NCLEX PN Test Questions with NGN
Question 1 of 5.
Extract:The nurse is performing a home health visit for an 84-year-old male. History and Physical Body System, Findings General, Client reports a 1-month-long history of fatigue and dyspnea that has worsened; he is unable to lie flat and sleeps in a chair at night, medical history includes myocardial infarction, chronic heart failure, chronic obstructive pulmonary disease, hypertension, and type 2 diabetes mellitus; client was diagnosed with benign prostatic hyperplasia 8 months ago; client is adherent with prescribed medications; client reports frequent consumption of donuts, hamburgers, steak, and fried chicken; BMI is 34 kg/m?; client reports 6-Ib (2.7-kg) weight gain in 1 week Neurological, Alert and oriented to person, place, time, and situation Pulmonary, Vital signs: RR 24, SpOz 88% on room air; labored breathing, crackles in bilateral lung bases; client expectorates frothy, pink-tinged sputum; client has a 40-year history of smoking 1 pack of cigarettes per day Cardiovascular, Vital signs: T 98.8 F (37.1 C), P 98, BP 113/92; S1, S2, and S3 present; 3+ bilateral lower extremity edema Genitourinary, Concentrated yellow urine; client reports increased urinary hesitancy and urgency Psychosocial, Client reports being lonely and has depressed mental status
Complete the following sentence/sentences by choosing from the list/lists of options. The nurse should recognize that the client is most likely experiencing--------------as evidenced by------------------
- A. High BMI
- B. Obstructive sleep apnea
- C. A heart failure exacerbation
- D. A chronic obstructive pulmonary disease exacerbation
- E. Orthopnea
- F. History of smoking
- C. A heart failure exacerbation
- E. Orthopnea
Correct arrangement
Explanation: The nurse should recognize that the client is most likely experiencing a heart failure (HF) exacerbation, as evidenced by orthopnea. Orthopnea (ie, labored breathing in the supine position), decreased capillary oxygen saturation, extra heart tones (eg, S3), bilateral lower extremity edema, >5 lb [2.3 kg] weight gain in 1 week, and adventitious lung sounds (eg, crackles) indicate fluid overload
Question 2 of 5.
Extract:History and Physical Body System Findings General The client comes to the emergency department with fatigue, shortness of breath, dry cough, and exertional dyspnea for 1 week; the client is homeless; medical history includes chronic heart failure, uncontrolled hypertension, coronary artery disease, and type 2 diabetes mellitus Pulmonary Vital signs: RR 22, SpO, 88% on room air, the client is dyspneic but can speak in full sentences; lung auscultation reveals decreased breath sounds at the lung bases and bilateral crackles; the client reports smoking 1 pack of cigarettes per day for 35 years; the client was hospitalized for pneumonia 6 months ago Cardiovascular Vital signs: T 99 F (37.2 C), P 90, BP 170/100; continuous cardiac monitor shows sinus rhythm with occasional premature ventricular contractions; S1, S2, and S3 are heard on auscultation; bilateral lower extremity pitting edema is noted
Select below the 5 findings that are most concerning.
A. The client comes to the emergency department with fatigue, shortness of breath, dry cough, and exertional dyspnea for 1 week;
B. the client is homeless;
C. Vital signs: RR 22, SpOz 88% on room air; the client is dyspneic but can speak in full sentences;
D. the client reports smoking 1 pack of cigarettes per day for 35 years;
E. S1, S2, and S3 are heard on auscultation;
F. continuous cardiac monitor shows sinus rhythm with occasional premature ventricular contractions;
Explanation: The client comes to the emergency department with fatigue, shortness of breath, dry cough, and exertional dyspnea for 1 week; the client is homeless; medical history includes chronic heart failure, uncontrolled hypertension, coronary artery disease, and type 2 diabetes mellitus Vital signs: RR 22, SpOz 88% on room air; the client is dyspneic but can speak in full sentences; lung auscultation reveals decreased breath sounds at the lung bases and bilateral crackles; the client reports smoking 1 pack of cigarettes per day for 35 years; the client was hospitalized for pneumonia 6 months ago Vital signs: T 99 F (37.2 C), P 90, BP 170/100; continuous cardiac monitor shows sinus rhythm with occasional premature ventricular contractions; S1, S2, and S3 are heard on auscultation; bilateral lower extremity pitting edema is noted
Question 3 of 5.
Extract:Nurses' Notes Outpatient Clinic Initial visit The child recently started attending a new preschool and hit a teacher during lunch. The parent says, "My child has never been aggressive before but has always been particular about food." The client was born at full term without complications and has no significant medical history. The child started babbling at age 6 months, and the parent reports that the first words were spoken around age 12 months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color. The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are normal, and the client is tracking adequately on growth curves. During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back and forth when the health care provider comes near. Laboratory Results Laboratory Test and Reference Range 1030 Glucose (random) 71-200 mg/dL (3.9-11.1 mmol/L) 110 mg/dL (6.1 mmol/L) Sodium 136-145 mEq/L (136-145 mmol/L)| 133 mEq/L (133 mmol/L)| Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L) 4.5 mEq/L (4.5 mmol/L) B-type natriuretic peptide <100 pg/mL (<100 ng/L) 640 pg/mL (640 ng/L) Diagnostic Results Chest X-ray 1030:Mild cardiomegaly Echocardiogram 1100:Mild left ventricular hypertrophy with left ventricular ejection fraction of 30%
The nurse suspects the client is experiencing acute decompensated heart failure. Which of the following findings are consistent with this condition? Select all that apply.
A. Crackles with auscultation
B. Decreased capillary oxygen saturation
C. Elevated b-type natriuretic peptide
D. Left ventricular ejection fraction 30%
E. Lower extremity pitting edema
Explanation: The findings all support the diagnosis of acute decompensated heart failure (ADHF): Crackles with auscultation: Indicative of pulmonary congestion due to fluid overload. Decreased capillary oxygen saturation: Reflects impaired gas exchange from fluid in the lungs. Elevated B-type natriuretic peptide (BNP): A level of 640 pg/mL is significantly elevated; BNP is released when the ventricles are stretched due to increased fluid volume. Left ventricular ejection fraction of 30%: Normal is 55 - 70%. This reduced EF confirms systolic dysfunction, common in ADHF. Lower extremity pitting edema: A classic sign of volume overload in right-sided or total heart failure.
Question 4 of 5.
Extract:Nurses' Notes Outpatient Clinic Initial visit The child recently started attending a new preschool and hit a teacher during lunch. The parent says, "My child has never been aggressive before but has always been particular about food." The client was born at full term without complications and has no significant medical history. The child started babbling at age 6 months, and the parent reports that the first words were spoken around age 12 months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color. The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are normal, and the client is tracking adequately on growth curves. During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back and forth when the health care provider comes near. Laboratory Results Laboratory Test and Reference Range 1030 Glucose (random) 71-200 mg/dL (3.9-11.1 mmol/L) 110 mg/dL (6.1 mmol/L) Sodium 136-145 mEq/L (136-145 mmol/L)| 133 mEq/L (133 mmol/L)| Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L) 4.5 mEq/L (4.5 mmol/L) B-type natriuretic peptide <100 pg/mL (<100 ng/L) 640 pg/mL (640 ng/L) Diagnostic Results Chest X-ray 1030:Mild cardiomegaly Echocardiogram 1100:Mild left ventricular hypertrophy with left ventricular ejection fraction of 30%
Drag words from the choices below to fill in the blanks. The nurse should prioritize interventions for acute decompensated heart failure to reduce the risk of the client developing-----------------------and ------------------
- A. Acute kidney injury
- B. Bacterial endocarditis
- C. Disseminated intravascular coagulation
- D. Acute Kidney Injury
- E. Dysrhythmias
- D. Acute Kidney Injury
- E. Dysrhythmias
Correct arrangement
Explanation: Dyshythmias due to structural changes (eg, cardiomegaly, ventricular hypertrophy) that alter electrical activity of the heart. Common dysrhythmias associated with HF include atrial fibrillation, life-threatening ventricular tachycardia, and ventricular fibrillation. • Acute kidney injury (AKI) due to hypoperfusion of vital organs (ie, decreased renal perfusion) secondary to decreased cardiac output. Decreased glomerular filtration can cause electrolyte imbalances (eg, hyperkalemia) related to AKI that can also be a precipitating factor for dyshythmias. • Pleural effusions can develop when fluid moves from capillaries to free spaces in the thoracic cavity as hydrostatic pressure in the pulmonary veins increases (back pressure).
Question 5 of 5.
Extract:Nurses' Notes Outpatient Clinic Initial visit The child recently started attending a new preschool and hit a teacher during lunch. The parent says, "My child has never been aggressive before but has always been particular about food." The client was born at full term without complications and has no significant medical history. The child started babbling at age 6 months, and the parent reports that the first words were spoken around age 12 months. The client then became quiet and "obsessed" with stacking blocks and organizing toys by color. The child can kick a ball, draw a circle, pedal a tricycle, and now says two-word phrases. Vitals signs are normal, and the client is tracking adequately on growth curves. During the evaluation, the child sits in the corner of the room playing with blocks. The client does not follow the parents gaze when the parent points to toys in the office. The child begins screaming and rocking back and forth when the health care provider comes near. Laboratory Results Laboratory Test and Reference Range 1030 Glucose (random) 71-200 mg/dL (3.9-11.1 mmol/L) 110 mg/dL (6.1 mmol/L) Sodium 136-145 mEq/L (136-145 mmol/L)| 133 mEq/L (133 mmol/L)| Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L) 4.5 mEq/L (4.5 mmol/L) B-type natriuretic peptide <100 pg/mL (<100 ng/L) 640 pg/mL (640 ng/L) Diagnostic Results Chest X-ray 1030:Mild cardiomegaly Echocardiogram 1100:Mild left ventricular hypertrophy with left ventricular ejection fraction of 30%
For each potential intervention, click to specify if the intervention is expected or not expected for the care of the client.
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Explanation: Expected interventions for acute decompensated heart failure (HF) focus on reducing cardiac workload and improving oxygenation. These include: • Daily weights should be performed to monitor fluid volume status and guide treatment. Ideally, daily weights should be performed at the same time of day, on the same scale, and with the client wearing the same amount of clothing. • Diuretics (eg, furosemide) prevent reabsorption of sodium and chloride in the kidneys, which increases fluid excretion in urine and decreases preload. Diuretics provide symptomatic relief by reducing pulmonary congestion and peripheral edema. These are the cornerstone of therapy and often a priority after oxygen therapy. • Fluid restriction is indicated to decrease circulating fluid volume and prevent excess strain on the heart. • Supplemental oxygen should be administered to improve oxygen delivery in clients with HF due to impaired gas exchange from pulmonary edema. • Antihypertensive medications reduce cardiac workload and improve contractility by lowering blood pressure (ie, afterload). Nebulized albuterol is a bronchodilator administered to improve oxygenation in clients with reactive airway disease (eg. asthma, chronic obstructive pulmonary disease). Bronchodilators will not improve oxygenation in clients with pulmonary edema and are not expected for treatment of HF.
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