NCLEX PN Practice Test with NGN Related

The nurse is caring for a 52-year-old client on the orthopedic unit.
Nurses' Notes
Postoperative Day 1
0900:
The client's left leg was placed in balanced suspension skeletal traction for a fractured femur 12 hours ago. The client is positioned supine in the center of the bed with the foot of the bed elevated 15 degrees. Traction ropes are free of frays, centered in the pulleys, and moving freely with attached weights resting on the bed frame.
Serous drainage noted around the pin sites. Left foot slightly cool to the touch with posterior tibial and dorsalis pedis pulses palpable at 2+ and capillary refill <2 seconds in the toes. Client has normal sensation and movement of the left toes. Client rates left leg pain as 8 on a scale of 0-10.
Vital signs are T 100.4 F (38 C), P 110, RR 18, and BP 132/68. Weight is 173 lb (78.5 kg).

Which statement by the client is the most concerning?

• A. I feel pain and tightness in my right calf.
• B. I stay in the same position in bed until physical therapy when I do my exercises.
• C. Sitting in this bed all day makes me feel so depressed.
• D. The drainage from the surgical site is cloudy today.

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.

Which of the following topics should the nurse reinforce during the initial prenatal visit? Select all that apply.

• A. Commitment to pain management preferences during labor
• B. Expected discomforts of pregnancy
• C. Foods to avoid
• D. Herbal supplements and over-the-counter medications to avoid
• E. Method of delivery
• F. Symptoms of potential pregnancy complications

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

Progress Notes
0910:
Client's parents were spoken to over the phone. Last evening, the client spent the night at a friend's housewhere some family members smoke cigarettes and have a pet cat that lives in the home.

Medical history:
No accidents or injuries were reported, vaccinations are up to date, mild persistent asthma was diagnosed at age 7, and client has atopic dermatitis.

Allergies: No known allergies.

Family history:
Client is an only child. Parents report having no known medical conditions. Paternal grandfather died of chronic obstructive pulmonary disease, and maternal grandmother has heart disease.

Social history:
Client lives with parents; they do not smoke cigarettes. There are no pets in the client's home.

Current medications:
Beclomethasone inhaler 2 puffs twice a day, albuterol (salbutamol) inhaler 2 puffs
every 4 hours as needed for quick relief of symptoms.

The nurse receives the following prescriptions. Which 3 actions should the nurse prioritize?

• A. Administer albuterol (salbutamol) with ipratropium bromide via nebulizer
• B. Administer initial dose of PO prednisone once
• C. Initiate maintenance IV fluids
• D. Initiate NPO status except oral medication
• E. Titrate oxygen to achieve an oxygen saturation of >95%

The nurse is caring for a 52-year-old client on the orthopedic unit.
Nurses' Notes
Postoperative Day 1
0900:
The client's left leg was placed in balanced suspension skeletal traction for a fractured femur 12 hours ago. The client is positioned supine in the center of the bed with the foot of the bed elevated 15 degrees. Traction ropes are free of frays, centered in the pulleys, and moving freely with attached weights resting on the bed frame.
Serous drainage noted around the pin sites. Left foot slightly cool to the touch with posterior tibial and dorsalis pedis pulses palpable at 2+ and capillary refill <2 seconds in the toes. Client has normal sensationand movement of the left toes. Client rates left leg pain as 8 on a scale of 0-10.
Vital signs are T 100.4 F (38 C), P 110, RR 18, and BP 132/68. Weight is 173 lb (78.5 kg).
Postoperative Day 15
0800:
The client is increasingly tearful and states, "Life is going on without me while I am lying in this bed. I miss my friends." Left leg is in balanced suspension traction. Weights are hanging freely from the traction device. A 1-inch area of purple discoloration is noted on the right heel. Pin sites are free of erythema, swelling, and purulent drainage. Perineum is reddened with areas of excoriation and erythematous papules. External urinary catheter is in place. Scapula and sacrum are free of erythema.
Vital signs are T 98.8 F (37.1 C), P 100, RR 16, and BP 122/72. Weight is 164 lb (74. 4 kg).

The nurse has reviewed the information from the Nurses' Notes. The nurse reinforces client teaching. Which statement by the client indicates a need for further teaching?

• A. I should request a protein shake with my meals.
• B. I will contact the staff right away if my external catheter is leaking.
• C. Resting my heel on a rolled towel will reduce pressure on my wound.
• D. The trapeze can be used to help me shift my weight around in the bed.

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.

The nurse suspects that the client is experiencing posttraumatic stress disorder. Which of the following symptoms are consistent with this condition? Select all that apply.

• A. Euphoric mood
• B. Flashbacks
• C. Hypervigilance
• D. Irritability
• E. Nightmares
• F. Self-blame