NCLEX-PN Test #13 3 — Questions and Answers
Question 1: A client calls the clinic to report she missed her combined oral contraceptive pill for 2 days. What advice should the nurse provide?
- Stop the pack and restart when her period begins
- Take both missed pills today, take today's pill as scheduled, and use backup contraception for 7 days (Correct answer)
- Take all missed pills at once and then continue the pack as usual
- Skip the missed pills and continue taking one pill per day from the current day
Correct answer: Take both missed pills today, take today's pill as scheduled, and use backup contraception for 7 days
For 2 consecutive missed combined oral contraceptive pills: take the most recently missed pill as soon as remembered (even if it means 2 pills in one day), discard the earlier missed pill, continue with the rest of the pack on schedule, and use backup contraception (condom) for 7 days. The risk of ovulation increases significantly with 2+ missed pills.
Question 2: A client presents for her annual gynecological exam. She is 30 years old and has had normal Pap smear results for the past 10 years. What is the current recommended Pap smear screening interval for this client?
- Every year
- Every 3 years (Pap alone) or every 5 years (Pap + HPV co-test) (Correct answer)
- Every 5 years starting at age 30 (Pap alone)
- Every 2 years
Correct answer: Every 3 years (Pap alone) or every 5 years (Pap + HPV co-test)
Per USPSTF and ACOG guidelines, women aged 30–65 may screen every 3 years with a Pap smear alone, every 5 years with HPV testing alone, or every 5 years with Pap + HPV co-testing. Women aged 21–29 should have a Pap smear every 3 years without HPV co-testing.
Question 3: The nurse is caring for a client who is 16 weeks pregnant and is scheduled for an amniocentesis. What is the primary purpose of amniocentesis at this gestational age?
- To assess fetal lung maturity
- To detect chromosomal abnormalities such as Down syndrome (trisomy 21) (Correct answer)
- To determine the amniotic fluid index
- To screen for gestational diabetes
Correct answer: To detect chromosomal abnormalities such as Down syndrome (trisomy 21)
Amniocentesis performed at 15–20 weeks gestation is primarily used for genetic testing — to detect chromosomal abnormalities (trisomy 21, trisomy 18, 13), neural tube defects (elevated AFP), and inherited metabolic disorders. Fetal lung maturity amniocentesis is performed in the third trimester.
Question 4: A client reports symptoms of menopause including hot flashes, vaginal dryness, and mood changes. She asks about hormone replacement therapy (HRT). Which statement by the nurse is most accurate?
- "HRT has no significant risks and should be taken for as long as your symptoms persist."
- "HRT is absolutely contraindicated for all women with any menopausal symptoms."
- "HRT is effective for symptom relief but carries increased risks including blood clots and breast cancer; benefits and risks should be individualized." (Correct answer)
- "Natural supplements are always safer and equally effective as HRT."
Correct answer: "HRT is effective for symptom relief but carries increased risks including blood clots and breast cancer; benefits and risks should be individualized."
HRT effectively relieves menopausal symptoms but carries risks: increased venous thromboembolism, breast cancer (with combined estrogen-progestin), and cardiovascular events. Current guidelines recommend using the lowest effective dose for the shortest time needed, individualized to the client's symptoms, risk factors, and preferences.
Question 5: A client with a history of ectopic pregnancy presents with severe, sharp lower quadrant pain, shoulder pain, and light-headedness. Which intervention is the priority?
- Obtain a urine pregnancy test and schedule an outpatient ultrasound
- Establish IV access, draw type and crossmatch, and prepare for possible emergency surgery (Correct answer)
- Administer NSAIDs for pain and observe for 2 hours
- Perform a pelvic examination to determine cervical dilation
Correct answer: Establish IV access, draw type and crossmatch, and prepare for possible emergency surgery
A ruptured ectopic pregnancy causes internal hemorrhage. Severe lower quadrant pain, referred shoulder pain (diaphragmatic irritation from blood), and light-headedness indicate hemodynamic compromise. This is a surgical emergency requiring: IV access × 2, blood type and crossmatch, fluid resuscitation, and urgent surgical intervention to control hemorrhage.
Question 6: The nurse is teaching a client about breast self-examination (BSE). When should a premenopausal client perform BSE?
- Daily, at the same time each morning
- Monthly, on the first day of the menstrual period
- Monthly, 5–7 days after the start of the menstrual period (Correct answer)
- Every 6 months, before her gynecologist appointment
Correct answer: Monthly, 5–7 days after the start of the menstrual period
Premenopausal women should perform BSE monthly, 5–7 days after the start of menstruation, when breast tissue is least tender and swollen (hormone levels are lowest). At the beginning of the period, estrogen-driven engorgement can make the exam less accurate. Postmenopausal women should select a consistent day each month.
NCLEX-PN Test #13 3
A client calls the clinic to report she missed her combined oral contraceptive pill for 2 days.
What advice should the nurse provide?