NCLEX PN Test Questions with NGN

Question 1 of 5.

Extract:The nurse is caring for a 16-year-old client. History and Physical Body System, Finding General, Client is brought to the emergency department due to nausea, vomiting, and abdominal pain that began 24 hr ago. Client has type 1 diabetes mellitus and usually takes insulin. Parents state that the client was at an overnight camp for the past 4 days and are unsure of how much insulin the client has been taking. Neurological, Client is lethargic but arousable to voice. The pupils are equal, round, and reactive to light and accommodation. Integumentary, Mucous membranes are dry, skin turgor is poor. Pulmonary, Vital signs are RR 36 and SpOz 95% on room air. Lung sounds are clear to auscultation. Deep respirations and a fruity odor on the breath are noted. Cardiovascular, Vital signs are T 98.4 F (36.9 C), P 110, and BP 98/58. Pulses are 3+ on all extremities, and capillary refill time is 4 sec. Gastrointestinal Normoactive bowel sounds are heard in all 4 quadrants; the abdomen is nontender. Genitourinary, Client voided dark yellow urine. Endocrine, Client is prescribed levothyroxine daily for hypothyroidism and has missed one dose of levothyroxine. Psychosocial, Parents state that the client has been sad and slightly withdrawn for the past 2 weeks after ending a romantic relationship. Laboratory Results Laboratory Test and Reference Range, 1000, 1600 Blood Chemistry. Glucose (random) ≤200 mg/dL (≤11.1 mmol/L), 504 mg/dL (28.0 mmol/L), 164 mg/dL (9.1 mmol/L) Sodium 136-145 mEq/L (136-145 mmol/L), 133 mEq/L (133 mmol/L), 135 mEq/L (135 mmol/L) Chloride 98-106 mEq/L (98-106 mmol/L), 101 mEq/L (101 mmol/L), 102 mEq/L (102 mmol/L) Potassium 3.5-5.0 mEq/L (3.5-5.0 mmol/L), 5.6 mEq/L (5.6 mmol/L), 3.2 mEq/L (3.2 mmol/L) Arterial Blood Gases Arterial pH 7.35-7.45 (7.35-7.45), 7.20 (7.20), 7.31 (7.31) HCOg 21-28 mEq/L (21-28 mmol/L), 13 mEq/L (13 mmol/L), 18 mEq/L (18 mmol/L) PaCO, 35-45 mm Hg (4.66-5.98 kPa), 30 mm Hg (3.99 KPa), 32 mm Hg (4.26 kPa) PaO, 80-100 mm Hg (10.64-13.33 KPa), 90 mm Hg (11.97 kPa), 90 mm Hg (11.97 kPa)

The nurse has reviewed the information from the Laboratory Results., For each client finding below, click to specify if the finding is consistent with the disease process of diabetic ketoacidosis or hyperosmolar hyperglycemic state. Each finding may support more than one disease process.

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.

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.

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 ------------------

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.