NCLEX-PN
NCLEX Physiological Adaptation Questions
Extract:
Question 1 of 5
The anemias most often associated with pregnancy are:
Correct Answer: A
Rationale: Folic acid and iron deficiency anemia are the most common anemias, prevalent in women of childbearing age with 50% of pregnant women having this type of anemia. Iron deficiency anemia during pregnancy is a result (usually) of the increase in the plasma level during pregnancy but not in the constituent level. Also, if a woman has this type of anemia prepregnancy, it gets worse during pregnancy.
Question 2 of 5
The nurse suspects an elderly client has been the victim of abuse. The client denies abuse and declines assistance. The nurse's next action should be to:
Correct Answer: D
Rationale: Although clients do have the right to refuse treatment, the nurse should remain nonjudgmental and inform the client of available services. Frequently elders are not aware of existing programs.
Question 3 of 5
Which of the following blood pressure parameters indicates PIH? Elevation over a baseline of:
Correct Answer: A
Rationale: These are the accepted parameters for mild PIH. Mild preclampsia includes an increase in systolic blood pressure higher than 30 mmHg or an increase in diastolic blood pressure higher than 15 mmHg, noted on two readings taken 6 hours apart (or 140/90).
Question 4 of 5
A client admitted to the medical nursing unit has classic symptoms of tuberculosis (TB) and tests positive on the purified protein derivative (PPD) skin test. Several months later, the nurse who cared for the client also tests positive on an annual TB skin test for work. The most likely course of treatment if the chest X-ray (CXR) is negative is to:
Correct Answer: B
Rationale: Exposure with a positive TB skin test usually requires six months of prophylactic treatment unless contraindicated.
Question 5 of 5
During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:
Correct Answer: B
Rationale: Generally oral sex leaves little physical evidence. Injury to the soft palate (such as bruising, abrasions, and petechiae) and pharyngeal gonorrhea are the only signs. Infants are at risk for sexual abuse.