NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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 1 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 an 84-year-old client with dementia.
Nurses' Notes
Medical-Surgical Unit
Day 1: The left antecubital peripheral IV insertion site has no erythema or edema, and the catheter flushes easily. The dressing is clean, dry, and intact. Potassium chloride infusion is initiated.
Day 3: Potassium chloride is infusing. The area surrounding the IV site is taut, edematous, blanched, and cool to the touch. Small, fluid-filled vesicles are noted around the IV site. Capillary refill distal to the IV site is >3 seconds. The client is grimacing and unable to verbally report pain.
Question 2 of 5
For each potential intervention, click to specify if the potential intervention is appropriate or not appropriate for the care of client.
| Potential Intervention | Appropriate | Not Appropriate |
|---|---|---|
| Elevate the affected extremity | ||
| Apply pressure to the affected area | ||
| Discontinue the potassium chloride infusion | ||
| Aspirate the potassium chloride from the IV catheter | ||
| Leave the IV catheter in place for potential antidote administration |
Correct Answer: A: Appropriate, B: Not Appropriate, C: Appropriate, D: Not Appropriate, E: Appropriate
Rationale: The symptoms suggest IV infiltration with potassium chloride, which is caustic. Elevating the extremity (
A) reduces swelling. Discontinuing the infusion (
C) prevents further damage. Leaving the catheter in place (E) allows for potential antidote administration. Applying pressure (
B) may worsen tissue damage, and aspirating (
D) is not standard for infiltration.
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 3 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.
Extract:
The nurse is caring for a 6-hour-old newborn.
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 4 of 5
The nurse recognizes that the client is most likely experiencing a tracheoesophageal fistula with esophageal atresia and will require interventions to prevent ___ and ___
Correct Answer: B,C
Rationale: Tracheoesophageal fistula can lead to aspiration pneumonia due to food entering the lungs and dehydration from inability to feed properly. These are the most immediate risks requiring intervention.
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 5 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.