NCLEX PN Practice Test with NGN

NCLEX PN Practice Test with NGN Related

Review NCLEX PN Practice Test with NGN related questions and content

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

For each finding below, click to specify if the finding is consistent with the disease process of myocardial infarction, pneumonia, or pulmonary embolism.

  • A. Dyspnea
  • B. Chest pain
  • C. Hypoxemia
  • D. Sinus tachycardia
  • E. Right lower extremity redness and edema
Correct Answer: A: Myocardial infarction, Pneumonia, Pulmonary embolism; B: Myocardial infarction, Pneumonia, Pulmonary embolism; C: Pneumonia, Pulmonary embolism; D: Myocardial infarction, Pulmonary embolism; E: Pulmonary embolism

Rationale: A: Dyspnea is common in all three due to impaired oxygenation or cardiac output. B: Chest pain occurs in all three, though the nature varies (e.g., pleuritic in pneumonia/PE, crushing in MI). C: Hypoxemia is typical in pneumonia (due to alveolar impairment) and PE (due to ventilation-perfusion mismatch). D: Sinus tachycardia is seen in MI (due to cardiac stress) and PE (due to hypoxia and embolism). E: Right lower extremity redness and edema suggest DVT, which is strongly associated with PE.

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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.
Correct Answer: A,C,D,E

Rationale: A: Appropriate, as RAI can contaminate utensils, posing a radiation risk to others. B: Not appropriate, as close contact with children should be limited for several days post-RAI to minimize radiation exposure. C: Appropriate, as RAI can affect fertility and fetal health, requiring a delay in pregnancy. D: Appropriate, as washing clothes separately reduces the risk of radiation exposure to others. E: Appropriate, as sleeping separately minimizes radiation exposure to household members.

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.

  • A. Excessively wastes controlled substances
  • B. Friends with many other nurses on the unit
  • C. Causes inventory discrepancies in the medication-dispensing machine
  • D. Frequently volunteers to administer medications for other nurses' clients
  • E. 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.

The nurse in the emergency department is caring for a 62-year-old client.
History and Physical
Neurological
The client is alert and oriented to time, place, person, and situation; the client reports sudden-onset right-sided facial drooping, speech is slurred; positive right-sided arm drift is seen
Eye, Ear, Nose, and Throat (EENT)
Bilateral pupils are equal, round, and reactive to light and accommodation

Pulmonary
Vital signs: RR 16, SpO, 95% on room air, lung sounds are clear bilaterally

Cardiovascular
Vital signs: T 99 F (37.2 C), P 86, BP 166/90; S1 and S2 are heard on auscultation; no murmurs are noted; the client has a history of hypertension

Musculoskeletal
Right-sided lower extremity weakness is seen

Endocrine
The client has diabetes mellitus

Psychosocial
The client reports drinking one glass of wine each evening with dinner, no tobacco use, and a history of major depression; the client takes sertraline.

Laboratory Results
During Admission
Blood Chemistry.
Glucose: 72 mg/dL (4.0 mmol/L)
Sodium: 133 mEq/L (133 mEq/L)
Chloride: 101 mEq/L (101 mmol/L)
Potassium: 3.7 mEq/L (3.7 mmol/L)



Laboratory Test and Reference Range
Blood Chemistry.
Glucose 74-106 mg/dL (4.1-5.9 mmol/L)
Sodium 136-145 mEq/L (136-145 mmol/L)
Chloride 98-106 mEq/L(98-106 mmol/L)
Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L

Diagnostic Results
Admission
CT scan of the head without contrast
1830:
No areas of hemorrhage are noted

The nurse is assisting the registered nurse in planning care for a client prescribed tissue plasminogen activator (tPA) therapy. Which of the following actions are appropriate prior to administration? Select all that apply.

  • A. Ask the client's caretaker about a history of recent surgery or trauma
  • B. Maintain BP ≤ 185/110
  • C. Plan to initiate subcutaneous heparin immediately after tPA infusion is complete
  • D. Review the client's current home medication list
  • E. Verify the exact time the stroke symptoms started
Correct Answer: A, B, D, E

Rationale: Recent surgery/trauma (A) is a contraindication for tPA. BP ≤ 185/110 (B) is required to reduce bleeding risk. Reviewing medications (D) identifies anticoagulants that contraindicate tPA. Verifying symptom onset time (E) ensures tPA is within the therapeutic window. Heparin post-tPA (C) increases bleeding risk and is not immediate.

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.

For each client finding, click to specify if the finding is consistent with presumptive, probable, or positive signs of pregnancy. Note: Each row must have one response option selected

  • A. Amenorrhea
  • B. Chadwick sign
  • C. Fetal heart rate
  • D. Nausea/vomiting
  • E. Breast tenderness
  • F. Home pregnancy test
  • G. Fetus visible on ultrasound
Correct Answer: A: Presumptive, B: Probable, C: Positive, D: Presumptive, E: Presumptive, F: Probable, G: Positive

Rationale: Presumptive signs are subjective and may have other causes (e.g., amenorrhea, nausea/vomiting, breast tenderness). Probable signs are objective but not definitive (e.g., Chadwick sign, positive home pregnancy test). Positive signs confirm pregnancy (e.g., fetal heart rate, fetus visible on ultrasound).

The nurse in the emergency department is caring for a 62-year-old client.
History and Physical
Neurological
The client is alert and oriented to time, place, person, and situation; the client reports sudden-onset right-sided facial drooping, speech is slurred; positive right-sided arm drift is seen
Eye, Ear, Nose, and Throat (EENT)
Bilateral pupils are equal, round, and reactive to light and accommodation

Pulmonary
Vital signs: RR 16, SpO, 95% on room air, lung sounds are clear bilaterally

Cardiovascular
Vital signs: T 99 F (37.2 C), P 86, BP 166/90; S1 and S2 are heard on auscultation; no murmurs are noted; the client has a history of hypertension

Musculoskeletal
Right-sided lower extremity weakness is seen

Endocrine
The client has diabetes mellitus

Psychosocial
The client reports drinking one glass of wine each evening with dinner, no tobacco use, and a history of major depression; the client takes sertraline.

Laboratory Results
During Admission
Blood Chemistry.
Glucose: 72 mg/dL (4.0 mmol/L)
Sodium: 133 mEq/L (133 mEq/L)
Chloride: 101 mEq/L (101 mmol/L)
Potassium: 3.7 mEq/L (3.7 mmol/L)



Laboratory Test and Reference Range
Blood Chemistry.
Glucose 74-106 mg/dL (4.1-5.9 mmol/L)
Sodium 136-145 mEq/L (136-145 mmol/L)
Chloride 98-106 mEq/L(98-106 mmol/L)
Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L

Diagnostic Results
Admission
CT scan of the head without contrast
1830:
No areas of hemorrhage are noted

Based on the clinical data, which condition should the nurse suspect?

  • A. Bell palsy
  • B. Guillain-Barré syndrome
  • C. Ischemic stroke
  • D. Seizure disorder
Correct Answer: C

Rationale: Sudden-onset right-sided facial drooping, slurred speech, arm drift, and leg weakness, with a non-hemorrhagic CT scan, strongly suggest ischemic stroke (C). Bell palsy (A) typically involves only facial weakness. Guillain-Barré (B) presents with ascending paralysis. Seizure disorder (D) lacks seizure activity in the history.

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