NCLEX-RN
NCLEX-RN Exam Questions
Extract:
Question 1 of 5
A client has been in labor for 10 hours. Her contractions have become hypoactive and slowed in duration. The fetus is at 0 station, cervix is dilated 8 cm and effaced 90%. The physician orders an oxytocin (Pitocin) infusion to be started at once. The RN begins the oxytocin infusion. It is important that the RN discontinue the infusion if which one of the following occur?
Correct Answer: A
Rationale: Contractions less than 2 minutes apart indicate hyperstimulation, which can reduce uterine blood flow, leading to fetal hypoxia. The infusion should be discontinued to prevent complications.
Question 2 of 5
The client is admitted with a diagnosis of molar pregnancy. Which laboratory test is most likely to be ordered?
Correct Answer: A
Rationale: Serum hCG levels are markedly elevated in molar pregnancy and are the primary test for diagnosis and monitoring. CBC and urinalysis may be ordered for general assessment but are less specific.
Question 3 of 5
The nurse has just received the change of shift report. Which client should the nurse assess first?
Correct Answer: B
Rationale: A suspected subdural hematoma is a medical emergency due to potential brain compression, requiring immediate assessment.
Question 4 of 5
The client with a cervical dilation of 8cm suddenly becomes short of breath,cyanotic and hypotensive. The nurse should suspect which of the following complications?
Correct Answer: A
Rationale: Amniotic fluid embolus is a rare but life-threatening complication characterized by sudden dyspnea cyanosis and hypotension due to amniotic fluid entering the maternal circulation. These symptoms are not typical of transition phase abruption or cord prolapse.
Question 5 of 5
A client with a gastrointestinal bleed has an NG tube to low continuous wall suction. Which technique is the correct procedure for the nurse to utilize when assessing bowel sounds?
Correct Answer: B
Rationale: Clamping the NG tube prevents suction noise, allowing accurate auscultation of bowel sounds. pH testing (
A) assesses gastric contents, irrigation (
C) is for patency, and high suction (
D) interferes with auscultation.