NCLEX-PN Test #13 3

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?

Accepted Answer

Take both missed pills today, take today's pill as scheduled, and use backup contraception for 7 days

Answer

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?

Accepted Answer

Every 3 years (Pap alone) or every 5 years (Pap + HPV co-test)

Answer

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?

Accepted Answer

To detect chromosomal abnormalities such as Down syndrome (trisomy 21)

Answer

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?

Accepted Answer

"HRT is effective for symptom relief but carries increased risks including blood clots and breast cancer; benefits and risks should be individualized."

Answer

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?

Accepted Answer

Establish IV access, draw type and crossmatch, and prepare for possible emergency surgery

Answer

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.

NCLEX Practice Test

NCLEX Practice Test

NCLEX-PN Test #13 3