NCLEX-RN
NCLEX RN Free Practice Questions Questions
Extract:
Question 1 of 5
A client is admitted to the labor and delivery unit in active labor. The physician performs an amniotomy. Which observation would the nurse expect to make immediately after the amniotomy?
Correct Answer: C
Rationale: After an amniotomy the nurse expects to observe a large amount of clear or straw-colored amniotic fluid indicating normal amniotic fluid. Fetal heart tones of 160 bpm are normal but not specific to amniotomy contractions are unrelated and green fluid suggests meconium which is abnormal.
Question 2 of 5
On admission to the postpartal unit, the nurse's assessment identifies the client's fundus to be soft, 2 fingerbreadths above the umbilicus, and deviated to the right. This is most likely an indication of:
Correct Answer: B
Rationale: A boggy displaced uterus in the immediate postpartum period is a sign of urinary distention. Because uterine ligaments are stretched, a full bladder can displace the uterus.
Question 3 of 5
A client with AIDS has impaired nutrition due to diarrhea. The nurse teaches the client about the need to avoid certain foods.
Correct Answer: A
Rationale: Raw foods like tossed salad (
A) can harbor pathogens, risky for AIDS patients with diarrhea. Baked chicken (
B), broiled fish (
C), and steamed rice (
D) are cooked and safer, indicating further teaching is needed for A.
Question 4 of 5
A client has recently been diagnosed with primary open-angle glaucoma. The nurse should tell the client to avoid taking:
Correct Answer: B
Rationale: Benadryl, an antihistamine, can increase intraocular pressure, worsening primary open-angle glaucoma, so it should be avoided.
Question 5 of 5
The client is admitted with a diagnosis of molar pregnancy. Which nursing intervention is most appropriate?
Correct Answer: A
Rationale: Molar pregnancy involves abnormal trophoblastic tissue not a viable fetus and can cause significant vaginal bleeding. Monitoring for bleeding is the most appropriate intervention. Cesarean delivery tocolytics and fetal monitoring are not indicated.