NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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
Progress Notes
0910:
Client's parents were spoken to over the phone. Last evening, the client spent the night at a friend's housewhere some family members smoke cigarettes and have a pet cat that lives in the home.
Medical history:
No accidents or injuries were reported, vaccinations are up to date, mild persistent asthma was diagnosed at age 7, and client has atopic dermatitis.
Allergies: No known allergies.
Family history:
Client is an only child. Parents report having no known medical conditions. Paternal grandfather died of chronic obstructive pulmonary disease, and maternal grandmother has heart disease.
Social history:
Client lives with parents; they do not smoke cigarettes. There are no pets in the client's home.
Current medications:
Beclomethasone inhaler 2 puffs twice a day, albuterol (salbutamol) inhaler 2 puffs
every 4 hours as needed for quick relief of symptoms.
Question 1 of 5
The nurse receives the following prescriptions. Which 3 actions should the nurse prioritize?
Correct Answer: A,B,E
Rationale: A: Nebulized albuterol and ipratropium are first-line treatments for acute asthma exacerbation to relieve bronchospasm. B: Prednisone reduces inflammation and prevents worsening. E: Titrating oxygen to >95% corrects hypoxia, a critical concern with SpO2 at 92%.
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, SpO2 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 2 of 5
The nurse has reviewed the information from the Progress Notes and Laboratory Results. For each potential intervention, click to specify if the intervention is expected or unexpected for the care of the client.
| Potential Intervention | Expected | Unexpected |
|---|---|---|
| Initiate seizure precautions | ||
| Monitor the client for suicidal ideation | ||
| Administer antidiarrheal and antiemetic medications as needed | ||
| Use a standardized scoring scale to assess for withdrawal symptoms |
Correct Answer: B,C,D
Rationale: B: Expected - Depression history increases suicide risk during withdrawal. C: Expected - Antidiarrheals and antiemetics manage withdrawal symptoms like nausea. D: Expected - Standardized scales (e.g., COWS) assess opioid withdrawal severity. A: Unexpected - Seizures are more associated with alcohol or benzodiazepine withdrawal, not opioids.
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 3 of 5
For each finding below, click to specify if the finding is consistent with the disease process of anaphylaxis or asthma exacerbation.
| Finding | Anaphylaxis | Asthma Exacerbation |
|---|---|---|
| Stridor | ||
| Wheezing | ||
| Tachycardia | ||
| Hypotension | ||
| Generalized flushing and itching |
Correct Answer: B,C: Asthma; C,D,E: Anaphylaxis
Rationale: B: Wheezing is characteristic of asthma exacerbation due to bronchoconstriction. C: Tachycardia can occur in both asthma (from hypoxia or stress) and anaphylaxis (from systemic reaction). D: Hypotension is typical in anaphylaxis due to vasodilation and fluid shifts. E: Generalized flushing and itching are hallmarks of anaphylaxis due to histamine release.
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 4 of 5
Which of the following precautions should be included to encourage a safe environment for age-appropriate play? Select all that apply.
Correct Answer: A,B,C,E
Rationale: A: Included - Padding furniture corners reduces injury risk. B: Included - A medical alert bracelet ensures others are aware of the child's hemophilia. C: Included - Ice packs help manage joint bleeding. E: Included - Rugs and play pads cushion falls. D: Not included - Restricting play is not age-appropriate and may hinder development.
Extract:
The nurse is caring for a client on the medical-surgical unit.
History
Admission
0500: The client is admitted with an abscess and cellulitis of the right leg. The abscess is noted on the lateral aspect of the right calf, with redness, swelling, and warmth extending from the knee to the ankle. The abscess was incised in the emergency department, and a moderate amount of purulent, yellowish-green drainage was noted. The leg was wrapped with gauze, and the client received the first dose of IV antibiotics and opioids for pain control.
The client reports chronic lower back pain and gastrosophageal reflux disease, and he was admitted to the hospital once last year for gastrointestinal bleeding. He is currently prescribed daily pantoprazole but takes it only a few times a week.
Vital signs: T 100.9 F (38.3 C), P 82, RR 14, BP 130/80, SpO, 95% on room air
Progress Notes
Medical-Surgical Unit
2300:
The client reports nausea, headache, and insomnia. The client is trembling, diaphoretic, and restless.
The client states, "I would sleep better if those mice and cats would stop climbing up and down the walls."
The upper portion of the clients dressing is saturated with yellowish-green drainage. The peripheral V was removed by the client, and dried blood is noted at the IV site. The IV catheter is on the floor. The client yelled and pushed the nurse's hands away during inspection of the IV site.
Vital signs: T 99 F (37.2 C), P 102, RR 18, BP 170/96, SpO≥ 95% on room air
Question 5 of 5
The client is preparing for discharge after treatment for cellulitis and alcohol withdrawal syndrome. The client expresses motivation to stop using alcohol and is prescribed naltrexone. Which of the following client statements indicate progress toward the goal of abstinence and long-term recovery? Select all that apply.
Correct Answer: A,B,E
Rationale: A: Acknowledging alcohol's negative impact shows insight. B: Joining a recovery program supports sobriety. E: Having a plan to manage cravings (e.g., calling a sponsor) indicates commitment. C is incorrect as it suggests continued drinking, and D blames others without addressing personal responsibility.