NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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.
Prescriptions
0820:
• 5% dextrose and 0.45% sodium chloride at 75 m/hr continuous
• 50% dextrose 25 mg IV push as needed for blood glucose <70 mg/dL (3.9 mmol/L)
• Ketorolac 15 mg IV push every 6 hours as needed for severe pain
• Ondansetron 8 mg PO every 8 hours as needed for nausea
• Pantoprazole 40 mg PO daily
• Potassium chloride 40 mEq/100 mL IVPB once
• Sips of clear liquids, advance diet as tolerated
Laboratory Results
Laboratory Test and Reference Range: 1 day postoperative
WBC count:
5000-10.000/mm3 (5-10 × 10%L): 12,000/mm3 (12 × 10°/L)
Urea nitrogen (BUN)
10-20 mg/dL (3.6-7.1 mmol/L): 24 mg/dL (8.6 mmol/L)
Creatinine
Male: 0.6-1.2 mg/dL(53-106 umol/L):
1.6 mg/dL (141.4 pmol/L)
Female: 0.5-1.1 mg/dL (44-97 umol/L):
Potassium
3.5-5.0 mEq/L (3.5--5.0 mmol/L): 3.3 mEq/L (3.3 mmol/L)
Sodium
135-145 mEq/L (135-145 mmol/L): 137 mEq/L (137 mmol/L)
Blood glucose level
74-106 mg/dL (4.1-5.9 mmol/L): 75 mg/dL (4.2 mmol/L)
Nurses’ Notes
0900:
Continuous IV fluids and potassium chloride infusion initiated; opioids discontinued per health care provider prescription. Ondansetron administered once for nausea. Assisted client to ambulate in hallway once; client currently sitting up in chair.
2100:
No emesis since 0800. Client has ambulated two more times and has remained out of bed. Ketorolac administered for abdominal pain rated as 7 on a scale of 0-10. Tolerating small sips of clear liquids. Bowel sounds absent.
Surgical Unit: 1 Day Postoperative
0700:
Client reports no nausea. Client ambulated 50 ft (15 m) this morning. After ambulation, client reports one small, loose bowel movement. Pain remains at 7 on a scale of 0-10. Tolerating clear liquids. Bowel sounds hypoactive.
Question 1 of 5
The nurse has reviewed the information from the Laboratory Results and Nurses' Notes. Which of the following findings indicate that the client condition is improving following treatment of postoperative ileus? Select all that apply.
Correct Answer: B, C, D, E
Rationale: Hypoactive bowel sounds (
B), a loose stool (
C), and passing flatus (
D) indicate returning bowel function, a sign of resolving ileus. Normalized potassium (E) from 3.3 to 3.5 mEq/L shows effective treatment. Elevated glucose (
A) is not relevant to ileus and indicates a new issue.
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 2 of 5
Select the 2 findings that require immediate follow-up.
Correct Answer: G,E
Rationale: Serous drainage (G) and a slightly cool foot (E) require immediate follow-up due to potential infection or compromised circulation.
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.
Question 3 of 5
Which client finding requires immediate follow-up by the nurse?
Correct Answer: A
Rationale: Hopelessness is a critical finding indicating a risk for suicide or severe depression, requiring immediate assessment and intervention in a client with post-traumatic stress symptoms and recent life stressors.
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 4 of 5
Select the findings that require immediate follow up.
Correct Answer: B,E
Rationale: B: Requires follow-up - Persistent vomiting despite antiemetics suggests a postoperative complication like ileus or obstruction. E: Requires follow-up - Abdominal distension and tenderness indicate potential ileus or obstruction, requiring urgent evaluation. A, C, D: Do not require immediate follow-up as they are expected or less urgent.
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
For each potential intervention, click to specify if the intervention anticipated or unanticipated for the care of the client.
| Potential Intervention | Anticipated | Unanticipated |
|---|---|---|
| Monitoring a platelet transfusion | ||
| Providing a soft-bristled toothbrush | ||
| Ensuring fall precautions are in place | ||
| Using a small-gauge needle for injections | ||
| Encouraging rest, ice, compression, and elevation | ||
| Reinforcing teaching about lifelong factor replacement |
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.