NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
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
Question 1 of 5
For each finding below, click to specify if the finding is consistent with the disease process of myocardial infarction, pneumonia, or pulmonary embolism.
Correct Answer: A: Myocardial infarction, Pneumonia, Pulmonary embolism; B: Myocardial infarction, Pneumonia, Pulmonary embolism; C: Pneumonia, Pulmonary embolism; D: Myocardial infarction, Pulmonary embolism; E: Pulmonary embolism
Rationale: A: Dyspnea is common in all three due to impaired oxygenation or cardiac output. B: Chest pain occurs in all three, though the nature varies (e.g., pleuritic in pneumonia/PE, crushing in MI). C: Hypoxemia is typical in pneumonia (due to alveolar impairment) and PE (due to ventilation-perfusion mismatch). D: Sinus tachycardia is seen in MI (due to cardiac stress) and PE (due to hypoxia and embolism). E: Right lower extremity redness and edema suggest DVT, which is strongly associated with PE.
Extract:
The nurse in the emergency department is caring for a 62-year-old client.
Progress Notes
Emergency Department
0900:
The client is brought to the emergency department by a family member after being found confused and lethargic. On arrival, the client is obtunded and does not respond to verbal stimuli.
Medical history includes major depressive disorder and chronic neck and back pain after a motor vehicle collision 2 years ago. The family member states that the client takes multiple medications but does not know which kind. The client was divorced a few months ago.
Physical examination shows 1-mm pupils, shallow breathing, and reduced bowel sounds. Fingerstick blood glucose is 78 mg/dL (4.3 mmol/L). ECG reveals normal sinus rhythm. Breath alcohol test is negative.
Vital signs: T 98.1 F (36.7 C), P 62, RR 8, BP 80/40, SpO2 94% on room air.
1800:
The client is awake, alert, and oriented to person, place, time, and situation. The client is experiencing severe withdrawal symptoms and is admitted for supervised detoxification.
Laboratory Results
Urine Drug Screen
On admission
Cocaine- Negative
Opioids- Positive
Amphetamines- Negative
Marijuana- Positive
Phencyclidine-Negative
Benzodiazepines- Negative
Barbiturates- Negative
Laboratory Test and Reference Range
Cocaine- Negative
Opioids- Negative
Amphetamines- Negative
Marijuana- Negative
Phencyclidine- Negative
Benzodiazepines- Negative
Barbiturates- Negative
Question 2 of 5
The nurse has reviewed the information from the Progress Notes and Laboratory Results. For each potential intervention, click to specify if the intervention is expected or unexpected for the care of the client.
| Potential Intervention | Expected | Unexpected |
|---|---|---|
| Initiate seizure precautions | ||
| Monitor the client for suicidal ideation | ||
| Administer antidiarrheal and antiemetic medications as needed | ||
| Use a standardized scoring scale to assess for withdrawal symptoms |
Correct Answer: B,C,D
Rationale: B: Expected - Depression history increases suicide risk during withdrawal. C: Expected - Antidiarrheals and antiemetics manage withdrawal symptoms like nausea. D: Expected - Standardized scales (e.g., COWS) assess opioid withdrawal severity. A: Unexpected - Seizures are more associated with alcohol or benzodiazepine withdrawal, not opioids.
Extract:
The nurse is caring for a client at a women’s health clinic.
History & Physical
Labor and delivery unit
0800:
A 28-year-old nulliparous female comes to the clinic for confirmation of suspected pregnancy due to amenorrhea and a positive home pregnancy test. The client's current exercise regimen includes indoor cycling and outdoor running. The client reports nausea, vomiting, and breast tenderness. She has a 28-day menstrual cycle, and her last menstrual period was March 10- 17. The health care provider notes a bluish-purple vaginal mucosa and cervix during pelvic examination and confirms a 12-week intrauterine pregnancy by sonography. A fetal heart rate of 155/min is detected with handheld Doppler.
Question 3 of 5
Which of the following laboratory tests should the nurse anticipate during the first prenatal visit? Select all that apply.
Correct Answer: C,D,E
Rationale: First prenatal visit tests include maternal blood type and screen, STI screen, and urinalysis. Glucose tolerance and Group B Streptococcus tests are performed later in pregnancy.
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
For each potential prescription, click to specify if the prescription is anticipated or contraindicated for the care of the client.
| Potential Prescription | Anticipated | Contraindicated |
|---|---|---|
| Heparin infusion | ||
| Acetaminophen PRN for pain | ||
| Physical therapy for mobility exercises | ||
| Supplemental oxygen to maintain SpO2 ≥ 90% | ||
| Sequential compression devices to bilateral lower extremities |
Correct Answer: A,B,D
Rationale: A: Heparin infusion is anticipated to treat pulmonary embolism and DVT by preventing further clot formation. B: Acetaminophen is anticipated for pain management, as it is safe for this client. C: Physical therapy is contraindicated due to the acute PE and DVT, as mobilization could dislodge clots. D: Supplemental oxygen is anticipated to correct hypoxemia (SpO2 89%). E: Sequential compression devices are contraindicated, as DVT is already present, and they could dislodge the clot.