NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 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 2 of 5
The nurse is teaching a client with osteoporosis about dietary modifications. Which food should the client be encouraged to include?
Correct Answer: C
Rationale: Dairy products are rich in calcium, essential for bone health in osteoporosis. Citrus fruits provide vitamin C, red meat offers iron, and whole grains supply fiber, but they are less critical for bone density.
Question 3 of 5
When assessing fetal heart rate status during labor, the monitor displays late decelerations with tachycardia and decreasing variability. What action should the nurse take?
Correct Answer: D
Rationale: This is not a normal occurrence. Late decelerations need prompt intervention for immediate infant recovery.
To increase O2 perfusion to the unborn infant, the mother should be placed on her left side. IV fluids should be increased, not decreased. Immediate action is warranted, such as reporting findings, turning mother on left side, administering O2, discontinuing oxytocin (Pitocin), assessing maternal blood pressure and the labor process, preparing for immediate cesarean delivery, and explaining plan of action to client.
Question 4 of 5
A client with a history of heart failure is admitted with complaints of edema. The nurse should give priority to:
Correct Answer: A
Rationale: Diuretics reduce edema in heart failure, improving fluid balance and symptoms.
Question 5 of 5
The client's membranes rupture during labor. The fetal heart rate suddenly drops to 90 bpm. The nurse's first action should be to:
Correct Answer: B
Rationale: A sudden drop in fetal heart rate to 90 bpm after membrane rupture suggests possible umbilical cord prolapse or compression. Turning the client to her left side improves placental perfusion and may relieve cord compression. Oxygen and notifying the physician are secondary and increasing IV fluid is less urgent.