2023 Nclex Final Exam Readiness Study Guide
(May-August QTR). With 100% Correct
Answers & Rationale Graded A+ (Guaranteed
Pass)
,Question: 1
Correct Answer: 2
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests
Rationale
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating
increased systemic circulation volume and increased right ventricular preload. Pulmonary artery
wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left
ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-
sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop
diuretic that will decrease both left- and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with
increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure
and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg,
methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right
ventricular preload and left ventricular preload.
Question: 2
Correct Answer: 2
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks."
,Rationale
, A cervical cerclage is placed to prevent preterm delivery, usually in clients with histories of
second trimester loss or premature birth. A heavy suture is placed transvaginally or
transabdominally to keep the internal cervical os closed. Placement occurs at 12–14 weeks
gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical
dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical
insufficiency (eg, short cervix) are noted.
Discharge instructions include activity restriction and recognition of signs of preterm
labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes (Option
2).
(Option 1) Bed rest is usually recommended for a few days after the procedure. Long-term bed
rest is individualized but uncommon and increases the risk for complications (eg, deep vein
thrombosis). Pelvic rest (eg, avoiding sexual intercourse) is determined by the health care
provider.
(Option 3) Mild abdominal cramping following cerclage placement is common; however,
regular contractions, pelvic pressure, and low back aches may indicate preterm labor.
(Option 4) The cerclage remains in place until 36–37 weeks gestation. Early removal is
indicated by rupture of membranes (to prevent infection) or preterm labor (to prevent damage to
the cervix as it dilates).
Educational objective:
Following cerclage placement, discharge teaching includes recognizing and reporting signs of
preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of membranes and
(May-August QTR). With 100% Correct
Answers & Rationale Graded A+ (Guaranteed
Pass)
,Question: 1
Correct Answer: 2
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests
Rationale
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating
increased systemic circulation volume and increased right ventricular preload. Pulmonary artery
wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left
ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-
sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop
diuretic that will decrease both left- and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with
increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure
and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg,
methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right
ventricular preload and left ventricular preload.
Question: 2
Correct Answer: 2
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks."
,Rationale
, A cervical cerclage is placed to prevent preterm delivery, usually in clients with histories of
second trimester loss or premature birth. A heavy suture is placed transvaginally or
transabdominally to keep the internal cervical os closed. Placement occurs at 12–14 weeks
gestation for clients with a history of cervical insufficiency (ie, painless, premature cervical
dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical
insufficiency (eg, short cervix) are noted.
Discharge instructions include activity restriction and recognition of signs of preterm
labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes (Option
2).
(Option 1) Bed rest is usually recommended for a few days after the procedure. Long-term bed
rest is individualized but uncommon and increases the risk for complications (eg, deep vein
thrombosis). Pelvic rest (eg, avoiding sexual intercourse) is determined by the health care
provider.
(Option 3) Mild abdominal cramping following cerclage placement is common; however,
regular contractions, pelvic pressure, and low back aches may indicate preterm labor.
(Option 4) The cerclage remains in place until 36–37 weeks gestation. Early removal is
indicated by rupture of membranes (to prevent infection) or preterm labor (to prevent damage to
the cervix as it dilates).
Educational objective:
Following cerclage placement, discharge teaching includes recognizing and reporting signs of
preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of membranes and
