NCLEX-PN
NCLEX PN Test Questions with NGN Questions
Extract:
The nurse is caring for a 16-year-old client.History and Physical
Body System, Finding
General,
Client is brought to the emergency department due to nausea, vomiting, and abdominal pain that began 24 hr
ago. Client has type 1 diabetes mellitus and usually takes insulin. Parents state that the client was at an
overnight camp for the past 4 days and are unsure of how much insulin the client has been taking.
Neurological,
Client is lethargic but arousable to voice. The pupils are equal, round, and reactive to light and accommodation.
Integumentary,
Mucous membranes are dry, skin turgor is poor.
Pulmonary,
Vital signs are RR 36 and SpOz 95% on room air. Lung sounds are clear to auscultation. Deep respirations and a
fruity odor on the breath are noted.
Cardiovascular,
Vital signs are T 98.4 F (36.9 C), P 110, and BP 98/58. Pulses are 3+ on all extremities, and capillary refill time is
4 sec.
Gastrointestinal Normoactive bowel sounds are heard in all 4 quadrants; the abdomen is nontender.
Genitourinary,
Client voided dark yellow urine.
Endocrine,
Client is prescribed levothyroxine daily for hypothyroidism and has missed one dose of levothyroxine.
Psychosocial,
Parents state that the client has been sad and slightly withdrawn for the past 2 weeks after ending a romantic relationship.
Laboratory Results
Laboratory Test and Reference Range, 1000, 1600
Blood Chemistry.
Glucose (random)
≤200 mg/dL
(≤11.1 mmol/L),
504 mg/dL
(28.0 mmol/L),
164 mg/dL
(9.1 mmol/L)
Sodium
136-145 mEq/L
(136-145 mmol/L),
133 mEq/L
(133 mmol/L),
135 mEq/L
(135 mmol/L)
Chloride
98-106 mEq/L
(98-106 mmol/L),
101 mEq/L
(101 mmol/L),
102 mEq/L
(102 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
5.6 mEq/L
(5.6 mmol/L),
3.2 mEq/L
(3.2 mmol/L)
Arterial Blood Gases
Arterial pH
7.35-7.45
(7.35-7.45),
7.20
(7.20),
7.31
(7.31)
HCOg
21-28 mEq/L
(21-28 mmol/L),
13 mEq/L
(13 mmol/L),
18 mEq/L
(18 mmol/L)
PaCO,
35-45 mm Hg
(4.66-5.98 kPa),
30 mm Hg
(3.99 KPa),
32 mm Hg
(4.26 kPa)
PaO,
80-100 mm Hg
(10.64-13.33 KPa),
90 mm Hg
(11.97 kPa),
90 mm Hg
(11.97 kPa)
Nurses' Notes
1600:
0.9% sodium chloride and regular insulin IV are continuously infusing. Lung sounds are clear to auscultation. Urine output
is 90 mL over the past 2 hr.
Vital signs are T 99 F (37.2 C), P 105, RR 28, BP 110/72, and SpO, 95% on room air.
Question 1 of 5
Drag words from the choices below to fill in the blank/blanks. The nurse understands that treatment for diabetic ketoacidosis is resolved when the-----------,--------, and ----------
Correct Answer: B,D,E
Rationale: Diabetic ketoacidosis (DK
A) causes anion gap metabolic acidosis generated by the ketoacid anions and beta-hydroxybutyrate. Anion gap is
calculated based on electrolyte levels to determine the balance of cations and anions (le, acids and bases).
IV insulin infusion may be discontinued on resolution of acidosis and ketosis, which generally occurs with a blood glucose level of <200
mg/dL (11.1 mmol/L). However, measurement of serum glucose alone is inappropriate for monitoring the response to treatment because
ketosis and acidemia may still be present. With fluid resuscitation and correction of hyperosmolality and hyperglycemia, ketoacids disappear
and the anion gap and arterial blood gas results normalize, pointing to resolution of metabolic acidosis and ketonuria ie, ketones in
urine.
Extract:
The nurse is caring for a 16-year-old client. History and Physical
Body System, Finding
General,
Client is brought to the emergency department due to nausea, vomiting, and abdominal pain that began 24 hr
ago. Client has type 1 diabetes mellitus and usually takes insulin. Parents state that the client was at an
overnight camp for the past 4 days and are unsure of how much insulin the client has been taking.
Neurological,
Client is lethargic but arousable to voice. The pupils are equal, round, and reactive to light and accommodation.
Integumentary,
Mucous membranes are dry, skin turgor is poor.
Pulmonary,
Vital signs are RR 36 and SpOz 95% on room air. Lung sounds are clear to auscultation. Deep respirations and a
fruity odor on the breath are noted.
Cardiovascular,
Vital signs are T 98.4 F (36.9 C), P 110, and BP 98/58. Pulses are 3+ on all extremities, and capillary refill time is
4 sec.
Gastrointestinal Normoactive bowel sounds are heard in all 4 quadrants; the abdomen is nontender.
Genitourinary,
Client voided dark yellow urine.
Endocrine,
Client is prescribed levothyroxine daily for hypothyroidism and has missed one dose of levothyroxine.
Psychosocial,
Parents state that the client has been sad and slightly withdrawn for the past 2 weeks after ending a romantic relationship.
Laboratory Results
Laboratory Test and Reference Range, 1000, 1600
Blood Chemistry.
Glucose (random)
≤200 mg/dL
(≤11.1 mmol/L),
504 mg/dL
(28.0 mmol/L),
164 mg/dL
(9.1 mmol/L)
Sodium
136-145 mEq/L
(136-145 mmol/L),
133 mEq/L
(133 mmol/L),
135 mEq/L
(135 mmol/L)
Chloride
98-106 mEq/L
(98-106 mmol/L),
101 mEq/L
(101 mmol/L),
102 mEq/L
(102 mmol/L)
Potassium
3.5-5.0 mEq/L
(3.5-5.0 mmol/L),
5.6 mEq/L
(5.6 mmol/L),
3.2 mEq/L
(3.2 mmol/L)
Arterial Blood Gases
Arterial pH
7.35-7.45
(7.35-7.45),
7.20
(7.20),
7.31
(7.31)
HCOg
21-28 mEq/L
(21-28 mmol/L),
13 mEq/L
(13 mmol/L),
18 mEq/L
(18 mmol/L)
PaCO,
35-45 mm Hg
(4.66-5.98 kPa),
30 mm Hg
(3.99 KPa),
32 mm Hg
(4.26 kPa)
PaO,
80-100 mm Hg
(10.64-13.33 KPa),
90 mm Hg
(11.97 kPa),
90 mm Hg
(11.97 kPa)
Question 2 of 5
Complete the following sentence by choosing from the lists of options. The nurse should first address the client's -------followed by the client's --------------
Correct Answer: A,D
Rationale: Hyperglycemia in diabetic ketoacidosis (DK
A) causes osmotic diuresis that leads to severe dehydration. When hyperglycemia exceeds the
renal threshold of glucose absorption, glucosuria (excretion of glucose in urine) occurs. Water loss is increased due to osmotic diuresis
induced by glucosuria, and extreme dehydration, hypotension, and decreased organ perfusion occur.
The priority intervention in DKA is to initiate an IV fluid bolus with 0.9% sodium chloride followed by insulin administration to lower serum
glucose levels. Rapid fluid resuscitation should occur before insulin infusion because insulin shifts water, potassium, and glucose into the
cells, worsening extracellular dehydration and electrolyte imbalances.
Therefore, for clients with DKA, the nurse should first address
hypovolemia followed by hyperglycemia.
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 3 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)
Extract:
The nurse is caring for a 34-year-old female client in the clinic.
Nurses' Notes
Initial Clinic Visit
The client is receiving a tuberculin skin test. The client works at a long-term care facility and has never been vaccinated for
tuberculosis. Medical history includes Crohn disease, major depression, and a blood transfusion following a motor vehicle collision 5
years ago. The client takes an immunosuppressant, oral contraceptive pills, and a selective serotonin reuptake inhibitor daily.
The client is currently providing housing for a family member who periodically experiences homelessness. The client has a pet dog.
Clinic Visit 2 Days Later
The client returns to the clinic for inspection of the tuberculin skin test injection site. There is a palpable, raised, hardened area around
the injection site that is 16 mm in diameter.
The client reports no cough, fever, fatigue, anorexia, weight loss, or nocturnal diaphoresis. Lung sounds are clear throughout all lobes
on auscultation.
Vital signs are T 98.5 F (36.9 C), P 72, RR 17, BP 118/72, and SpO 98% on room air.
Clinic Visit 6 Months Later
The client reports fatigue; intermittent fevers; decreased appetite; a 6-Ib (2.7-kg) weight loss; and a productive, chronic cough that
began 5 weeks ago. The client has not started the antibiotic regimen for latent tuberculosis.
Diagnostic Results
Chest x-ray
Lungs appear normal. There are no infiltrates, cavitation, or effusions.
Question 4 of 5
The nurse is reinforcing teaching on the plan of care for active tuberculosis. For each of the statements made by the nurse, click to specify if the statement is appropriate or not appropriate to include in the teaching.
| Nurse Statement | Appropriate | Not Appropriate |
|---|---|---|
| A nurse will need to watch you take your medications | ||
| You should notify anyone that has frequently been in close contact with you | ||
| Weekly complete blood counts will track whether your antibiotics are effective | ||
| Alcohol use while taking these medications can increase your risk for liver damage |
Correct Answer:
Rationale: The duration of standard treatment of active tuberculosis (T
B) is long, typically over the course of months, which makes it difficult for many
clients to adhere to the medication regimen. Proper client teaching increases medication adherence and helps minimize transmission of the
infection to others
The nurse should reinforce the following teaching:
• Direct observational therapy, which is the process of directly handing the medications to clients and watching them swallow the
medications. This has been shown to increase medication adherence in clients with active TB.
• Notifying close contacts of clients with recent active TB infection to reduce transmission to others. The nurse should teach the client
to reduce contact with family members and keep living spaces well ventilated.
• Alcohol use increases the risk for liver damage while taking antibiotics for active TB (rifampin, isoniazid, pyrazinamide, ethambutol).
Monitoring antibiotic effectiveness with weekly blood counts is not appropriate because antibiotic effectiveness is evaluated with month
sputum tests until there are two consecutive negative results.
Extract:
The nurse is caring for a 20-year-old female client.
Nurses' Notes
Urgent Care Clinic
0845: The parent brought the client to the clinic due to vomiting and weakness. The parent states that the client has experienced
sore throat and nasal congestion for the past week. The client has had 4 episodes of emesis during the past 24 hours and
diffuse, constant abdominal pain. The parent also reports that the client has had increased thirst and urine output over the
past 2 months.
The client's last menstrual period ended approximately 6 weeks ago with no abnormalities. Pregnancy status is unknown. The
client does not take any medications and does not use tobacco, alcohol, or recreational substances. Family history includes
hypertension and diabetes mellitus.
The client appears drowsy and is oriented to person and time only. The abdomen is soft without rigidity or rebound
tenderness, and bowel sounds are normal. No blood is present in emesis. Respirations are rapid and deep. Breath sounds
are clear.
Vital signs are T 98.8 F (37.1 C), P 128, RR 30, and BP 88/60 mm Hg.
Finger-stick blood glucose level is 600 mg/dL (33.3 mmol/L).
Question 5 of 5
For each potential finding below, click to specify if the finding is consistent with the disease process of diabetic ketoacidosis, ruptured appendix, or ruptured ectopic pregnancy. Each finding may support more than one disease process.
| Finding | Diabetic ketoacidosis | Ruptured appendix | Ruptured ectopic pregnancy |
|---|---|---|---|
| Polyuria | |||
| Vomiting | |||
| Tachypnea | |||
| Tachycardia | |||
| Hyperglycemia | |||
| Abdominal pain |
Correct Answer:
Rationale: Diabetic ketoacidosis (DK
A) is a complication of diabetes mellitus that results from lack of insulin. Insulin is required to transport glucose
into cells for energy, which means that lack of insulin leads to intracellular starvation despite the high level of glucose circulating in the blood
(hyperglycemia). Physiologic responses to hyperglycemia include osmotic diuresis (polyuria) for reduction of blood glucose levels and
breakdown of fat into acidic ketone bodies for energy. This leads to states of dehydration (as evidenced by tachycardia), electrolyte
imbalance, and metabolic acidosis. Ketoacidosis leads to tachypnea and deep respirations (Kussmaul respirations), as well as abdominal
pain and vomiting.
Appendicitis is an inflammation of the appendix often resulting from obstruction by fecal matter. Appendiceal obstruction traps colonic fluid
and mucus, causing increased intraluminal pressure and inflammation. This impairs perfusion of the appendix, resulting in swelling and
ischemia. Clinical manifestations include fever, abdominal pain, rebound abdominal tenderness, tachycardia, nausea, and vomiting.
Abdominal pain usually begins near the umbilicus and migrates to the right lower quadrant (eg, McBurney point). Tachypnea, as well as a
compensatory response, can be present, especially if there is a ruptured appendix or evidence of sepsis causing lactic acidosis (metabolic
acidosis).