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NCLEX Exam in Multiple Choice with Answer 127th Edition
1. A nurse collects data from a pregnant client with iron deficiency anemia for additional risk factors associated with the anemia. Which finding would support potential further maternal compromise?
A. Appropriate intake of chicken and green leafy vegetables
B. Vaginal spotting times two since the last prenatal visit
C. Daily intake of elemental iron
D. Daily intake of six to eight glasses of water
Answer: B. Vaginal spotting times two since the last prenatal visit
Rationale: A variety of factors can further complicate the potential maternal and fetal effects of iron deficiency anemia during pregnancy. Such factors would include geographic location, socioeconomic status, daily nutrition and fluid intake, compliance to supplemental medication regimes, and blood loss during pregnancy. Options 1 and 4 represent appropriate client behaviors during pregnancy to ensure adequate nutrition and fluid balance. Option 3 represents daily supplementation during pregnancy. A history of vaginal spotting may compromise maternal hemoglobin levels even further during the antenatal period.
Test-Taking Strategy: Focus on the issues of the question, iron deficiency anemia and potential further maternal compromise. Use the process of elimination noting that options 1, 3, and 4 represent appropriate client behaviors during pregnancy. Review the causes of iron deficiency anemia during pregnancy if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Data Collection
Content Area: Maternity/Antepartum
Reference: Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 717.
2. A pregnant anemic client is concerned about her baby’s condition following delivery. Which nursing response would best support the client?
A. “You will not have any problems if you follow all the advice the physician has given you.”
B. “Your baby will need to spend a few days in the neonatal intensive care unit following delivery.”
C. “Don’t worry about your baby; complications are rare.”
D. “The effects of anemia on your baby are difficult to predict, but let’s review your plan of care to ensure you are providing the best nutrition and growth potential.”
Answer: D. “The effects of anemia on your baby are difficult to predict, but let’s review your plan of care to ensure you are providing the best nutrition and growth potential.”
Rationale: The effects of maternal iron deficiency anemia on the developing fetus and neonate are unclear. In general it is believed that the fetus will receive adequate maternal stores of iron, even if a deficiency is present. Neonates of severely anemic mothers have been reported to experience reduced red cell volume, hemoglobin, and iron stores. Option 4 provides the most realistic support for the client and allows the nurse an opportunity to review the client’s plan of care to clarify information and reassure the mother.
Test-Taking Strategy: Use therapeutic communication techniques and knowledge regarding the effects of anemia to answer the question. Options 1 and 3 identify false reassurances. Option 2 is incorrect and will cause anxiety and fear in the client. Review therapeutic communication techniques and the effects of anemia on the fetus if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Psychosocial Integrity
Integrated Process: Caring
Content Area: Maternity/Antepartum
Reference: Murray, S., McKinney, E., & Gorrie, T. (2002). Foundations of maternal-newborn nursing (3rd ed.). Philadelphia: W.B. Saunders, p. 717.
3. During the intrapartum period, the nurse assists the health care team to ensure appropriate intravenous (IV) fluid intake and oxygen consumption for the laboring client with sickle cell disease. This action primarily will:
A. Stimulate the labor process.
B. Prevent the necessity of a cesarean delivery.
C. Prevent dehydration and hypoxemia.
D. Eliminate the need for analgesic administration.
Answer: C. Prevent dehydration and hypoxemia.
Rationale: A variety of conditions, including dehydration, hypoxemia, infection, and exertion can stimulate the sickling process during the intrapartum period. Maintaining adequate IV fluid intake and the administration of oxygen via face mask will help to ensure a safe environment for both the mother and fetus during labor. Options 1, 2, and 4 are incorrect.
Test-Taking Strategy: Use the process of elimination and knowledge regarding the effects of sickle cell anemia in the pregnant client. Note the relationship between “IV fluid intake and oxygen consumption” in the question and “dehydration and hypoxemia” in the correct option. Review the effects of sickle cell anemia if you had difficulty with this question.
Level of Cognitive Ability: Comprehension
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Maternity/Intrapartum
Reference: Leifer, G. (2005). Maternity nursing (9th ed.). Philadelphia: W.B. Saunders, p. 226.
4. A nurse in a postpartum unit identifies which client as being most at risk for developing endometritis following delivery?
A. A primigravida with a normal spontaneous vaginal delivery
B. A gravida II who delivered vaginally following an 18-hour labor
C. A woman experiencing an elective cesarean delivery at 38 weeks gestation
D. An adolescent experiencing an emergency cesarean delivery for fetal distress
Answer: D. An adolescent experiencing an emergency cesarean delivery for fetal distress
Rationale: Endometritis is an acute infection of the mucous lining of the uterus that occurs immediately after delivery. Cesarean delivery is the primary risk factor for uterine infection, especially after emergency procedures. Other risk factors include prolonged rupture of membranes, multiple vaginal examinations, and an excessive length of labor. Options 1, 2, and 3 do not describe the client “most at risk” to develop endometritis following delivery.
Test-Taking Strategy: Use the process of elimination. Recalling that cesarean delivery is the primary risk factor for uterine infection will assist in eliminating options 1 and B. From the remaining options, recalling that this serious complication is most likely to occur after emergency procedures will then direct you to option D. Review the risk factors associated with endometritis 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/Postpartum
Reference: Lowdermilk, D., & Perry, S.E. (2004). Maternity & women’s health care (8th ed.). St. Louis: Mosby, pp. 163-164.
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