NCLEX-RN
NCLEX-RN Exam Questions
Extract:
Question 1 of 5
The amniocentesis reveals that the patient has a high AFP level. The nurse is aware that a high level of AFP is associated with which of the following?
Correct Answer: A
Rationale: High alpha-fetoprotein (AFP) levels in amniotic fluid are associated with neural tube defects such as myelomeningocele (a type of spina bifida). Esophageal atresia omphalocele and Trisomy 21 (Down syndrome) are not typically associated with elevated AFP levels.
Question 2 of 5
Nursing care of the infant prior to surgical closure of a meningomyelocele would include:
Correct Answer: B
Rationale: A saline-soaked sterile dressing protects the sac from contamination by air and prevents drying.
Question 3 of 5
The physician recommends immediate hospital admission for a client with PIH. She says to the nurse, 'It's not so easy for me to just go right to the hospital like that.' After acknowledging her feelings, which of these approaches by the nurse would probably be best?
Correct Answer: B
Rationale: This answer does not hold the client accountable for her own health. The nurse should explore potential reasons for the client's anxiety: are there small children at home, is the husband out of town? The nurse should aid the client in seeking support or interventions to decrease the anxiety of hospitalization. Repeating the physician's reason for recommending hospitalization may not aid the client in dealing with her reasons for anxiety. The concern for self and welfare of baby may be secondary to a woman who is in a crisis situation. The nurse should explore the client's potential reasons for anxiety. For example, is there another child in the home who is ill, or is there a husband who is overseas and not able to return on short notice?
Question 4 of 5
The nurse would be concerned if a client exhibited which of the following symptoms during her postpartum stay?
Correct Answer: C
Rationale: Bradycardia is an expected assessment during the postpartum period. Diuresis can occur during labor and the postpartum period and is an expected physiological adaptation. A return of rubra after the serosa period may indicate a postpartal complication. Diaphoresis, especially at night, is an expected physiological change and does not indicate an infectious process. Bradycardia, diuresis, and diaphoresis are normal postpartum physiological responses to adjust the cardiac output and blood volume to the nonpregnant state.
Question 5 of 5
Which of the following interventions will be useful for the patient with Alzheimer's dementia who exhibits prosopagnosia?
Correct Answer: B
Rationale: Prosopagnosia is the inability to recognize faces. Labeled pictures of family and friends can help the patient identify familiar people improving social interaction and reducing confusion. The other options do not directly address face recognition.