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National Council Licensure Examination (NCLEX) Quiz with Best Answer 13th Edition
1. A clinic nurse is reviewing the records of the pregnant clients that will be seen in the clinic. Which client profile presents the greatest risk for human immunodeficiency virus (HIV) infection?
A. A 33-year-old gravida III client
B. An adolescent with multiple heterosexual contacts
C. A 25-year-old client with a history of spontaneous abortions
D. A multigravida client with a history of repeat cesarean deliveries
Answer: B. An adolescent with multiple heterosexual contacts
Rationale: Though all women are at risk for developing HIV during their reproductive years, it is believed that adolescents are particularly at risk because they engage in high-risk behaviors. The client profiles in options 1, 3, and 4 identify potential at-risk situations for a variety of obstetrical risk factors, but not necessarily HIV infection.
Test-Taking Strategy: Use the process of elimination and knowledge regarding the transmission of HIV to assist in answering the question. This focus will direct you to option B. Review the etiology related to HIV if you had difficulty with this question.
Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Maternity/Antepartum Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 110.
2. Methylergonovine maleate (Methergine) is prescribed for a client in the immediate postpartum period. The nurse tells the client that the medication has been prescribed to:
A. Relax the muscles of the uterus
B. Relieve nausea
C. Promote lactation
D. Stimulate contraction of the uterus
Answer: D. Stimulate contraction of the uterus
Rationale: Methylergonovine maleate (Methergine) is an ergot alkaloid that stimulates smooth muscles. Because the smooth muscle of the uterus is especially sensitive to the medication, it is used in the postpartum period to stimulate the uterus to contract and prevent or control postpartum hemorrhage. Options 1, 2, and 3 are incorrect actions of the medication.
Test-Taking Strategy: Use the process of elimination. Recalling that the medication is used to control hemorrhage will direct you to option D. Review the action and purpose of this medication if you had difficulty with this question.
Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Maternity/Postpartum Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, pp. 241, 247.
3. Oxytocin (Pitocin) is administered to a client following the delivery of the placenta. The nurse assisting in caring for the client observes for an effective response from the medication by monitoring for:
A. Urinary output
B. Milk production
C. Decreased afterbirth pains
D. Uterine contractions
Answer: D. Uterine contractions
Rationale: Oxytocin stimulates uterine contractions and may be administered to reduce the incidence of hemorrhage after expulsion of the placenta. It does not directly affect urinary output or milk production. The subsequent contraction of the uterus may cause an increase in the afterbirth pains.
Test-Taking Strategy: Use the process of elimination. Recalling that the medication causes uterine contractions and is used to control hemorrhage will direct you to option D. Review the action and purpose of this medication if you had difficulty with this question.
Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Maternity/Postpartum Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 206.
4. A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The client is positioned on the delivery room table, and the nurse places the client in the:
A. Trendelenburg’s position with the legs in stirrups
B. Semi-Fowler’s position with a pillow under the knees
C. Prone position with the legs separated and elevated
D. Supine position with a wedge under the right hip
Answer: D. Supine position with a wedge under the right hip
Rationale: Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This occurrence leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and subsequently the fetus. The best position to prevent this would be side-lying with the uterus displaced off the abdominal vessels. Positioning for abdominal surgery necessitates a supine position; however, a wedge placed under the right hip provides displacement of the uterus. Trendelenburg positioning places pressure from the pregnant uterus on the diaphragm and lungs, decreasing respiratory capacity and oxygenation. A semi-Fowler’s, prone, or Trendelenburg’s position with the legs in stirrups is not practical for this type of abdominal surgery.
Test-Taking Strategy: Use the process of elimination, noting that the client is having a cesarean delivery. Also, recall the appropriate position to prevent vena cava syndrome. Visualizing each of the positions identified in the options will direct you to option D. If you had difficulty with this question, review care to the client having a cesarean delivery.
Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Maternity/Intrapartum Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 456.
5. A nurse is providing emergency measures to a pregnant client with a prolapsed cord. The mother becomes anxious and frightened and says to the nurse, “Why are all of these people in here? Is my baby going to be alright?” Which problem is the client most likely experiencing at this time?
A. Fear
B. Powerlessness
C. Ineffective coping
D. Disturbed sensory perception
Answer: A. Fear
Rationale: The mother is anxious and frightened, and the appropriate nursing diagnosis for the client at this time is fear. There are no data in the question to support the nursing diagnoses of powerlessness, ineffective coping, or disturbed sensory perception, although these nursing diagnoses may be a consideration for this client at some point during the hospitalized experience.
Test-Taking Strategy: When answering questions related to nursing diagnosis, focus specifically on the data provided in the question. Note the relation between the words “frightened” in the question and “fear” in the correct option. Review the defining characteristics for fear if you had difficulty with this question.
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