Test Bank for RN NCLEX Exam/ All Practice Questions
g g g g g g g g g
with Correct Verified Answers/ All Chapters Covered/
g g g g g g g
Updated 2024. g
Isgagprocessgofglearninggagdifferentgculturegtogadaptgtogagnewgorgchanginggenvironment.g-
gCorrectgAnswerg-gAcculturation.
Itgisgagsubjectivegperspectivegofgthegperson'sgheritagegandgagsensegofgbelonginggtogaggroupg-
gCorrectgAnswerg-gEthnicgidentity
Includegmeditation,grelaxationgtechniques,gimagery,gmusicgtherapy,gmassage,gtouch,glaughter,ghumor,g&
gspiritualgmeasuresg(prayer).g-gCorrectgAnswerg-gLow-riskgtherapies:
Agpregnantgclientgisgseengforgagregulargprenatalgvisitgandgtellsgthegnursegthatgshegisgexperiencinggirreg
ulargcontractions.gThegnursegdeterminesgthatgshegisgexperiencinggBraxtongHicksgcontractions.gOngtheg
basisgofgthisgfinding,gwhichgnursinggactiongisgappropriate?
A. Contactgthegprimaryghealthgcaregprovider.
B. Instructgthegclientgtogmaintaingbedgrestgforgthegremaindergofgthegpregnancy.
C. Informgthegclientgthatgthesegcontractionsgaregcommongandgmaygoccurgthroughoutgthegpregnancy.
D. Callgthegmaternitygunitgandginformgthemgthatgthegclientgwillgbegadmittedgingagpretermglaborgconditio
n.g-gANSWERg-gC
BraxtongHicksgcontractionsgaregirregular,gpainlessgcontractionsgthatgmaygoccurgintermittentlygthroughou
tgpregnancy.gBecausegBraxtongHicksgcontractionsgmaygoccurgandgaregnormalgingsomegpregnantgwome
ngduringgpregnancy,gtheregisgnogreasongtognotifygthegprimaryghealthgcaregprovider.gThisgclientgisgnotgin
gpretermglaborgand,gtherefore,gdoesgnotgneedgtogbegplacedgongbedgrestgorgbegadmittedgtogtheghospita
lgtogbegmonitored.
Agclientgarrivesgatgthegclinicgforgthegfirstgprenatalgassessment.gShegtellsgthegnursegthatgthegfirstgdaygofgh
erglastgnormalgmenstrualgperiodgwasgOctoberg19,g2020.gUsinggNäegele'sgrule,gwhichgexpectedgdategof
deliverygshouldgthegnursegdocumentgingthegclient'sgchart?
pg.g1
,A. Julyg12,g2021
B. Julyg26,g2021
C. Augustg12,g2021
D. Augustg26,g2021g-gANSWERg-gB
AccurategusegofgNäegele'sgrulegrequiresgthatgthegwomanghavegagregularg28-
daygmenstrualgcycle.gSubtractg3gmonthsgandgaddg7gdaysgtogthegfirstgdaygofgtheglastgmenstrualgperiod,g
andgthengaddg1gyeargtogthatgdate:gfirstgdaygofgtheglastgmenstrualgperiod,gOctoberg19,g2020;gsubtractg3
gmonths,gJulyg19,g2020;gaddg7gdays,gJulyg26,g2020;gaddg1gyear,gJulyg26,g2021.
Thegnursegisgcollectinggdatagduringgangadmissiongassessmentgofgagclientgwhogisgpregnantgwithgtwins.gT
hegclientghasgaghealthyg5-year-
oldgchildgwhogwasgdeliveredgatg38gweeksgandgtellsgthegnursegthatgshegdoesgnotghavegaghistorygofganygty
pegofgabortiongorgfetalgdemise.gUsinggGTPAL,gwhatgshouldgthegnursegdocumentgingthegclient'sgchart?
A. Gg=g3,gTg=g2,gPg=g0,gAg=g0,gLg=g1
B. Gg=g2,gTg=g1,gPg=g0,gAg=g0,gLg=g1
C. Gg=g1,gTg=g1,gPg=g1,gAg=g0,gLg=g1
D. Gg=g2,gTg=g0,gPg=g0,gAg=g0,gLg=g1g-gANSWERg-gB
PregnancygoutcomesgcangbegdescribedgwithgthegacronymgGTPAL.gGgisggravidity,gthegnumbergofgpregna
ncies;gTgisgtermgbirths,gthegnumbergborngatgtermg(longergthang37gweeks);gPgisgpretermgbirths,gthegnum
bergborngbeforeg37gweeksgofggestation;gAgisgabortionsgorgmiscarriages,gthegnumbergofgabortionsgor
miscarriagesg(includedginggravidagifgbeforeg20gweeksgofggestation;gincludedgingparityg[numbergofgbirths]
gifgpastg20gweeksgofggestation);gandgLgisgthegnumbergofgcurrentglivinggchildren.gAgwomangwhogisgpregn
antgwithgtwinsgandghasgagchildghasgaggravidagofg2.gBecausegthegchildgwasgdeliveredgatg38gweeks,gthegnu
mbergofgtermgbirthsgisg1,gandgthegnumbergofgpretermgbirthsgisg0.gThegnumbergofgabortionsgisg0,gandgth
egnumbergofglivinggchildrengisg1.
Thegnursegisgcaringgforgagclientginglabor.gWhichgassessmentgfindingsgindicategtogthegnursegthatgthegclien
tgisgbeginninggthegsecondgstagegofglabor?gSelectgallgthatgapply.
A. Thegcontractionsgaregregular.
B. Thegmembranesghavegruptured.
C. Thegcervixgisgdilatedgcompletely.
pg.g2
,D. Thegclientgbeginsgtogexpelgcleargvaginalgfluid.
E. ThegFergusongreflexgisginitiatedgfromgperinealgpressure.g-gANSWERg-gC,gE
Thegsecondgstagegofglaborgbeginsgwhengthegcervixgisgdilatedgcompletelygandgendsgwithgbirthgofgt
he
neonate.gThegwomanghasgagstronggurgegtogpushgingstageg2gwhengthegFergusongreflexgisgactivated.gOpti
ons
1,g2,gandg4garegnotgspecificgassessmentgfindingsgofgthegsecondgstagegofglaborgandgoccurgingstag
e 1.
Thegnursegisgreviewinggtruegandgfalseglaborgsignsgwithgagmultiparousgclient.gThegnursegdeterminesgthatgtheg
clientgunderstandsgthegsignsgofgtrueglaborgifgshegmakesgwhichgstatement?
A. "Igwon'tgbeginglaborguntilgmygbabygdrops."
B. "Mygcontractionsgwillgbegfeltgingmygabdominalgarea."
C. "MygcontractionsgwillgnotgbegasgpainfulgifgIgwalkgaround."
D. "Mygcontractionsgwillgincreasegingdurationgandgintensity."g-gANSWERg-gD
Trueglaborgisgpresentgwhengcontractionsgincreasegingdurationgandgintensity.gLighteninggorgdroppingglea
dsgtogengagementg(presentinggpartgreachesgtheglevelgofgthegischialgspine)gandgoccursgwhengthegfetus
descendsgintogthegpelvisgaboutg2gweeksgbeforegdelivery.gContractionsgfeltgingthegabdominalgareagandgc
ontractionsgthatgeasegwithgwalkinggaregsignsgofgfalseglabor.
Becausegofgtheirghealthg&gdietarygpractices,gNativegAmericans,gLatinogAmericans,gHispanicgAmericans,g
&gAfricangAmericans.g-gCorrectgAnswerg-gHighgriskgofgobesityg&gdiabetesgmellitus
Surgerygisgnotgprohibited,gbutgthegadministrationgofgbloodgandgbloodgproductsgisgforbidden.gThisgreligi
ousggroupgbelievesgthegsoulgcannotglivegaftergdeath.gAdministrationgofgmedicationgisgangacceptablegpr
acticegexceptgifgthegmedicationgisgderivedgfromgbloodgproducts.g-gCorrectgAnswerg-
gJehovah'sgWitnesses
Believersgadheregtogdietarygkosherglaws.gIngthisgreligion,gthegdairy-meatgcombinationgisgunacceptable.
Onlygfishgthatghavegscalesgandgfinsgaregallowed;gmeatsgthatgaregallowedgincludeganimalsgthatgaregveget
ablegeaters,gcloven-hoofed,gandgrituallygslaughtered.g-gCorrectgAnswerg-gOrthodoxgJudaism
includegwholegmedicalgsystems,gmind-bodygmedicine,gbiologicallygbasedgpractices,gmanipulativeg&gbody-
gbasedgpractices,g&genergygmedicine.g-gCorrectgAnswerg-
gFivegcategoriesgofgcomplementarygandgalternativegmedicineg(CAM):
pg.g3
, Focused,gmaintainsgstronggcontrol,gmakesgdecisions,g&gaddressesgallgproblems.gDominatesggroupg&gco
mmands,grathergthangseeksgsuggestionsgorginput.gManagergaddressesgproblemg(qualitygimprovement)g
withgtaff,gdesignsgagplangwithoutginput,g&gwantsgallgproblemsgreportedgdirectlygbackgtogherg-gCorrect
Answerg-gAutocraticgleader
Participativeg&gwouldglikelygmeetgwithgeachgstaffgpersongindividuallygtogdeterminegstaffgmember's
perceptiongofgproblem.gWouldgalsogspeakgwithgthegstaffgaboutganygissuesg&gaskgthegstaffgforginputgwith
gdevelopinggagplan.g-gCorrectgAnswerg-gDemocraticgleader
Passivegandgnondirective.gWouldgstategwhatgthegproblemgwasg&ginformgstaffgthatgthegstaffgneededgtogc
omegupgwithgagplangtog"fixgit."g-gCorrectgAnswerg-gLaissez-fairegleader
Assessmentgfindingsgincludegcough,gdyspnea,gcrackles,gtachypnea,gtachycardia,gelevatedgbloodgpressur
e,gboundinggpulse,gelevatedgCVP,gweightggain,gedema,gneckg&ghandgveingdistention,galteredgLOC,g&
decreasedghematocrit.g-gCorrectgAnswerg-gOverhydrationgorgfluidgoverloadg&goccursgwhengfluidgintakegor
fluidgretention
Avocado,gbananas,gcantaloupe,gcarrots,gfish,gmushrooms,goranges,gpotatoes,gpork,gbeef,gveal,graisins,gsp
inach,gstrawberries,g>omatoesg-gCorrectgAnswerg-gCommongfoodgsourcesgofgpotassium:
Musclegweakness,gincreasedgurinarygoutput,g&gdecreasedgspecificggravitygofgthegurinegwouldgbegnotedg
-gCorrectgAnswerg-gHyponatremia
Causativegfactorsgrelategtogmalnutritiongorgstarvationg>hegusegofgaluminumghydroxide-
basedgorgmagnesium-basedgantacids.gMalnutritiongisgassociatedgwithgalcoholism.g-
gCorrectgAnswerg-gHypophosphatemia
Renalginsufficiency,ghypoparathyroidism,g>umorglysisgsyndrome;gcausativegfactors.gShouldgavoidgfood
sghighgingphosphates;gfish,geggs,gmilkgproducts,gvegetables,gwholeggrains,g&gcarbonatedgbeverages.g-
CorrectgAnswerg-gHyperphosphatemia
Vomiting,gdiarrhea,gconditionsgthatgincreasedgrespiration'sgorgincreasedgurinarygoutput,ginsufficientgintr
avenousgfluidgreplacement,gdraininggfistulas,gpresencegofgileostomygorgcolostomy.gDiuretics,g&ggastroi
ntestinalgsuctioning.g-gCorrectgAnswerg-gCausesgofgagfluidgvolumegdeficit
pg.g4
g g g g g g g g g
with Correct Verified Answers/ All Chapters Covered/
g g g g g g g
Updated 2024. g
Isgagprocessgofglearninggagdifferentgculturegtogadaptgtogagnewgorgchanginggenvironment.g-
gCorrectgAnswerg-gAcculturation.
Itgisgagsubjectivegperspectivegofgthegperson'sgheritagegandgagsensegofgbelonginggtogaggroupg-
gCorrectgAnswerg-gEthnicgidentity
Includegmeditation,grelaxationgtechniques,gimagery,gmusicgtherapy,gmassage,gtouch,glaughter,ghumor,g&
gspiritualgmeasuresg(prayer).g-gCorrectgAnswerg-gLow-riskgtherapies:
Agpregnantgclientgisgseengforgagregulargprenatalgvisitgandgtellsgthegnursegthatgshegisgexperiencinggirreg
ulargcontractions.gThegnursegdeterminesgthatgshegisgexperiencinggBraxtongHicksgcontractions.gOngtheg
basisgofgthisgfinding,gwhichgnursinggactiongisgappropriate?
A. Contactgthegprimaryghealthgcaregprovider.
B. Instructgthegclientgtogmaintaingbedgrestgforgthegremaindergofgthegpregnancy.
C. Informgthegclientgthatgthesegcontractionsgaregcommongandgmaygoccurgthroughoutgthegpregnancy.
D. Callgthegmaternitygunitgandginformgthemgthatgthegclientgwillgbegadmittedgingagpretermglaborgconditio
n.g-gANSWERg-gC
BraxtongHicksgcontractionsgaregirregular,gpainlessgcontractionsgthatgmaygoccurgintermittentlygthroughou
tgpregnancy.gBecausegBraxtongHicksgcontractionsgmaygoccurgandgaregnormalgingsomegpregnantgwome
ngduringgpregnancy,gtheregisgnogreasongtognotifygthegprimaryghealthgcaregprovider.gThisgclientgisgnotgin
gpretermglaborgand,gtherefore,gdoesgnotgneedgtogbegplacedgongbedgrestgorgbegadmittedgtogtheghospita
lgtogbegmonitored.
Agclientgarrivesgatgthegclinicgforgthegfirstgprenatalgassessment.gShegtellsgthegnursegthatgthegfirstgdaygofgh
erglastgnormalgmenstrualgperiodgwasgOctoberg19,g2020.gUsinggNäegele'sgrule,gwhichgexpectedgdategof
deliverygshouldgthegnursegdocumentgingthegclient'sgchart?
pg.g1
,A. Julyg12,g2021
B. Julyg26,g2021
C. Augustg12,g2021
D. Augustg26,g2021g-gANSWERg-gB
AccurategusegofgNäegele'sgrulegrequiresgthatgthegwomanghavegagregularg28-
daygmenstrualgcycle.gSubtractg3gmonthsgandgaddg7gdaysgtogthegfirstgdaygofgtheglastgmenstrualgperiod,g
andgthengaddg1gyeargtogthatgdate:gfirstgdaygofgtheglastgmenstrualgperiod,gOctoberg19,g2020;gsubtractg3
gmonths,gJulyg19,g2020;gaddg7gdays,gJulyg26,g2020;gaddg1gyear,gJulyg26,g2021.
Thegnursegisgcollectinggdatagduringgangadmissiongassessmentgofgagclientgwhogisgpregnantgwithgtwins.gT
hegclientghasgaghealthyg5-year-
oldgchildgwhogwasgdeliveredgatg38gweeksgandgtellsgthegnursegthatgshegdoesgnotghavegaghistorygofganygty
pegofgabortiongorgfetalgdemise.gUsinggGTPAL,gwhatgshouldgthegnursegdocumentgingthegclient'sgchart?
A. Gg=g3,gTg=g2,gPg=g0,gAg=g0,gLg=g1
B. Gg=g2,gTg=g1,gPg=g0,gAg=g0,gLg=g1
C. Gg=g1,gTg=g1,gPg=g1,gAg=g0,gLg=g1
D. Gg=g2,gTg=g0,gPg=g0,gAg=g0,gLg=g1g-gANSWERg-gB
PregnancygoutcomesgcangbegdescribedgwithgthegacronymgGTPAL.gGgisggravidity,gthegnumbergofgpregna
ncies;gTgisgtermgbirths,gthegnumbergborngatgtermg(longergthang37gweeks);gPgisgpretermgbirths,gthegnum
bergborngbeforeg37gweeksgofggestation;gAgisgabortionsgorgmiscarriages,gthegnumbergofgabortionsgor
miscarriagesg(includedginggravidagifgbeforeg20gweeksgofggestation;gincludedgingparityg[numbergofgbirths]
gifgpastg20gweeksgofggestation);gandgLgisgthegnumbergofgcurrentglivinggchildren.gAgwomangwhogisgpregn
antgwithgtwinsgandghasgagchildghasgaggravidagofg2.gBecausegthegchildgwasgdeliveredgatg38gweeks,gthegnu
mbergofgtermgbirthsgisg1,gandgthegnumbergofgpretermgbirthsgisg0.gThegnumbergofgabortionsgisg0,gandgth
egnumbergofglivinggchildrengisg1.
Thegnursegisgcaringgforgagclientginglabor.gWhichgassessmentgfindingsgindicategtogthegnursegthatgthegclien
tgisgbeginninggthegsecondgstagegofglabor?gSelectgallgthatgapply.
A. Thegcontractionsgaregregular.
B. Thegmembranesghavegruptured.
C. Thegcervixgisgdilatedgcompletely.
pg.g2
,D. Thegclientgbeginsgtogexpelgcleargvaginalgfluid.
E. ThegFergusongreflexgisginitiatedgfromgperinealgpressure.g-gANSWERg-gC,gE
Thegsecondgstagegofglaborgbeginsgwhengthegcervixgisgdilatedgcompletelygandgendsgwithgbirthgofgt
he
neonate.gThegwomanghasgagstronggurgegtogpushgingstageg2gwhengthegFergusongreflexgisgactivated.gOpti
ons
1,g2,gandg4garegnotgspecificgassessmentgfindingsgofgthegsecondgstagegofglaborgandgoccurgingstag
e 1.
Thegnursegisgreviewinggtruegandgfalseglaborgsignsgwithgagmultiparousgclient.gThegnursegdeterminesgthatgtheg
clientgunderstandsgthegsignsgofgtrueglaborgifgshegmakesgwhichgstatement?
A. "Igwon'tgbeginglaborguntilgmygbabygdrops."
B. "Mygcontractionsgwillgbegfeltgingmygabdominalgarea."
C. "MygcontractionsgwillgnotgbegasgpainfulgifgIgwalkgaround."
D. "Mygcontractionsgwillgincreasegingdurationgandgintensity."g-gANSWERg-gD
Trueglaborgisgpresentgwhengcontractionsgincreasegingdurationgandgintensity.gLighteninggorgdroppingglea
dsgtogengagementg(presentinggpartgreachesgtheglevelgofgthegischialgspine)gandgoccursgwhengthegfetus
descendsgintogthegpelvisgaboutg2gweeksgbeforegdelivery.gContractionsgfeltgingthegabdominalgareagandgc
ontractionsgthatgeasegwithgwalkinggaregsignsgofgfalseglabor.
Becausegofgtheirghealthg&gdietarygpractices,gNativegAmericans,gLatinogAmericans,gHispanicgAmericans,g
&gAfricangAmericans.g-gCorrectgAnswerg-gHighgriskgofgobesityg&gdiabetesgmellitus
Surgerygisgnotgprohibited,gbutgthegadministrationgofgbloodgandgbloodgproductsgisgforbidden.gThisgreligi
ousggroupgbelievesgthegsoulgcannotglivegaftergdeath.gAdministrationgofgmedicationgisgangacceptablegpr
acticegexceptgifgthegmedicationgisgderivedgfromgbloodgproducts.g-gCorrectgAnswerg-
gJehovah'sgWitnesses
Believersgadheregtogdietarygkosherglaws.gIngthisgreligion,gthegdairy-meatgcombinationgisgunacceptable.
Onlygfishgthatghavegscalesgandgfinsgaregallowed;gmeatsgthatgaregallowedgincludeganimalsgthatgaregveget
ablegeaters,gcloven-hoofed,gandgrituallygslaughtered.g-gCorrectgAnswerg-gOrthodoxgJudaism
includegwholegmedicalgsystems,gmind-bodygmedicine,gbiologicallygbasedgpractices,gmanipulativeg&gbody-
gbasedgpractices,g&genergygmedicine.g-gCorrectgAnswerg-
gFivegcategoriesgofgcomplementarygandgalternativegmedicineg(CAM):
pg.g3
, Focused,gmaintainsgstronggcontrol,gmakesgdecisions,g&gaddressesgallgproblems.gDominatesggroupg&gco
mmands,grathergthangseeksgsuggestionsgorginput.gManagergaddressesgproblemg(qualitygimprovement)g
withgtaff,gdesignsgagplangwithoutginput,g&gwantsgallgproblemsgreportedgdirectlygbackgtogherg-gCorrect
Answerg-gAutocraticgleader
Participativeg&gwouldglikelygmeetgwithgeachgstaffgpersongindividuallygtogdeterminegstaffgmember's
perceptiongofgproblem.gWouldgalsogspeakgwithgthegstaffgaboutganygissuesg&gaskgthegstaffgforginputgwith
gdevelopinggagplan.g-gCorrectgAnswerg-gDemocraticgleader
Passivegandgnondirective.gWouldgstategwhatgthegproblemgwasg&ginformgstaffgthatgthegstaffgneededgtogc
omegupgwithgagplangtog"fixgit."g-gCorrectgAnswerg-gLaissez-fairegleader
Assessmentgfindingsgincludegcough,gdyspnea,gcrackles,gtachypnea,gtachycardia,gelevatedgbloodgpressur
e,gboundinggpulse,gelevatedgCVP,gweightggain,gedema,gneckg&ghandgveingdistention,galteredgLOC,g&
decreasedghematocrit.g-gCorrectgAnswerg-gOverhydrationgorgfluidgoverloadg&goccursgwhengfluidgintakegor
fluidgretention
Avocado,gbananas,gcantaloupe,gcarrots,gfish,gmushrooms,goranges,gpotatoes,gpork,gbeef,gveal,graisins,gsp
inach,gstrawberries,g>omatoesg-gCorrectgAnswerg-gCommongfoodgsourcesgofgpotassium:
Musclegweakness,gincreasedgurinarygoutput,g&gdecreasedgspecificggravitygofgthegurinegwouldgbegnotedg
-gCorrectgAnswerg-gHyponatremia
Causativegfactorsgrelategtogmalnutritiongorgstarvationg>hegusegofgaluminumghydroxide-
basedgorgmagnesium-basedgantacids.gMalnutritiongisgassociatedgwithgalcoholism.g-
gCorrectgAnswerg-gHypophosphatemia
Renalginsufficiency,ghypoparathyroidism,g>umorglysisgsyndrome;gcausativegfactors.gShouldgavoidgfood
sghighgingphosphates;gfish,geggs,gmilkgproducts,gvegetables,gwholeggrains,g&gcarbonatedgbeverages.g-
CorrectgAnswerg-gHyperphosphatemia
Vomiting,gdiarrhea,gconditionsgthatgincreasedgrespiration'sgorgincreasedgurinarygoutput,ginsufficientgintr
avenousgfluidgreplacement,gdraininggfistulas,gpresencegofgileostomygorgcolostomy.gDiuretics,g&ggastroi
ntestinalgsuctioning.g-gCorrectgAnswerg-gCausesgofgagfluidgvolumegdeficit
pg.g4