NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
The nurse is caring for an 8-year-old client who was brought to the emergency department after
becoming short of breath at school.
History and Physical
General
Well-nourished child; currently sitting in the tripod position; patches of dry, scaly, reddened skin are present in the creases of bilateral elbows and behind both knees; client reports that these areas itch
Neurological
Alert and oriented to person, place, and time
Eye, Ear, Nose, andThroat (EENT)
Pupils equal, round, and reactive to light and accommodation; client reports no nasal congestion
Pulmonary
Vital signs: RR 34, SpO 92% on room air, airway patent, intercostal retractions noted during inspiration; expiratory wheezes auscultated bilaterally; dry, spasmodic cough is noted; no stridor; difficulty speaking in complete sentences
Cardiovascular
Vital signs: T 98.8 F (37.1 C), P 110, BP 94/60; S1 and S2 heard on auscultation; nom murmurs noted; peripheral pulses 2+; capillary refill 3 seconds; no edema
Gastrointestinal
Abdomen soft; bowel sounds normal
Psychosocial
Client appears anxious and is crying, client speaks in short phrases, stating, "left my medicine at a friend's house" and "feels like I can't breathe"; client cannot remember the name of the prescribed home medication; client's parents were notified and are en route to hospital
Question 1 of 5
For each finding below, click to specify if the finding is consistent with the disease process of anaphylaxis or asthma exacerbation.
Correct Answer: B,C: Asthma; C,D,E: Anaphylaxis
Rationale: B: Wheezing is characteristic of asthma exacerbation due to bronchoconstriction. C: Tachycardia can occur in both asthma (from hypoxia or stress) and anaphylaxis (from systemic reaction). D: Hypotension is typical in anaphylaxis due to vasodilation and fluid shifts. E: Generalized flushing and itching are hallmarks of anaphylaxis due to histamine release.
Extract:
The nurse is caring for a client on the medical-surgical unit.
History
Admission
0500: The client is admitted with an abscess and cellulitis of the right leg. The abscess is noted on the lateral aspect of the right calf, with redness, swelling, and warmth extending from the knee to the ankle. The abscess was incised in the emergency department, and a moderate amount of purulent, yellowish-green drainage was noted. The leg was wrapped with gauze, and the client received the first dose of IV antibiotics and opioids for pain control.
The client reports chronic lower back pain and gastrosophageal reflux disease, and he was admitted to the hospital once last year for gastrointestinal bleeding. He is currently prescribed daily pantoprazole but takes it only a few times a week.
Vital signs: T 100.9 F (38.3 C), P 82, RR 14, BP 130/80, SpO, 95% on room air
Progress Notes
Medical-Surgical Unit
2300:
The client reports nausea, headache, and insomnia. The client is trembling, diaphoretic, and restless.
The client states, "I would sleep better if those mice and cats would stop climbing up and down the walls."
The upper portion of the clients dressing is saturated with yellowish-green drainage. The peripheral V was removed by the client, and dried blood is noted at the IV site. The IV catheter is on the floor. The client yelled and pushed the nurse's hands away during inspection of the IV site.
Vital signs: T 99 F (37.2 C), P 102, RR 18, BP 170/96, SpO≥ 95% on room air
Question 2 of 5
The nurse is planning care with the registered nurse. For each potential intervention, click to specify if the intervention is anticipated or unanticipated for the care of the client.
| Potential Intervention | Anticipated | Unanticipated |
|---|---|---|
| Keep the room well lit | ||
| Keep the client on NPO status | ||
| Administer 0.9% sodium chloride IV infusion | ||
| Place padding on the headboard and side rails of the bed | ||
| Turn the television to a channel with news about current events | ||
| Evaluate the client's behavior with a standardized assessment tool |
Correct Answer: A,C,D,F
Rationale: A: Anticipated - Keeping the room well lit reduces confusion and hallucinations in alcohol withdrawal. B: Unanticipated - NPO status is not indicated unless specific conditions (e.g., surgery) apply. C: Anticipated - IV fluids support hydration during withdrawal. D: Anticipated - Padding prevents injury during potential seizures. E: Unanticipated - News may increase agitation. F: Anticipated - Standardized tools (e.g., CIWA-Ar) assess withdrawal severity.
Extract:
Nurses' Notes
Emergency Department
A newborn is brought to the emergency department due to coughing and difficulty feeding. The client was born at home 6 hours ago via spontaneous vaginal birth. With each attempt to breastfeed, the client coughs, vomits, and "turns blue." The mother did not receive prenatal care. She reports a history of opioid use disorder but reports no opioid use during pregnancy.
Vital signs: T 98.6 F (37 C), P 120, RR 50, and SpO, 95% on room air. Abdominal distension is present. Ballard scoring estimates the client at 37 weeks gestation. Weight and length are consistent with the 25th and 50th percentiles for estimated age, respectively.
1 Hour Later
After attempting a bottle feed with 10 mL of formula, the client has a coughing episode, and there is formula mixed with saliva in the mouth. Coarse breath sounds are noted bilaterally with intercostal retractions. S1 and S2 are present with no murmurs. Neurologic examination shows normal neuromuscular findings.
A nasogastric tube insertion is attempted per prescription by the health care provider, and resistance is met at 10 cm of insertion.
Question 3 of 5
The practical nurse is assisting the registered nurse with the client's care. The newborn has received a gastrostomy tube and is scheduled for surgical repair of esophageal atresia and tracheoesophageal fistula. For each intervention, click to specify if the intervention is indicated or not indicated for the care of the newborn. Note: Each row must have one response option selected.
| Intervention | Indicated | Not Indicated |
|---|---|---|
| Administer IV fluids | ||
| Monitor for episodes of apnea | ||
| Set up suction equipment at the bedside | ||
| Provide feedings through a gastrostomy tube | ||
| Maintain the newborn's head in an elevated position |
Correct Answer: A,B,C,E
Rationale: IV fluids prevent dehydration, monitoring for apnea addresses respiratory risks, suction equipment manages secretions, and an elevated head position reduces aspiration risk. Gastrostomy tube feedings are not indicated pre-surgery due to the fistula.
Extract:
The nurse is caring for a 12-month-old male client.
History and Physical
Body System
General
The client is brought to the emergency department by the parents due to increased leg bruising and left knee swelling for 1 day; the parents report that the client seems more tired and less playful; both parents and the sister are healthy, but a maternal uncle died at age 7 after mild head trauma.
Integumentary
Good hygiene; no abrasions; no burns; bilateral scattered lower extremity bruising
Eye, Ear, Nose, and Throat (EENT)
The parents report that the client's gums have been bleeding when chewing on crackers
Pulmonary
Vital signs: RR 38, SpO 100% on room air, upper respiratory infection 3 weeks ago that completely resolved after 4 days.
Cardiovascular
Vital signs: T 98.7 F (37.1 C), P 136
Musculoskeletal
Left knee redness and swelling with limited range of motion; the client can bear weight on both lower extremities; the parents state the child has recently started learning to walk by holding onto furniture and sometimes falls
Genitourinary
The parents state that urine output has been normal; urine is clear and pale yellow; the penis is uncircumcised
Psychosocial
The client is cooperative during examination; the client appears appropriately dressed for the season and weather; the mother says the child has no interest in toilet-training.
Laboratory Results.
Laboratory Test and Reference Range
Hematology.
Hematocrit
1-6 years: 39% (0.39)
30%-40%:
(0.30-0.40)
WBC
<_ 2 years: 8000/mm3 (8.0 × 10%/L)
6200-17,000/mm3
(6.2-17.0 × 10°/L)
Platelets
150,000-400,000/mm3: 163,000/mm3 (163 × 10°/L)
(150-400 × 10°/L)
aPTT (Activated partial thromboplastin time)
30-40 sec: 60 sec
PT
11-12.5 sec: 12 sec
Factor VIII
55%-145%: 6%
Factor IX
60%-140%: 100%
Question 4 of 5
Which of the following statements by the client's parent indicate teaching was effective? Select all that apply.
Correct Answer: B,C,D
Rationale: B: Correct - Hemophilia A is X-linked, so future children may inherit it. C: Correct - Contact sports increase bleeding risk and should be avoided. D: Correct - Tingling indicates possible joint bleeding, requiring prompt attention. A: Incorrect - Ibuprofen can increase bleeding risk. E: Incorrect - Preventive factor replacement is often needed regularly, not just before surgeries.
Extract:
The nurse is caring for an 82-year-old client in the emergency department.
Nurses' Notes
0930:
The client reports shortness of breath and left-sided chest pain for 2 days. The client fractured the right femoral neck a month ago after a fall and decided against operative management. Since then, the client has been wheelchair dependent and takes acetaminophen for fracture pain management. The client was placed on continuous cardiac monitoring.
History and physical
Body System
Neurological
The client is awake, alert, and oriented to person, place, time, and situation; the client appears anxious
Pulmonary
Vital signs are RR 22, SpOz 89% on room air; bilateral breath sounds are clear; pain increases with inhalation; the client reports shortness of breath for the past 2 days; the client smoked 1 pack of cigarettes per day for 10 years.
Cardiovascular
Vital signs are T 99.8 F (37.7 C), P 110, BP 110/60; S1 and S2 are present; there are no murmurs, redness and edema of the right lower extremity are noted; sinus tachycardia is seen on the monitor, chest pain is reported as 7 on a scale of 0-10
Musculoskeletal
The client has osteoporosis, is wheelchair dependent, and is unable to bear weight on the right leg
Diagnostic Results
CT pulmonary angiography
1030: Pulmonary embolism is confirmed
Lower extremity doppler ultrasound
1100: Deep venous thrombosis is noted in the right lower extremity.
Question 5 of 5
Which of the following statements by the nurse indicate a correct understanding of heparin therapy? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: A: Correct, as recent surgery or hemorrhagic stroke are contraindications due to bleeding risk. B: Correct, as heparin is typically administered via IV infusion pump for precise dosing. C: Correct, as high-risk medications like heparin often require dual verification. D: Correct, as significant platelet decrease may indicate heparin-induced thrombocytopenia, requiring discontinuation. E: Correct, as baseline CBC and coagulation panels are needed before starting heparin. F: Incorrect, as heparin dosing is adjusted based on aPTT, not PT/INR, which is used for warfarin.