NCLEX-PN
NCLEX PN Exam Cram
1. What skin color does a client with jaundice have?
- A. pale
- B. ruddy
- C. yellow
- D. pink
Correct answer: C
Rationale: The correct answer is C: yellow. Jaundice is a condition characterized by yellowing of the skin due to increased levels of bilirubin in the blood. This excess bilirubin causes the skin and whites of the eyes to appear yellow. Choice A, pale, is not typically associated with jaundice. Choice B, ruddy, describes a reddish skin color and is not indicative of jaundice. Choice D, pink, is a normal skin color and not a symptom of jaundice.
2. The healthcare provider should utilize data about which of the following to provide information about the nutritional status of a client being evaluated for malnutrition?
- A. triceps skinfold measurement
- B. fasting blood glucose level
- C. hemoglobin A1c level
- D. serum lipid profile results
Correct answer: A
Rationale: Objective anthropometric measurements such as triceps skinfold and mid-arm circumference (MAC), along with weight, are usually used to diagnose malnutrition. Triceps skinfold measurement specifically helps assess body fat and muscle mass, providing valuable information about the client's nutritional status. Fasting blood glucose level, hemoglobin A1c level, and serum lipid profile results are important tests in assessing different aspects of health such as diabetes management and cardiovascular risk, but they are not specific indicators of malnutrition.
3. What is the priority nursing action for a laboring client dilated to 6 cm receiving an epidural?
- A. Continuous monitoring of maternal blood pressure.
- B. Frequent auscultation of the fetal heart rate.
- C. Administering an IV fluid bolus of at least 500 cc.
- D. Frequent monitoring of the maternal temperature.
Correct answer: A
Rationale: The priority nursing action for a laboring client dilated to 6 cm receiving an epidural is continuous monitoring of maternal blood pressure. This is crucial because epidural anesthesia can lead to a precipitous drop in blood pressure, which can be dangerous for both the mother and fetus by reducing cardiac output and placental perfusion. While frequent auscultation of the fetal heart rate is important, it is not the priority in this situation. Administering an IV fluid bolus of at least 500 cc may not be necessary if the client's blood pressure is stable. Monitoring the maternal temperature is also essential but takes precedence over blood pressure monitoring.
4. Which of the following blood pressure parameters indicates PIH? Elevation over a baseline of:
- A. 30 mmHg systolic and/or 15 mmHg diastolic.
- B. 40 mmHg systolic and/or 20 mmHg diastolic.
- C. 10 mmHg systolic and/or 5 mmHg diastolic.
- D. 20 mmHg systolic and/or 20 mmHg diastolic.
Correct answer: A
Rationale: The correct answer is A: 30 mmHg systolic and/or 15 mmHg diastolic. These parameters indicate mild PIH (pregnancy-induced hypertension). Mild preeclampsia is characterized by an increase in systolic blood pressure greater than 30 mmHg or an increase in diastolic blood pressure greater than 15 mmHg, observed on two readings taken 6 hours apart (or reaching 140/90). Choice B (40 mmHg systolic and/or 20 mmHg diastolic) represents a more significant elevation and would indicate a more severe condition than mild PIH. Choices C (10 mmHg systolic and/or 5 mmHg diastolic) and D (20 mmHg systolic and/or 20 mmHg diastolic) do not meet the criteria for indicating PIH as they are below the accepted parameters for mild PIH.
5. In the treatment of symptomatic bradycardia, which medication is most commonly recognized?
- A. Questran
- B. Digitalis
- C. Nitroglycerin
- D. Atropine
Correct answer: D
Rationale: Atropine is the medication most commonly recognized for the treatment of symptomatic bradycardia because it increases the rate of conduction in the AV node, helping to alleviate bradycardia. Questran is a medication used to lower cholesterol levels and is not indicated for bradycardia. Digitalis, such as Digoxin, is used for heart failure and atrial fibrillation but not typically for bradycardia. Nitroglycerin is primarily used for angina and not bradycardia.
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