Test Prep NCLEX-RN Exam Dumps & Practice Test Questions

Question 1:

A 25-year-old woman suspects she might be pregnant and schedules a prenatal checkup with a nurse practitioner. 

Her last menstrual period began on May 20. Using Naegele’s rule, what is her estimated due date?

A. March 27
B. February 1
C. February 27
D. January 3

Answer: C

Explanation:

Naegele’s rule is a widely used method to estimate a pregnant woman’s due date, also called the estimated date of confinement (EDC). This rule is based on the first day of the woman’s last menstrual period (LMP). The calculation involves subtracting three months from the LMP date, adding seven days, and then adjusting the year if needed.

Let's apply this step-by-step to the given LMP of May 20:

• Starting with May 20, subtracting three months takes us back to February 20.

• Adding seven days to February 20 gives us February 27.

• Since this date falls in the same year, no year adjustment is necessary.

Therefore, the expected delivery date is February 27.

Looking at the other options:

• March 27 is too far forward and would not fit the typical 40-week gestational period.

• February 1 is too early and does not align with the 280-day pregnancy duration.

• January 3 is significantly too early and would suggest a much longer pregnancy than normal.

In summary, based on Naegele’s rule, the estimated due date for a woman with an LMP of May 20 is February 27. This method assumes a 28-day menstrual cycle and a 40-week pregnancy duration. It’s important for healthcare providers to understand and communicate this formula, as it guides prenatal care timelines, screenings, and interventions. The accurate calculation of the due date helps in monitoring fetal development and preparing both mother and healthcare team for delivery. Hence, option C is the correct choice.

Question 2:

A nurse practitioner assesses a patient who is about 9 weeks pregnant. The practitioner explains to the patient common physical symptoms experienced during the first trimester. 

Which symptom should the nurse mention?

A. Nausea and vomiting
B. Feeling the baby move (quickening)
C. Gaining 6–8 pounds
D. Noticeable abdominal enlargement

Answer: A

Explanation:

At around 9 weeks of pregnancy, the woman is in the first trimester, a period characterized by many hormonal and physical changes. One of the most frequent and well-known symptoms during this early phase is nausea and vomiting, often called “morning sickness.” Despite the name, this nausea can occur any time of the day and generally begins between weeks 4 and 6 of pregnancy. It is caused by hormonal fluctuations, particularly rising levels of human chorionic gonadotropin (hCG) and estrogen. Most women experience this symptom throughout the first trimester, with some experiencing relief afterward, while others may have it longer.

Other options are less typical for this stage of pregnancy:

• Quickening (feeling the baby’s movements) usually occurs between 16 and 25 weeks, which is well beyond the first trimester. So, a woman at 9 weeks would not yet feel fetal movement.

• A weight gain of 6–8 pounds is more characteristic of the second and third trimesters. During the first trimester, most women gain between 1 and 5 pounds, depending on their starting weight and other factors.

• Noticeable abdominal enlargement generally does not occur until the second trimester because the uterus is still small and remains within the pelvis during the first trimester.

In conclusion, nausea and vomiting are hallmark symptoms of early pregnancy. Understanding these common physical changes helps healthcare providers educate patients on what to expect and manage symptoms effectively. Therefore, the correct answer is A.

Question 3:

A woman who is six weeks pregnant asks during her initial prenatal appointment, "Is there any amount of alcohol that is safe to consume during pregnancy?" What should the nurse’s answer be?

A. Up to 1 oz daily
B. Up to 2 oz daily
C. Up to 4 oz weekly
D. No alcohol at all

Answer: D

Explanation:

It is a well-established medical consensus that no amount of alcohol is considered safe during pregnancy. Scientific studies have shown that any alcohol consumption during this critical developmental period can harm the fetus, potentially leading to fetal alcohol syndrome (FAS), fetal alcohol spectrum disorders (FASDs), and various cognitive and physical developmental impairments. These conditions may result in lifelong disabilities affecting learning, behavior, and physical health.

Authoritative organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) explicitly recommend complete abstinence from alcohol throughout the entire pregnancy. This caution is especially important during the first trimester, when the fetus undergoes rapid growth and organ formation, making it particularly vulnerable to teratogenic effects of alcohol.

No research has identified a safe threshold or amount of alcohol consumption that can be considered harmless for the developing fetus. Even small amounts can carry risks, so the safest approach is zero alcohol intake throughout pregnancy.

Regarding the other options:
A and B suggest that daily consumption of small amounts of alcohol might be acceptable, but this contradicts current medical guidelines that emphasize total avoidance.
C implies that limited weekly alcohol might be safe, which is also inaccurate, as any consumption poses a potential risk.

Therefore, the most appropriate and evidence-based guidance for a pregnant woman is to avoid alcohol completely to protect fetal health, making D the correct response.

Question 4:

A 38-year-old pregnant woman comes for her routine prenatal exam at 30 weeks gestation. 

Which health issue should the nurse practitioner be especially vigilant about given her maternal age?

A. Iron-deficiency anemia
B. Sexually transmitted infections
C. Intrauterine growth restriction
D. Pregnancy-induced hypertension

Answer: D

Explanation:

In pregnant women aged 35 and older, often termed advanced maternal age, one of the primary health risks to monitor is pregnancy-induced hypertension (PIH). PIH involves elevated blood pressure that develops after 20 weeks of gestation and can progress to more severe conditions like preeclampsia, characterized by high blood pressure and organ dysfunction such as proteinuria.

Age-related physiological changes, including vascular stiffness and altered hormonal regulation, increase susceptibility to hypertension during pregnancy. This condition affects placental blood flow and may lead to complications for both mother and fetus if left unmanaged.

The other listed conditions are important to consider but are not as closely linked to advanced maternal age as PIH:
A. Iron-deficiency anemia is common in pregnancy but not specifically more frequent in older mothers, and it can be managed with supplements.
B. Sexually transmitted infections are related to sexual behavior rather than age, so advanced maternal age does not inherently increase this risk.
C. Intrauterine growth restriction (IUGR) can result from various factors, including PIH, but PIH itself is the more direct and primary risk to monitor in this age group. IUGR may be a consequence rather than the initial condition.

Therefore, vigilant monitoring for signs of pregnancy-induced hypertension and associated complications should be a priority in prenatal care for pregnant women aged 38, making D the correct answer.

Question 5:

A pregnant client comes in for her 6-month prenatal visit and reports a weight gain of 10 pounds over the past 2 months. Her physical exam shows no abnormalities. 

How should the nurse assess her understanding and adherence to the previous dietary and weight management advice?

A. She is following the diet as instructed.
B. She requires additional education and support.
C. She should increase her calorie consumption.
D. She must be immediately placed on a restrictive diet.

Correct Answer: B

Explanation:

During pregnancy, appropriate weight gain is crucial for the health of both mother and baby. However, the pace of weight gain matters significantly. In this case, the client has gained 10 pounds in just 2 months, which is approximately 5 pounds per month. This may be higher than the typical recommendation, which usually ranges from about 1 to 4 pounds per month during the second trimester, depending on the woman's pre-pregnancy weight and overall health.

Option A assumes the client is correctly following her diet plan, but the rapid weight gain suggests otherwise. The weight increase could imply excessive calorie intake or misunderstanding of nutritional guidance, making this option less likely.

Option B is the best choice because the nurse should recognize that the client may not fully grasp or implement the advice given earlier. Additional teaching and reinforcement of proper dietary habits are necessary to ensure healthy weight gain and to minimize risks such as gestational diabetes or hypertension.

Option C is incorrect because increasing calorie intake is generally unnecessary during the second trimester beyond a modest increase. Excessive calorie consumption is more likely contributing to the current rapid weight gain.

Option D—immediate restrictive dieting—is not appropriate. Restrictive diets during pregnancy may lead to nutrient deficiencies harmful to both mother and fetus. Instead, the nurse’s focus should be on balanced nutrition and gradual adjustment rather than drastic measures.

In conclusion, the nurse should provide further education and support to help the client manage her weight gain within healthy limits, making B the most appropriate answer.

Question 6:

Why do pregnant women with diabetes often face challenges in managing their blood sugar levels during the later stages of pregnancy? The nurse explains that this difficulty is primarily caused by which factor?

A. Reduced kidney filtration and increased tubular reabsorption
B. Lowered estrogen hormone levels
C. Decreased progesterone hormone levels
D. Elevated human placental lactogen hormone levels

Correct Answer: D

Explanation:

Pregnant women with diabetes frequently experience difficulty controlling their blood glucose during the second half of pregnancy due to hormonal changes that affect insulin function. The key hormone involved is human placental lactogen (hPL), which is produced by the placenta and rises significantly as pregnancy advances, especially in the second and third trimesters.

hPL plays a vital role in ensuring the fetus receives adequate glucose by increasing the mother’s insulin resistance. This means the mother’s cells become less responsive to insulin, making it harder for insulin to lower blood glucose effectively. In women without diabetes, the pancreas compensates by producing more insulin. However, in diabetic patients, insulin production or utilization is impaired, resulting in elevated blood sugar levels.

Option A relates to kidney function but does not directly affect insulin resistance or blood sugar regulation during pregnancy, so it is not the correct explanation.

Option B is incorrect because estrogen levels generally increase during pregnancy and do not cause insulin resistance.

Option C is also incorrect, as progesterone levels rise to maintain pregnancy but do not directly impact insulin sensitivity or glucose metabolism.

Therefore, the increased human placental lactogen levels (D) are primarily responsible for the insulin resistance and resultant difficulties in glucose control during the latter half of pregnancy in diabetic women. Understanding this hormonal influence helps guide monitoring and treatment adjustments for better glycemic control.

Question 7:

What is the recommended serum glucose range that a nurse should aim for when managing blood sugar levels in a pregnant patient with diabetes to reduce the risk of perinatal complications?

A. 70 mg/dL and 120 mg/dL
B. 100 mg/dL and 200 mg/dL
C. 40 mg/dL and 130 mg/dL
D. 90 mg/dL and 200 mg/dL

Answer: A

Explanation:

Managing blood glucose levels in pregnant patients with diabetes—whether gestational or pre-existing—is critical for ensuring the health of both mother and baby. Uncontrolled glucose can lead to serious perinatal complications including fetal macrosomia (excessive fetal growth), neonatal hypoglycemia after birth, and increased risk of perinatal mortality. Therefore, maintaining tight glucose control during pregnancy is essential.

The accepted clinical guidelines, such as those from the American Diabetes Association, emphasize keeping blood glucose within a safe target range. For pregnant women, this typically means fasting glucose values between 70 and 95 mg/dL and postprandial glucose (measured about one hour after meals) below 120 mg/dL. This range supports optimal fetal development and minimizes risks related to hyperglycemia or hypoglycemia.

Option A, stating 70 mg/dL to 120 mg/dL, aligns well with these targets and reflects the clinical goal for serum glucose control during pregnancy. Maintaining glucose in this range helps prevent complications like excessive fetal growth and perinatal mortality.

Option B’s range (100 mg/dL to 200 mg/dL) is too broad and high, especially the upper limit, which can increase risks such as preterm labor and poor fetal outcomes. Option C includes a dangerously low lower limit of 40 mg/dL, risking maternal hypoglycemia with potential for dizziness, fainting, and fetal distress. Option D’s upper limit of 200 mg/dL is also excessively high and inconsistent with recommended post-meal glucose goals.

In summary, the optimal serum glucose range for pregnant clients with diabetes is 70 mg/dL to 120 mg/dL to ensure both maternal safety and fetal well-being.

Question 8:

If a fetal heart rate monitor during labor shows late decelerations accompanied by tachycardia and decreased variability, what is the nurse’s best immediate response?

A. Continue monitoring as this is a normal pattern.
B. Position the patient on her right side.
C. Reduce intravenous fluid administration.
D. Notify the physician or midwife immediately.

Answer: D

Explanation:

The fetal heart rate (FHR) pattern characterized by late decelerations, tachycardia, and decreasing variability is a strong indication of fetal distress and warrants immediate action. Late decelerations are gradual reductions in heart rate that begin after a contraction’s peak and resolve only after the contraction ends. This pattern suggests uteroplacental insufficiency, meaning the placenta may not be delivering enough oxygen to the fetus, which can compromise fetal well-being.

Tachycardia, an elevated fetal heart rate, often accompanies hypoxia or fetal stress and can also indicate infection. Decreased variability—the reduction in the normal fluctuations of the heart rate—is concerning because it signals that the fetus may not be tolerating the stress of labor well. Together, these signs point to an urgent need for medical assessment and intervention.

The nurse’s primary responsibility is to report these abnormal findings immediately to the physician or midwife (Option D). This ensures timely evaluation and decision-making, which may include interventions such as maternal oxygen administration, fluid bolus to improve uterine perfusion, or preparation for emergency delivery if necessary.

Option A (continuing to monitor without action) is unsafe as these signs are not normal and can precede severe fetal compromise. Option B (turning the client on the right side) can help improve placental blood flow in some cases but is not sufficient alone and should not delay reporting. Option C (decreasing IV fluids) is contraindicated because maintaining or increasing maternal hydration may help improve fetal oxygenation.

Prompt communication with the healthcare team allows for rapid, appropriate responses that can prevent fetal hypoxia and potential morbidity or mortality, making Option D the correct and safest choice.

Question 9:

A patient diagnosed with preeclampsia is prescribed magnesium sulfate by the physician. 

What is the primary therapeutic purpose of administering magnesium sulfate in managing preeclampsia?

A. To prevent seizures
B. To inhibit uterine contractions
C. To provide sedation
D. To promote fetal lung development

Correct Answer: A

Explanation:

Magnesium sulfate is a cornerstone treatment in managing preeclampsia, particularly because of its ability to prevent seizures, which are the hallmark of eclampsia—a severe and potentially fatal complication of preeclampsia. The main therapeutic goal of magnesium sulfate in this setting is to act as an anticonvulsant. It works by stabilizing nerve cells and interfering with neuromuscular transmission, thereby reducing the likelihood of seizure activity.

Option A is correct because magnesium sulfate helps to prevent seizures in women diagnosed with severe preeclampsia, which is critical to avoid progression to eclampsia. This prophylactic use is supported by extensive clinical evidence showing reduced seizure incidence when magnesium sulfate is administered appropriately.

Option B, preventing uterine contractions, is incorrect in the context of preeclampsia management. While magnesium sulfate can relax smooth muscle and may sometimes be used to delay premature labor, this is not its purpose when treating preeclampsia. Its role in preeclampsia is seizure prevention, not to suppress contractions.

Option C, sedation, is also inaccurate as the main goal. Although magnesium sulfate may have sedative side effects due to its depressant effect on the central nervous system, sedation is not its intended therapeutic use in preeclampsia.

Option D is incorrect because magnesium sulfate does not promote fetal lung maturity. Instead, corticosteroids like betamethasone are used for fetal lung development in cases of preterm labor. Magnesium sulfate’s role is focused on maternal seizure prevention and has some neuroprotective benefits for the fetus, but it does not directly enhance lung development.

In summary, magnesium sulfate’s primary indication in preeclampsia is seizure prophylaxis, making A the correct answer.

Question 10:

What is the main purpose of performing the initial Apgar score assessment on a newborn immediately after delivery?

A. To detect major motor abnormalities
B. To establish a baseline for the infant’s long-term adaptation
C. To assess the newborn’s vital physiological functions
D. To identify congenital abnormalities

Correct Answer: C

Explanation:

The Apgar score is a rapid assessment tool used shortly after birth to evaluate a newborn’s immediate physical condition and vital signs, providing critical information on how well the baby is adapting to life outside the womb. This scoring system assesses five key parameters: appearance (skin color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (breathing effort). Each parameter is scored between 0 to 2, with a total possible score of 10.

The primary purpose of the first Apgar score is to quickly determine if the newborn needs urgent medical attention to support vital functions like breathing and circulation. This assessment is done at 1 minute and again at 5 minutes after birth to monitor progress or deterioration.

Option C is correct because the Apgar score focuses on evaluating essential life-sustaining functions. For example, a heart rate above 100 beats per minute and strong respiratory effort indicate good adaptation to extrauterine life. Muscle tone and reflexes further help determine neurological status immediately after birth.

Option A is incorrect since the Apgar score is not designed to detect gross motor abnormalities; it assesses muscle tone as part of overall status, but detailed neurological or motor assessments occur later.

Option B is not the best choice because while the Apgar score provides an initial snapshot, it is not primarily intended as a baseline for long-term monitoring but rather for immediate postnatal evaluation.

Option D is incorrect because the Apgar score does not identify congenital malformations. Structural abnormalities require more comprehensive examinations beyond this quick scoring system.

In conclusion, the initial Apgar score’s main goal is to assess the newborn’s vital physiological functions and determine if resuscitative efforts or further intervention are necessary, making C the correct answer.