NCLEX PN Practice Test with NGN Related

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

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

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.
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 an 82-year-old client in the emergency department.
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

Diagnostic Results
CT pulmonary angiography
1030: Pulmonary embolism is confirmed

Lower extremity doppler ultrasound
1100: Deep venous thrombosis is noted in the right lower extremity.

For each potential prescription, click to specify if the prescription is anticipated or contraindicated for the care of the client.

• A. Heparin infusion
• B. Acetaminophen PRN for pain
• C. Physical therapy for mobility exercises
• D. Supplemental oxygen to maintain SpO2 ≥ 90%
• E. Sequential compression devices to bilateral lower extremities