NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
Nurses' Notes
Clinic Visit
0915:
The client reports substernal chest discomfort and intermittent palpitations that began this morning. Medical
history includes coronary artery disease and stable angina. Daily medications include aspirin, metoprolol,
atorvastatin, and lisinopril. The client has been traveling for the past week and ran out of one of the
medications.
Vital Signs 0915
T
98.2 F (36.8 C)
P
116
RR
16
BP
138/89
SpOz
98% on room air
Question 1 of 5
The nurse is caring for a 65-year-old client in the clinic. Complete the following sentence by choosing from the list of options.The nurse suspects that the clients condition is most likely related to the abrupt discontinuation of-----------------
Correct Answer: B
Rationale: Beta-adrenergic antagonists, also known as beta blockers (eg, metoprolol, atenolol), are commonly used to treat
hypertension, heart failure, and anxiety. Beta blockers reduce cardiac workload by inhibiting the action of catecholamines (eg,
epinephrine, norepinephrine) on beta-adrenergic receptors in the heart. This slows electrical conduction through the heart,
which decreases heart rate and blood pressure.
Abrupt discontinuation of beta blockers can result in rebound hypertension, angina, palpitations, myocardial infarction,
arrhythmias (eg, tachycardia, ventricular tachycardia), or sudden death. These discontinuation-associated risks are caused
by increased beta-adrenergic receptor sensitivity to circulating catecholamines, resulting in an increased sympathetic
response. Withdrawal symptoms should resolve after resumption of the medication.
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.
Laboratory Results
Laboratory Test and
Reference Range
1030
Glucose (random)
71-200 mg/dL
(3.9-11.1 mmol/L)
110 mg/dL (6.1 mmol/L)
Sodium
136-145 mEq/L
(136-145 mmol/L)|
133 mEq/L (133 mmol/L)|
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L)
4.5 mEq/L (4.5 mmol/L)
B-type natriuretic peptide
<100 pg/mL
(<100 ng/L)
640 pg/mL (640 ng/L)
Diagnostic Results
Chest X-ray
1030:Mild cardiomegaly
Echocardiogram
1100:Mild left ventricular hypertrophy with left ventricular ejection fraction of 30%
Question 2 of 5
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 |
|---|---|---|
| Daily weights | ||
| IV furosemide | ||
| Fluid restriction | ||
| Supplemental oxygen | ||
| Antihypertensive medications | ||
| Nebulized albuterol breathing treatments |
Correct Answer:
Rationale: Expected interventions for acute decompensated heart failure (HF) focus on reducing cardiac workload and improving
oxygenation. These include:
• Daily weights should be performed 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 of clothing.
• Diuretics (eg, furosemide) prevent reabsorption of sodium and chloride in the kidneys, which increases fluid excretion in
urine and decreases preload. Diuretics provide symptomatic relief by reducing pulmonary congestion and peripheral
edema. These are the cornerstone of therapy and often a priority after oxygen therapy.
• Fluid restriction is indicated to decrease circulating fluid volume and prevent excess strain on the heart.
• Supplemental oxygen should be administered to improve oxygen delivery in clients with HF due to impaired gas
exchange from pulmonary edema.
• Antihypertensive medications reduce cardiac workload and improve contractility by lowering blood pressure (ie,
afterload).
Nebulized albuterol is a bronchodilator administered to improve oxygenation in clients with reactive airway disease (eg.
asthma, chronic obstructive pulmonary disease). Bronchodilators will not improve oxygenation in clients with pulmonary
edema and are not expected for treatment of HF.
Extract:
History
Labor and Delivery Unit
Admission: The client, gravida 1 para 0, at 16 weeks gestation with a twin pregnancy reports nausea and vomiting for the past
several weeks. The client also reports dry heaving, increasing weakness, light-headedness, and an inability to tolerate
oral intake for the past 24 hours. In addition, the client has had occasional right-sided, shooting pain from the abdomen
to the groin that occurs with sudden position changes. The pain quickly resolves without intervention per the client's
report. She has had no contractions or vaginal bleeding and has felt no fetal movement during this pregnancy. The
client has a history of childhood asthma and is currently taking no asthma medications. The client reports no other
pregnancy complications.
Physical
Prepregnancy,12 Weeks Gestation 16 Weeks Gestation(Prenatal Visit),(Labor and Delivery Admission)
Height ,5 ft 5 in (165.1 cm),5 ft 5 in (165.1 cm)|, 5 ft 5 in (165.1 cm)
Weight, 145 lb (65.8 kg),148 lb (67.1 kg),138 lb (62.6 kg)
BMI, 24.1 kg/m2, 24.6 kg/m2,23.0 kg/m2
Vital Signs
12 Weeks Gestation(Prenatal Visit),16 Weeks Gestation(Labor and Delivery Admission)
T,98.7 F (37.1 C),99.8 F (37.7 C)
P,70,101
RR,14,18
BP,122/78,90/55
SpO2,99% on room air,96% on room air
Laboratory Results
Laboratory Test and Reference Range, 16 Weeks Gestation
Blood Chemistry.
Sodium
136-145 mEq/L
(136-145 mmol/L)|,
136 mEq/L
(136 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
2.7 mEq/L
(2.7 mmol/L)
TSH
0.3-5.0 uU/mL
(0.3-5.0 mU/L),
0.4 pu/mL
(0.4 mU/L)
Hematology.
Hemoglobin (pregnant)
>11 g/dL
(>110 g/L),
16 g/dL
(160 g/L)
Hematocrit (pregnant)
>33%
(>0.33),
49%
(0.49)
Urinalysis
Specific gravity
1.005-1.030
1.030,
Ketones
Not present,
Present
Giucose
Not present,
Not present
Nitrites
Not present,
Not present
Question 3 of 5
The nurse has reviewed the information from the Laboratory Results. The nurse suspects that the client may have hyperemesis gravidarum. Which of the following findings support this diagnosis? Select a that apply.
Correct Answer: A,B,D,E
Rationale: Hyperemesis gravidarum (HG) is characterized by severe, persistent nausea and vomiting during pregnancy and weight loss of 25% of
prepregnancy weight. The exact cause of HG is unknown, but it is believed that pregnancy-related increases in hormone levels (eg, human
chorionic gonadotropin [hCG]) contribute to the condition. Laboratory findings that assist with the diagnosis of HG include:
• Elevated hematocrit level reflects hemoconcentration, which occurs due to dehydration from excessive vomiting and decreased fluid
intake (Option 1).
• Hypokalemia occurs due to excessive loss of potassium via vomiting and/or insufficient intake of potassium (Option 2).
• Ketonuria (ie, the presence of ketones in urine) results from the metabolism of fat for energy due to a lack of nutritional intake (Option
4).
• High urine specific gravity reflects the concentration of urine; concentrated urine may indicate that the client's volume is depleted,
which is common in HG (Option 5).
Extract:
The nurse is caring for a 58-year-old client.
Admission Note
Emergency Department
A client with colorectal cancer reports intractable bilious vomiting for the past day; it is accompanied by severe, colicky
abdominal pain. The client cannot tolerate oral intake and has not passed gas or had a bowel movement since the
symptoms began. The abdomen is distended, and bowel sounds are hyperactive.
Vital Signs
Emergency Department
T, 97.3 F (36.3 C)
P, 98
RR, 18
BP, 110/70
SpO2, 98% on room air
Question 4 of 5
The nurse is contributing to the client's plan of care. For each potential intervention, click to specify if the intervention is indicated or not indicated for the care of the client.
| Potential Intervention | Indicated | Not Indicated |
|---|---|---|
| Administer antiemetic | ||
| Insert a nasogastric tube | ||
| Place the client on a soft diet | ||
| Obtain an abdominal CT scan | ||
| Administer a stimulant laxative |
Correct Answer:
Rationale: Small bowel obstruction (SBO) is an intestinal blockage that obstructs the flow of intestinal contents (eg, fluid, gas, fecal
material). The blockage may be due to mechanical (eg, surgical adhesions, hernias, tumors) or nonmechanical/functional (eg,
paralytic ileus) causes. As intestinal contents accumulate, clients develop abdominal distension, colicky abdominal pain,
bilious vomiting, and inability to pass flatus or stool.
Clients with SBO are at risk for fluid, electrolyte, and nutritional imbalances due to decreased intestinal absorption. Clients may
develop bowel necrosis and perforation due to impaired intestinal blood flow, which can lead to peritonitis and sepsis.
The practical nurse should anticipate assisting the registered nurse with the following interventions for a client with SBO:
• Inserting a nasogastric tube for gastrointestinal decompression to reduce abdominal distension and improve intestinal
blood flow
• Administering antiemetics (eg, ondansetron) to prevent further fluid and electrolyte imbalance from vomiting
• Preparing the client for abdominal CT scan to determine the size and location of intestinal obstruction
• Administering IV fluids to improve fluid volume status
In clients with SBO, bowel rest (ie, NPO status) with gastric decompression is prescribed; therefore, a soft diet is not
indicated. Stimulant laxatives increase intestinal motility and are not indicated for clients with intestinal obstruction due to
the risk for bowel perforation.
Extract:
History and Physical
Body System, Finding
General,
Client is brought to the emergency department due to nausea, vomiting, and abdominal pain that began 24 hr
ago. Client has type 1 diabetes mellitus and usually takes insulin. Parents state that the client was at an
overnight camp for the past 4 days and are unsure of how much insulin the client has been taking.
Neurological,
Client is lethargic but arousable to voice. The pupils are equal, round, and reactive to light and accommodation.
Integumentary,
Mucous membranes are dry, skin turgor is poor.
Pulmonary,
Vital signs are RR 36 and SpOz 95% on room air. Lung sounds are clear to auscultation. Deep respirations and a
fruity odor on the breath are noted.
Cardiovascular,
Vital signs are T 98.4 F (36.9 C), P 110, and BP 98/58. Pulses are 3+ on all extremities, and capillary refill time is
4 sec.
Gastrointestinal Normoactive bowel sounds are heard in all 4 quadrants; the abdomen is nontender.
Genitourinary,
Client voided dark yellow urine.
Endocrine,
Client is prescribed levothyroxine daily for hypothyroidism and has missed one dose of levothyroxine.
Psychosocial,
Parents state that the client has been sad and slightly withdrawn for the past 2 weeks after ending a romantic relationship.
Question 5 of 5
Select 4 clinical findings that require immediate follow-up.
Correct Answer: A,B,C,E
Rationale: Type 1 diabetes mellitus is an endocrine disorder characterized by the absence of insulin production in the pancreas. Glucose requires insulin
to be transported from the extracellular space into the cell. Without insulin, glucose continues to circulate in the extracellular space, causing
serum hyperglycemia and intracellular glucose starvation that can lead to diabetic ketoacidosis (DK
A).
In DKA, the body breaks down fat for energy (ie, ketosis). This leads to high levels of ketones in the blood, which can cause life-threatening
metabolic acidosis. Clinical findings concerning for DKA require immediate follow-up and include:
• Nausea, vomiting, and abdominal pain—a common presentation of DKA (especially in children) that can be related to delayed gastric
emptying and/or ileus from electrolyte abnormalities and metabolic acidosis
• Neurologic symptoms (eg, lethargy, obtundation) due to progressive hyperglycemia and acidosis
• Signs of dehydration (eg, dry mucous membranes, prolonged P3 sec] capillary refill time) due to osmotic water loss caused by
glucose in the urine