NCLEX-RN
NCLEX-RN Exam Practice Questions
Extract:
Question 1 of 5
The nurse is caring for a client with a diagnosis of gestational trophoblastic disease. Which intervention is most appropriate?
Correct Answer: A
Rationale: Gestational trophoblastic disease requires monitoring hCG levels to assess for resolution or progression to malignancy (e.g. choriocarcinoma).
Tocolytics fetal monitoring and vaginal delivery are not indicated as there is no viable fetus.
Question 2 of 5
A 3-year-old female client is brought into the pediatric clinic because she limps. She has not been to the clinic since she was 9 months old. The nurse practitioner describes the limp as a 'Trendelenburg gait.' This gait is characteristic of:
Correct Answer: B
Rationale: (A, C,
D) A Trendelenburg gait is not characteristic of any of these disorders. The downward slant of one hip is a positive sign of dislocation in the weight-bearing hip. If one hip is dislocated, the child walks with a characteristic limp known as the Trendelenburg gait.
Question 3 of 5
A 24-hours' postpartum client complains of discomfort at the episiotomy site. On assessment, the nurse notes the episiotomy is without signs of infection. To relieve the discomfort, the nurse should first:
Correct Answer: A
Rationale: Warm, moist heat will promote circulation and provide comfort. A sitz bath should be tried before medication is given. Pain medication can be given when other comfort measures such as a sitz bath and topical applications are ineffective. Kegel exercises facilitate sitting by decreasing tension on the episiotomy. They will not be effective for pain control or sustained comfort level. Ice packs are appropriate to apply in the first 12 hours post-delivery to produce vasoconstriction and to reduce edema to the area.
Question 4 of 5
A client is admitted to the postpartal unit with a large amount of lochia rubra, uterine enlargement, and excessive clots. Which medication will likely be ordered for the client?
Correct Answer: D
Rationale: Hemabate, a prostaglandin, is used to treat postpartum hemorrhage by promoting uterine contractions to control bleeding. Fentanyl and Stadol are analgesics, and Prepidil is for labor induction, not hemorrhage.
Question 5 of 5
The client is admitted with a diagnosis of gestational trophoblastic disease. Which vital sign change is most likely to be observed?
Correct Answer: A
Rationale: Gestational trophoblastic disease can cause maternal tachycardia due to elevated hCG or bleeding. Fetal bradycardia is not relevant (no viable fetus) and hypotension is less common unless hemorrhage occurs.