NCLEX Practice Exam 37 (10 Questions)

1. A primigravida. age 42. is 6 weeks pregnant. Based on the client's age. her infant is at risk for:

Down syndrome

Respiratory distress syndrome

Turner’s syndrome

Pathological jaundice

The client who is age 42 is at risk for fetal anomalies such as Down syndrome and other chromosomal aberrations. Answers B. C. and D are incorrect because the client is not at higher risk for respiratory distress syndrome or pathological jaundice. and Turner’s syndrome is a genetic disorder.

Explanation

The client who is age 42 is at risk for fetal anomalies such as Down syndrome and other chromosomal aberrations. Answers B. C. and D are incorrect because the client is not at higher risk for respiratory distress syndrome or pathological jaundice. and Turner’s syndrome is a genetic disorder.

2. A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with:

Magnesium sulfate

Calcium gluconate

Dinoprostone (Prostin E.)

Bromocriptine (Parlodel)

The client with a missed abortion will have induction of labor. Prostin E. is a form of prostaglandin used to soften the cervix. Magnesium sulfate is used for preterm labor and preeclampsia. calcium gluconate is the antidote for magnesium sulfate. and Pardel is a dopamine receptor stimulant used to treat Parkinson’s disease; therefore. answers A. B. and D are incorrect. Pardel was used at one time to dry breast milk.

Explanation

The client with a missed abortion will have induction of labor. Prostin E. is a form of prostaglandin used to soften the cervix. Magnesium sulfate is used for preterm labor and preeclampsia. calcium gluconate is the antidote for magnesium sulfate. and Pardel is a dopamine receptor stimulant used to treat Parkinson’s disease; therefore. answers A. B. and D are incorrect. Pardel was used at one time to dry breast milk.

3. A pregnant client. age 32. asks the nurse why her doctor has recommended a serum alpha fetoprotein. The nurse should explain that the doctor has recommended the test:

Because it is a state law

To detect cardiovascular defects

Because of her age

To detect neurological defects

Alpha fetoprotein is a screening test done to detect neural tube defects such as spina bifida. The test is not mandatory. as stated in answer A. It does not indicate cardiovascular defects. and the mother’s age has no bearing on the need for the test. so answers B and C are incorrect.

Explanation

Alpha fetoprotein is a screening test done to detect neural tube defects such as spina bifida. The test is not mandatory. as stated in answer A. It does not indicate cardiovascular defects. and the mother’s age has no bearing on the need for the test. so answers B and C are incorrect.

4. A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. The nurse should anticipate the client's need for:

Supplemental oxygen

Fluid restriction

Blood transfusion

Delivery by Caesarean section

Clients with sickle cell crises are treated with heat. hydration. oxygen. and pain relief. Fluids are increased. not decreased. Blood transfusions are usually not required. and the client can be delivered vaginally; thus. answers B. C. and D are incorrect.

Explanation

Clients with sickle cell crises are treated with heat. hydration. oxygen. and pain relief. Fluids are increased. not decreased. Blood transfusions are usually not required. and the client can be delivered vaginally; thus. answers B. C. and D are incorrect.

5. A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy?

Insulin requirements moderate as the pregnancy progresses.

A decreased need for insulin occurs during the second trimester.

Elevations in human chorionic gonadotrophin decrease the need for insulin.

Fetal development depends on adequate insulin regulation.

Fetal development depends on adequate nutrition and insulin regulation. Insulin needs increase during the second and third trimesters. insulin requirements do not moderate as the pregnancy progresses. and elevated human chorionic gonadotrophin elevates insulin needs. not decreases them; therefore. answers A. B. and C are incorrect.

Explanation

Fetal development depends on adequate nutrition and insulin regulation. Insulin needs increase during the second and third trimesters. insulin requirements do not moderate as the pregnancy progresses. and elevated human chorionic gonadotrophin elevates insulin needs. not decreases them; therefore. answers A. B. and C are incorrect.

6. Which statement made by the nurse describes the inheritance pattern of autosomal recessive disorders?

An affected newborn has unaffected parents.

An affected newborn has one affected parent.

Affected parents have a one in four chance of passing on the defective gene.

Affected parents have unaffected children who are carriers.

Autosomal recessive disorders can be passed from the parents to the infant. If both parents pass the trait. the child will get two abnormal genes and the disease results. Parents can also pass the trait to the infant. Answer A is incorrect because. to have an affected newborn. the parents must be carriers. Answer B is incorrect because both parents must be carriers. Answer D is incorrect because the parents might have affected children.

Explanation

Autosomal recessive disorders can be passed from the parents to the infant. If both parents pass the trait. the child will get two abnormal genes and the disease results. Parents can also pass the trait to the infant. Answer A is incorrect because. to have an affected newborn. the parents must be carriers. Answer B is incorrect because both parents must be carriers. Answer D is incorrect because the parents might have affected children.

7. A client with preeclampsia has been receiving an infusion containing magnesium sulfate for a blood pressure that is 160/80; deep tendon reflexes are 1 plus. and the urinary output for the past hour is 100mL. The nurse should:

Continue the infusion of magnesium sulfate while monitoring the client’s blood pressure

Stop the infusion of magnesium sulfate and contact the physician

Slow the infusion rate and turn the client on her left side

Administer calcium gluconate IV push and continue to monitor the blood pressure

The client’s blood pressure and urinary output are within normal limits. The only alteration from normal is the decreased deep tendon reflexes. The nurse should continue to monitor the blood pressure and check the magnesium level. The therapeutic level is 4.8–9.6mg/dL. Answers B. C. and D are incorrect. There is no need to stop the infusion at this time or slow the rate. Calcium gluconate is the antidote for magnesium sulfate. but there is no data to indicate toxicity.

Explanation

The client’s blood pressure and urinary output are within normal limits. The only alteration from normal is the decreased deep tendon reflexes. The nurse should continue to monitor the blood pressure and check the magnesium level. The therapeutic level is 4.8–9.6mg/dL. Answers B. C. and D are incorrect. There is no need to stop the infusion at this time or slow the rate. Calcium gluconate is the antidote for magnesium sulfate. but there is no data to indicate toxicity.

8. The nurse is responsible for performing a neonatal assessment on a full-term infant. At 1 minute. the nurse could expect to find:

An apical pulse of 100

An absence of tonus

Cyanosis of the feet and hands

Jaundice of the skin and sclera

Cyanosis of the feet and hands is acrocyanosis. This is a normal finding 1 minute after birth. An apical pulse should be 120–160. and the baby should have muscle tone. making answers A and B incorrect. Jaundice immediately after birth is pathological jaundice and is abnormal. so answer D is incorrect.

Explanation

Cyanosis of the feet and hands is acrocyanosis. This is a normal finding 1 minute after birth. An apical pulse should be 120–160. and the baby should have muscle tone. making answers A and B incorrect. Jaundice immediately after birth is pathological jaundice and is abnormal. so answer D is incorrect.

9. A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse's response is based on the knowledge that:

There is no need to take thyroid medication because the fetus’s thyroid produces a thyroid-stimulating hormone.

Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy.

It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism.

Fetal growth is arrested if thyroid medication is continued during pregnancy.

During pregnancy. the thyroid gland triples in size. This makes it more difficult to regulate thyroid medication. Answer A is incorrect because there could be a need for thyroid medication during pregnancy. Answer C is incorrect because the thyroid function does not slow. Fetal growth is not arrested if thyroid medication is continued. so answer D is incorrect.

Explanation

During pregnancy. the thyroid gland triples in size. This makes it more difficult to regulate thyroid medication. Answer A is incorrect because there could be a need for thyroid medication during pregnancy. Answer C is incorrect because the thyroid function does not slow. Fetal growth is not arrested if thyroid medication is continued. so answer D is incorrect.

10. A client in the prenatal clinic is assessed to have a blood pressure of 180/96. The nurse should give priority to:

Providing a calm environment

Obtaining a diet history

Administering an analgesic

Assessing fetal heart tones

A calm environment is needed to prevent seizure activity. Any stimulation can precipitate seizures. Obtaining a diet history should be done later. and administering an analgesic is not indicated because there is no data in the stem to indicate pain. Therefore. answers B and C are incorrect. Assessing the fetal heart tones is important. but this is not the highest priority in this situation as stated in answer D.

Explanation

A calm environment is needed to prevent seizure activity. Any stimulation can precipitate seizures. Obtaining a diet history should be done later. and administering an analgesic is not indicated because there is no data in the stem to indicate pain. Therefore. answers B and C are incorrect. Assessing the fetal heart tones is important. but this is not the highest priority in this situation as stated in answer D.