NCLEX RN NEXT GEN WITH CASE STUDIES 2023 UPDATE

NCLEX RN NEXT GEN  135 QUESTIONS AND ANSWERS  5 CASE STUDY  130 QUESTIONS  2023 1. A client is 10 minutes postpartum from a forceps delivery of a 4500-gram Down syndrome neonate over a right mediolateral episiotomy. The client is at risk for each of the following nursing diagnoses. Which of the diagnoses is highest priority at this time? 2. Fluid volume deficit. 2. A client is postpartum 24 hours from a spontaneous vaginal delivery with rupture of membranes for 42 hours. Which of the following signs/symptoms should the nurse report to the client’s health care practitioner? 1. Foul-smelling lochia. 3. A 4-month-old male infant is brought into the pediatric clinic by his mother. She reports that she Noted over the past several weeks that her baby’s lips and mouth and his fingernails and toenails have become bluish-gray color. She also states that he seems to tire easily and that even nursing seems to wear him out. Lately, he has had several spells where he has suddenly turned blue, has had difficulty breathing, and has been very irritable. During one of these spells, he became limp and seemed to have passed out for a short time. An echocardiogram reveals a thickening of the right ventricular wall with an overriding aorta, a large subaortic ventricular septal defect, and narrowing of the pulmonary outflow with stenosis of the pulmonary valve. A. What is this infant's probable diagnosis? From the case description, the child possesses a birth defect that is affecting the blood flow. The blood vessels have not formed correctly leading to challenges in blood flow and other adverse effects as described by the case. The infant can thus be probably diagnosed with Tetralogy of Fallot. B. Describe the shunting of the blood that occurs with this disorder and its relationship to the development of cyanosis It is known that tetralogy of Fallot is a congenital heart defect. It is a disorder that comprises four various conditions namely: pulmonary stenosis, overriding of the aorta, ventricular septal defect, and ventricular hypertrophy. Pulmonary stenosis conditions obstruct the blood flow from the right ventricle. This obstruction increases the pressure in the right ventricular and thus shunts blood from the right ventricle to the left ventricle. The ventricular septal defect leads to a mixing of oxygenated and deoxygenated blood. A ventricular septal defect is a hole within the walls that separate the two lower chambers of the heart. As a result of a mixed up, the blood that is pumped for circulation will be poorly oxygenated. The situation results in cyanotic appearance in affected infants due to lack of oxygen. 4. The nurse is performing a gestational age assessment on a full-term newborn during the first hour of transition using the Ballard (Dubowitz) scale. Based on this assessment, the nurse determines that the neonate has a maturity rating of 40-weeks. What findings should the nurse identify to determine if the neonate is small for gestational age (SGA)? (Select all that apply.) A. Admission weight of 4 pounds, 15 ounces (2244 grams) B. Head to heel length of 17 inches (42.5 cm). C. Frontal occipital circumference of 12.5 inches (31.25 cm). 5. A client at 20 weeks gestation comes to the antepartum clinic complaining of vaginal warts (human papillomavirus). What information should the nurse provide this client? A. Treatment options, while limited due to the pregnancy, are available 6. One week after missing her menstrual period, a woman performs an OTC pregnancy test and it is positive. Which hormone is responsible for producing the positive result? C. Human chorionic gonadotrophin 7. A new mother, who is lacto-ovo vegetarian, plans to breastfeed her infant. What information should the nurse provide prior to discharge? B. Continue prenatal vitamins with B12 while breast feeding 8. A nurse is preparing to provide discharge teaching to a client who is newly diagnoses with diabetes mellitus. Which of the following statements by the client indicates a readiness to learn? I’d like to wait until my partner is here so that we can both learn together 9. A home health nurse is preparing to make an initial visit to a family following a referral from a local provider. Identify the sequence of steps the nurse should take when conducting a home visit. Clarify the reason for the referral with the providers office Contact the family to determine availability and readiness to make an appointment Identify family needs and interventions using the nursing process Discuss plans for future visits with the family Record information about the home visit according to agency policy While treatments aimed toward stabiRachaeling B.W.'s respiratory and volume status are started, you begin the secondary survey. G). During your assessment, you note the following ecchymotic areas on B.W.'s abdomen. What might this signify? Liver and spleen damage/laceration 27. The nurse has been assigned a group of cardiac clients. What would be the most important information for the nurse to check on the initial evaluation of each client? Select all that apply: Presence of cardiac pain. Presence of jugular vein distention. Heart sounds and apical rate. Presence of diaphoresis. 28. A client with generalized anxiety disorder does not want to communicate with friends, smokes 2 to 3 packages of cigarettes a day, and describes difficulty concentrating at work. Which coping strategy should the nurse include in the plan of care? Focus on small achievable tasks, not taxing problems. 29. The nurse is assessing a 3-month-old infant who had a pylorotomy yesterday. This child should be medicated for pain based on which findings? (Select all that apply.) Restlessness. Increased respiratory rate. Clenched fists. Increased pulse rate 30. Rachael is a G2 P1001 who came in at 1510 in labor. Her water broke at 1835, she received an epidural for labor and was started on Pitocin to augment her labor at 2130 after her labor stalled out at 2100. Her BP has been elevated throughout her labor and went up to 210/110 so she was started on Magnesium Sulfate 2gm/hr at 2145. She delivered a 9-pound male at 2300 after 10 minutes of pushing and had a third-degree laceration. EBL was 500mL.