NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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 sensation and 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).
Question 1 of 5
The nurse recognizes that improperly maintained skeletal traction may lead to........ and.....
Correct Answer: C,D
Rationale: Improperly maintained traction can cause increased pain (
C) and bone malunion (
D) due to misalignment or inadequate stabilization.
Extract:
The nurse is caring for a client at a women’s health clinic.
History & Physical
Labor and delivery unit
0800:
A 28-year-old nulliparous female comes to the clinic for confirmation of suspected pregnancy due to amenorrhea and a positive home pregnancy test. The client's current exercise regimen includes indoor cycling and outdoor running. The client reports nausea, vomiting, and breast tenderness. She has a 28-day menstrual cycle, and her last menstrual period was March 10- 17. The health care provider notes a bluish-purple vaginal mucosa and cervix during pelvic examination and confirms a 12-week intrauterine pregnancy by sonography. A fetal heart rate of 155/min is detected with handheld Doppler.
Question 2 of 5
Which of the following laboratory tests should the nurse anticipate during the first prenatal visit? Select all that apply.
Correct Answer: C,D,E
Rationale: First prenatal visit tests include maternal blood type and screen, STI screen, and urinalysis. Glucose tolerance and Group B Streptococcus tests are performed later in pregnancy.
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 3 of 5
Based on the client's clinical manifestations, which condition should the nurse suspect?
Correct Answer: A
Rationale: Trembling, diaphoresis, restlessness, hallucinations, and elevated vital signs (P 102, BP 170/96) are classic signs of alcohol withdrawal syndrome, especially given the absence of gastrointestinal bleeding symptoms and the presence of neurological symptoms.
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 4 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:
The nurse is caring for a 58-year-old client on a medical-surgical unit.
History and Physical
General
The client is vomiting bright red blood; medical history includes alcohol use disorder, liver cirrhosis, and hypertension; the client was admitted a year ago for alcohol-induced acute pancreatitis
Neurological
The client is oriented to person and place; the pupils are equal, round, and reactive to light and accommodation
Eye, Ear, Nose, and Throat (EENT)
Yellow scleras are noted
Pulmonary
Vital signs are RR 18, SpO 94% on room air
Cardiovascular
Vital signs are T 99 F (37.2 C), P 102, BP 90/40; S1 and S2 are heard on auscultation; peripheral pulses are 2+ in all extremities; 1+ edema is noted at the bilateral lower extremities
Gastrointestinal
The abdomen is distended and nontender to palpation; the flanks are dull to percussion; bowel sounds are hypoactive; distended veins are present around the umbilicus
Genitourinary
Client is voiding amber-colored urine
Question 5 of 5
Which of the following findings require immediate follow-up? Select all that apply.
Correct Answer: B,C,E
Rationale: B: Distended abdomen suggests ascites, common in cirrhosis, requiring urgent evaluation. C: Hypotension (90/40) indicates potential shock, especially with bleeding. E: Vomiting blood (hematemesis) is a medical emergency in cirrhosis, suggesting variceal bleeding. A is normal, D is less urgent, and F indicates jaundice but is not immediately life-threatening.