Mock NCLEX RN Exam
Question 1 of 5.
The nurse has been assigned a client who delivered a 6-lb, 12-oz baby boy vaginally 40 minutes ago. The initial assessment of greatest importance for this client would be:
A. Length of her labor
B. Type of episiotomy
C. Amount of IV fluid to be infused
D. Character of the fundus
Explanation: The length of labor has little bearing on the fourth stage of labor. The type of labor and delivery is significant. The type of episiotomy will affect the client's comfort level. However, the nurse's assessment and implementations center on prevention of hemorrhage during the fourth stage of labor. The amount of bleeding from the episiotomy or hematoma formation is of higher priority than the type of episiotomy. The amount of IV fluid to be infused is a nursing function to be attended to; however, it is lower in priority than determining if hemorrhaging is occurring. Character of the fundus would be the priority nursing assessment because changes in uterine tone may identify possible postpartum hemorrhage.
Question 2 of 5.
The physician has ordered a low-residue diet for a client with Crohn's disease. Which food is not permitted in a low-residue diet?
A. Mashed potatoes
B. Smooth peanut butter
C. Fried fish
D. Rice
Explanation: A low-residue diet minimizes fiber and irritating foods; fried fish is high in fat and can irritate the gut, making it unsuitable for Crohn's disease.
Question 3 of 5.
The physician has ordered Eskalith (lithium carbonate) 500 mg three times a day and Risperdal (risperidone) 2 mg twice daily for a client admitted with bipolar disorder, acute manic episodes. The best explanation for the client's medication regimen is:
A. The client's symptoms of acute mania are typical of undiagnosed schizophrenia.
B. Antipsychotic medication is used to manage behavioral excitement until mood stabilization occurs.
C. The client will be more compliant with a medication that allows some feelings of hypomania.
D. Antipsychotic medication prevents psychotic symptoms commonly associated with the use of mood stabilizers.
Explanation: Risperidone, an antipsychotic, is used to control acute manic symptoms like agitation, while lithium stabilizes mood over time, addressing the immediate behavioral excitement.
Question 4 of 5.
Which one of the following situations represents a maturational crisis for the family?
A. A four-year-old entering nursery school
B. Development of preeclampsia during pregnancy
C. Loss of employment and health benefits
D. Hospitalization of a grandfather with a stroke
Explanation: A maturational crisis involves normal developmental transitions, such as a child entering nursery school, which can stress family dynamics.
Question 5 of 5.
The nurse is making room assignments for four obstetrical clients. If only one private room is available, it should be assigned to:
A. A multigravida with diabetes mellitus
B. A primigravida with preeclampsia
C. A multigravida with preterm labor
D. A primigravida with hyperemesis gravidarum
Explanation: Preeclampsia requires close monitoring due to risks like seizures or stroke, making a private room essential for a primigravida with this condition.
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