NCLEX-PN Practice Test 7
10 free NCLEX-PN practice questions in the real exam format, covering the official content areas, with an explanation for every answer.
Question 1 of 10
Reduction of Risk PotentialMedical Record
Day 1 1000 — Skilled nursing visit. Client states his breathing has been "much worse" for 2 days and that he has used his albuterol inhaler about every 2 hours since yesterday. His sputum has changed from white to thick yellow-green, and he is coughing up more of it than usual. Sitting upright in his recliner, leaning forward with his arms on his knees, and speaking in 4- to 5-word phrases. Pursed-lip breathing. Using neck and shoulder muscles with each breath. Barrel-shaped chest. Expiratory wheezes in all lung fields; breath sounds diminished at both bases. SpO2 87% on oxygen 2 L/min by nasal cannula. Alert and oriented to person, place, time and situation. Ate his usual breakfast of oatmeal and coffee. Oxygen concentrator running and tubing intact. Wife reports that she had a cold last week.
72-year-old male receiving home health skilled nursing visits twice weekly after a hospital stay for a COPD exacerbation 3 weeks ago. The RN case manager completed the start-of-care assessment 10 days ago.
Medical history: chronic obstructive pulmonary disease (COPD) for 12 years; forced expiratory volume in 1 second (FEV1) 38% of predicted. Continuous home oxygen for 18 months. Hypertension. Former smoker (50 pack-years), quit 3 years ago. Completed pulmonary rehabilitation last year and uses pursed-lip breathing as taught.
Baseline at start of care: SpO2 89–91% on oxygen 2 L/min; respiratory rate 18–20/min; speaks in full sentences; small amount of white sputum each morning; breath sounds diminished at both bases, no wheezes; walks about 50 ft (15 m) before needing to rest. Weight 172 lb (78 kg).
Immunizations: influenza vaccine this season; pneumococcal conjugate vaccine received. No known drug allergies.
Social: lives with his wife in a single-story home. His wife smokes cigarettes. Oxygen is supplied by a home oxygen concentrator with 50 ft (15 m) of tubing and one backup cylinder.
| Time | Temp | HR (/min) | RR (/min) | BP (mm Hg) | SpO2 |
|---|---|---|---|---|---|
| Start of care (10 days ago) | 36.8 °C (98.2 °F) | 88 | 18 | 138/82 | 90% on 2 L/min |
| Day 1 1000 | 37.9 °C (100.2 °F) | 108 | 26 | 146/88 | 87% on 2 L/min |
| Test | Result | Reference range |
|---|---|---|
| White blood cells (WBC) | 8.2 × 10³/µL | 4.5–11.0 × 10³/µL |
| Hemoglobin (Hgb) | 16.1 g/dL | 13.5–17.5 g/dL |
| Hematocrit (HCT) | 49% | 41–53% |
| Sodium | 140 mEq/L | 135–145 mEq/L |
| Potassium | 4.2 mEq/L | 3.5–5.0 mEq/L |
| Bicarbonate (total CO2) | 31 mEq/L | 22–29 mEq/L |
| Blood urea nitrogen (BUN) | 16 mg/dL | 7–20 mg/dL |
| Creatinine | 0.9 mg/dL | 0.7–1.3 mg/dL |
| Glucose (fasting) | 98 mg/dL | 70–99 mg/dL |
| Arterial blood gas on 2 L/min: pH | 7.38 | 7.35–7.45 |
| Arterial blood gas: PaCO2 | 52 mm Hg | 35–45 mm Hg |
| Arterial blood gas: PaO2 | 60 mm Hg | 80–100 mm Hg |
| Date/Time | Order |
|---|---|
| Start of care | Oxygen 2 L/min by nasal cannula continuously. May titrate between 1 and 3 L/min to keep SpO2 88–92%. |
| Start of care | Notify the RN case manager and primary health care provider for SpO2 below 88% on prescribed oxygen, respiratory rate above 24/min, temperature above 37.8 °C (100.0 °F), change in sputum color or amount, or new confusion or drowsiness. |
| Start of care | tiotropium soft mist inhaler 2.5 mcg/actuation, 2 inhalations once daily |
| Start of care | fluticasone-salmeterol dry powder inhaler 250 mcg/50 mcg, 1 inhalation twice daily; rinse mouth after use |
| Start of care | albuterol HFA inhaler 90 mcg/actuation, 2 puffs every 4 hours as needed for shortness of breath |
| Start of care | lisinopril 10 mg orally once daily |
| Start of care | Skilled nursing (LPN) visits twice weekly under RN case manager; daily weight at home; reinforce COPD self-management and oxygen safety |
The nurse makes a home health visit to a 72-year-old client with chronic obstructive pulmonary disease (COPD) and documents the 1000 nurses' note. Highlight the findings that require follow-up.