NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
The nurse is performing a home health visit for an 84-year-old male.
History and Physical
Body System, Findings
General,
Client reports a 1-month-long history of fatigue and dyspnea that has worsened; he is unable to lie
flat and sleeps in a chair at night, medical history includes myocardial infarction, chronic heart
failure, chronic obstructive pulmonary disease, hypertension, and type 2 diabetes mellitus; client
was diagnosed with benign prostatic hyperplasia 8 months ago; client is adherent with prescribed
medications; client reports frequent consumption of donuts, hamburgers, steak, and fried chicken;
BMI is 34 kg/m?; client reports 6-Ib (2.7-kg) weight gain in 1 week
Neurological,
Alert and oriented to person, place, time, and situation
Pulmonary,
Vital signs: RR 24, SpOz 88% on room air; labored breathing, crackles in bilateral lung bases; client
expectorates frothy, pink-tinged sputum; client has a 40-year history of smoking 1 pack of cigarettes
per day
Cardiovascular,
Vital signs: T 98.8 F (37.1 C), P 98, BP 113/92; S1, S2, and S3 present; 3+ bilateral lower extremity
edema
Genitourinary, Concentrated yellow urine; client reports increased urinary hesitancy and urgency
Psychosocial,
Client reports being lonely and has depressed mental status
Question 1 of 5
The health care provider has confirmed that the client is experiencing an exacerbation of heart failure. For each potential prescription, click to specify if the prescription is expected or unexpected for the care of the client.
Correct Answer:
Rationale: Heart failure (F) exacerbation management focuses on improving oxygenation and reducing fluid overload. Expected
prescriptions include:
• Performing daily weights to monitor fluid volume status and guide treatment. Ideally, daily weights should be performed
at the same time of day, on the same scale, and with the client wearing the same amount/type of clothes. Rapid weight
gain (ie, >5 lb/week [(2.3 kg/week]) should be communicated to the health care provider immediately.
• Administering loop diuretics (eg, furosemide, torsemide, bumetanide) to prevent reabsorption of sodium and chloride in
the kidneys, which increases fluid excretion and urine output. This provides symptom relief by reducing pulmonary
congestion and peripheral edema.
• Applying compression stockings, a common nopharmacological intervention, to promote venous blood return and
reduce peripheral edema.
Limiting mobility is unexpected for a client with increased fluid volume. The client should be encouraged to ambulate
frequently to promote venous return, exercise cardiac muscle, and reduce risk of deep venous thrombosis.
Increasing oral fluid intake is unexpected for a client with hypervolemia (ie, heart failure exacerbation) because it
exacerbates existing symptoms (eg, edema, pulmonary congestion).
Extract:
The nurse is caring for a 64-year-old client.
History and Physical
Body System, Findings
General ,
The client reports a 24-hour history of blurred vision and redness in the left eye with a left-sided headache.
This evening, the client developed acute, severe pain in the left eye accompanied by occasional nausea and
vomiting. The client reports no use of systemic or topical eye medications. Medical history includes
osteoarthritis and hypercholesterolemia.
Eye, Ear, Nose, and Throat (EENT),
The client wears eyeglasses to correct farsighted vision. Right eye: pupil 2 mm and reactive to light,
conjunctiva clear. Left eye: pupil 4 mm and nonreactive to light with red conjunctiva. Bilateral lens opacity is noted.
Pulmonary,
Vital signs are RR 20 and SpO, 96% on room air. The lungs are clear to auscultation bilaterally.
Cardiovascular,
Vital signs are T 99 F (37.2 C), P 88, and BP 140/82.
Psychosocial,
The client reports a great deal of emotional stress following the recent death of the client's spouse that is accompanied by lack of sleep, poor appetite, and a 7.9-lb (3.6-kg) weight loss within the past month. The client takes diphenhydramine for sleep.
Question 2 of 5
Select 5 findings that require immediate follow-up.
Correct Answer: A,D,E,F,G
Rationale: This client is experiencing signs of acute angle-closure glaucoma (ACG), a medical emergency characterized by a sudden elevation in
intraocular pressure (IOP). The onset of symptoms is typically sudden; however, acute ACG requires rapid intervention to prevent permane
vision loss. Manifestations of acute ACG include:
• Blurry vision
• Unilateral headache
• Sudden, severe eye pain
• Conjunctival redness
• Middilated pupils (4-6 mm) nonreactive to light
Extract:
Nurses' Notes
Outpatient Clinic
Initial
visit
The child recently started attending a new preschool and hit a teacher during lunch. The parent says, "My
child has never been aggressive before but has always been particular about food."
The client was born at full term without complications and has no significant medical history. The child
started babbling at age 6 months, and the parent reports that the first words were spoken around age 12
months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color.
The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are
normal, and the client is tracking adequately on growth curves.
During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow
the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back
and forth when the health care provider comes near.
Question 3 of 5
The client returns to the clinic 6 months after starting behavioral therapy. Which statement by the parent indicates a need for further therapy?
Correct Answer: A
Rationale: Early childhood intervention programs (eg, behavioral therapy) are a critical component for clients with autism spectrum
disorder and can have positive long-term effects on presenting symptoms and social skills. Therapy helps increase
communication and language skills; improve focus, social skills, memory, and academic functioning; and decrease problematic
behaviors through positive reinforcement and other behavioral approaches
When evaluating the outcomes of therapy, the nurse should recognize that clients who demonstrate narrowed, restricted
interests (eg, eating the same foods) indicate a need for additional therapy
Extract:
The nurse is caring for a 34-year-old female client in the clinic.
Nurses' Notes
Initial Clinic Visit
The client is receiving a tuberculin skin test. The client works at a long-term care facility and has never been vaccinated for
tuberculosis. Medical history includes Crohn disease, major depression, and a blood transfusion following a motor vehicle collision 5
years ago. The client takes an immunosuppressant, oral contraceptive pills, and a selective serotonin reuptake inhibitor daily.
The client is currently providing housing for a family member who periodically experiences homelessness. The client has a pet dog.
Clinic Visit 2 Days Later
The client returns to the clinic for inspection of the tuberculin skin test injection site. There is a palpable, raised, hardened area around
the injection site that is 16 mm in diameter.
The client reports no cough, fever, fatigue, anorexia, weight loss, or nocturnal diaphoresis. Lung sounds are clear throughout all lobes
on auscultation.
Vital signs are T 98.5 F (36.9 C), P 72, RR 17, BP 118/72, and SpO 98% on room air.
Clinic Visit 6 Months Later
The client reports fatigue; intermittent fevers; decreased appetite; a 6-Ib (2.7-kg) weight loss; and a productive, chronic cough that
began 5 weeks ago. The client has not started the antibiotic regimen for latent tuberculosis.
Diagnostic Results
Chest x-ray
Lungs appear normal. There are no infiltrates, cavitation, or effusions.
Question 4 of 5
I can never get tuberculosis again once I finish treatment
Correct Answer: D
Rationale: Rifampin is often used in the management of both latent and active tuberculosis (T
B) but reduces the effectiveness of oral contraceptive
pills.
Therefore, the client should be instructed to use additional methods of contraception during treatment and for 1 month following
the completion of treatment (Option 4).
Extract:
Nurses' Notes
Outpatient Clinic
Initial
visit
The child recently started attending a new preschool and hit a teacher during lunch. The parent says, "My
child has never been aggressive before but has always been particular about food."
The client was born at full term without complications and has no significant medical history. The child
started babbling at age 6 months, and the parent reports that the first words were spoken around age 12
months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color.
The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are
normal, and the client is tracking adequately on growth curves.
During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow
the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back
and forth when the health care provider comes near.
Question 5 of 5
For each finding below, click to specify if the finding is consistent with the disease process of autism spectrum disorder, obsessive-compulsive disorder, or separation anxiety disorder. Each finding may support more than one disease process.
| Finding | Autism Spectrum Disorder | Obsessive-Compulsive Disorder | Separation Anxiety Disorder |
|---|---|---|---|
| Ritualized pattern of behavior | |||
| Disinterest in social interaction | |||
| Lack of spontaneous eye contact | |||
| Restricted, fixated thoughts or interests |
Correct Answer:
Rationale: Symptoms of autism spectrum disorder (AS
D) range in severity from one individual to another. Clients often demonstrate a
ritualized pattern of behavior, resulting in distress and self-harm (eg, hitting the head) in response to changes in routine or
environment. Other manifestations include disinterest in social interaction, deficiency in verbal and nonverbal
communication (eg, lack of spontaneous eye contact or facial expressions), and restricted, fixated thoughts or interests
(eg, attached to unusual objects).
Obsessive-compulsive disorder (OC
D) is characterized by obsessions (ie, restricted, fixated thoughts, impulses, or
images) and compulsions (ie, ritualistic, repetitive behaviors performed to reduce anxiety or prevent an adverse event).
These compulsions are time consuming and cause significant distress. In contrast to those with OCD, clients with ASD are not
bothered about their preoccupations or mannerisms and do not desire to change. Clients with OCD do not have issues with
social interaction or social-emotional reciprocity (eg, poor eye contact).