NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
The nurse in the emergency department is caring for a 62-year-old client.
Progress Notes
Emergency Department
0900: The client is brought to the emergency department by a family member after being found confused and lethargic. On arrival, the client is obtunded and does not respond to verbal stimuli.
Medical history includes major depressive disorder and chronic neck and back pain after a motor vehicle collision 2 years ago. The family member states that the client takes multiple medications but does not know which kind. The client was divorced a few months ago.
Physical examination shows 1-mm pupils, shallow breathing, and reduced bowel sounds. Fingerstick blood glucose is 78 mg/dL (4.3 mmol/L). ECG reveals normal sinus rhythm. Breath alcohol test is negative.
Vital signs: T 98.1 F (36.7 C), P 62, RR 8, BP 80/40, SpO, 94% on room air.
1800:
The client is awake, alert, and oriented to person, place, time, and situation. The client is experiencing severe withdrawal symptoms and is admitted for supervised detoxification.
Laboratory Results
Urine Drug Screen
On admission
Cocaine- Negative
Opioids- Positive
Amphetamines- Negative
Marijuana- Positive
Phencyclidine-Negative
Benzodiazepines- Negative
Barbiturates- Negative
Laboratory Test and Reference Range
Cocaine- Negative
Opioids- Negative
Amphetamines- Negative
Marijuana- Negative
Phencyclidine- Negative
Benzodiazepines- Negative
Barbiturates- Negative
Question 1 of 5
The nurse is evaluating teaching for the client who is newly prescribed methadone for opioid use disorder. Which of the following client statements indicate that the teaching has been effective? Select all that apply.
Correct Answer: B,C,E
Rationale: B: Rising slowly prevents orthostatic hypotension, a methadone side effect. C: Avoiding alcohol reduces CNS depression risk. E: Reporting dizziness or palpitations ensures timely management of adverse effects. A is incorrect as extra doses require provider approval, and D is incorrect as stopping abruptly can cause withdrawal.
Extract:
The nurse is caring for an 8-year-old client who was brought to the emergency department after
becoming short of breath at school.
History and Physical
General
Well-nourished child; currently sitting in the tripod position; patches of dry, scaly, reddened skin are present in the creases of bilateral elbows and behind both knees; client reports that these areas itch
Neurological
Alert and oriented to person, place, and time
Eye, Ear, Nose, andThroat (EENT)
Pupils equal, round, and reactive to light and accommodation; client reports no nasal congestion
Pulmonary
Vital signs: RR 34, SpO 92% on room air, airway patent, intercostal retractions noted during inspiration; expiratory wheezes auscultated bilaterally; dry, spasmodic cough is noted; no stridor; difficulty speaking in complete sentences
Cardiovascular
Vital signs: T 98.8 F (37.1 C), P 110, BP 94/60; S1 and S2 heard on auscultation; nom murmurs noted; peripheral pulses 2+; capillary refill 3 seconds; no edema
Gastrointestinal
Abdomen soft; bowel sounds normal
Psychosocial
Client appears anxious and is crying, client speaks in short phrases, stating, "left my medicine at a friend's house" and "feels like I can't breathe"; client cannot remember the name of the prescribed home medication; client's parents were notified and are en route to hospital
Question 2 of 5
Select the findings that require immediate follow up.
Correct Answer: B,C,D,G
Rationale: B: RR 34 and SpO2 92% indicate respiratory distress and hypoxia, requiring immediate intervention. C: Intercostal retractions and wheezes suggest severe airway obstruction. D: Difficulty speaking in complete sentences indicates significant respiratory compromise. G: Anxiety and crying reflect distress and may exacerbate respiratory issues.
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 3 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:
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
The practical nurse is assisting the registered nurse with the client's care. The newborn has received a gastrostomy tube and is scheduled for surgical repair of esophageal atresia and tracheoesophageal fistula. For each intervention, click to specify if the intervention is indicated or not indicated for the care of the newborn. Note: Each row must have one response option selected.
| Intervention | Indicated | Not Indicated |
|---|---|---|
| Administer IV fluids | ||
| Monitor for episodes of apnea | ||
| Set up suction equipment at the bedside | ||
| Provide feedings through a gastrostomy tube | ||
| Maintain the newborn's head in an elevated position |
Correct Answer: A,B,C,E
Rationale: IV fluids prevent dehydration, monitoring for apnea addresses respiratory risks, suction equipment manages secretions, and an elevated head position reduces aspiration risk. Gastrostomy tube feedings are not indicated pre-surgery due to the fistula.
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.