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NCLEX Practice Test and Answers 2019 / 2020 93th Edition
1. A nurse is asked to check a unit of blood with another nurse before initiating a transfusion. The nurse notes that the blood type, Rh, expiration date, and unit number on the bag match the requisition. There is a discrepancy, however, in the client’s name. Which of the following actions would the nurse take?
A. Hang the unit of blood because the blood information matches
B. Cross out the incorrect name and write in the correct one
C. Notify the physician that the client will not receive any blood
D. Call the blood bank about the discrepancy
Answer: D. Call the blood bank about the discrepancy
Rationale: The nurse should call the blood bank to notify them of the discrepancy. The unit should not be hung, and information on the requisition or bag should not be altered in any way. The nurse assigned to the client may choose to call the physician, but the nature of that communication would be to report a delay in the transfusion due to the problem, not to report that there would be no transfusion.
Test-Taking Strategy: The key word in the question is discrepancy. This tells you that the question is seeking a response that indicates the behavior of the nurse after analyzing this clinical problem. Knowledge of basic transfusion-related procedures should help you to eliminate each of the incorrect options. Review these procedures if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Implementation
Content Area: Fundamental Skills
Reference: Christensen, B., & Kockrow, E. (2003). Foundations of nursing (4th ed.). St. Louis: Mosby, p. 449.
2. A pregnant client in the prenatal clinic states that her last menstrual period (LMP) began April 5 and ended April 1B. According to Nägele’s rule, what would be the estimated date of delivery (EDD)?
A. January 21
B. December 19
C. January 12
D. January 19
Answer: C. January 12
Rationale: Nägele’s rule is a noninvasive method of calculating the EDD as follows: add 7 days to the first day of the LMP, subtract 3 months, and add 1 year. This is based on the assumption that the menstrual cycle is 28 days. April 5 plus 7 days minus 3 months is January 12.
Test-Taking Strategy: Use the process of elimination. The issue relates to the application of Nägele’s rule. Remember to use the first day of the LMP to calculate the EDD. Options 1, 2, and 4 are miscalculations. Review Nägele’s rule if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 34.
3. A nurse in the prenatal clinic is collecting data on a client who is in the second trimester of pregnancy. The nurse notes that the pulse rate of the client has increased since the last visit. The nurse interprets this finding as most likely:
A. An indication of a cardiac problem
B. A sign of the client’s excitement about pregnancy
C. An abnormal finding
D. A normal finding
Answer: D. A normal finding
Rationale: Between 14 and 20 weeks, the pulse rate increases slowly, up 10 to 15 beats per minute, which lasts until term. Cardiac output and blood volume increase. Blood pressure decreases during the first half of pregnancy, returning to baseline in the second half of pregnancy. Options 1 and 3 are incorrect. Although excitement may cause an increase in pulse rate, the most likely cause is the combination of normal physiological changes that occur during pregnancy.
Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 3 first because they are similar. Noting the key words most likely will easily direct you to option 4 from the remaining options. Review the physiological changes that occur in pregnancy if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 39.
4. A nurse is reviewing the laboratory results of a pregnant client and notes that the hemoglobin level is decreased. Physiological anemia is documented in the client’s record by the physician. The nurse plans care knowing that this type of anemia is a result of:
A. Increased blood volume of the mother during pregnancy
B. Decreased metabolism of iron during pregnancy
C. Poor intake of iron-rich foods
D. Decreased maternal hemoglobin formation
Answer: A. Increased blood volume of the mother during pregnancy
Rationale: During the latter part of the first trimester, the blood volume of the mother increases more rapidly than blood cell production, leading to a decrease in the concentration of hemoglobin and erythrocytes. This is a normal process that causes a physiological anemia of pregnancy, or hemodilution. There is an increased metabolism of iron and maternal hemoglobin formation. The poor intake of iron-rich foods may cause an anemic condition, but physiological anemia of pregnancy occurs as a result of increased blood volume of the mother during pregnancy.
Test-Taking Strategy: Use the process of elimination. Recalling the physiological changes contributing to anemia in pregnancy will direct you to option A. Remember, during the latter part of the first trimester, the blood volume of the mother increases more rapidly than blood cell production, leading to a decrease in the concentration of hemoglobin and erythrocytes. Review these changes if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Planning
Content Area: Maternity/Antepartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 225.
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