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 sensationand 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).
Postoperative Day 15
0800:
The client is increasingly tearful and states, "Life is going on without me while I am lying in this bed. I miss my friends." Left leg is in balanced suspension traction. Weights are hanging freely from the traction device. A 1-inch area of purple discoloration is noted on the right heel. Pin sites are free of erythema, swelling, and purulent drainage. Perineum is reddened with areas of excoriation and erythematous papules. External urinary catheter is in place. Scapula and sacrum are free of erythema.
Vital signs are T 98.8 F (37.1 C), P 100, RR 16, and BP 122/72. Weight is 164 lb (74. 4 kg).
Question 2 of 5
The nurse has reviewed the information from the Nurses' Notes. The nurse reinforces client teaching. Which statement by the client indicates a need for further teaching?
Correct Answer: C
Rationale: Resting the heel on a rolled towel may increase pressure on the wound, worsening the purple discoloration noted on the right heel. The other statements reflect appropriate understanding of nutritional needs, catheter care, and mobility assistance.
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)
Question 3 of 5
The nurse has reviewed the information from the Prescriptions and Laboratory Results. The nurse is planning care with the registered nurse. Select 2 prescriptions the nurse should anticipate initiating first.
Correct Answer: A, F
Rationale: IV fluids (
A) are critical to maintain hydration and electrolyte balance, especially with vomiting and ileus. Potassium chloride (F) addresses the low potassium level (3.3 mEq/L). Dextrose is not needed with normal glucose (75 mg/dL). Ketorolac and ondansetron are as-needed, and pantoprazole is daily but less urgent. Clear liquids may exacerbate ileus.
Extract:
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
During a diaper change, the client becomes cyanotic with frothy secretions from the mouth and nose. What action should nurse perform first?
Correct Answer: C
Rationale: Suctioning clears the airway of frothy secretions, addressing the immediate cause of cyanosis. This is the first priority before other interventions.
Extract:
The nurse is caring for a client in the clinic.
Nurses' Notes
Initial Clinic Visit
The client reports progressive fatigue and weakness over the past 2 months. Pallor and minor glossitis are noted. Laboratory results show a decreased hemoglobin. The client is instructed to take an iron supplement for treatment of iron-deficiency anemia.
Clinic Visit: 2 Weeks Later
The client reports discomfort and straining with bowel movements over the past week. Stool has become increasingly hard and pellet-like. The client reports feeling bloated with crampy abdominal pain that is relieved with defecation. The abdomen is nontender to palpation.
Question 5 of 5
The nurse is contributing to the client's plan of care. For each potential intervention, click to specify if the intervention is expected or not expected for the care of the client.
| Potential Intervention | Expected | Not Expected |
|---|---|---|
| Recommend a stool softener | ||
| Take the iron supplement with meals | ||
| Encourage warm fluids with breakfast | ||
| Increase consumption of dairy products | ||
| Increase intake of raw fruits and vegetables | ||
| Drink eight to ten 8-oz glasses of water per day |
Correct Answer: A,C,E,F
Rationale: A: Stool softeners are expected to manage constipation, a side effect of iron supplements. C: Warm fluids aid bowel motility. E: Raw fruits and vegetables increase fiber to relieve constipation. F: Adequate hydration softens stool and prevents constipation.