NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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 1 of 5
For each potential intervention, click to specify if the intervention anticipated or unanticipated for the care of the client.
Correct Answer: B,C,D,E,F
Rationale: B: Anticipated - A soft-bristled toothbrush reduces gum bleeding risk in hemophilia. C: Anticipated - Fall precautions prevent injuries that could cause bleeding. D: Anticipated - Small-gauge needles minimize tissue trauma. E: Anticipated - RICE is used for joint bleeding in hemophilia. F: Anticipated - Lifelong factor replacement is standard for hemophilia management. A: Unanticipated - Platelet transfusion is not indicated as platelet count is normal.
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 2 of 5
Based on the client's history and physical examination findings, which disease process is the most likely cause of this client's current condition?
Correct Answer: D
Rationale: The client's recent immobility (wheelchair dependence post-femoral fracture), right lower extremity redness and edema (suggesting DVT), dyspnea, chest pain, hypoxemia (SpO2 89%), and sinus tachycardia strongly indicate venous thromboembolism, likely a pulmonary embolism secondary to DVT.
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 3 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.
| Client Statement | Improved | Not Improved |
|---|---|---|
| I woke up only once last night. | ||
| I want to talk about the nightmare I had. | ||
| I am thinking about selling my car and taking the bus instead. | ||
| I have been journaling my stressors and emotional reactions to them. | ||
| Sometimes I still get upset by small issues. but I control my feelings better now. |
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 is evaluating the client's use of hearing aids. Nurses' Notes
The client reports keeping hearing aids in a box in the bedside table when asleep. The client demonstrates pulling the top of the ear down and back to insert the hearing aid. When the device makes a whistling sound, the client reports turning the volume up. Every few days, when the aids are dirty, the client washes them gently with a wet washcloth. Before taking a break from the hearing aids over the weekend, the client removes the battery
Question 4 of 5
Select 3 findings that require follow-up.
Correct Answer: C,D,E
Rationale: Turning up the volume for whistling (feedback) may indicate improper fit. Washing hearing aids with water can damage them. Removing batteries for storage is correct, but follow-up ensures proper technique.
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 5 of 5
Based on the client's clinical manifestations, which condition should the nurse suspect?
Correct Answer: A
Rationale: Trembling, diaphoresis, restlessness, hallucinations, and elevated vital signs (P 102, BP 170/96) are classic signs of alcohol withdrawal syndrome, especially given the absence of gastrointestinal bleeding symptoms and the presence of neurological symptoms.