NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
The nurse is caring for a 58-year-old client on a medical-surgical unit.
History and Physical
General
The client is vomiting bright red blood; medical history includes alcohol use disorder, liver cirrhosis, and hypertension; the client was admitted a year ago for alcohol-induced acute pancreatitis
Neurological
The client is oriented to person and place; the pupils are equal, round, and reactive to light and accommodation
Eye, Ear, Nose, and Throat (EENT)
Yellow scleras are noted
Pulmonary
Vital signs are RR 18, SpO 94% on room air
Cardiovascular
Vital signs are T 99 F (37.2 C), P 102, BP 90/40; S1 and S2 are heard on auscultation; peripheral pulses are 2+ in all extremities; 1+ edema is noted at the bilateral lower extremities
Gastrointestinal
The abdomen is distended and nontender to palpation; the flanks are dull to percussion; bowel sounds are hypoactive; distended veins are present around the umbilicus
Genitourinary
Client is voiding amber-colored urine
Nurses’ notes.
Postoperative Day 1
1000:
The client underwent banding of esophageal varices 1 day ago. Today, the client is somnolent and oriented to person only. Speech is slurred. Flapping tremors are present in the clients arms and hands. The abdomen is soft and distended; bowel sounds are present. Dark-colored stool is noted. Amber-colored urine is noted. Vital signs are T 98.2 F (36.8 C), P 85, RR 24, BP 132/76, SpOz 94% on room air.
Question 1 of 5
For each finding, specify if the finding is expected or unexpected for this client.
Correct Answer: A: Expected, B: Expected, C: Expected, D: Expected, E: Expected, F: Unexpected
Rationale:
A) Expected: RR 24 is slightly elevated but consistent with cirrhosis and post-op status.
B) Expected: Somnolence, disorientation, slurred speech, and flapping tremors indicate hepatic encephalopathy, common in cirrhosis.
C) Expected: Amber urine is typical in cirrhosis due to dehydration or bilirubin.
D) Expected: Stabilized vitals (BP 132/76, P 85) are post-treatment improvements. E) Expected: Dark stool is from variceal bleeding or banding, and distended abdomen is from ascites. F) Unexpected: No musculoskeletal issues (e.g., tremors are neurological) are noted.
Extract:
The nurse in an inpatient mental health unit is caring for a 43-year-old client.
History
Admission:
The client comes to the inpatient psychiatric facility for an evaluation. The client is having distressing nightmares, flashbacks, and feelings of being "on edge" since a severe motor vehicle collision 6 months ago that resulted in the death of the client's sibling. The client blames self for the sibling's death and verbalizes feelings of guilt. The client reports an inability to sleep well and being quick to anger, both of which led to job loss and the client seeking help. The client reports a loss of interest in previously enjoyed activities, such as working out and interacting with friends. The client has started smoking cigarettes daily since the collision and typically consumes ≥4 alcoholic beverages per day. Mental status examination reveals an irritable, guarded, and easily distracted mood. The client's appearance is well- kept, and grooming and hygiene are appropriate. The client’s speech is hyperverbal yet coherent, and thought process is organized. The client admits to feelings of hopelessness after the death of the sibling. The client reports occasionally seeing "shadows" but no visual hallucinations. The client has no homicidal ideations or history of violence toward others.
Vital signs: P 78, RR 17, BP 132/78.
Nurses' Notes
Inpatient - Mental Health Unit
2100:
Client appears anxious and withdrawn, and states, "I am afraid to sleep at night because I get nightmares about my sibling." The client would not elaborate on the content of the nightmares.
1200:
Client attended the first session of cognitive-behavioral therapy.
1300:
Client was observed yelling at peers in the day room because someone changed the television channel. The client is irritable with poor impulse control.
1700: Client appears to be having a panic attack and was found shaking in the room in tears after waking up from a nightmare. The client reports heart palpitations and appears diaphoretic.
Vital signs: P 112/min, RR 20, BP 155/98.
Question 2 of 5
During the acute phase of a panic attack, the nurse should..... and........
Correct Answer: A,D
Rationale: During a panic attack, staying with the client (
A) provides safety and support, and reassuring them of their safety (
D) helps reduce anxiety. Privacy (
B), discussing triggers (
C), teaching (E), or offering a phone (F) are not appropriate during the acute phase.
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 topics should the nurse reinforce during the initial prenatal visit? Select all that apply.
Correct Answer: B,C,D,F
Rationale: The initial prenatal visit should focus on educating about expected discomforts (e.g., nausea), foods to avoid (e.g., raw fish), medications/supplements to avoid, and symptoms of complications. Pain management and delivery method are discussed later.
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 4 of 5
The client is preparing for discharge after treatment for cellulitis and alcohol withdrawal syndrome. The client expresses motivation to stop using alcohol and is prescribed naltrexone. Which of the following client statements indicate progress toward the goal of abstinence and long-term recovery? Select all that apply.
Correct Answer: A,B,E
Rationale: A: Acknowledging alcohol's negative impact shows insight. B: Joining a recovery program supports sobriety. E: Having a plan to manage cravings (e.g., calling a sponsor) indicates commitment. C is incorrect as it suggests continued drinking, and D blames others without addressing personal responsibility.
Extract:
The nurse is caring for a 25-year-old female client.
History and Physical
Body System
General
Client reports jitteriness, anxiety, and palpitations for the past 2 months. Fine hand tremor is noted. Client reports insomnia for approximately 1 week.
Integumentary
Client is diaphoretic.
Eye, Ear, Nose, andThroat (EENT)
Exophthalmos is noted. Goiter is present.
Gastrointestinal
Client reports 10 lb (4.5 kg) weight loss over the past month. Bowel sounds are normoactive. Client reports diarrhea for the past few days.
Reproductive
Last menstrual period was 3 months ago.
Vital Signs
T 99.2 F (37.3 C)
P 164
RR 22
BP 156/92
Question 5 of 5
For each finding below, click to specify if the finding is consistent with the disease process of hyperthyroidism or hypothyroidism. Each finding may support more than one disease process. Note: Each column must have at least one response option selected.
| Finding | Hyperthyroidism | Hypothyroidism |
|---|---|---|
| Weight gain | ||
| Tachycardia | ||
| Constipation | ||
| Exophthalmos | ||
| Heat intolerance | ||
| Fine hand tremor |
Correct Answer: A: Hypothyroidism, B: Hyperthyroidism, C: Hypothyroidism, D: Hyperthyroidism, E: Hyperthyroidism, F: Hyperthyroidism
Rationale: Hyperthyroidism is characterized by increased metabolic rate, leading to tachycardia, exophthalmos, heat intolerance, and fine hand tremor. Hypothyroidism, with a decreased metabolic rate, is associated with weight gain and constipation.