NCLEX-RN Exam Actual Questions and Answers with {NGN} Case Study with solutions

NCLEX-RN Exam Actual Questions and Answers with {NGN} Case Study with solutions Question #1 A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric examination with the nurse practitioner to determine the status of her possible pregnancy. Her last menstrual period began May 20, and her estimated date of confinement using Ngeles rule is: • A. March 27 • B. February 1 • C. February 27 • D. January 3 Correct Answer: C ️ (A)March 27 is a miscalculation. (B) February 1 is a miscalculation. (C) February 27 is the correct answer. To calculate the estimated date of confinement using Nageles rule, subtract 3 months from the date that the last menstrual cycle began and then add 7 days to the result. (D) January 3 is a miscalculation. Question #2 The nurse practitioner determines that a client is approximately 9 weeks gestation. During the visit, the practitioner informs the client about symptoms of physical changes that she will experience during her first trimester, such as: • A. Nausea and vomiting • B. Quickening • C. A 6–8 lb weight gain • D. Abdominal enlargement Correct Answer: A ️ (A) Nausea and vomiting are experienced by almost half of all pregnant women during the first 3 months of pregnancy as a result of elevated human chorionic gonadotropin levels and changed carbohydrate metabolism. (B) Quickening is the mothers perception of fetal movement and generally does not occur until 1820 weeks after the last menstrual period in primigravidas, but it may occur as early as 16 weeks in multigravidas. (C) During the first trimester there should be only a modest weight gain of 24 lb. It is not uncommon for women to lose weight during the first trimester owing to nausea and/or vomiting. (D) Physical changes are not apparent until the second trimester, when the uterus rises out of the pelvis. Case Study: Patient Profile: Jane Smith, a 32-year-old female, presents to the emergency department with complaints of severe abdominal pain, nausea, and vomiting. She has a medical history of cholecystitis and a previous cholecystectomy. She reports that the pain started in the right upper quadrant and has since radiated to her right shoulder. She denies any recent trauma or illness. Assessment Findings: Vital signs: Blood pressure 130/80 mmHg, heart rate 90 bpm, respiratory rate 18 bpm, temperature 37.2°C (99°F) Abdominal examination reveals tenderness in the right upper quadrant with guarding Laboratory results: Complete blood count: WBC 14,000/mm³, hemoglobin 13.5 g/dL, hematocrit 40% Liver function tests: Elevated levels of AST, ALT, and total bilirubin Amylase and lipase levels within normal range Diagnosis: Based on the patient's symptoms, history of cholecystitis, and physical examination findings, the nurse suspects acute pancreatitis. Plan of Care: Pain management: Administer analgesics as prescribed, such as intravenous morphine, to alleviate pain and promote patient comfort. Assess pain levels regularly using a pain scale and adjust medication dosages accordingly. Monitor for any adverse effects of pain medications, such as respiratory depression or sedation. Nausea and vomiting management: Administer antiemetic medications, such as ondansetron, to control nausea and vomiting. Encourage the patient to avoid oral intake until nausea subsides to prevent further discomfort and potential exacerbation of symptoms. Provide frequent oral hygiene to relieve dry mouth and promote patient comfort. Monitoring and supportive measures: Monitor vital signs regularly, including temperature, heart rate, blood pressure, and respiratory rate, to assess for any signs of deterioration or complications. Maintain strict intake and output records to monitor fluid balance and detect any signs of dehydration. Insert a nasogastric tube if necessary to decompress the stomach and relieve gastrointestinal symptoms. NPO (nothing by mouth) and bowel rest: