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 helping the client prepare for discharge after 3 days of inpatient detoxification. Which of the following actions should the nurse take? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: All are appropriate: A: Identifying maladaptive behaviors supports recovery. B: Support groups aid long-term sobriety. C: Naloxone training prevents overdose deaths. D: Referrals ensure continued care. E: Education on medications (e.g., methadone) ensures adherence.
Extract:
The nurse is caring for an 82-year-old client in the emergency department.
Nurses' Notes
0930:
The client reports shortness of breath and left-sided chest pain for 2 days. The client fractured the right femoral neck a month ago after a fall and decided against operative management. Since then, the client has been wheelchair dependent and takes acetaminophen for fracture pain management. The client was placed on continuous cardiac monitoring.
History and physical
Body System
Neurological
The client is awake, alert, and oriented to person, place, time, and situation; the client appears anxious
Pulmonary
Vital signs are RR 22, SpOz 89% on room air; bilateral breath sounds are clear; pain increases with inhalation; the client reports shortness of breath for the past 2 days; the client smoked 1 pack of cigarettes per day for 10 years.
Cardiovascular
Vital signs are T 99.8 F (37.7 C), P 110, BP 110/60; S1 and S2 are present; there are no murmurs, redness and edema of the right lower extremity are noted; sinus tachycardia is seen on the monitor, chest pain is reported as 7 on a scale of 0-10
Musculoskeletal
The client has osteoporosis, is wheelchair dependent, and is unable to bear weight on the right leg
Diagnostic Results
CT pulmonary angiography
1030: Pulmonary embolism is confirmed
Lower extremity doppler ultrasound
1100: Deep venous thrombosis is noted in the right lower extremity.
Question 2 of 5
For each potential prescription, click to specify if the prescription is anticipated or contraindicated for the care of the client.
| Potential Prescription | Anticipated | Contraindicated |
|---|---|---|
| Heparin infusion | ||
| Acetaminophen PRN for pain | ||
| Physical therapy for mobility exercises | ||
| Supplemental oxygen to maintain SpO2 ≥ 90% | ||
| Sequential compression devices to bilateral lower extremities |
Correct Answer: A,B,D
Rationale: A: Heparin infusion is anticipated to treat pulmonary embolism and DVT by preventing further clot formation. B: Acetaminophen is anticipated for pain management, as it is safe for this client. C: Physical therapy is contraindicated due to the acute PE and DVT, as mobilization could dislodge clots. D: Supplemental oxygen is anticipated to correct hypoxemia (SpO2 89%). E: Sequential compression devices are contraindicated, as DVT is already present, and they could dislodge the clot.
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.
Nurses' Notes
Inpatient - Mental Health Unit
2100:
Client appears anxious and withdrawn, and states, "I am afraid to sleep at night because I get nightmares about my sibling." The client would not elaborate on the content of the nightmares.
1200:
Client attended the first session of cognitive-behavioral therapy.
1300:
Client was observed yelling at peers in the day room because someone changed the television channel. The client is irritable with poor impulse control.
1700: Client appears to be having a panic attack and was found shaking in the room in tears after waking up from a nightmare. The client reports heart palpitations and appears diaphoretic.
Vital signs: P 112/min, RR 20, BP 155/98.
Question 3 of 5
For each of the statements made by the client, click to specify whether the statement indicates that the client's status has improved or not improved.
| Client Statement | Improved | Not Improved |
|---|---|---|
| I woke up only once last night. | ||
| I want to talk about the nightmare I had. | ||
| I am thinking about selling my car and taking the bus instead. | ||
| I have been journaling my stressors and emotional reactions to them. | ||
| Sometimes I still get upset by small issues. but I control my feelings better now. |
Correct Answer: A,D,E
Rationale: Statements indicating improvement include waking up less frequently (
A), journaling stressors (
D), and better emotional control (E). Wanting to talk about nightmares (
B) and avoiding driving (
C) do not clearly indicate improvement.
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 4 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 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.
Nurses' Notes
Inpatient - Mental Health Unit
2100:
Client appears anxious and withdrawn, and states, "I am afraid to sleep at night because I get nightmares about my sibling." The client would not elaborate on the content of the nightmares.
1200:
Client attended the first session of cognitive-behavioral therapy.
1300:
Client was observed yelling at peers in the day room because someone changed the television channel. The client is irritable with poor impulse control.
1700: Client appears to be having a panic attack and was found shaking in the room in tears after waking up from a nightmare. The client reports heart palpitations and appears diaphoretic.
Vital signs: P 112/min, RR 20, BP 155/98.
Question 5 of 5
During the acute phase of a panic attack, the nurse should..... and........
Correct Answer: A,D
Rationale: During a panic attack, staying with the client (
A) provides safety and support, and reassuring them of their safety (
D) helps reduce anxiety. Privacy (
B), discussing triggers (
C), teaching (E), or offering a phone (F) are not appropriate during the acute phase.