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 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 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 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).

The nurse recognizes that improperly maintained skeletal traction may lead to........ and.....

• A. Rheumatoid arthritis
• B. Osteomalacia
• C. Increased pain
• D. Bone malunion
• E. Muscle spasms

The nurse is caring for a client on the medical-surgical unit.
History
Admission
0500: The client is admitted with an abscess and cellulitis of the right leg. The abscess is noted on the lateral aspect of the right calf, with redness, swelling, and warmth extending from the knee to the ankle. The abscess was incised in the emergency department, and a moderate amount of purulent, yellowish-green drainage was noted. The leg was wrapped with gauze, and the client received the first dose of IV antibiotics and opioids for pain control.
The client reports chronic lower back pain and gastrosophageal reflux disease, and he was admitted to the hospital once last year for gastrointestinal bleeding. He is currently prescribed daily pantoprazole but takes it only a few times a week.
Vital signs: T 100.9 F (38.3 C), P 82, RR 14, BP 130/80, SpO, 95% on room air

Progress Notes
Medical-Surgical Unit
2300:
The client reports nausea, headache, and insomnia. The client is trembling, diaphoretic, and restless.
The client states, "I would sleep better if those mice and cats would stop climbing up and down the walls."
The upper portion of the clients dressing is saturated with yellowish-green drainage. The peripheral V was removed by the client, and dried blood is noted at the IV site. The IV catheter is on the floor. The client yelled and pushed the nurse's hands away during inspection of the IV site.
Vital signs: T 99 F (37.2 C), P 102, RR 18, BP 170/96, SpO≥ 95% on room air

The nurse recognizes that the client is most at risk for ___ related to ___

• A. Seizures
• B. Septic shock
• C. Hypovolemic shock
• D. Cellulitis
• E. Substance withdrawal
• F. Gastrointestinal bleeding