NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
A client has been in labor 10 hours and is becoming very tired. She has dilated to 7 cm and is at 0 station with the fetus in a right occipitoposterior position. She is complaining of severe backache with each contraction. One comfort measure the nurse can employ is to:
Correct Answer: C
Rationale: This measure is inappropriate. The knee-chest position is employed to take pressure off the cord. Effleurage is a comfort measure but not the one that will contribute most to the relief of backache caused by a posterior position. Sacral pressure will counteract the pressure created by the position of the fetal head. The client is not completely dilated. Pushing is contraindicated until the second stage of labor.
Question 2 of 5
A client with HELLP syndrome is admitted to the labor and delivery unit for observation. The nurse knows that the client will have elevated:
Correct Answer: B
Rationale: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is characterized by elevated liver enzymes, reflecting liver dysfunction.
Question 3 of 5
Cheyne-Stokes respiratory pattern can be associated with which of the following conditions?
Correct Answer: C
Rationale: Cheyne-Stokes respiratory pattern is most often associated with increased intracranial pressure secondary to changes in pressure in the cerebral and cerebellar areas.
Question 4 of 5
A client with a history of a hiatal hernia is being taught about lifestyle modifications. The nurse should encourage the client to:
Correct Answer: A
Rationale: Maintaining a healthy weight reduces abdominal pressure, alleviating hiatal hernia symptoms. Large meals, flat sleeping, and caffeine worsen reflux.
Question 5 of 5
The nurse is teaching a client with type 1 diabetes about insulin administration. Which statement by the client indicates a need for further teaching?
Correct Answer: D
Rationale: In type 1 diabetes, insulin requirements may change during illness, and skipping doses without medical guidance can lead to ketoacidosis. The other statements are correct: rotating sites prevents lipodystrophy, checking blood sugar guides dosing, and mixing insulins is allowed.