NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
Nurses' Notes
Outpatient Clinic
Initial
visit
The child recently started attending a new preschool and hit a teacher during lunch. The parent says,
"My
child has never been aggressive before but has always been particular about food."
The client was born at full term without complications and has no significant medical history. The child
started babbling at age 6 months, and the parent reports that the first words were spoken around age 12
months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color.
The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are
normal, and the client is tracking adequately on growth curves.
During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow
the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back
and forth when the health care provider comes near.
Laboratory Results
Laboratory Test and
Reference Range
1030
Glucose (random)
71-200 mg/dL
(3.9-11.1 mmol/L)
110 mg/dL (6.1 mmol/L)
Sodium
136-145 mEq/L
(136-145 mmol/L)|
133 mEq/L (133 mmol/L)|
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L)
4.5 mEq/L (4.5 mmol/L)
B-type natriuretic peptide
<100 pg/mL
(<100 ng/L)
640 pg/mL (640 ng/L)
Diagnostic Results
Chest X-ray
1030:Mild cardiomegaly
Echocardiogram
1100:Mild left ventricular hypertrophy with left ventricular ejection fraction of 30%
Question 1 of 5
The nurse suspects the client is experiencing acute decompensated heart failure. Which of the following findings are consistent with this condition? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: The findings all support the diagnosis of acute decompensated heart failure (ADHF):
Crackles with auscultation: Indicative of pulmonary congestion due to fluid overload.
Decreased capillary oxygen saturation: Reflects impaired gas exchange from fluid in the lungs.
Elevated B-type natriuretic peptide (BNP): A level of 640 pg/mL is significantly elevated; BNP is released when the ventricles are stretched due to increased fluid volume.
Left ventricular ejection fraction of 30%: Normal is 55–70%. This reduced EF confirms systolic dysfunction, common in ADHF.
Lower extremity pitting edema: A classic sign of volume overload in right-sided or total heart failure.
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 2 of 5
The practical nurse is assisting the registered nurse with preparing the client's plan of care. Which of the following interventions are appropriate to include in the plan of care? Select all that apply.
Correct Answer: A,B,C,D
Rationale: In addition to ophthalmic medications (eg, beta blockers, cholinergic medications) and oral or IV carbonic anhydrase inhibitors, clients with
acute angle-closure glaucoma (ACG) require the following measures to prevent further vision loss and ensure safety:
• Administration of an osmotic diuretic (eg, mannitol) to reduce intraocular pressure (IOP). Mannitol increases plasma oncotic
pressure, pulling water from the extravascular space into the intravascular space. This fluid, along with the diuretic, is excreted through
the kidneys, thereby reducing IOP. This is similar to the management of cerebral (brain) edema (Option 1).
• Administration of an antiemetic medication (eg, ondansetron) to alleviate nausea because vomiting can cause a sharp increase in IOP,
further worsening acute ACG (Option 2)
• Implementation of fall precautions (eg, provide nonskid socks, turn on bed alarm, clear a pathway to the bathroom) to ensure client
safety. Many eye drops cause blurred vision for several minutes after administration, worsening the client's already impaired vision
(Option 3).
• Instruction to avoid activities that increase IOP (eg, bending/stooping, straining, coughing, blowing the nose, laughing) (Option 4)
(Option 5) Applying a pressure patch to the eye is typically done as a postoperative intervention for ocular surgeries (eg, corneal
transolantation) and is not necessary to include in the olan of care for this client.
Extract:
The nurse is performing a home health visit for an 84-year-old male.
History and Physical
Body System, Findings
General,
Client reports a 1-month-long history of fatigue and dyspnea that has worsened; he is unable to lie
flat and sleeps in a chair at night, medical history includes myocardial infarction, chronic heart
failure, chronic obstructive pulmonary disease, hypertension, and type 2 diabetes mellitus; client
was diagnosed with benign prostatic hyperplasia 8 months ago; client is adherent with prescribed
medications; client reports frequent consumption of donuts, hamburgers, steak, and fried chicken;
BMI is 34 kg/m?; client reports 6-Ib (2.7-kg) weight gain in 1 week
Neurological,
Alert and oriented to person, place, time, and situation
Pulmonary,
Vital signs: RR 24, SpOz 88% on room air; labored breathing, crackles in bilateral lung bases; client
expectorates frothy, pink-tinged sputum; client has a 40-year history of smoking 1 pack of cigarettes
per day
Cardiovascular,
Vital signs: T 98.8 F (37.1 C), P 98, BP 113/92; S1, S2, and S3 present; 3+ bilateral lower extremity
edema
Genitourinary, Concentrated yellow urine; client reports increased urinary hesitancy and urgency
Psychosocial,
Client reports being lonely and has depressed mental status
Prescriptions
Home Medication Record
Medication, Scheduled
Pravastatin 20 mg PO once daily, 2100
Furosemide 40 mg PO once daily, 0900
Tamsulosin 0.4 mg PO once daily, 0900
Potassium chloride 20 mg PO once daily, 0900
Metformin 1000 mg PO bid, 0900, 2100
Carvedilol 6.25 mg PO bid;hold for systolic blood pressure ≤100 mm Hg and/or HR <65/min, 0900, 2100
Sacubitril 97 mg/valsartan 103 mg PO bid, 0900, 2100
Question 3 of 5
Drag words from the choices below to fill in the blank/blanks.The nurse recognizes that furosemide was effective as evidenced by------------,-----------------, and ------------------
Correct Answer: A,B,E
Rationale: Loop diuretics (eg, furosemide) block renal reabsorption of sodium, chloride, and potassium, which increases fluid excretion
in the urine (ie, diuresis). Diuresis decreases intravascular volume, resulting in decreased peripheral edema (eg, from 3+ to
2+). In addition, as fluid volume decreases, pulmonary congestion improves, thereby resulting in improved oxygen exchange
and reduced work of breathing
Extract:
History and Physical
Body System
Findings
General
Client reports a 1-week history of general malaise, fever and chills, night sweats, fatigue, and
poor appetite. Client has poorly controlled hypertension, hypercholesterolemia, and mitral
valve prolapse and regurgitation.
Eye, Ear, Nose, and
Throat (EENT)
Poor dental hygiene. Client reports having 2 teeth extracted 3 weeks ago.
Pulmonary
Vital signs are RR 18 and SpO, 96% on room air. Lungs are clear to auscultation bilaterally.
Cardiovascular
Vital signs are T 100.4 F (38 C), P 105, and BP 140/82. Sinus tachycardia with occasional
premature ventricular contractions on cardiac monitor. S1 and S2 heard on auscultation with
loud systolic murmur at the apex. Peripheral pulses 2+; no edema noted.
Integumentary
Small, erythematous macular lesions on both palms. Thin, brown longitudinal lines on several
nail beds.
Question 4 of 5
Select below the 4 findings that are most concerning at this time.
Correct Answer: B,C,D,F
Rationale: This client has multiple findings concerning for infective endocarditis (IE), which occurs when an infectious organism enters the
innermost layer of the heart (ie, endocardium) and forms a vegetation on a heart valve. Findings concerning for IE include:
• Recent tooth extraction: Dental procedures (eg, tooth extraction) increase the risk for infectious organisms entering the
bloodstream, potentially leading to IE. Other risk factors include a history of IV drug use, presence of a distant infection
(eg, leg cellulitis), or presence of a prosthetic heart valve
• Fever: Elevated temperature is a sign of infection, which is a common finding in clients with IE.
• Nontender, erythematous, macular lesions on the palms or soles (Janeway lesions): Janeway lesions are
characteristic of IE. They occur when turbulent blood flow through the heart valves causes pieces of endocardial
vegetation to break off, forming microemboli that travel through the arteries to end-capillaries and block blood flow.
• Nonblanching, thin, red/dark longitudinal lines under the nail beds (splinter hemorrhages): Like Janeway lesions,
splinter hemorrhages are caused by microemboli that break off from vegetative lesions in the heart and travel through the
arteries to end-capillaries and block blood flow.
Extract:
History
Emergency Department
Admission: The client is brought to the emergency department for psychiatric evaluation after being found on the
roof of a seven-floor office tower screaming, "I am going to jump! Life is not worth living anymore!" The
client admits having attempted to jump off the building and wishes the police had not intervened. The
client reports that thoughts of self-harm have increased in intensity since a divorce 2 months ago. The
client's thoughts of self-harm are intermittent, with no reports of suicidal thoughts at the present time.
The client reports losing 10 pounds in the past month without trying, difficulty concentrating on tasks,
and feeling tired most of the day. No history of violence or trauma. The client reports recurring feelings
of worthlessness but no auditory/visual hallucinations or homicidal ideations.
Medical history includes seizures, but the client has not been taking prescribed levetiracetam. The client
reports smoking 1 pack of cigarettes per day for the past 3 years.
Vital signs: T 97.2 F (36.2 C), P 100, BP 153/70, RR 19
Question 5 of 5
Select below the 4 findings that indicate the client is at risk for suicidal ideation
Correct Answer: A,B,D,E
Rationale: When caring for a client in a state of crisis, the nurse should monitor for suicidal ideation. The nurse should consider the
client's demographics, mental and physical health history, family history of suicide, previous suicide attempts, and protective
factors (eg, support system, coping skills). Factors that increase the client's risk for suicide include:
• Previous attempted suicide (eg, jumping off a building)
• Thoughts, intent, or plan to self-harm
• History of substance use (eg, cocaine, marijuana)
• Significant or sudden life loss, change, or stressor (eg, divorce)
• Mental health disorder (eg, depression)
• Symptoms of severe depression (eg, weight loss, difficulty concentrating, fatigue, feelings of worthlessness)