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
Which of the following findings indicate that the client is improving as expected? Select all that apply.
Correct Answer: A,B,C,D
Rationale: Clinical improvement in a client with heart failure includes manifestations of reduced cardiac workload and improved fluid
volume status and gas exchange. A decrease in blood pressure from 170/100 mm Hg to 138/70 mm Hg and increased
urinary output indicate effectiveness of diuretics to reduce circulatory fluid volume and antihypertensive medications to
decrease cardiac workload . In addition, clear lung sounds and an increased capillary oxygen
saturation (SpO2) indicate a decrease in pulmonary congestion and an improvement in fluid volume status
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 2 of 5
For each finding below, click to specify if the finding is consistent with the disease process of infective endocarditis, pericarditis, or pneumonia. Each finding may support more than one disease process.
| Finding | Infective Endocarditis | Pericarditis | Pneumonia |
|---|---|---|---|
| New or worsening cardiac murmurs | |||
| Muffled heart sounds on auscultation | |||
| Splinter hemorrhages on the nail beds | |||
| Presence of flu-like symptoms and fever | |||
| Substernal pain that is aggravated by inspiration |
Correct Answer:
Rationale: Infective endocarditis occurs when an infectious organism forms a vegetation on a heart valve (interior of the heart). Clients
often have nonspecific symptoms of infection such as fever, flu-like symptoms (myalgia, arthralgia), and malaise.
Vegetation on a heart valve makes the valve dysfunctional, creating a new or worsening cardiac murmur. Pieces of
endocardial vegetation can break off, forming microemboli that travel through the arteries to end-capillaries and block blood
flow (eg, splinter hemorrhages on the nail beds), and cause erythematous macular lesions on the palms or soles (Janeway
lesions).
Acute pericarditis is inflammation of the membranous sac surrounding the exterior of the heart (pericardium), which often
causes an increased fluid in the pericardial cavity (ie, pericardial effusion). If pericardial effusions accumulate rapidly or are
very large, they may compress the heart, altering the mechanics of the cardiac cycle (ie, cardiac tamponade). Clinical
manifestations of pericarditis include muffled heart sounds on auscultation, presence of flu-like symptoms and fever, and
substernal pain that is aggravated by inspiration (ie, pleuritic chest pain). Pericardial friction rub, a superficial scratching or
squeaky sound, may be present, but cardiac murmurs are not present (no valve involvement) and embolic phenomena are
uncommon.
Pneumonia is an infection in the lungs that results in the production of cellular debris and purulent secretions that obstruct the
alveoli and prevent adequate oxygenation. Clinical manifestations include the presence of flu-like symptoms and fever,
pleuritic chest pain, tachycardia, low capillary oxygen saturation (SpO2), crackles, and productive cough with purulent
sputum.
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 3 of 5
Complete the following sentences by choosing from the lists of options. The client is diagnosed with acute primary angle-closure glaucoma. The nurse anticipates a prescription of ------------ ophthalmic drops to ------------------
Correct Answer: C,E
Rationale: Treatment of acute angle-closure glaucoma (ACG) primarily involves reducing intraocular pressure (IOP) by decreasing aqueous humor
production and increasing aqueous humor outflow. Beta-adrenergic antagonists ("beta blockers") (eg, timolol, betaxolol), alpha-adrenergic
agonists (eg, apracionidine, brimonidine), and carbonic anhydrase inhibitors (eg, acetazolamide) reduce aqueous humor production, while
cholinergic medications (eg, pilocarpine) cause pupillary constriction by acting on smooth muscle of the iris and increasing outflow of aqueous
humor. Prostaglandin agonists (eg, latanoprost, bimatoprost) also increase outflow of aqueous humor.
Ophthalmic beta-adrenergic antagonist medications typically cause minimal visual disturbances and are used as first-line treatment.
Nonselective beta-adrenergic antagonists (eg, timolol) exert their action on both beta-1 (eg, heart) and beta-2 (eg, lungs) adrenoreceptors. B
blocking the action of beta-2 adrenergic receptors, these medications can cause bronchospasms in those with lung disease (eg, chronic
obstructive pulmonary disease, asthma).
Extract:
The nurse is caring for a 68-year-old client in the emergency department.
Nurses' Notes,
Emergency Department
1020:
The client reports shortness of breath, a 2-lb weight gain over the past week, and lower extremity swelling. The client
reports slight chest discomfort during activity that is relieved with rest. Medical history is significant for hypertension.
myocardial infarction, heart failure, coronary artery disease, and chronic stable angina. Current medications include
metoprolol, furosemide, potassium chloride, lisinopril, and aspirin. The client takes all medications as prescribed except
one; he states, "I do not take that water pill because I got tired of having to go to the bathroom all the time."
S1 and S2 are present; a prominent S3 is heard. Respirations are labored with inspiratory crackles in the middle and at the
base of the lungs. The abdomen is soft and nontender with normoactive bowel sounds. There is 3+ pitting edema in the
bilateral lower extremities.
Vital Signs,
1020
T ,98.8 F (37.1 C)
P, 60
RR, 24
BP, 168/96
SpO2, 90% on room air
Question 4 of 5
Drag words from the choices below to fill in the blank/blanks. The nurse should immediately follow up on the client's-----------------------and-----------
Correct Answer: C,B
Rationale: Heart failure (HF) is a chronic, progressive condition characterized by impaired ventricular function that leads to decreased cardiac output and
causes blood to back up into the lungs and systemic circulation. This results in fluid volume overload that is commonly treated with diuretics,
such as furosemide (ie, "water pill"), that remove excess fluid through increased urination.
A client with HF who is experiencing dyspnea, inspiratory crackles, weight gain, and peripheral edema is demonstrating fluid volume overload
from a probable acute HF exacerbation. The nurse should immediately follow up on potentially life-threatening findings such as the client's:
• Blood pressure, which is moderately elevated and requires urgent intervention with medications (eg, diuretics). Fluid overload causes
increased pressure in the blood vessels, leading to hypertension that increases afterload. This is especially concerning for HF because
the heart muscle is already weak and cannot withstand additional afterload.
• Respiratory findings (ie, capillary oxygen saturation [SpOz) 90% on room air, inspiratory crackles, tachypnea, dyspnea, labored
respirations) because these likely indicate pulmonary edema. Crackles are a manifestation of pulmonary edema caused by fluid in the
alveoli that leads to impaired gas exchange and hypoxemia.
(Incorrect) Weiaht aain and lower extremity edema are also indicators of fluid volume overload however these findinas are not directly life
Question 5 of 5
Which of the following prescriptions are indicated for this client? Select all that apply.
Correct Answer: A,B,C,E
Rationale: This client's medical history includes hypertension, myocardial infarction, heart failure (HF), coronary artery disease, and chronic stable
angina, which place the client at high risk for several complications. When assisting in planning care for a client with a history of HF who is
experiencing dyspnea and chest discomfort, the nurse should anticipate the following prescriptions:
• A 12-lead ECG to assist in identifying acute dyshythmias and acute coronary syndromes (eg, myocardial infarction, unstable angina)
(Option 1)
• Chest x-ray to visualize pulmonary congestion, cardiomegaly, and the presence of other potential causes for the client's dyspnea (eg,
pneumonia, pleural effusion). Common causes of pleural effusions include HF (Option 2).
• The client's current weight to establish a baseline indicator of fluid volume status (Option 3)
• Serum electrolyte levels to identify fluid and electrolyte imbalances that may impair myocardial contractility (Option 5)