NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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Client appears anxious and withdrawn, and states, "I am afraid to sleep at night because I get nightmares about my sibling."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 1 of 5
For each of the statements made by the client, click to specify whether the statement indicates that the client's status has improved or not improved.
Correct Answer: A,D,E
Rationale: Statements indicating improvement include waking up less frequently (
A), journaling stressors (
D), and better emotional control (E). Wanting to talk about nightmares (
B) and avoiding driving (
C) do not clearly indicate improvement.
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.
Question 2 of 5
For each potential intervention, click to specify if the intervention is appropriate or not appropriate for the care of the client.
| Potential Intervention | Appropriate | Not Appropriate |
|---|---|---|
| Provide the client privacy during flashbacks | ||
| Help the client identify available support systems | ||
| Directly ask if the client is having thoughts of self-harm | ||
| Determine the client's ability to perform activities of daily living | ||
| Reinforce the use of progressive muscle relaxation for anxiety | ||
| Avoid discussion of the traumatic event when speaking to the client |
Correct Answer: B,C,E
Rationale: Appropriate interventions include identifying support systems (
B), directly assessing for self-harm (
C), and using relaxation techniques (E). Providing privacy during flashbacks (
A) may increase distress, assessing ADLs (
D) is less urgent, and avoiding discussion of the trauma (F) may hinder therapeutic progress.
Extract:
The practical nurse is assisting the registered nurse with the care of a 58-year-old client in the emergency department.
Nurses' Notes
Initial Clinic Visit
The client monitors blood pressure (BP) at home and reports that it has been elevated for the past month. BP is 157/92 mm Hg. Physical examination is normal. The client is prescribed a thiazide diuretic for hypertension.
Emergency Department 4 Weeks Later
The client reports muscle weakness and severe cramping in the lower extremities with increased lethargy over the past 3 days. BP is 123/75 mm Hg. Physical examination findings include 1+ deep tendon reflexes bilaterally.
Question 3 of 5
The nurse recognizes that the client is most likely experiencing.......... and, without prompt intervention, is at risk for...........
Correct Answer: A,F
Rationale: The client is most likely experiencing hypokalemia and, without prompt intervention, is at risk for cardiac dysrhythmias. Thiazide diuretics can cause potassium loss, leading to muscle weakness, cramping, and lethargy. Low potassium levels can disrupt cardiac electrical activity, risking dysrhythmias.
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 4 of 5
For each finding, specify if the finding is expected or unexpected for this client.
| Finding | Expected | Unexpected |
|---|---|---|
| Respiratory | ||
| Neurological | ||
| Genitourinary | ||
| Cardiovascular | ||
| Gastrointestinal | ||
| Musculoskeletal |
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 the surgical unit is caring for a 57-year-old client who underwent an abdominal hysterectomy.
Progress Notes
1 Day Postoperative
0800:
The client underwent total abdominal hysterectomy with bilateral oophorectomy and tumor debulking 1 day ago for treatment of ovarian cancer. She has had four episodes of vomiting with bilious emesis over the past 12 hours, which have continued despite V antiemetic administration. The client has been receiving V broad-spectrum antibiotics since the procedure. The skin is warm. A low transverse abdominal incision is present; staples are clean and dry. Chest expansion is symmetric; respirations are unlabored: diminished breath sounds are auscultated in bilateral lower lobes. Radial pulses 2+ bilaterally, capillary refill <3 seconds in all four extremities; no peripheral edema is noted. The client reports frequent hot flashes occurring roughly every hour, starting last night. The abdomen is markedly distended and tender to palpation. Bowel sounds are absent in all four quadrants; the client reports no flatus. Urine is clear yellow with moderate output. The client reports incontinence with coughing or during episodes of vomiting.
Question 5 of 5
The health care provider suspects that the client is experiencing postoperative ileus. The nurse should prepare the client for and provide.
Correct Answer: B
Rationale: Postoperative ileus is characterized by absent bowel sounds, abdominal distension, and lack of flatus, as noted in the client. Abdominal and pelvic x-rays are used to confirm the diagnosis by identifying air-fluid levels or dilated bowel loops. A digital rectal examination is not diagnostic for ileus. Emergency surgery is not indicated without evidence of obstruction or perforation. Enteral feedings or clear liquids are contraindicated until ileus resolves, and total parenteral nutrition is typically reserved for prolonged cases.