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.
Question 2 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.
| Finding | Behavior Regression | Diabetes Mellitus | Urinary Tract Infection |
|---|---|---|---|
| Fatigue | |||
| Irritability | |||
| Polydipsia | |||
| Urinary frequency | |||
| Nocturnal enuresis |
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:
History and Physical
Body System,Findings
General
Client has history of coronary artery disease, hypertension, hyperlipidemia, diverticulosis, and
osteoarthritis; Helicobacter pylori infection 2 years ago; client reports taking over-the-counter
ibuprofen every 8 hours for left knee pain for the past 2 weeks; daily medications include aspirin,
carvedilol, lisinopril, and atorvastatin
Neurological
Alert and oriented to person, place, time, and situation
Pulmonary
Vital signs: RR 20, SpO 96% on room air, lung sounds clear bilaterally; no shortness of breath;
client smokes 1 pack of cigarettes per day and smokes marijuana 1 or 2 times weekly
Cardiovascular
Vital signs: P 110, BP 90/62; no chest pain; S1 and S2 heard on auscultation; peripheral pulses
2+; client states feeling lightheaded and reports passing out about 1 hour ago
Gastrointestinal
Abdominal pain rated as 4 on a scale of 0-10; one episode of hematemesis; two episodes of
large, black, liquid stools in the morning
Musculoskeletal
Examination of the knees shows crepitus that is worse on the left; no swelling, warmth, or
erythema; range of motion is normal
Psychosocial
Client reports drinking 1 or 2 glasses of wine per day
Question 3 of 5
The nurse is reinforcing discharge teaching to the client. Which of the following client statements indicate that the teaching has been effective? Select all that apply.
Correct Answer: D,E
Rationale: It is important that clients with peptic ulcer disease understand the signs and symptoms of a recurrence of gastrointestinal
bleeding (ie, melena, hematemesis). If these symptoms occur, the client should immediately notify the health care provider
to prevent life-threatening complications (eg, hemorrhagic shock) (Option 4).
To prevent new peptic ulcer formation or exacerbation, the nurse should instruct clients to limit activities that stimulate
production of gastric acid and impair ulcer healing (eg, smoking). Varenicline is a partial nicotine agonist that aids in smoking
cessation and may be useful for this client
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 4 of 5
The nurse is reinforcing teaching to the client and the parents about management of type 1 diabetes mellitus and prescribed insulin therapy. For each potential instruction, click to specify whether the instruction is appropriate or not appropriate to include in the teaching
| Potential Instruction | Appropriate | Not Appropriate |
|---|---|---|
| Track carbohydrate intake | ||
| Rotate insulin injection sites | ||
| Wear a medical alert bracelet | ||
| Demonstrate insulin injections on a doll | ||
| Store unopened insulin vials at room temperature |
Correct Answer:
Rationale: Type 1 diabetes mellitus (DM) is characterized by insulin deficiency and management requires insulin therapy for blood glucose
control. The nurse should provide dietary teaching and instructions for insulin administration. Appropriate instructions to
include in the teaching include:
• Track carbohydrate intake to guide insulin administration and maintain blood glucose levels. Exogenous insulin
administration increases the risk of hypoglycemia. Carbohydrate intake should be relatively consistent each day to avoid
hyperglycemia or hypoglycemia.
• Rotate insulin injection sites to prevent tissue scarring or loss of subcutaneous tissue (ie, lipoatrophy).
• Wear a medical alert bracelet to indicate type 1 DM in the event of hypoglycemia and unconsciousness.
• Demonstrate insulin injections on a doll before performing injections on the child to help prepare the client and family.
Insulin vials that remain unopened should be stored in the refrigerator until opened and can be used up to the expiration date.
Once opened, the vial can be stored at room temperature for approximately 1 month. Injections are less painful when the vial
is stored at room temperature, and lipodystrophy is less likely. Storing the unopened vials at room temperature is not
appropriate to include in the teaching
Extract:
The nurse is caring for a 37-year-old client.
Admission Note
Antepartum Unit
1100:
The client, gravida 2 para 1 at 34 weeks gestation, is admitted to the hospital with right upper quadrant pain. The client
reports feeling extremely fatigued and nauseated and has vomited 3 times in the past 2 hours.
Physical examination shows right upper quadrant tenderness. Lower extremities have 2+ pitting edema; deep tendon
reflexes are 3+.
Laboratory Results
Laboratory Test and Reference Range, Admission
Hematology.
Platelets
150,000-400,000/mm3
(150-400 x 10°/L),
82,000/mm3
(82 x 10%/L)
Hemoglobin (pregnant)
>11 g/dL
(>110 g/L),
9.6 g/dL
(96 g/L)
Blood Chemistry.
Creatinine
Female: 0.5-1.1 mg/dL
(44.2-97.2 umol/L),
1.5 mg/dL
(114.4 umol/L)
Alanine aminotransferase
4-36 U/L
(0.07-0.60 ukat/L),
265 U/LI
(4.43 pkat/L)
Aspartate aminotransferase
0-35 U/LI
(0-0.58 ukat/L),
308 U/L
(5.14 ukat/L)
Lipase
0-160 U/L,
53 U/L
Amylase
30-220 U/L,
75 U/L
Urine Dipstick
Protein,
Increased
Vital Signs
1100
T,98.6 F (37 C)
P, 112
RR,20
BP,150/80
SpO2.98% on room air
Question 5 of 5
The nurse is reviewing the collected client data to assist with preparing the client's plan of care. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address the condition, and 2 parameters the nurse should monitor to measure the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer:
Rationale: HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome is a life-threatening pregnancy-related disorder that typically
occurs >20 weeks gestation. Although HELLP syndrome is often considered a variant of preeclampsia, clients can develop this syndrome
without hypertension or proteinuria. Clinical manifestations may include elevated liver enzymes, right upper quadrant pain (due to swelling of
the liver), malaise, nausea, and decreased platelet count.
Appropriate interventions include:
• Preparing the client for birth, which is the only definitive treatment
• Assisting with the initiation of magnesium sulfate infusion for seizure prophylaxis
• Administering antihypertensive medications PRN to help prevent stroke
• Evaluating deep tendon reflexes frequently to monitor for hyperreflexia and clonus, which may indicate increased central nervous
system irritability and precede eclampsia; hyporeflexia may indicate magnesium toxicity.
• Monitoring clotting factors to evaluate bleeding risk and monitor for disseminated intravascular coagulation, a complication of HELLP
syndrome