2026/2027 NCLEX FINAL EXAM READINESS
x x x x x
STUDY GUIDE WITH 100% CORRECT ANS
x x x x x
WERS & RATIONALE GRADED A+ (GUARA
x x x x x
NTEED PASS) x
Question:x1
CorrectxAnswer:x2
xWhatxinterventionxisxessentialxpriorxtoxstartingxaxclientxonxatorvastatinxtherapy?
1. Assessingxforxmusclexstrength
2. Assessingxthexclient'sxdietaryxintake
3. Determiningxifxthexclientxisxonxdigoxinxtherapy
4. Monitoringxliverxfunctionxtests
Rationale
Thexclient'sxcentralxvenousxpressurex(CVP)xisxelevatedx(normalxvaluex2-
8xmmxHg),xindicatingxincreasedxsystemicxcirculationxvolumexandxincreasedxrightxventricularxprelo
ad.xPulmonaryxarteryxwedgexpressurex(PAWP)xisxalsoxelevatedx(normalxvaluex6-
12xmmxHg),xindicatingxincreasedxleftxventricularxpreload.xInxthexpresencexofxincreasedxCVPxandxP
AWP,xcoarsexcracklesxindicatexleft-
xsidedxfailure.xThextreatmentxgoalxisxtoxdecreasexfluidxvolumexandxpreload.xFurosemidexisxaxloopxdi
ureticxthatxwillxdecreasexbothxleft-xandxright-sidedxpreload.
(Optionx1)xAxfluidxbolusxofx500xmLxofxsodiumxchloridexisxcontraindicatedxinxaxclientxwithxincrease
dxleftxandxrightxventricularxpreloadxasxitxwouldxexacerbatexfluidxoverload.
(Optionx3)xBetaxblockersx(eg,xmetoprolol,xatenolol,xesmolol)xwillxdecreasexbothxbloodxpressurexan
dxafterload.xxHowever,xtheyxwillxnotxdecreasexpreload.
(Optionx4)xVancomycinxisxanxantibioticxusedxtoxtreatxgram-
positivexbacterialxinfectionsx(eg,xmethicillin-
xresistantxStaphylococcusxaureus);xitxhasxnoxeffectxonxfluidxstatus.
Educationalxobjective:
Loopxdiureticsx(eg,xfurosemide,xbumetanide,xtorsemide)xarexeffectivexinxdecreasingxbothxrightxv
entricularxpreloadxandxleftxventricularxpreload.
Question:x2
CorrectxAnswer:x2
Thexnursexprovidesxdischargexinstructionsxtoxaxclientxatx14xweeksxgestationxwhoxhasxreceivedxaxprophylact
icxcervicalxcerclage.x Whichxclientxstatementxindicatesxanxunderstandingxofxteaching?
1. "Ixneedxtoxbexonxbedxrestxforxthexdurationxofxmyxpregnancy."
2. "IxwillxnotifyxmyxhealthxcarexproviderxifxIxstartxhavingxlowxbackxaches."
, 3. "Pelvicxpressurexisxtoxbexexpectedxafterxcerclagexplacement."
4. "Thexcerclagexwillxbexremovedxoncexmyxbabyxisxatx28xweeks."
Rationale
Axcervicalxcerclagexisxplacedxtoxpreventxpretermxdelivery,xusuallyxinxclientsxwithxhistoriesxofxs
econdxtrimesterxlossxorxprematurexbirth.xAxheavyxsuturexisxplacedxtransvaginallyxorxtransabdomi
nallyxtoxkeepxthexinternalxcervicalxosxclosed.xPlacementxoccursxatx12–
14xweeksxgestationxforxclientsxwithxaxhistoryxofxcervicalxinsufficiencyx(ie,xpainless,xprematurexc
ervicalxdilationxandxmiscarriagexorxpretermxdelivery)xorxupxtox23xweeksxgestationxifxsignsxofxcerv
icalxinsufficiencyx(eg,xshortxcervix)xarexnoted.
Dischargexinstructionsxincludexactivityxrestrictionxandxrecognitionxofxsignsxofxpreterm
laborx(eg,xlowxbackxaches,xcontractions,xpelvicxpressure)xandxrupturexofxmembranesx(Optionx2
).
(Optionx1)xBedxrestxisxusuallyxrecommendedxforxaxfewxdaysxafterxthexprocedure.xLong-
termxbedxrestxisxindividualizedxbutxuncommonxandxincreasesxthexriskxforxcomplicationsx(eg,xdeepxv
einxthrombosis).xPelvicxrestx(eg,xavoidingxsexualxintercourse)xisxdeterminedxbyxthexhealthxcarexpro
vider.
(Optionx3)xMildxabdominalxcrampingxfollowingxcerclagexplacementxisxcommon;xhowever,xregular
xcontractions,xpelvicxpressure,xandxlowxbackxachesxmayxindicatexpretermxlabor.
(Optionx4)xThexcerclagexremainsxinxplacexuntilx36–
37xweeksxgestation.xEarlyxremovalxisxindicatedxbyxrupturexofxmembranesx(toxpreventxinfection)xorx
pretermxlaborx(toxpreventxdamagextoxthexcervixxasxitxdilates).
Educationalxobjective:
Followingxcerclagexplacement,xdischargexteachingxincludesxrecognizingxandxreportingxsignsxofxp
retermxlaborx(eg,xlowxbackxaches,xcontractions,xpelvicxpressure)xorxrupturexofxmembranesxandxun
,derstandingxactivityxrestrictionsx(eg,xbedxrestxforxaxshortxtimexafterxplacement)
Question:x3
, CorrectxAnswer:x1
Duringxthexfirstxprenatalxassessment,xthexclientxreportsxthexlastxnormalxmenstrualxperiodxstartingxon
xMarchx1xandxendingxonxMarchx5,xbutxalsoxslightxspottingxonxMarchx23.xThexclientxhadxunprotected
xintercoursexonxMarchx15.x UsingxNaegele'sxrule,xwhatxisxthexestimatedxdatexofxbirth?
1. Decemberx8
2. Decemberx12
3. Decemberx22
4. Decemberx30
Rationale
Variousxmethodsxtoxdeterminexthexestimatedxdatexofxbirthx(EDB)xincludexusexofxNaegele'sxrule,xu
ltrasound,xuterinexheightxmeasurementx(McDonald'sxmeasurement),xandxauscultationxofxfetalxhear
txratexwithxaxDopplerxdevice.xThexmostxaccuratexdatingxofxpregnancyxinvolvesxusexofxultrasoundxar
oundxthex16th-
18thxweekxofxpregnancy.xHowever,xNaegele'sxrulexcanxbexusedxtoxquicklyxdeterminexanxEDBxearl
yxinxthexpregnancy.xThisxcalculationxusesxthexdatexofxthexfirstxdayxofxthexlastxnormalxmenstrualxperi
odx(LMP)xforxdeterminationxofxEDB.
EDBx=x(LMPxminusx3xmonths)x+x7xdays
Thisxclient'sxLMPxisxMarchx1,xminusx3xmonthsx=xDecemberx1.xAddx7xdaysxtoxobtainxEDBx=xDecem
berx8.
ClientsxwhoxconceivexinxJanuary,xFebruary,xandxmostxofxMarchxwillxdeliverxinxthexcurrent
year.xThosexwhoxconceivexafterxMarchxwillxdeliverxinxthexfollowingxyear;xasxaxresult,xaxthirdxstepxisx
addingx1xtoxthexcurrentxyearxtoxdeterminexthexestimatedxdatexofxbirth.xForxexample,xLMPxofxMayx1
0,x2014,xwouldxhavexanxEDBxofxFebruaryx17,x2015.
ItxisximportantxtoxnotexthatxNaegele'sxrulexisxbasedxonxaxclientxhavingxaxmenstrualxcyclexofx28xdays.
x Itxthereforexmayxnotxbexasxaccuratexifxthexclientxhasxaxshorterxorxlongerxmenstrualxcycle.
(Optionx2)xUsingxthexlastxdayxofxthexLMPxtoxcalculatexEDBxprovidesxanxinaccuratexduexdatexasxclie
ntsxmayxhavexvaryingxlengthsxofxmenstrualxbleeding.
(Optionx3)xConceptionxoccursxaroundxthextimexofxovulationxandxisxaboutx14xdaysxfromxthexbeginni
ngxofxthexLMP.xEggsxarexfertilexforxaboutx12-
24xhoursxafterxovulationxwithxspermxablextoxremainxfertilexforx24-
72xhours.xImplantationxofxthextrophoblastxoccursxaboutx7-
10xdaysxafterxfertilization.xUsingxthexconceptionxdatexcalculatesxthexgestationalxagexofxthexembryox
approximatelyx2xweeksxlaterxthanxthextruexgestationalxage.
(Optionx4)xSpottingxaroundxthextimexthexnextxmenstrualxperiodxisxduexmayxbexconsideredxnormalxa
ndxisxprobablyxcausedxbyximplantationxofxthextrophoblastxintoxthexuterinexendometrial
lining.xThisxisxnotxconsideredxaxproblem,xbutxusingxthisxoccurrencextoxdatexthexpregnancyxerroneou
slyxdelaysxthexEDBxbyx4xweeks.xItxisximportantxtoxcalculatexEDBxfromxthexbeginningxofxthexlastxnor
malxmenstrualxperiod.
Educationalxobjective:
Naegele'sxrulexprovidesxaxquickxdeterminationxofxthexestimatedxdatexofxbirthx(EDB).xEDBx=x(LM
Pxminusx3xmonths)x+x7xdays.xIfxthexLMPxoccursxinxJanuary,xFebruary,xorxMarch,xthexEDBxwillxbex
inxthexcurrentxyear.x IfxthexLMPxoccursxafterxMarch,xthexEDBxwillxbexinxthexnextxyear.
x x x x x
STUDY GUIDE WITH 100% CORRECT ANS
x x x x x
WERS & RATIONALE GRADED A+ (GUARA
x x x x x
NTEED PASS) x
Question:x1
CorrectxAnswer:x2
xWhatxinterventionxisxessentialxpriorxtoxstartingxaxclientxonxatorvastatinxtherapy?
1. Assessingxforxmusclexstrength
2. Assessingxthexclient'sxdietaryxintake
3. Determiningxifxthexclientxisxonxdigoxinxtherapy
4. Monitoringxliverxfunctionxtests
Rationale
Thexclient'sxcentralxvenousxpressurex(CVP)xisxelevatedx(normalxvaluex2-
8xmmxHg),xindicatingxincreasedxsystemicxcirculationxvolumexandxincreasedxrightxventricularxprelo
ad.xPulmonaryxarteryxwedgexpressurex(PAWP)xisxalsoxelevatedx(normalxvaluex6-
12xmmxHg),xindicatingxincreasedxleftxventricularxpreload.xInxthexpresencexofxincreasedxCVPxandxP
AWP,xcoarsexcracklesxindicatexleft-
xsidedxfailure.xThextreatmentxgoalxisxtoxdecreasexfluidxvolumexandxpreload.xFurosemidexisxaxloopxdi
ureticxthatxwillxdecreasexbothxleft-xandxright-sidedxpreload.
(Optionx1)xAxfluidxbolusxofx500xmLxofxsodiumxchloridexisxcontraindicatedxinxaxclientxwithxincrease
dxleftxandxrightxventricularxpreloadxasxitxwouldxexacerbatexfluidxoverload.
(Optionx3)xBetaxblockersx(eg,xmetoprolol,xatenolol,xesmolol)xwillxdecreasexbothxbloodxpressurexan
dxafterload.xxHowever,xtheyxwillxnotxdecreasexpreload.
(Optionx4)xVancomycinxisxanxantibioticxusedxtoxtreatxgram-
positivexbacterialxinfectionsx(eg,xmethicillin-
xresistantxStaphylococcusxaureus);xitxhasxnoxeffectxonxfluidxstatus.
Educationalxobjective:
Loopxdiureticsx(eg,xfurosemide,xbumetanide,xtorsemide)xarexeffectivexinxdecreasingxbothxrightxv
entricularxpreloadxandxleftxventricularxpreload.
Question:x2
CorrectxAnswer:x2
Thexnursexprovidesxdischargexinstructionsxtoxaxclientxatx14xweeksxgestationxwhoxhasxreceivedxaxprophylact
icxcervicalxcerclage.x Whichxclientxstatementxindicatesxanxunderstandingxofxteaching?
1. "Ixneedxtoxbexonxbedxrestxforxthexdurationxofxmyxpregnancy."
2. "IxwillxnotifyxmyxhealthxcarexproviderxifxIxstartxhavingxlowxbackxaches."
, 3. "Pelvicxpressurexisxtoxbexexpectedxafterxcerclagexplacement."
4. "Thexcerclagexwillxbexremovedxoncexmyxbabyxisxatx28xweeks."
Rationale
Axcervicalxcerclagexisxplacedxtoxpreventxpretermxdelivery,xusuallyxinxclientsxwithxhistoriesxofxs
econdxtrimesterxlossxorxprematurexbirth.xAxheavyxsuturexisxplacedxtransvaginallyxorxtransabdomi
nallyxtoxkeepxthexinternalxcervicalxosxclosed.xPlacementxoccursxatx12–
14xweeksxgestationxforxclientsxwithxaxhistoryxofxcervicalxinsufficiencyx(ie,xpainless,xprematurexc
ervicalxdilationxandxmiscarriagexorxpretermxdelivery)xorxupxtox23xweeksxgestationxifxsignsxofxcerv
icalxinsufficiencyx(eg,xshortxcervix)xarexnoted.
Dischargexinstructionsxincludexactivityxrestrictionxandxrecognitionxofxsignsxofxpreterm
laborx(eg,xlowxbackxaches,xcontractions,xpelvicxpressure)xandxrupturexofxmembranesx(Optionx2
).
(Optionx1)xBedxrestxisxusuallyxrecommendedxforxaxfewxdaysxafterxthexprocedure.xLong-
termxbedxrestxisxindividualizedxbutxuncommonxandxincreasesxthexriskxforxcomplicationsx(eg,xdeepxv
einxthrombosis).xPelvicxrestx(eg,xavoidingxsexualxintercourse)xisxdeterminedxbyxthexhealthxcarexpro
vider.
(Optionx3)xMildxabdominalxcrampingxfollowingxcerclagexplacementxisxcommon;xhowever,xregular
xcontractions,xpelvicxpressure,xandxlowxbackxachesxmayxindicatexpretermxlabor.
(Optionx4)xThexcerclagexremainsxinxplacexuntilx36–
37xweeksxgestation.xEarlyxremovalxisxindicatedxbyxrupturexofxmembranesx(toxpreventxinfection)xorx
pretermxlaborx(toxpreventxdamagextoxthexcervixxasxitxdilates).
Educationalxobjective:
Followingxcerclagexplacement,xdischargexteachingxincludesxrecognizingxandxreportingxsignsxofxp
retermxlaborx(eg,xlowxbackxaches,xcontractions,xpelvicxpressure)xorxrupturexofxmembranesxandxun
,derstandingxactivityxrestrictionsx(eg,xbedxrestxforxaxshortxtimexafterxplacement)
Question:x3
, CorrectxAnswer:x1
Duringxthexfirstxprenatalxassessment,xthexclientxreportsxthexlastxnormalxmenstrualxperiodxstartingxon
xMarchx1xandxendingxonxMarchx5,xbutxalsoxslightxspottingxonxMarchx23.xThexclientxhadxunprotected
xintercoursexonxMarchx15.x UsingxNaegele'sxrule,xwhatxisxthexestimatedxdatexofxbirth?
1. Decemberx8
2. Decemberx12
3. Decemberx22
4. Decemberx30
Rationale
Variousxmethodsxtoxdeterminexthexestimatedxdatexofxbirthx(EDB)xincludexusexofxNaegele'sxrule,xu
ltrasound,xuterinexheightxmeasurementx(McDonald'sxmeasurement),xandxauscultationxofxfetalxhear
txratexwithxaxDopplerxdevice.xThexmostxaccuratexdatingxofxpregnancyxinvolvesxusexofxultrasoundxar
oundxthex16th-
18thxweekxofxpregnancy.xHowever,xNaegele'sxrulexcanxbexusedxtoxquicklyxdeterminexanxEDBxearl
yxinxthexpregnancy.xThisxcalculationxusesxthexdatexofxthexfirstxdayxofxthexlastxnormalxmenstrualxperi
odx(LMP)xforxdeterminationxofxEDB.
EDBx=x(LMPxminusx3xmonths)x+x7xdays
Thisxclient'sxLMPxisxMarchx1,xminusx3xmonthsx=xDecemberx1.xAddx7xdaysxtoxobtainxEDBx=xDecem
berx8.
ClientsxwhoxconceivexinxJanuary,xFebruary,xandxmostxofxMarchxwillxdeliverxinxthexcurrent
year.xThosexwhoxconceivexafterxMarchxwillxdeliverxinxthexfollowingxyear;xasxaxresult,xaxthirdxstepxisx
addingx1xtoxthexcurrentxyearxtoxdeterminexthexestimatedxdatexofxbirth.xForxexample,xLMPxofxMayx1
0,x2014,xwouldxhavexanxEDBxofxFebruaryx17,x2015.
ItxisximportantxtoxnotexthatxNaegele'sxrulexisxbasedxonxaxclientxhavingxaxmenstrualxcyclexofx28xdays.
x Itxthereforexmayxnotxbexasxaccuratexifxthexclientxhasxaxshorterxorxlongerxmenstrualxcycle.
(Optionx2)xUsingxthexlastxdayxofxthexLMPxtoxcalculatexEDBxprovidesxanxinaccuratexduexdatexasxclie
ntsxmayxhavexvaryingxlengthsxofxmenstrualxbleeding.
(Optionx3)xConceptionxoccursxaroundxthextimexofxovulationxandxisxaboutx14xdaysxfromxthexbeginni
ngxofxthexLMP.xEggsxarexfertilexforxaboutx12-
24xhoursxafterxovulationxwithxspermxablextoxremainxfertilexforx24-
72xhours.xImplantationxofxthextrophoblastxoccursxaboutx7-
10xdaysxafterxfertilization.xUsingxthexconceptionxdatexcalculatesxthexgestationalxagexofxthexembryox
approximatelyx2xweeksxlaterxthanxthextruexgestationalxage.
(Optionx4)xSpottingxaroundxthextimexthexnextxmenstrualxperiodxisxduexmayxbexconsideredxnormalxa
ndxisxprobablyxcausedxbyximplantationxofxthextrophoblastxintoxthexuterinexendometrial
lining.xThisxisxnotxconsideredxaxproblem,xbutxusingxthisxoccurrencextoxdatexthexpregnancyxerroneou
slyxdelaysxthexEDBxbyx4xweeks.xItxisximportantxtoxcalculatexEDBxfromxthexbeginningxofxthexlastxnor
malxmenstrualxperiod.
Educationalxobjective:
Naegele'sxrulexprovidesxaxquickxdeterminationxofxthexestimatedxdatexofxbirthx(EDB).xEDBx=x(LM
Pxminusx3xmonths)x+x7xdays.xIfxthexLMPxoccursxinxJanuary,xFebruary,xorxMarch,xthexEDBxwillxbex
inxthexcurrentxyear.x IfxthexLMPxoccursxafterxMarch,xthexEDBxwillxbexinxthexnextxyear.
