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
Select the findings that require immediate follow-up.
Correct Answer: B,C,D
Rationale: B: SpO2 of 89% indicates hypoxemia, requiring immediate oxygen supplementation. C: Tachycardia (P 110) and low BP (110/60) suggest cardiovascular instability, needing urgent evaluation. D: Severe chest pain (7/10) warrants immediate investigation for potential cardiac or pulmonary issues. A: Anxiety is noted but not immediately life-threatening. E: Musculoskeletal issues are chronic and do not require immediate follow-up.
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
Question 2 of 5
Which of the following laboratory tests does the nurse anticipate to help determine the cause of the client's condition? Select all that apply.
Correct Answer: A,D,E
Rationale: A: Anticipated - Testing for clotting factors VIII and IX is essential to diagnose hemophilia, given the symptoms and family history. D: Anticipated - Platelet count helps rule out thrombocytopenia as a cause of bleeding. E: Anticipated - PTT (partial thromboplastin time) assesses the intrinsic clotting pathway, which is prolonged in hemophilia. B, C: Not indicated as they do not directly assess bleeding disorders.
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 3 of 5
Which clinical finding is most concerning at this time?
Correct Answer: C
Rationale: Tachycardia (pulse 164) is most concerning as it may indicate severe hyperthyroidism or other cardiovascular issues requiring immediate intervention.
Extract:
The nurse is caring for a 52-year-old client on the orthopedic unit.
Nurses' Notes
Postoperative Day 1
0900:
The client's left leg was placed in balanced suspension skeletal traction for a fractured femur 12 hours ago. The client is positioned supine in the center of the bed with the foot of the bed elevated 15 degrees. Traction ropes are free of frays, centered in the pulleys, and moving freely with attached weights resting on the bed frame.
Serous drainage noted around the pin sites. Left foot slightly cool to the touch with posterior tibial and dorsalis pedis pulses palpable at 2+ and capillary refill <2 seconds in the toes. Client has normal sensation and movement of the left toes. Client rates left leg pain as 8 on a scale of 0-10.
Vital signs are T 100.4 F (38 C), P 110, RR 18, and BP 132/68. Weight is 173 lb (78.5 kg).
Question 4 of 5
Which statement by the client is the most concerning?
Correct Answer: A
Rationale: Pain and tightness in the calf (
A) is concerning for deep venous thrombosis, a potentially life-threatening complication requiring immediate attention.
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.