infection of the urethra, bladder, ureters, and/or kidneys. Common manifestations include
fatigue, fever, painful urination (ie, dysuria), urinary frequency and urgency, and nocturnal enuresis. Irritability may be a
sign of illness in a child who has difficulty verbalizing or understanding the cause of the symptoms. Although increased urinary
frequency is seen (due to bladder irritation), volume is not excessive (unlike osmotic diuresis of DM); therefore, clients are not
dehydrated and would not report polydipsia.
Extract:
The nurse is caring for a 34-year-old female client in the clinic.
Nurses' Notes
Initial Clinic Visit
The client is receiving a tuberculin skin test. The client works at a long-term care facility and has never been vaccinated for
tuberculosis. Medical history includes Crohn disease, major depression, and a blood transfusion following a motor vehicle collision 5
years ago. The client takes an immunosuppressant, oral contraceptive pills, and a selective serotonin reuptake inhibitor daily.
The client is currently providing housing for a family member who periodically experiences homelessness. The client has a pet dog.
Clinic Visit 2 Days Later
The client returns to the clinic for inspection of the tuberculin skin test injection site. There is a palpable, raised, hardened area around
the injection site that is 16 mm in diameter.
The client reports no cough, fever, fatigue, anorexia, weight loss, or nocturnal diaphoresis. Lung sounds are clear throughout all lobes
on auscultation.
Vital signs are T 98.5 F (36.9 C), P 72, RR 17, BP 118/72, and SpO 98% on room air.
Clinic Visit 6 Months Later
The client reports fatigue; intermittent fevers; decreased appetite; a 6-Ib (2.7-kg) weight loss; and a productive, chronic cough that
began 5 weeks ago. The client has not started the antibiotic regimen for latent tuberculosis.
Diagnostic Results
Chest x-ray
Lungs appear normal. There are no infiltrates, cavitation, or effusions.
Question 2 of 5
I can never get tuberculosis again once I finish treatment
Correct Answer: D
Rationale: Rifampin is often used in the management of both latent and active tuberculosis (T
B) but reduces the effectiveness of oral contraceptive
pills.
Therefore, the client should be instructed to use additional methods of contraception during treatment and for 1 month following
the completion of treatment (Option 4).
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 3 of 5
For each potential finding below, click to specify if the finding is consistent with the disease process of diabetic ketoacidosis, ruptured appendix, or ruptured ectopic pregnancy. Each finding may support more than one disease process.
| Finding | Diabetic ketoacidosis | Ruptured appendix | Ruptured ectopic pregnancy |
|---|---|---|---|
| Polyuria | |||
| Vomiting | |||
| Tachypnea | |||
| Tachycardia | |||
| Hyperglycemia | |||
| Abdominal pain |
Correct Answer:
Rationale: Diabetic ketoacidosis (DK
A) is a complication of diabetes mellitus that results from lack of insulin. Insulin is required to transport glucose
into cells for energy, which means that lack of insulin leads to intracellular starvation despite the high level of glucose circulating in the blood
(hyperglycemia). Physiologic responses to hyperglycemia include osmotic diuresis (polyuria) for reduction of blood glucose levels and
breakdown of fat into acidic ketone bodies for energy. This leads to states of dehydration (as evidenced by tachycardia), electrolyte
imbalance, and metabolic acidosis. Ketoacidosis leads to tachypnea and deep respirations (Kussmaul respirations), as well as abdominal
pain and vomiting.
Appendicitis is an inflammation of the appendix often resulting from obstruction by fecal matter. Appendiceal obstruction traps colonic fluid
and mucus, causing increased intraluminal pressure and inflammation. This impairs perfusion of the appendix, resulting in swelling and
ischemia. Clinical manifestations include fever, abdominal pain, rebound abdominal tenderness, tachycardia, nausea, and vomiting.
Abdominal pain usually begins near the umbilicus and migrates to the right lower quadrant (eg, McBurney point). Tachypnea, as well as a
compensatory response, can be present, especially if there is a ruptured appendix or evidence of sepsis causing lactic acidosis (metabolic
acidosis).
Extract:
The nurse is performing a home health visit for an 84-year-old male.
History and Physical
Body System, Findings
General,
Client reports a 1-month-long history of fatigue and dyspnea that has worsened; he is unable to lie
flat and sleeps in a chair at night, medical history includes myocardial infarction, chronic heart
failure, chronic obstructive pulmonary disease, hypertension, and type 2 diabetes mellitus; client
was diagnosed with benign prostatic hyperplasia 8 months ago; client is adherent with prescribed
medications; client reports frequent consumption of donuts, hamburgers, steak, and fried chicken;
BMI is 34 kg/m?; client reports 6-Ib (2.7-kg) weight gain in 1 week
Neurological,
Alert and oriented to person, place, time, and situation
Pulmonary,
Vital signs: RR 24, SpOz 88% on room air; labored breathing, crackles in bilateral lung bases; client
expectorates frothy, pink-tinged sputum; client has a 40-year history of smoking 1 pack of cigarettes
per day
Cardiovascular,
Vital signs: T 98.8 F (37.1 C), P 98, BP 113/92; S1, S2, and S3 present; 3+ bilateral lower extremity
edema
Genitourinary, Concentrated yellow urine; client reports increased urinary hesitancy and urgency
Psychosocial,
Client reports being lonely and has depressed mental status
Prescriptions
Home Medication Record
Medication, Scheduled
Pravastatin 20 mg PO once daily, 2100
Furosemide 40 mg PO once daily, 0900
Tamsulosin 0.4 mg PO once daily, 0900
Potassium chloride 20 mg PO once daily, 0900
Metformin 1000 mg PO bid, 0900, 2100
Carvedilol 6.25 mg PO bid;hold for systolic blood pressure ≤100 mm Hg and/or HR <65/min, 0900, 2100
Sacubitril 97 mg/valsartan 103 mg PO bid, 0900, 2100
Question 4 of 5
The nurse has reviewed the information from the Prescriptions. The nurse is reinforcing education on heart failure management. Which of the following client statements indicate a correct understanding of the teaching? Select all that apply.
Correct Answer: A,C,D
Rationale: Pharmacological management of heart failure (HF) focuses on reducing cardiac workload and improving cardiac output. Beta
blockers (eg, carvedilol) reduce cardiac workload by inhibiting the action of catecholamines (eg, epinephrine, norepinephrine)
on beta-adrenergic receptors in the heart. Beta blockers decrease myocardial oxygen demand by decreasing blood
pressure (BP) and heart rate (HR).
Therefore, clients prescribed antihypertensive medications (eg, carvedilol) should be
instructed to check BP and HR before each dose to monitor for hypotension and bradycardia
Loop diuretics (eg, furosemide, bumetanide) are potassium-wasting, which increases the client's risk of hypokalemia
Angiotensin system inhibitors (eg, sacubitril-valsartan) and potassium supplements cause hyperkalemia. Clients should be
taught symptoms of hypo- or hyperkalemia (eg, muscle cramps) and instructed to notify the health care provider if they occur
(Option 4).
Extract:
The nurse is caring for a 24-year-old client.
Nurses' Notes
Emergency Department
1300:
The client is brought to the emergency department after a motor vehicle collision in which the driver's side airbag deployed.
The client was driving the vehicle and was not restrained by a seat belt. The client reports shortness of breath and chest
pain on inspiration and expiration.
History and Physical
Body System ,Findings
Neurological,
Awake, alert, and oriented to person; pupils equal, round, and reactive to light and accommodation; client is
agitated and moves all extremities spontaneously but does not follow commands
Integumentary, Superficial lacerations to the face; diffuse bruising noted on upper extremities and chest wall
Pulmonary,
Vital signs: RR 30, SpOz 92% via nonrebreather mask; unilateral chest wall expansion observed on inspiration;
left-sided tracheal deviation noted; breath sounds diminished throughout the right lung field
Cardiovascular,
Vital signs: P 104, BP 90/58; S1 and S2 heard on auscultation; all pulses palpable; no extremity peripheral edema
noted
Psychosocial ,Alcohol odor noted on the client's breath
Question 5 of 5
Drag words from the choices below to fill in the blank/blanks.The nurse understands that the client is most at risk for------------and------------
Correct Answer: E,C
Rationale: The nurse understands that the client is most at risk for respiratory failure and decreased cardiac output.
Decreased cardiac output is the most concerning complication in a client with a tension pneumothorax. The trapped air in a tension
pneumothorax causes increased pressure, compressing the affected lung more until it is completely collapsed and then compressing the
heart and great vessels (vena cava, aorta), ultimately inhibiting venous return.
If the pleural pressure continues to increase, eventually the pleural cavity will crowd the trachea, forcing it to deviate (shift) to the unaffected
side where the unaffected lung can be compressed. Clients are at high risk for respiratory failure due to hypoxemia. Without treatment, the
lungs cannot meet the demands for oxygenation and the client will die.