NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
The nurse is caring for a 64-year-old client.
History and Physical
Body System, Findings
General ,
The client reports a 24-hour history of blurred vision and redness in the left eye with a left-sided headache.
This evening, the client developed acute, severe pain in the left eye accompanied by occasional nausea and
vomiting. The client reports no use of systemic or topical eye medications. Medical history includes
osteoarthritis and hypercholesterolemia.
Eye, Ear, Nose, and Throat (EENT),
The client wears eyeglasses to correct farsighted vision. Right eye: pupil 2 mm and reactive to light,
conjunctiva clear. Left eye: pupil 4 mm and nonreactive to light with red conjunctiva. Bilateral lens opacity is noted.
Pulmonary,
Vital signs are RR 20 and SpO, 96% on room air. The lungs are clear to auscultation bilaterally.
Cardiovascular,
Vital signs are T 99 F (37.2 C), P 88, and BP 140/82.
Psychosocial,
The client reports a great deal of emotional stress following the recent death of the client's spouse that is accompanied by lack of sleep, poor appetite, and a 7.9-lb (3.6-kg) weight loss within the past month. The client takes diphenhydramine for sleep.
Question 1 of 5
The nurse reinforces discharge teaching to the client after laser peripheral iridotomy. Which of the following client statements indicate an understanding of the teaching? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: Laser peripheral iridotomy is a surgical intervention for acute angle-closure glaucoma (ACG) that involves creating a small hole in the iris to
prevent the drainage pathway from closing and improve movement of aqueous humor into regular outflow channels. Ophthalmic alpha-
adrenergic agonists (eg, apraclonidine, brimonidine) are administered postoperatively to reduce aqueous humor production and prevent an
elevation in intraocular pressure.
Important considerations for the administration of ophthalmic drops include:
• Pulling the lower eyelid down by gently pressing on the lower orbital bone to expose the conjunctival sac (Option 1)
• Applying pressure over the inner corner of the eye (eg, lacrimal duct) after each medication to avoid systemic absorption (Option 2)
• Waiting at least 5 minutes before instilling a different medication into the same eye to allow absorption of the first medication and to
avoid overflow with multiple drops (Option 4)
• Holding the dropper ½*% in (1-2 cm) above the conjunctival sac to prevent contamination of the dropper and infection of the eye
(Option 5)
Clients should also be instructed to consult with their health care provider before taking over-the-counter medications (eg, decongestants,
anticholinergics, antihistamines) because a subsequent episode of acute ACG may be triggered by certain medications (Option 3).
Extract:
Nurses Notes
Emergency Department
0900:
The client has new-onset tremors, extreme restlessness, nausea, and anxiety. The client recently had a back
injury and was prescribed tramadol. The client also takes sertraline for major depression. On examination,
the client is flushed and diaphoretic. The client's voice is tremulous. Mild rigidity and tremors are noted in the
lower extremities. Deep tendon reflexes are 3+. Pupillary dilation and ocular clonus are present.
Vital Signs
0900
T
100.9 F (38.3 C)
P
125
RR
20
BP
160/100
Sp02
99% on room air
Laboratory Results
Laboratory Test and Reference Range
0900
TSH
0.3-5 uU/mL
(0.3-5 mU/L)
2 pU/mL
(2 mU/L)
WBC
5000-10,000/mm3
(5.0-10.0 × 10%/L)
7800/mm3
(7.8 × 10%L)
Question 2 of 5
The nurse is caring for a 42-year-old client in the emergency department. The nurse is reviewing the collected client data to assist with preparing the client's plan of care. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to measure the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer:
Rationale: Serotonin syndrome (ie, serotonin toxicity) is a life-threatening condition caused by excess serotonin in the central nervous
system. Tramadol is an analgesic medication with serotonergic activity that can lead to serotonin syndrome when taken with a
selective serotonin reuptake inhibitor (eg, sertraline).
Clinical manifestations include mental status changes (eg, anxiety, restlessness, agitation), autonomic dysregulation (eg,
diaphoresis, tachycardia, hypertension, hyperthermia), and neuromuscular hyperactivity. Treatment involves discontinuing all
serotonergic medications (eg, sertraline, tramadol) and administering a benzodiazepine to improve agitation and
decrease muscle contraction (eg, clonus), which reduces temperature.
Extract:
The nurse is caring for a 24-year-old client.
Nurses' Notes
Emergency Department
1300:
The client is brought to the emergency department after a motor vehicle collision in which the driver's side airbag deployed.
The client was driving the vehicle and was not restrained by a seat belt. The client reports shortness of breath and chest
pain on inspiration and expiration.
History and Physical
Body System ,Findings
Neurological,
Awake, alert, and oriented to person; pupils equal, round, and reactive to light and accommodation; client is
agitated and moves all extremities spontaneously but does not follow commands
Integumentary, Superficial lacerations to the face; diffuse bruising noted on upper extremities and chest wall
Pulmonary,
Vital signs: RR 30, SpOz 92% via nonrebreather mask; unilateral chest wall expansion observed on inspiration;
left-sided tracheal deviation noted; breath sounds diminished throughout the right lung field
Cardiovascular,
Vital signs: P 104, BP 90/58; S1 and S2 heard on auscultation; all pulses palpable; no extremity peripheral edema
noted
Psychosocial ,Alcohol odor noted on the client's breath
Question 3 of 5
Drag words from the choices below to fill in the blank/blanks.The nurse understands that the client is most at risk for------------and------------
Correct Answer: E,C
Rationale: The nurse understands that the client is most at risk for respiratory failure and decreased cardiac output.
Decreased cardiac output is the most concerning complication in a client with a tension pneumothorax. The trapped air in a tension
pneumothorax causes increased pressure, compressing the affected lung more until it is completely collapsed and then compressing the
heart and great vessels (vena cava, aorta), ultimately inhibiting venous return.
If the pleural pressure continues to increase, eventually the pleural cavity will crowd the trachea, forcing it to deviate (shift) to the unaffected
side where the unaffected lung can be compressed. Clients are at high risk for respiratory failure due to hypoxemia. Without treatment, the
lungs cannot meet the demands for oxygenation and the client will die.
Extract:
The nurse is caring for a 64-year-old client.
History and Physical
Body System, Findings
General ,
The client reports a 24-hour history of blurred vision and redness in the left eye with a left-sided headache.
This evening, the client developed acute, severe pain in the left eye accompanied by occasional nausea and
vomiting. The client reports no use of systemic or topical eye medications. Medical history includes
osteoarthritis and hypercholesterolemia.
Eye, Ear, Nose, and Throat (EENT),
The client wears eyeglasses to correct farsighted vision. Right eye: pupil 2 mm and reactive to light,
conjunctiva clear. Left eye: pupil 4 mm and nonreactive to light with red conjunctiva. Bilateral lens opacity is noted.
Pulmonary,
Vital signs are RR 20 and SpO, 96% on room air. The lungs are clear to auscultation bilaterally.
Cardiovascular,
Vital signs are T 99 F (37.2 C), P 88, and BP 140/82.
Psychosocial,
The client reports a great deal of emotional stress following the recent death of the client's spouse that is accompanied by lack of sleep, poor appetite, and a 7.9-lb (3.6-kg) weight loss within the past month. The client takes diphenhydramine for sleep.
Question 4 of 5
The nurse reinforces discharge teaching to the client after laser peripheral iridotomy. Which of the following client statements indicate an understanding of the teaching? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: Laser peripheral iridotomy is a surgical intervention for acute angle-closure glaucoma (ACG) that involves creating a small hole in the iris to
prevent the drainage pathway from closing and improve movement of aqueous humor into regular outflow channels. Ophthalmic alpha-
adrenergic agonists (eg, apraclonidine, brimonidine) are administered postoperatively to reduce aqueous humor production and prevent an
elevation in intraocular pressure.
Important considerations for the administration of ophthalmic drops include:
• Pulling the lower eyelid down by gently pressing on the lower orbital bone to expose the conjunctival sac (Option 1)
• Applying pressure over the inner corner of the eye (eg, lacrimal duct) after each medication to avoid systemic absorption (Option 2)
• Waiting at least 5 minutes before instilling a different medication into the same eye to allow absorption of the first medication and to
avoid overflow with multiple drops (Option 4)
• Holding the dropper ½*% in (1-2 cm) above the conjunctival sac to prevent contamination of the dropper and infection of the eye
(Option 5)
Clients should also be instructed to consult with their health care provider before taking over-the-counter medications (eg, decongestants,
anticholinergics, antihistamines) because a subsequent episode of acute ACG may be triggered by certain medications (Option 3).
Extract:
Nurses' Notes
Initial Clinic Visit
1100:
The client has experienced enuresis at night for the past 2 weeks and frequently requests to use the
bathroom while at school. The client was previously toilet trained with no nighttime bed wetting for 6 months;
the client recently relocated to a new home and school where the client lives with parents.
The parent reports that the client has recently demonstrated fatigue, irritability, and multiple behavioral
outbursts that resemble past temper tantrums. The client frequently reports feeling thirsty. No dysuria or
urinary hesitancy is reported.
Weight and height were in the 40th percentiles at the previous visit a year ago. Growth charts today show
the client's weight in the 20th percentile and height in the 40th percentile.
The client appears tired and irritable. Dry mucous membranes are noted with no increased work of
breathing. The lungs are clear to auscultation bilaterally. No cardiac murmur is heard.
Question 5 of 5
The nurse has reviewed the information from the Laboratory Results. Complete the following sentence/sentences by choosing from the list/lists of options. Complete the following sentence by choosing from the lists of options . The client is most likely experiencing---------- and requires ------------- to prevent-------------
Correct Answer: B,D,F
Rationale: The client is most likely experiencing diabetes mellitus (DM) and requires blood glucose management to prevent
hyperglycemia.
A urinalysis positive for glucose and ketones are manifestations that should raise suspicion of DM. Ketones are produced
when the body cannot use glucose for energy and breaks down fat stores instead. Ketonuria is a sign of diabetic ketoacidosis
(DK
A), a life-threatening complication of DM. Clients with new-onset type 1 DM often present with DKA. Blood glucose
management in those with type 1 DM will require insulin administration.