NCLEX Style Questions

A client is in active labor. Which of the following assessments would warrant immediate intervention? a. Alpha-fetoprotein (MSAFP) values of two times normal b. Two fetal heart rate accelerations during contractions lasting 15 seconds c. Fetal heart rate which slows at the peak of the contraction and lasts until after the contraction ends d. Fetal heart rate which slows at the beginning of the contraction and recovers as the contraction ends

c. Fetal heart rate which slows at the peak of the contraction and lasts until after the contraction ends

A gravid client, 25 years old, is diagnosed with gallstones. She asks her nurse, "aren't I too young to get gallstones?" the nurse bases her response on which of the following? a. Progesterone slows emptying of the gallbladder making pregnant women high risk for the disease. b. Gallbladder disease has a strong genetic component so the woman should be advised to seek a genetic counselor. c. Older women are no more prone to gallstones than are younger women d. Gallbladder disease is related to a high dietary intake of carbohydrates

a. Progesterone slows emptying of the gallbladder making pregnant women high risk for the disease.

The nurse explains to a patient who has missed a second menstrual cycle that a combination of presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs are expected by the nurse when making a practical diagnosis? Select all that apply A. Elevated hCG levels in blood and urine B. Abdominal enlargement C. Fetal movement detected by the examiner D. Bluish-purple coloration of vagina and cervix E. Occasional mild contractions

A. Elevated hCG levels in blood and urine B. Abdominal enlargement D. Bluish-purple coloration of vagina and cervix E. Occasional mild contractions

A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse tell the patient are normal changes of pregnancy? Select all that apply. A. Waddling gait B. Increased risk of falls C. Low back pain D. Increased fractures E. Severe muscle aches F. Right ligament pain

A. Waddling gait B. Increased risk of falls C. Low back pain F. Right ligament pain

A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit? A. Signs of infection B. Breast changes C. A change in EDD D. Support bras

B. Breast changes

A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and 32 weeks gestation, respectively, a singleton birth born at 39 weeks gestation, and two pregnancies lost in the first trimester. In which way will the nurse define the patient's obstetrical history? A. G5, T3, P2, A2, L3 B. G6, T1, P4, A2, L5 C. G6, T1, P2, A2, L5 D. G5, T4, P0, A4, L3

C. G6, T1, P2, A2, L5

A patient in the third trimester of pregnancy reports having heartburn nearly every day. Which recommendations does the nurse make to alleviate the problem? Select all that apply. A. Consume three moderate-sized meals daily. B. Sip clear, carbonated beverages when eating. C. Assume a low Fowler position after meals. D. Avoid eating 3 hours prior to bedtime. E. Avoid consuming spicy, fatty, or fried food.

D. Avoid eating 3 hours prior to bedtime. E. Avoid consuming spicy, fatty, or fried food.

A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her last menstrual period (LMP) date as April 14. Using Naegele's rule, the nurse will set the estimated date of delivery (EDD) as what date? A. July 21 B. January 7 C. July 14 D. January 21

D. January 21

The baby is entering the pelvis in the vertex position and in extended attitude. The nurse determines that which of the following positions is consistent with this situation? a. LMA ( left mentum anterior ) b. LSP ( left sacral posterior ) c. ROP ( right occiput posterior ) d. LOA ( left occiput anterior )

a. LMA ( left mentum anterior )

A client has just done a fetal kick count assessment. She noted six movements during the last hour. If taught correctly, what should her next action be? a. Nothing because further action is not warranted b. Call the provider to set up a NST c. Redo the test during the next 30 min. d. Drink a glass of orange juice and redo the test

a. Nothing because further action is not warranted

A 15-year-old client is being seen for her first prenatal visit. Because of this client's special nutritional needs, the nurse evaluates the client's intake of : a. Protein and magnesium b. Calcium and iron c. Carbohydrates and zinc d. Folic acid and thiamine

b. Calcium and iron

A pregnant woman mentions to the clinic nurse that she and her husband enjoyed working together on projects around the house. She states , "I always wear protective gloves when I work". The nurse should advise the woman that, even when wearing gloves, which of the following projects could be high risk to the baby's health a. Replacing a light fixture in the nursery b. Sanding the paint from an antique crib c. Planting tulip bulbs in the side garden d. Shoveling snow from the driveway

b. Sanding the paint from an antique crib

The nurse is monitoring a woman, G2P1001, 41 weeks gestation, in labor. At 12 PM assessment revealed: cervix 4cm; 80% effaced; -3 station; FHT moderate variability. A 5 PM assessment revealed cervix 6 cm; 90%, -3 station; FHT 124, moderate variability. At 10 PM assessment: cervix 8 cm, 100% effaced, -3 station, FHT 128 with moderate variability. Based on the assessments, which of the following should the nurse suspect a. Labor is progressing well b. The woman may be experiencing cephalopelvic disproportion (CPD) c. The baby is in fetal distress d. The woman will be in second stage of labor in three hours

b. The woman may be experiencing cephalopelvic disproportion (CPD)

A woman at 42 weeks gestation, is admitted to the labor and delivery suite for induction. A biophysical profile report on the client's chart states a score of 6/10. The nurse should monitor this client carefully for which of the following? a. Maternal hypertension b. Maternal hyperglycemia c. Moderate fetal heart rate variability d. Late fetal heart rate decelerations

d. Late fetal heart rate decelerations