NCLEX-PN Test #6 2 Flashcards
6 cards from real NCLEX practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 NCLEX-PN Test #6 2 flashcards as text
A client at 34 weeks gestation presents with painless, bright red vaginal bleeding. Which condition does the nurse suspect?
Answer: Placenta previa
Painless, bright red vaginal bleeding in the third trimester is the hallmark of placenta previa (abnormal placental implantation over the cervical os). Abruptio placentae typically presents with painful, dark red bleeding and a rigid uterus. A vaginal examination is contraindicated until placenta previa is ruled out by ultrasound.
A client with preeclampsia is receiving IV magnesium sulfate. Which finding indicates magnesium toxicity?
Answer: Respiratory rate of 10 breaths per minute
Respiratory depression (rate < 12/min) is a sign of magnesium toxicity. Loss of deep tendon reflexes (areflexia) is the earliest sign of toxicity. Normal therapeutic monitoring includes DTRs every hour, urine output ≥25 mL/hr, and respirations ≥12/min. The antidote is calcium gluconate.
An APGAR score of 6 is assigned to a newborn at 1 minute. What is the priority nursing intervention?
Answer: Provide stimulation, dry the infant, and administer supplemental oxygen
APGAR 4–6 indicates moderate newborn depression requiring intervention. The initial actions are stimulation (rubbing back, flicking feet), drying, warming, and supplemental oxygen. Scores 0–3 require immediate resuscitation. Naloxone is only given for known opioid exposure causing respiratory depression.
The nurse is caring for a client with HELLP syndrome. Which laboratory findings are consistent with this diagnosis?
Answer: Hemolysis (low Hgb), elevated liver enzymes, low platelet count
HELLP syndrome stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. It is a severe variant of preeclampsia with potentially fatal complications including DIC, liver rupture, and placental abruption. Prompt delivery is the definitive treatment.
The PN is assessing a newborn at 24 hours of life and notes jaundice involving the face and upper chest. Which type of jaundice is this most likely?
Answer: Physiological jaundice — expected normal finding
Physiological jaundice appears after 24 hours of age and progresses in a head-to-toe pattern as bilirubin levels rise. It is caused by the breakdown of fetal hemoglobin and immature liver conjugation. Jaundice appearing within the first 24 hours of life is pathological and requires urgent evaluation.
A client at 38 weeks gestation has group B Streptococcus (GBS) positive culture. Which intrapartum nursing action is most important?
Answer: Administer prophylactic IV penicillin at least 4 hours before delivery
Intrapartum antibiotic prophylaxis (IAP) with IV penicillin G (or ampicillin) is the standard of care for GBS-positive clients. The goal is to achieve adequate antibiotic levels in the fetus/neonate to prevent early-onset GBS neonatal sepsis. At least 4 hours before delivery provides optimal protection.