NCLEX PN Practice Test with NGN Related

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.

The nurse recognizes that the client is most likely experiencing a tracheoesophageal fistula with esophageal atresia and will require interventions to prevent ___ and ___

• A. Hernia
• B. Dehydration
• C. Aspiration pneumonia
• D. Necrotizing enterocolitis

The nurse is caring for a 12-month-old male client.
History and Physical
Body System
General
The client is brought to the emergency department by the parents due to increased leg bruising and left knee swelling for 1 day; the parents report that the client seems more tired and less playful; both parents and the sister are healthy, but a maternal uncle died at age 7 after mild head trauma.

Integumentary
Good hygiene; no abrasions; no burns; bilateral scattered lower extremity bruising

Eye, Ear, Nose, and Throat (EENT)
The parents report that the client's gums have been bleeding when chewing on crackers

Pulmonary
Vital signs: RR 38, SpO 100% on room air, upper respiratory infection 3 weeks ago that completely resolved after 4 days.

Cardiovascular
Vital signs: T 98.7 F (37.1 C), P 136

Musculoskeletal
Left knee redness and swelling with limited range of motion; the client can bear weight on both lower extremities; the parents state the child has recently started learning to walk by holding onto furniture and sometimes falls

Genitourinary
The parents state that urine output has been normal; urine is clear and pale yellow; the penis is uncircumcised

Psychosocial
The client is cooperative during examination; the client appears appropriately dressed for the season and weather; the mother says the child has no interest in toilet-training.

Laboratory Results.
Laboratory Test and Reference Range
Hematology.

Hematocrit
1-6 years: 39% (0.39)
30%-40%:
(0.30-0.40)

WBC
<_ 2 years: 8000/mm3 (8.0 × 10%/L)
6200-17,000/mm3
(6.2-17.0 × 10°/L)
Platelets
150,000-400,000/mm3: 163,000/mm3 (163 × 10°/L)
(150-400 × 10°/L)


aPTT (Activated partial thromboplastin time)
30-40 sec: 60 sec

PT
11-12.5 sec: 12 sec

Factor VIII
55%-145%: 6%

Factor IX
60%-140%: 100%

For each potential intervention, click to specify if the intervention anticipated or unanticipated for the care of the client.

• A. Monitoring a platelet transfusion
• B. Providing a soft-bristled toothbrush
• C. Ensuring fall precautions are in place
• D. Using a small-gauge needle for injections
• E. Encouraging rest, ice, compression, and elevation
• F. Reinforcing teaching about lifelong factor replacement

The nurse is caring for an 8-year-old client who was brought to the emergency department after
becoming short of breath at school.
Nurses' Notes
0920:
Nebulized administration of albuterol (salbutamol) and ipratropium bromide completed. Client continues to have a dry cough. Breath sounds are clear to auscultation; no intercostal retractions are visible.
Vital signs: RR 24, SpO2 96% on 6 L humidified oxygen via nasal cannula.

Select the findings that indicate the client is progressing as expected.

• A. Nebulized administration of albuterol (salbutamol) and ipratropium bromide completed
• B. Client continues to have a dry cough
• C. Breath sounds are clear to auscultation
• D. no intercostal retractions are visible
• E. Vital signs: RR 24, SpO2 96% on 6 L humidified oxygen via nasal cannula

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

For each finding below, click to specify if the finding is consistent with the disease process of anaphylaxis or asthma exacerbation.

• A. Stridor
• B. Wheezing
• C. Tachycardia
• D. Hypotension
• E. Generalized flushing and itching

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

Select the findings that require immediate follow-up.

• A. The client is awake, alert, and oriented to person, place, time, and situation; the client appears anxious
• B. Vital signs are RR 22, SpO2 89% on room air;
• C. Vital signs are T 99.8 F (37.7 C), P 110, BP 110/60;
• D. chest pain is reported as 7 on a scale of 0-10
• E. The client has osteoporosis, is wheelchair dependent, and is unable to bear weight on the right leg
• G.