NCLEX PN Practice Test with NGN Related

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 client is most likely experiencing.......... and requires intervention to prevent............

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Addison disease
• D. Addisonian crisis
• E. Myxedema
• F. Acute thyrotoxicosis

The nurse is caring for a 66-year-old client in the emergency department.
Nurses' Notes
Emergency Department
1930:
The client is admitted for cellulitis of the right arm due to V drug use. The client was diagnosed with HIV 25 years ago and is taking antiretroviral therapy but reports frequently skipping doses. This is the client's third admission to the hospital within the past 6 months for complications due to IV drug use.
2015:
While assisting with an IV catheter placement, the nurse accidentally sustains a needlestick injury.

For each potential intervention, click to specify if the intervention is indicated or not indicated for the care of the client.

• A. Wash the injury with soap and water
• B. Screen the client for hepatitis C virus
• C. Squeeze tissue to let the wound bleed
• D. Anticipate initiating antiretrovirals for the nurse
• E. Anticipate initiating oral antibiotics for the nurse
• F. Replace the cap on the needle prior to disposal

The nurse is caring for a 58-year-old client on a medical-surgical unit.
History and Physical
General
The client is vomiting bright red blood; medical history includes alcohol use disorder, liver cirrhosis, and hypertension; the client was admitted a year ago for alcohol-induced acute pancreatitis

Neurological
The client is oriented to person and place; the pupils are equal, round, and reactive to light and accommodation

Eye, Ear, Nose, and Throat (EENT)
Yellow scleras are noted

Pulmonary
Vital signs are RR 18, SpO 94% on room air

Cardiovascular
Vital signs are T 99 F (37.2 C), P 102, BP 90/40; S1 and S2 are heard on auscultation; peripheral pulses are 2+ in all extremities; 1+ edema is noted at the bilateral lower extremities

Gastrointestinal
The abdomen is distended and nontender to palpation; the flanks are dull to percussion; bowel sounds are hypoactive; distended veins are present around the umbilicus

Genitourinary
Client is voiding amber-colored urine

The nurse is monitoring the transfusion of prescribed packed RBCs (PRBCs) initiated by the registered nurse. Which of the following actions are appropriate? Select all that apply.

• A. The blood transfusion rate is set to infuse over 6 hours
• B. The blood transfusion tubing is primed with lactated Ringer solution
• C. The nurse stays with the client for the first 15 minutes of the transfusion
• D. The PRBCs are administered through Y-type tubing with an in-line filter
• E. The registered nurse verifies client and blood product identifiers with the licensed practical nurse

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

Select client findings that require immediate follow-up.

• A. The client reports nausea, headache, and insomnia.
• B. The client is trembling, diaphoretic, and restless.
• C. The client states, 'I would sleep better if those mice and cats would stop climbing up and down the walls.'
• D. The upper portion of the client's dressing is saturated with yellowish-green drainage.
• E. The peripheral IV was removed by the client, and dried blood is noted at the IV site.
• F. The IV catheter is on the floor. The client yelled and pushed the nurse's hands away during inspection of the IV site.
• G. Vital signs: T 99 F (37.2 C), P 102, RR 18, BP 170/96, SpO2 95% on room air

The nurse in the surgical unit is caring for a 57-year-old client who underwent an abdominal hysterectomy.
Progress Notes
1 Day Postoperative
0800:
The client underwent total abdominal hysterectomy with bilateral oophorectomy and tumor debulking 1 day ago for treatment of ovarian cancer. She has had four episodes of vomiting with bilious emesis over the past 12 hours, which have continued despite V antiemetic administration. The client has been receiving V broad-spectrum antibiotics since the procedure. The skin is warm. A low transverse abdominal incision is present; staples are clean and dry. Chest expansion is symmetric; respirations are unlabored: diminished breath sounds are auscultated in bilateral lower lobes. Radial pulses 2+ bilaterally, capillary refill <3 seconds in all four extremities; no peripheral edema is noted. The client reports frequent hot flashes occurring roughly every hour, starting last night. The abdomen is markedly distended and tender to palpation. Bowel sounds are absent in all four quadrants; the client reports no flatus. Urine is clear yellow with moderate output. The client reports incontinence with coughing or during episodes of vomiting.

Prescriptions
0820:
• 5% dextrose and 0.45% sodium chloride at 75 m/hr continuous
• 50% dextrose 25 mg IV push as needed for blood glucose <70 mg/dL (3.9 mmol/L)
• Ketorolac 15 mg IV push every 6 hours as needed for severe pain
• Ondansetron 8 mg PO every 8 hours as needed for nausea
• Pantoprazole 40 mg PO daily
• Potassium chloride 40 mEq/100 mL IVPB once
• Sips of clear liquids, advance diet as tolerated

Laboratory Results
Laboratory Test and Reference Range: 1 day postoperative

WBC count:
5000-10.000/mm3 (5-10 × 10%L): 12,000/mm3 (12 × 10°/L)

Urea nitrogen (BUN)
10-20 mg/dL (3.6-7.1 mmol/L): 24 mg/dL (8.6 mmol/L)

Creatinine
Male: 0.6-1.2 mg/dL(53-106 umol/L):
1.6 mg/dL (141.4 pmol/L)
Female: 0.5-1.1 mg/dL (44-97 umol/L):

Potassium
3.5-5.0 mEq/L (3.5--5.0 mmol/L): 3.3 mEq/L (3.3 mmol/L)

Sodium
135-145 mEq/L (135-145 mmol/L): 137 mEq/L (137 mmol/L)

Blood glucose level
74-106 mg/dL (4.1-5.9 mmol/L): 75 mg/dL (4.2 mmol/L)

The nurse has reviewed the information from the Prescriptions and Laboratory Results. The nurse is planning care with the registered nurse. Select 2 prescriptions the nurse should anticipate initiating first.

• A. 5% dextrose and 0.45% sodium chloride at 75 m/hr continuous
• B. 50% dextrose 25 mg IV push as needed for blood glucose <70 mg/dL (3.9 mmol/L)
• C. Ketorolac 15 mg IV push every 6 hours as needed for severe pain
• D. Ondansetron 8 mg PO every 8 hours as needed for nausea
• E. Pantoprazole 40 mg PO daily
• F. Potassium chloride 40 mEq/100 mL IVPB once
• G. Sips of clear liquids, advance diet as tolerated