NCLEX-PN
NCLEX PN Practice Test with NGN Questions
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 1 of 5
Which of the following topics should the nurse reinforce during the initial prenatal visit? Select all that apply.
Correct Answer: B,C,D,F
Rationale: The initial prenatal visit should focus on educating about expected discomforts (e.g., nausea), foods to avoid (e.g., raw fish), medications/supplements to avoid, and symptoms of complications. Pain management and delivery method are discussed later.
Extract:
The nurse is caring for an 8-year-old client who was brought to the emergency department after
becoming short of breath at school.
History and Physical
General
Well-nourished child; currently sitting in the tripod position; patches of dry, scaly, reddened skin are present in the creases of bilateral elbows and behind both knees; client reports that these areas itch
Neurological
Alert and oriented to person, place, and time
Eye, Ear, Nose, andThroat (EENT)
Pupils equal, round, and reactive to light and accommodation; client reports no nasal congestion
Pulmonary
Vital signs: RR 34, SpO 92% on room air, airway patent, intercostal retractions noted during inspiration; expiratory wheezes auscultated bilaterally; dry, spasmodic cough is noted; no stridor; difficulty speaking in complete sentences
Cardiovascular
Vital signs: T 98.8 F (37.1 C), P 110, BP 94/60; S1 and S2 heard on auscultation; nom murmurs noted; peripheral pulses 2+; capillary refill 3 seconds; no edema
Gastrointestinal
Abdomen soft; bowel sounds normal
Psychosocial
Client appears anxious and is crying, client speaks in short phrases, stating, "left my medicine at a friend's house" and "feels like I can't breathe"; client cannot remember the name of the prescribed home medication; client's parents were notified and are en route to hospital
Progress Notes
0910:
Client's parents were spoken to over the phone. Last evening, the client spent the night at a friend's housewhere some family members smoke cigarettes and have a pet cat that lives in the home.
Medical history:
No accidents or injuries were reported, vaccinations are up to date, mild persistent asthma was diagnosed at age 7, and client has atopic dermatitis.
Allergies: No known allergies.
Family history:
Client is an only child. Parents report having no known medical conditions. Paternal grandfather died of chronic obstructive pulmonary disease, and maternal grandmother has heart disease.
Social history:
Client lives with parents; they do not smoke cigarettes. There are no pets in the client's home.
Current medications:
Beclomethasone inhaler 2 puffs twice a day, albuterol (salbutamol) inhaler 2 puffs
every 4 hours as needed for quick relief of symptoms.
Question 2 of 5
Which of the following interventions should the nurse anticipate?
Correct Answer: A,B,C,E
Rationale: A: Oral prednisone reduces airway inflammation in asthma exacerbations. B: Nebulized albuterol and ipratropium relieve bronchospasm. C: Semi-Fowler position aids breathing by reducing diaphragm pressure. E: Continuous pulse oximetry monitors oxygenation status.
Extract:
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 3 of 5
During a diaper change, the client becomes cyanotic with frothy secretions from the mouth and nose. What action should nurse perform first?
Correct Answer: C
Rationale: Suctioning clears the airway of frothy secretions, addressing the immediate cause of cyanosis. This is the first priority before other interventions.
Extract:
The nurse in the emergency department is caring for a 62-year-old client.
Progress Notes
Emergency Department
0900: The client is brought to the emergency department by a family member after being found confused and lethargic. On arrival, the client is obtunded and does not respond to verbal stimuli.
Medical history includes major depressive disorder and chronic neck and back pain after a motor vehicle collision 2 years ago. The family member states that the client takes multiple medications but does not know which kind. The client was divorced a few months ago.
Physical examination shows 1-mm pupils, shallow breathing, and reduced bowel sounds. Fingerstick blood glucose is 78 mg/dL (4.3 mmol/L). ECG reveals normal sinus rhythm. Breath alcohol test is negative.
Vital signs: T 98.1 F (36.7 C), P 62, RR 8, BP 80/40, SpO, 94% on room air.
1800:
The client is awake, alert, and oriented to person, place, time, and situation. The client is experiencing severe withdrawal symptoms and is admitted for supervised detoxification.
Laboratory Results
Urine Drug Screen
On admission
Cocaine- Negative
Opioids- Positive
Amphetamines- Negative
Marijuana- Positive
Phencyclidine-Negative
Benzodiazepines- Negative
Barbiturates- Negative
Laboratory Test and Reference Range
Cocaine- Negative
Opioids- Negative
Amphetamines- Negative
Marijuana- Negative
Phencyclidine- Negative
Benzodiazepines- Negative
Barbiturates- Negative
Question 4 of 5
The nurse is helping the client prepare for discharge after 3 days of inpatient detoxification. Which of the following actions should the nurse take? Select all that apply.
Correct Answer: A,B,C,D,E
Rationale: All are appropriate: A: Identifying maladaptive behaviors supports recovery. B: Support groups aid long-term sobriety. C: Naloxone training prevents overdose deaths. D: Referrals ensure continued care. E: Education on medications (e.g., methadone) ensures adherence.
Extract:
Question 5 of 5
The nurse is assisting with a staff in-service regarding safe handling of controlled substances. For each behavior or finding, click to specify whether the behavior/finding is concerning or not concerning for possible drug diversion.
| Behavior/Finding | Concerning | Not Concerning |
|---|---|---|
| Excessively wastes controlled substances | ||
| Friends with many other nurses on the unit | ||
| Causes inventory discrepancies in the medication-dispensing machine | ||
| Frequently volunteers to administer medications for other nurses' clients | ||
| Asks for another nurse's password to the medication-dispensing system |
Correct Answer: A,C,D,E
Rationale: A: Excessive wasting of controlled substances is concerning as it may indicate diversion for personal use or distribution. C: Inventory discrepancies suggest possible theft or misuse. D: Frequently volunteering to administer medications may provide opportunities for diversion. E: Requesting another nurse's password is a security breach and highly concerning for diversion.