NCLEX-PN
NCLEX PN Test Questions with NGN Questions
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 1 of 5
For each finding below, click to specify if the finding is consistent with the disease process of acute upper gastrointestinal bleed or acute lower gastrointestinal bleed. Each finding may support more than one disease process.
Correct Answer:
Rationale: Upper gastrointestinal (Gl) bleeding can occur in the esophagus (eg, esophageal varices or in the stomach and duodenum
(eg, peptic ulcer). Findings associated with upper GI bleeding include the following:
• Melena (ie, dark, tarry stools) is due to the release of iron (heme) as blood passes through the entire GI tract and
hemoglobin becomes partially digested
• NSAID use increases the risk of peptic ulcer formation by inhibiting cyclooxygenase-1, an enzyme that helps protect the
stomach lining and promote platelet aggregation.
• Hematemesis (ie, vomiting blood) is due to the presence of blood in the upper GI tract (eg, esophagus, stomach,
duodenum); the blood usually has a coffee ground appearance due to digestion by gastric acid
• Helicobacter pylori infection increases gastric secretions, promoting peptic ulcer formation.
Lower Gl bleeding occurs in structures past the duodenum (eg, small and large intestine, rectum, anus) and is commonly
associated with inflammatory (eg, Crohn disease, ulcerative colitis, diverticulosis) or vascular (eg, hemorrhoids) conditions.
Diverticulosis is a condition where diverticula (ie, hollow outpouchings from the intestine) develop, usually in the large
intestine and occasionally in the small intestine. Diverticula weaken the intestinal wall and increase the risk for GI bleeding.
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).
Laboratory Results
Laboratory Test and Reference Range, 0900
Glucose, serum (random)
≤200 mg/dL
(<11.1 mmol/L),
573 mg/dL
(31.8 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
5.7 mEq/L
(5.7 mmol/L)
Question 2 of 5
Drag words from the choices below to fill in the blanks. The nurse gathers supplies for medication administration. The nurse recognizes that the priority prescriptions are -------and ----------
Correct Answer: E,B
Rationale: The priority intervention for management of diabetic ketoacidosis is fluid resuscitation with isotonic IV fluid, typically starting with large-voli
0.9% sodium chloride IV boluses (eg, 1 L/hr) to prevent life-threatening hypovolemic shock. Fluid resuscitation also helps normalize
glucose and electrolyte levels via hemodilution. After initial large-volume boluses are complete, either hypotonic or isotonic IV fluids are
administered at continuous rate. Administration of regular insulin continuous IV infusion is also essential to correct hyperglycemia.
Extract:
The nurse is caring for a 64-year-old client.
History and Physical
Body System, Findings
General ,
The client reports a 24-hour history of blurred vision and redness in the left eye with a left-sided headache.
This evening, the client developed acute, severe pain in the left eye accompanied by occasional nausea and
vomiting. The client reports no use of systemic or topical eye medications. Medical history includes
osteoarthritis and hypercholesterolemia.
Eye, Ear, Nose, and Throat (EENT),
The client wears eyeglasses to correct farsighted vision. Right eye: pupil 2 mm and reactive to light,
conjunctiva clear. Left eye: pupil 4 mm and nonreactive to light with red conjunctiva. Bilateral lens opacity is noted.
Pulmonary,
Vital signs are RR 20 and SpO, 96% on room air. The lungs are clear to auscultation bilaterally.
Cardiovascular,
Vital signs are T 99 F (37.2 C), P 88, and BP 140/82.
Psychosocial,
The client reports a great deal of emotional stress following the recent death of the client's spouse that is accompanied by lack of sleep, poor appetite, and a 7.9-lb (3.6-kg) weight loss within the past month. The client takes diphenhydramine for sleep.
Question 3 of 5
For each finding below, click to specify if the finding is consistent with the disease process of acute angle-closure glaucoma, cataracts, or macular degeneration. Each finding may support more than one disease process.
| Finding | Acute Angle-Closure Glaucoma | Cataracts | Macular Degeneration |
|---|---|---|---|
| Blind spots | |||
| Opaque lens | |||
| Blurred vision | |||
| Unilateral headache | |||
| Conjunctival redness | |||
| Nausea and vomiting | |||
| Increased intraocular pressure |
Correct Answer:
Rationale: Acute angle-closure glaucoma (ACG) is the sudden onset of increased intraocular pressure (IOP) due to impaired aqueous humor drainag
through the angle of the anterior chamber. Acute ACG typically occurs spontaneously but may be triggered by impaired aqueous outflow frol
pupillary dilation (eg, emotional excitement, medications (decongestants, anticholinergics, antihistamines], darkness). As IOP increases,
clients report seeing halos around lights and/or develop blurry vision, unilateral headache, conjunctival redness, and nausea and
vomiting. Increased IOP damages the optic nerve, and the cornea becomes edematous; therefore, light cannot travel effectively from the
cornea to the optic nerve, causing halos to be seen.
Cataracts are a slowly progressive pacification of the lens that results from oxidative damage. Refractive changes in the lens cause clients
to initially develop difficulty reading fine print because of the opaque lens. As the cataract progresses, clients develop painless, blurry visio
and have difficulty with nighttime driving because they see a glare and halos around lights. Halos and glare occur because light cannot
travel through the opacified lens effectively and instead disperses in various angles.
Age-related macular degeneration (AM
D) is a progressive, incurable disease of the eye characterized by deterioration of the macula, the
central portion of the retina. This deterioration causes visual disturbances (wavy or blurred vision), blind spots, or loss of the central field
vision; peripheral vision remains intact. AMD has a vascular pathogenesis that is unrelated to increased IOP. Clients with AMD have a norm
cornea, lens, and optic nerve; therefore, halos are not seen.
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
Question 4 of 5
Select 5 findings that require further investigation.
Correct Answer: A,B,D,E
Rationale: A client with chronic heart failure (HF) who reports worsening fatigue, dyspnea, orthopnea, and peripheral edema is likely
experiencing declining oxygenation due to fluid volume overload. Assessment findings that require further investigation
include:
• Orthopnea: Labored breathing in the supine position is a common manifestation in clients with HF due to pulmonary
edema. Clients with orthopnea often sleep on a chair or on propped-up pillows to decrease work of breathing.
Paroxysmal nocturnal dyspnea, which is waking up in the middle of the night with suffocation due to dyspnea, is another
characteristic finding in HF.
• Crackles on auscultation: Crackles are a manifestation of pulmonary edema caused by fluid in the alveoli. Pulmonary
edema is concerning for worsening HF and impaired gas exchange.
• Peripheral edema and rapid weight gain (ie, >5 Ib/week [2.3 kg/week]): These symptoms are concerning for fluid
volume overload
• Hypoxemia: Decreased capillary oxygen saturation (SpO, <95%) is a sign of inadequate gas exchange. This is most
likely related to pulmonary edema from HF exacerbation.
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 5 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