NCLEX PN Practice Test with NGN Related

The nurse in an inpatient mental health unit is caring for a 43-year-old client.
History
Admission:
The client comes to the inpatient psychiatric facility for an evaluation. The client is having distressing nightmares, flashbacks, and feelings of being "on edge" since a severe motor vehicle collision 6 months ago that resulted in the death of the client's sibling. The client blames self for the sibling's death and verbalizes feelings of guilt. The client reports an inability to sleep well and being quick to anger, both of which led to job loss and the client seeking help. The client reports a loss of interest in previously enjoyed activities, such as working out and interacting with friends. The client has started smoking cigarettes daily since the collision and typically consumes ≥4 alcoholic beverages per day. Mental status examination reveals an irritable, guarded, and easily distracted mood. The client's appearance is well- kept, and grooming and hygiene are appropriate. The client’s speech is hyperverbal yet coherent, and thought process is organized. The client admits to feelings of hopelessness after the death of the sibling. The client reports occasionally seeing "shadows" but no visual hallucinations. The client has no homicidal ideations or history of violence toward others.
Vital signs: P 78, RR 17, BP 132/78.

Which client finding requires immediate follow-up by the nurse?

• A. Hopelessness
• B. Hyperverbal speech
• C. Insomnia
• D. Irritability

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.

During a diaper change, the client becomes cyanotic with frothy secretions from the mouth and nose. What action should nurse perform first?

• A. Activate the rapid response team
• B. Initiate rescue breathing with a bag valve mask
• C. Perform nasal and oropharyngeal suction
• D. Prepare the newborn for intubation

The nurse in the surgical unit is caring for a 57-year-old client who underwent an abdominal hysterectomy.
Progress Notes
1 Day Postoperative
0800:
The client underwent total abdominal hysterectomy with bilateral oophorectomy and tumor debulking 1 day ago for treatment of ovarian cancer. She has had four episodes of vomiting with bilious emesis over the past 12 hours, which have continued despite V antiemetic administration. The client has been receiving V broad-spectrum antibiotics since the procedure. The skin is warm. A low transverse abdominal incision is present; staples are clean and dry. Chest expansion is symmetric; respirations are unlabored: diminished breath sounds are auscultated in bilateral lower lobes. Radial pulses 2+ bilaterally, capillary refill <3 seconds in all four extremities; no peripheral edema is noted. The client reports frequent hot flashes occurring roughly every hour, starting last night. The abdomen is markedly distended and tender to palpation. Bowel sounds are absent in all four quadrants; the client reports no flatus. Urine is clear yellow with moderate output. The client reports incontinence with coughing or during episodes of vomiting.

Prescriptions
0820:
• 5% dextrose and 0.45% sodium chloride at 75 m/hr continuous
• 50% dextrose 25 mg IV push as needed for blood glucose <70 mg/dL (3.9 mmol/L)
• Ketorolac 15 mg IV push every 6 hours as needed for severe pain
• Ondansetron 8 mg PO every 8 hours as needed for nausea
• Pantoprazole 40 mg PO daily
• Potassium chloride 40 mEq/100 mL IVPB once
• Sips of clear liquids, advance diet as tolerated

Laboratory Results
Laboratory Test and Reference Range: 1 day postoperative

WBC count:
5000-10.000/mm3 (5-10 × 10%L): 12,000/mm3 (12 × 10°/L)

Urea nitrogen (BUN)
10-20 mg/dL (3.6-7.1 mmol/L): 24 mg/dL (8.6 mmol/L)

Creatinine
Male: 0.6-1.2 mg/dL(53-106 umol/L):
1.6 mg/dL (141.4 pmol/L)
Female: 0.5-1.1 mg/dL (44-97 umol/L):

Potassium
3.5-5.0 mEq/L (3.5--5.0 mmol/L): 3.3 mEq/L (3.3 mmol/L)

Sodium
135-145 mEq/L (135-145 mmol/L): 137 mEq/L (137 mmol/L)

Blood glucose level
74-106 mg/dL (4.1-5.9 mmol/L): 75 mg/dL (4.2 mmol/L)

The nurse has reviewed the information from the Prescriptions and Laboratory Results. The nurse is planning care with the registered nurse. Select 2 prescriptions the nurse should anticipate initiating first.

• A. 5% dextrose and 0.45% sodium chloride at 75 m/hr continuous
• B. 50% dextrose 25 mg IV push as needed for blood glucose <70 mg/dL (3.9 mmol/L)
• C. Ketorolac 15 mg IV push every 6 hours as needed for severe pain
• D. Ondansetron 8 mg PO every 8 hours as needed for nausea
• E. Pantoprazole 40 mg PO daily
• F. Potassium chloride 40 mEq/100 mL IVPB once
• G. Sips of clear liquids, advance diet as tolerated

The nurse is caring for a 25-year-old female client.
History and Physical
Body System
General
Client reports jitteriness, anxiety, and palpitations for the past 2 months. Fine hand tremor is noted. Client reports insomnia for approximately 1 week.
Integumentary
Client is diaphoretic.
Eye, Ear, Nose, andThroat (EENT)
Exophthalmos is noted. Goiter is present.
Gastrointestinal
Client reports 10 lb (4.5 kg) weight loss over the past month. Bowel sounds are normoactive. Client reports diarrhea for the past few days.
Reproductive
Last menstrual period was 3 months ago.
Vital Signs
T 99.2 F (37.3 C)
P 164
RR 22
BP 156/92

The nurse is reinforcing client teaching about home precautions following the first dose of RAI. For each nurse statement, click to specify whether the statement is appropriate or not appropriate to include in the teaching.

• A. Avoid sharing utensils with your spouse.
• B. It is safe to hold your child 2 hours after treatment.
• C. Delay pregnancy attempts for the next 4-6 months.
• D. Wash your clothes separately from those of others.
• E. You should sleep in a separate bedroom for 1-2 weeks.

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.

Select client findings that are most concerning to the nurse.

• A. The client is brought to the emergency department by a family member after being found confused and lethargic.
• B. The client is obtunded and does not respond to verbal stimuli.
• C. Medical history includes major depressive disorder and chronic neck and back pain after a motor vehicle collision 2 years ago.
• D. Physical examination shows 1-mm pupils, shallow breathing, and reduced bowel sounds.
• E. Fingerstick blood glucose is 78 mg/dL (4.3 mmol/L).
• F. Vital signs: T 98.1 F (36.7 C), P 62, RR 8, BP 80/40, SpO2 94% on room air.