NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
The nurse is caring for a 6-hour-old newborn.
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 1 of 5
The nurse recognizes that the client is most likely experiencing a tracheoesophageal fistula with esophageal atresia and will require interventions to prevent ___ and ___
Correct Answer: B,C
Rationale: Tracheoesophageal fistula can lead to aspiration pneumonia due to food entering the lungs and dehydration from inability to feed properly. These are the most immediate risks requiring intervention.
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
For each client finding, click to specify if the finding is consistent with presumptive, probable, or positive signs of pregnancy. Note: Each row must have one response option selected
| Client Finding | Presumptive | Probable | Positive |
|---|---|---|---|
| Amenorrhea | |||
| Chadwick sign | |||
| Fetal heart rate | |||
| Nausea/vomiting | |||
| Breast tenderness | |||
| Home pregnancy test | |||
| Fetus visible on ultrasound |
Correct Answer: A: Presumptive, B: Probable, C: Positive, D: Presumptive, E: Presumptive, F: Probable, G: Positive
Rationale: Presumptive signs are subjective and may have other causes (e.g., amenorrhea, nausea/vomiting, breast tenderness). Probable signs are objective but not definitive (e.g., Chadwick sign, positive home pregnancy test). Positive signs confirm pregnancy (e.g., fetal heart rate, fetus visible on ultrasound).
Extract:
The nurse in the emergency department is caring for a 62-year-old client.
History and Physical
Neurological
The client is alert and oriented to time, place, person, and situation; the client reports sudden-onset right-sided facial drooping, speech is slurred; positive right-sided arm drift is seen
Eye, Ear, Nose, and Throat (EENT)
Bilateral pupils are equal, round, and reactive to light and accommodation
Pulmonary
Vital signs: RR 16, SpO, 95% on room air, lung sounds are clear bilaterally
Cardiovascular
Vital signs: T 99 F (37.2 C), P 86, BP 166/90; S1 and S2 are heard on auscultation; no murmurs are noted; the client has a history of hypertension
Musculoskeletal
Right-sided lower extremity weakness is seen
Endocrine
The client has diabetes mellitus
Psychosocial
The client reports drinking one glass of wine each evening with dinner, no tobacco use, and a history of major depression; the client takes sertraline.
Laboratory Results
During Admission
Blood Chemistry.
Glucose: 72 mg/dL (4.0 mmol/L)
Sodium: 133 mEq/L (133 mEq/L)
Chloride: 101 mEq/L (101 mmol/L)
Potassium: 3.7 mEq/L (3.7 mmol/L)
Laboratory Test and Reference Range
Blood Chemistry.
Glucose 74-106 mg/dL (4.1-5.9 mmol/L)
Sodium 136-145 mEq/L (136-145 mmol/L)
Chloride 98-106 mEq/L(98-106 mmol/L)
Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L
Diagnostic Results
Admission
CT scan of the head without contrast
1830:
No areas of hemorrhage are noted
Nurses’ notes
Intensive Care Unit
2100:
Tissue plasminogen activator infusion is complete.
2330:
The client suddenly has become combative and confused and is disoriented to person, place, and time. The client vomited once forcefully. Neurologic assessment shows confusion and right-sided weakness.
Vital signs: T 100 F (37.8 C), P 105, RR 18, BP 188/94, SpO2 96% on room air.
Question 3 of 5
The nurse has reviewed the information from the Nurses' Notes. Which of the following is the priority action?
Correct Answer: C
Rationale: The client's sudden change in mental status (combative, confused, disoriented) and vomiting after tissue plasminogen activator (tP
A) infusion suggest a possible intracranial hemorrhage, a known complication of tPA. A repeat CT scan is the priority to assess for this life-threatening condition.
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
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.
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 nurse recognizes that the client is most at risk for ___ related to ___
Correct Answer: A,E
Rationale: Seizures are a significant risk in alcohol withdrawal syndrome, which is suggested by the client's symptoms of trembling, diaphoresis, restlessness, and hallucinations.