NCLEX PN ARCHER REVIEW |EXAM QUESTIONS & DETAILED SOLUTIONS (LATEST UPDATE 2025 |2026.

NCLEX PN ARCHER REVIEW |EXAM QUESTIONS & DETAILED SOLUTIONS (LATEST UPDATE 2025 |2026. Quiz_________________? *NGN The clinic nurse is caring for a 38-year-old male Item 5 of 6 Physician Orders 12-lead electrocardiogram (ECG) atenolol 25 mg by mouth daily pitavastatin 1 mg by mouth daily fenofibrate 45 mg by mouth daily with food The nurse receives, reviews, and implements the physician orders Complete the sentences below by choosing from the list of options The nurse needs to obtain baseline (electrocardiogram, cardiac enzymes, or liver function tests) prior to administering atenolol because atenolol would be contraindicated if the client (had low liver enzymes, atrioventricular block or had an elevated troponin.) The nurse understands that the prescribed fenofibrate is intended to (lower blood pressure, reduce triglycerides, or decrease high density lipoproteins.) Prior to administering the prescribed pitavastatin, the nurse needs to obtain baseline (urine analysis, liver function tests, or c-reactive protein.) - Answer electrocardiogram atrioventricular block reduce triglycerides liver function tests Rationale: Beta-blockers are contraindicated in atrioventricular blocks (AV blocks). An AV block is detected by obtaining a 12-lead electrocardiogram; thus, obtaining the ECG is essential before the client is discharged with the prescription. AV blocks occur when there is partial or complete interruption of impulse transmission from the atria to the ventricles. They are categorized in various degrees. If a client had an AV block and received a beta blocker, it could worsen the blockade. The client's triglycerides are dangerously elevated, and out of all the concerning findings, the high triglycerides put the client at serious risk for a vascular event (stroke or acute coronary syndrome). Fenofibrate is an adjunctive medication used to target high triglyceride levels with the intent to reduce them to a therapeutic level. Both fenofibrate and pitavastatin require the client to have a baseline liver function test. These medications may be hepatotoxic; thus, a baseline level and consistent monitoring are strongly recommended to prevent and promptly detect liver injury. Quiz_________________? *NGN* 72-year-old male presents to the emergency department Item 1 of 6 Nurses' Notes 1430 - A 72-year-old white male stated he hasn't felt good lately and feels sad much of the time. He becomes tearful when telling you about the loss of his wife eight months ago. He states he feels lonely and hopeless. The client also stated that the osteoarthritis he was diagnosed with five years ago has worsened. He stated that lately, he gets tired easily but has difficulty falling and staying asleep. He reported that the only activity he has maintained is attending church services. Which four (4) assessment findings require further investigation by the nurse? Feelings of hopelessness Worsening osteoarthritis Only attending church services Feelings of loneliness Loss of his wife eight months ago Sleep disturbances - Answer Feelings of hopelessness Feelings of loneliness Loss of his wife eight months ago Sleep disturbances Rationale: The client is exhibiting depressive symptoms that are a concern for suicidality. His hopelessness, loneliness, the recent loss of his wife, and sleep disturbances were all quite concerning. Hopelessness is a very significant risk factor for suicide because it inhibits forward-thinking by the client. Consequently, the client's loneliness from losing his wife is also a risk factor for suicide. This significant disruption in a support system likely stems from the client's dysphoria. Insomnia is a risk factor for suicide ideations and further characterizes the client's depression. Quiz_________________? *NGN* 72-year-old male presents to the emergency department Item 2 of 6 Based on these findings, it would be essential for the nurse to make which statement? "Would you tell me more about your bedtime routine?" "Could you describe the severity and quality of your pain?" "Are you having any thoughts of harming yourself?" "Have you ever received mental health services before?" - Answer "Are you having any thoughts of harming yourself?" Rationale: It is essential that the nurse recognize the client's cues as a concern for suicide. It is appropriate for the nurse to ask the client directly if he is having any thoughts of harming himself. The nurse should not ask leading questions such as "You are not thinking about harming yourself, are you?" This type of question discourages the client from being honest. Assessing the client's bedtime rituals, pain level, or history of obtaining mental health services does not address the core concern of the client's safety. Quiz_________________? *NGN* 72-year-old male presents to the emergency department Item 3 of 6 Complete the following sentence from the list of options The greatest concern for this client is (word choices: major depressive disorder, suicide, or insomnia) evidenced by the client's (word choices: feelings of hopelessness, increasing fatigue, or sleep disturbances) - Answer Suicide Feelings of hopelessness Rationale: Suicide is absolutely the primary concern for this client. Central to suicidality is a client feeling hopeless, and this was explicitly expressed by the client. The depressive disorder that the client is likely experiencing needs to be addressed but is not life-threatening as the thoughts of suicide. Quiz_________________? *NGN* 72-year-old male presents to the emergency department Item 4 of 6 Orders Admit to involuntary status Provide enhanced observation Regular diet Consult psychiatry Additional Nursing Note 1450 - Client endorsed suicidal ideations stating, "I am thinking about ending my life." The client verbalized no specific plan. Enhanced observation and suicide precautions were initiated based on the client's statements. Removed all sharps from the room. The client's belongings were inventoried and stored. The nurse updates the nursing note with an entry at 1450 and receives orders from the primary healthcare provider (PHCP) The nurse is developing the plan of care for this client. For each possible intervention, click to specify whether or not the intervention is appropriate - Answer Restrict the client's visitors: Not Appropriate Open letters and packages before giving them to the client: Not Appropriate Provide information on how to obtain their medical record: Appropriate Round at frequent and regular intervals: Not Appropriate Inform the client that they may not leave the facility: Appropriate Rationale: When a client is admitted involuntarily, they still retain the client bill of rights. It would be appropriate to provide information on how a client may obtain their medical record because this is a right afforded to the client. It would also be appropriate to inform the client that leaving the facility is prohibited while being admitted involuntarily. It is not appropriate to restrict visitors or open postal packages prior to giving them to the client. The client has the right to privacy, opening postal packages, and denying the client phone privileges would violate their bill of rights. Finally, rounding the client at regular intervals is discouraged. It would be appropriate to round on the client at irregular intervals to decrease predictability and enhance client surveillance. Quiz_________________? *NGN* 72-year-old male presents to the emergency department Item 5 of 6 Medications Bupropion 150 XL PO After receiving a consultation with psychiatry, the physician prescribed this client medications The nurse prepares to administer the prescribed bupropion. Which two (2) teaching points should the nurse reinforce? This medication may cause you to gain weight. You may notice a decreased libido while on this medicine. Have a diet that has a consistent intake of salt and water. You may have more energy with the medication. You will need ongoing laboratory work while on this medicine. Take this medication in the morning to prevent sleep problems. - Answer You may have more energy with the medication. Take this medication in the morning to prevent sleep problems. Rationale: Bupropion is an atypical antidepressant that modulates norepinephrine and dopamine. This medication is activating and does provide the client with increased energy, therefore, decreasing their weight. Bupropion does not cause sexual side effects like other antidepressants. Considering that this medication is activating, it would be appropriate for the nurse to advise the client to take it in the morning and not in the evening to avoid worsening the insomnia. Laboratory work is not necessary while a client is taking bupropion, nor is maintaining a diet consistent in fluid and salt. This dietary recommendation is for lithium. Quiz_________________? *NGN* 72-year-old male presents to the emergency department Item 6 of 6 Progress Note The client was alert and oriented. He described his mood as good and had a cheerful affect. He denied any suicidal ideations. The client stated he still isn't sleeping well and would like a prescription for a sleep aid. The client has not attended group therapy since admission. The client stated he would be staying with friends from church. He also stated that he found an outpatient therapist. Click to highlight the findings in the progress note that specify that the client is ready for discharge - Answer The client was alert and oriented. He described his mood as good and had a cheerful affect. He denied any suicidal ideations. The client stated he would be staying with friends from church. He also stated that he found an outpatient therapist. Rationale: Client statements and behavior indicating he is ready for discharge are alert and oriented. This is a positive cognitive finding. His mood and affect appear positive and harmonious and, thus, is also another indicator for discharge. The client stating that he will be staying with friends from church is reassuring as he will have a support system after discharge. Finally, working with an outpatient therapist is a reassuring finding. Findings that indicate that the client is not ready for discharge include his reluctance to attend inpatient group therapy and not being able to sleep. His report of insomnia will need to be mitigated to help decrease his further risk of suicide.