NCLEX-PN
NCLEX PN Practice Test with NGN Questions
Extract:
The nurse is caring for an 82-year-old client in the emergency department.
Nurses' Notes
0930:
The client reports shortness of breath and left-sided chest pain for 2 days. The client fractured the right femoral neck a month ago after a fall and decided against operative management. Since then, the client has been wheelchair dependent and takes acetaminophen for fracture pain management. The client was placed on continuous cardiac monitoring.
History and physical
Body System
Neurological
The client is awake, alert, and oriented to person, place, time, and situation; the client appears anxious
Pulmonary
Vital signs are RR 22, SpOz 89% on room air; bilateral breath sounds are clear; pain increases with inhalation; the client reports shortness of breath for the past 2 days; the client smoked 1 pack of cigarettes per day for 10 years.
Cardiovascular
Vital signs are T 99.8 F (37.7 C), P 110, BP 110/60; S1 and S2 are present; there are no murmurs, redness and edema of the right lower extremity are noted; sinus tachycardia is seen on the monitor, chest pain is reported as 7 on a scale of 0-10
Musculoskeletal
The client has osteoporosis, is wheelchair dependent, and is unable to bear weight on the right leg
Diagnostic Results
CT pulmonary angiography
1030: Pulmonary embolism is confirmed
Lower extremity doppler ultrasound
1100: Deep venous thrombosis is noted in the right lower extremity.
Question 1 of 5
For each potential prescription, click to specify if the prescription is anticipated or contraindicated for the care of the client.
| Potential Prescription | Anticipated | Contraindicated |
|---|---|---|
| Heparin infusion | ||
| Acetaminophen PRN for pain | ||
| Physical therapy for mobility exercises | ||
| Supplemental oxygen to maintain SpO2 ≥ 90% | ||
| Sequential compression devices to bilateral lower extremities |
Correct Answer: A,B,D
Rationale: A: Heparin infusion is anticipated to treat pulmonary embolism and DVT by preventing further clot formation. B: Acetaminophen is anticipated for pain management, as it is safe for this client. C: Physical therapy is contraindicated due to the acute PE and DVT, as mobilization could dislodge clots. D: Supplemental oxygen is anticipated to correct hypoxemia (SpO2 89%). E: Sequential compression devices are contraindicated, as DVT is already present, and they could dislodge the clot.
Extract:
The nurse is caring for a 58-year-old client on a medical-surgical unit.
History and Physical
General
The client is vomiting bright red blood; medical history includes alcohol use disorder, liver cirrhosis, and hypertension; the client was admitted a year ago for alcohol-induced acute pancreatitis
Neurological
The client is oriented to person and place; the pupils are equal, round, and reactive to light and accommodation
Eye, Ear, Nose, and Throat (EENT)
Yellow scleras are noted
Pulmonary
Vital signs are RR 18, SpO 94% on room air
Cardiovascular
Vital signs are T 99 F (37.2 C), P 102, BP 90/40; S1 and S2 are heard on auscultation; peripheral pulses are 2+ in all extremities; 1+ edema is noted at the bilateral lower extremities
Gastrointestinal
The abdomen is distended and nontender to palpation; the flanks are dull to percussion; bowel sounds are hypoactive; distended veins are present around the umbilicus
Genitourinary
Client is voiding amber-colored urine
Question 2 of 5
Which of the following findings require immediate follow-up? Select all that apply.
Correct Answer: B,C,E
Rationale: B: Distended abdomen suggests ascites, common in cirrhosis, requiring urgent evaluation. C: Hypotension (90/40) indicates potential shock, especially with bleeding. E: Vomiting blood (hematemesis) is a medical emergency in cirrhosis, suggesting variceal bleeding. A is normal, D is less urgent, and F indicates jaundice but is not immediately life-threatening.
Extract:
The nurse is caring for a client in the clinic.
Nurses' Notes
Initial Clinic Visit
The client reports progressive fatigue and weakness over the past 2 months. Pallor and minor glossitis are noted. Laboratory results show a decreased hemoglobin. The client is instructed to take an iron supplement for treatment of iron-deficiency anemia.
Clinic Visit: 2 Weeks Later
The client reports discomfort and straining with bowel movements over the past week. Stool has become increasingly hard and pellet-like. The client reports feeling bloated with crampy abdominal pain that is relieved with defecation. The abdomen is nontender to palpation.
Question 3 of 5
The nurse is contributing to the client's plan of care. For each potential intervention, click to specify if the intervention is expected or not expected for the care of the client.
| Potential Intervention | Expected | Not Expected |
|---|---|---|
| Recommend a stool softener | ||
| Take the iron supplement with meals | ||
| Encourage warm fluids with breakfast | ||
| Increase consumption of dairy products | ||
| Increase intake of raw fruits and vegetables | ||
| Drink eight to ten 8-oz glasses of water per day |
Correct Answer: A,C,E,F
Rationale: A: Stool softeners are expected to manage constipation, a side effect of iron supplements. C: Warm fluids aid bowel motility. E: Raw fruits and vegetables increase fiber to relieve constipation. F: Adequate hydration softens stool and prevents constipation.
Extract:
The nurse is caring for an 84-year-old client with dementia.
Nurses' Notes
Medical-Surgical Unit
Day 1: The left antecubital peripheral IV insertion site has no erythema or edema, and the catheter flushes easily. The dressing is clean, dry, and intact. Potassium chloride infusion is initiated.
Day 3: Potassium chloride is infusing. The area surrounding the IV site is taut, edematous, blanched, and cool to the touch. Small, fluid-filled vesicles are noted around the IV site. Capillary refill distal to the IV site is >3 seconds. The client is grimacing and unable to verbally report pain.
Question 4 of 5
For each potential intervention, click to specify if the potential intervention is appropriate or not appropriate for the care of client.
| Potential Intervention | Appropriate | Not Appropriate |
|---|---|---|
| Elevate the affected extremity | ||
| Apply pressure to the affected area | ||
| Discontinue the potassium chloride infusion | ||
| Aspirate the potassium chloride from the IV catheter | ||
| Leave the IV catheter in place for potential antidote administration |
Correct Answer: A: Appropriate, B: Not Appropriate, C: Appropriate, D: Not Appropriate, E: Appropriate
Rationale: The symptoms suggest IV infiltration with potassium chloride, which is caustic. Elevating the extremity (
A) reduces swelling. Discontinuing the infusion (
C) prevents further damage. Leaving the catheter in place (E) allows for potential antidote administration. Applying pressure (
B) may worsen tissue damage, and aspirating (
D) is not standard for infiltration.
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 5 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.