Free NCLEX-RN Health Promotion questions
22 original Health Promotion questions on aging process / lifespan care, ante-, intra-, postpartum and newborn care, developmental stages and transitions, health promotion / disease prevention, in Next Generation NCLEX formats.
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NCLEX-RN Health Promotion questions
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At her first prenatal visit, a client reports that the first day of her last menstrual period was June 24, 2026. Her cycles are regular, every 28 days. Using Naegele's rule, which date will the nurse record as the estimated date of delivery?
Correct answer: C
Naegele's rule has three steps: subtract 3 months from the first day of the last menstrual period, add 7 days, then adjust the year. June 24 minus 3 months is March 24; adding 7 days gives March 31; because the date has moved into the next calendar year, the EDD is March 31, 2027. The rule assumes a 28-day cycle and the date is plus or minus 2 weeks.
- A This applies the month and day steps correctly but skips the final step of adjusting the year.
- B This subtracts 7 days instead of adding them.
- C Correct: June 24 minus 3 months is March 24, plus 7 days is March 31, and the year advances to 2027.
- D This subtracts 3 months and adjusts the year but leaves out the 7 days.
Learn this topic: Prenatal care: what each visit checks and which signs can't wait 5-minute lesson
Source: Open RN Nursing Health Promotion, 9.7 First Prenatal Visit ·
A client at 30 weeks' gestation comes for a routine prenatal visit. Her blood pressure at the last visit was 112/70 mm Hg. For each finding, indicate whether it is expected or requires follow-up.
Expected Requires follow-up Blood pressure 146/94 mm Hg Fetal heart rate 146/min Headache since yesterday that rest has not relieved Mild swelling of both ankles at the end of the day Fundal height 30 cm Puffiness around the eyes and swollen hands Select one option in each row.
Correct answer: Blood pressure 146/94 mm Hg: Requires follow-up; Fetal heart rate 146/min: Expected; Headache since yesterday that rest has not relieved: Requires follow-up; Mild swelling of both ankles at the end of the day: Expected; Fundal height 30 cm: Expected; Puffiness around the eyes and swollen hands: Requires follow-up
Routine prenatal findings are judged against expected ranges: a fetal heart rate of 110–160/min and a fundal height in centimeters that roughly equals the weeks of gestation between about 18 and 36 weeks. Some ankle swelling is normal in pregnancy. A new blood pressure of 140/90 mm Hg or higher after 20 weeks, a headache that does not go away and swelling of the face or hands are warning signs of a hypertensive disorder such as preeclampsia and need prompt follow-up.
- Blood pressure 146/94 mm Hg Requires follow-up: a new reading of 140/90 mm Hg or higher after 20 weeks suggests a hypertensive disorder such as preeclampsia.
- Fetal heart rate 146/min Expected: the fetal heart rate is within 110–160/min.
- Headache since yesterday that rest has not relieved Requires follow-up: a headache that will not go away is an urgent maternal warning sign.
- Mild swelling of both ankles at the end of the day Expected: some swelling of the feet and ankles is normal in pregnancy.
- Fundal height 30 cm Expected: at 30 weeks a fundal height of about 30 cm matches gestational age.
- Puffiness around the eyes and swollen hands Requires follow-up: swelling of the face, around the eyes or of the hands is a sign of preeclampsia, unlike dependent ankle swelling.
Learn this topic: Prenatal care: what each visit checks and which signs can't wait 5-minute lesson
Source: Open RN Nursing Health Promotion, 9.9 Second Trimester Prenatal Care · MedlinePlus Medical Encyclopedia: Preeclampsia · CDC Hear Her: Urgent Maternal Warning Signs ·
The nurse teaches a client at 32 weeks' gestation about fetal movement counts and warning signs. Which statements by the client indicate understanding of the teaching? Select all that apply.
Select all that apply.
Correct answer: A, C, D
Daily fetal movement counts in the third trimester should reach at least 10 movements within 2 hours. If the fetus has not moved within an hour, the client can eat or drink something, lie on her left side or walk briefly, then keep counting, and she calls the provider if there are fewer than 10 movements in 2 hours. Fever of 100.4°F or higher, leaking fluid and swelling of the face or hands are urgent warning signs that need care right away, not at the next visit.
- A Correct: the expected minimum is 10 fetal movements within 2 hours.
- B Incorrect: leaking fluid may mean rupture of membranes and needs care right away.
- C Correct: eating or drinking and lying on the left side are recommended when the fetus has not moved within an hour.
- D Correct: a fever of 100.4°F or higher is an urgent maternal warning sign.
- E Incorrect: swelling of the face and hands is a warning sign of preeclampsia, not a normal finding.
- F Incorrect: fetal movement counts are done daily in the third trimester, not only when the client feels ill.
Learn this topic: Prenatal care: what each visit checks and which signs can't wait 5-minute lesson
Source: Open RN Nursing Health Promotion, 9.10 Third Trimester Prenatal Care · CDC Hear Her: Urgent Maternal Warning Signs · Open RN Nursing Health Promotion, 9.9 Second Trimester Prenatal Care ·
One minute after birth, the nurse assesses a newborn: heart rate 132/min; slow, irregular breathing with a weak cry; some flexion of the arms and legs with little movement; cries and pulls away when the soles are flicked; pink body with blue hands and feet. What is the newborn's 1-minute Apgar score?
Correct answer: B
Score each Apgar sign 0, 1 or 2 and add them. Heart rate above 100/min = 2; slow, irregular, weak breathing = 1; some flexion with little movement = 1; crying and pulling away on stimulation = 2; pink body with blue extremities (acrocyanosis) = 1. The total of 7 is in the normal 7–10 range, so routine care continues.
- A This scores the heart rate as 1, but any rate above 100/min earns 2 points.
- B Correct: 2 (heart rate) + 1 (respirations) + 1 (tone) + 2 (grimace) + 1 (color) = 7.
- C This gives 2 points for tone or respirations, but flexion with little movement and a weak, irregular cry each earn only 1.
- D This gives full points for color and tone, but blue hands and feet score 1 and little movement scores 1.
Learn this topic: Assessing the newborn right after birth: Apgar, vital signs and warmth 5-minute lesson
Source: Open RN Nursing Health Promotion, 12.5 Applying the Nursing Process and Clinical Judgment Model to Newborn Care · MedlinePlus Medical Encyclopedia: Apgar score · OpenStax Maternal-Newborn Nursing, 22.1 Apgar Scoring ·
The nurse places an undressed newborn on an unwarmed metal scale. The newborn is losing heat mainly by . The best way to prevent this type of heat loss is to . If the newborn becomes chilled, the nurse should monitor for .
Choose the best option from each list to complete the sentence.
Correct answer: conduction; cover the scale with a warmed blanket; hypoglycemia
Conduction is heat loss through direct contact with a cooler surface, such as a cold scale, hands or stethoscope; it is prevented by warming or covering surfaces before the newborn touches them. Evaporation (wet skin), convection (moving air) and radiation (nearby cold objects not in contact) have different fixes. Cold stress raises the newborn's oxygen and glucose needs, so a chilled newborn is at risk for hypoglycemia.
- Conduction is correct because the skin is in direct contact with a cold surface; evaporation needs wet skin, convection needs moving air and radiation involves objects not touching the newborn.
- Covering the scale with a warmed blanket removes the cold contact surface; drying, turning off a fan and moving away from a window target evaporation, convection and radiation.
- Hypoglycemia is correct because cold stress increases glucose use; a bulging fontanelle and high blood pressure are not effects of cold stress.
Learn this topic: Assessing the newborn right after birth: Apgar, vital signs and warmth 5-minute lesson
Source: OpenStax Maternal-Newborn Nursing, 22.3 Neutral Thermal Environment · Open RN Nursing Health Promotion, 12.5 Applying the Nursing Process and Clinical Judgment Model to Newborn Care ·
One hour after birth, the nurse assesses a term newborn. For each finding, indicate whether it is expected or requires follow-up.
Expected Requires follow-up Heart rate 148/min Nasal flaring and grunting with each breath Bluish hands and feet with a pink trunk Axillary temperature 97.0°F (36.1°C) Respiratory rate 50/min with brief pauses of 5 to 8 seconds Bluish color of the lips and tongue Select one option in each row.
Correct answer: Heart rate 148/min: Expected; Nasal flaring and grunting with each breath: Requires follow-up; Bluish hands and feet with a pink trunk: Expected; Axillary temperature 97.0°F (36.1°C): Requires follow-up; Respiratory rate 50/min with brief pauses of 5 to 8 seconds: Expected; Bluish color of the lips and tongue: Requires follow-up
Normal newborn values are a heart rate of 120–160/min, a respiratory rate of 40–60/min with periodic breathing (pauses of up to about 10 seconds), and a core temperature of 97.7–99.5°F (36.5–37.5°C). Acrocyanosis of the hands and feet is expected in the first 24–48 hours. Nasal flaring, grunting, central cyanosis and a temperature below the normal range are abnormal and must be reported and treated.
- Heart rate 148/min Expected: 148/min is within the newborn range of 120–160/min.
- Nasal flaring and grunting with each breath Requires follow-up: nasal flaring and grunting are signs of respiratory distress.
- Bluish hands and feet with a pink trunk Expected: acrocyanosis is normal in the first 24–48 hours.
- Axillary temperature 97.0°F (36.1°C) Requires follow-up: 97.0°F (36.1°C) is below the normal 97.7–99.5°F (36.5–37.5°C) range and signals heat loss.
- Respiratory rate 50/min with brief pauses of 5 to 8 seconds Expected: short pauses within an otherwise normal rate are periodic breathing; only pauses longer than 20 seconds are reported.
- Bluish color of the lips and tongue Requires follow-up: blue lips and tongue are central cyanosis, which points to poor oxygenation.
Learn this topic: Assessing the newborn right after birth: Apgar, vital signs and warmth 5-minute lesson
The nurse assesses a 9-month-old infant at a well-child visit. Which finding requires follow-up?
Correct answer: D
CDC milestones are skills most children (75% or more) can do by a given age, so a missed milestone needs follow-up and screening. By 9 months most infants sit without support, babble sounds like "mamamama," and are shy or fearful with strangers. Walking alone is listed at 18 months and saying "mama" or "dada" as a name at 1 year, so their absence at 9 months is not yet a concern.
- A Expected: shyness, clinginess or fear around strangers is a 9-month milestone.
- B Expected: walking without holding on is an 18-month milestone.
- C Expected: at 9 months infants babble; calling a parent "mama" or "dada" is a 1-year milestone.
- D Correct: sitting without support is a 9-month movement milestone, so its absence needs follow-up.
Learn this topic: Growth and development milestones from birth to adolescence 6-minute lesson
Source: CDC Milestones by 9 Months · CDC Milestones by 18 Months · CDC Learn the Signs. Act Early: Milestones ·
The nurse reviews a developmental history for a 24-month-old child. For each finding, indicate whether it is expected for age or requires follow-up.
Expected for age Requires follow-up Runs and kicks a ball No longer says the words she used at 18 months Does not walk unless holding on to furniture Puts two words together, such as "more milk" Is not yet understood by strangers most of the time Does not point to show the parent something interesting Select one option in each row.
Correct answer: Runs and kicks a ball: Expected for age; No longer says the words she used at 18 months: Requires follow-up; Does not walk unless holding on to furniture: Requires follow-up; Puts two words together, such as "more milk": Expected for age; Is not yet understood by strangers most of the time: Expected for age; Does not point to show the parent something interesting: Requires follow-up
Compare the child with the milestones most children reach by each age, and treat any loss of skills as a reason to act early. Running, kicking a ball and two-word phrases are 2-year milestones. Walking without holding on and pointing to share interest are expected by 18 months, so their absence at 24 months is a missed milestone. Being understood by others most of the time is listed at 3 years.
- Runs and kicks a ball Expected: running and kicking a ball are 2-year movement milestones.
- No longer says the words she used at 18 months Requires follow-up: losing skills a child once had always calls for early action and screening.
- Does not walk unless holding on to furniture Requires follow-up: walking without holding on is expected by 18 months.
- Puts two words together, such as "more milk" Expected: saying at least two words together is a 2-year language milestone.
- Is not yet understood by strangers most of the time Expected: talking well enough for others to understand most of the time is a 3-year milestone.
- Does not point to show the parent something interesting Requires follow-up: pointing to show something interesting is expected by 18 months.
Learn this topic: Growth and development milestones from birth to adolescence 6-minute lesson
Source: CDC Milestones by 18 Months · CDC Milestones by 2 Years · CDC Milestones by 3 Years · CDC Learn the Signs. Act Early: Milestones ·
A 4-year-old whose younger sister was just admitted with pneumonia tells the nurse, "She got sick because I yelled at her." Which response by the nurse is best?
Correct answer: A
Preschoolers are in Piaget's preoperational stage and use magical thinking, so they may believe their own behavior caused an illness. The nurse supports the child by giving a simple explanation and reassuring the child that the illness is not their fault. Detailed factual explanations fit school-age children in the concrete operational stage.
- A Correct: it gives a simple, direct reassurance that the child did not cause the illness.
- B Incorrect: a detailed explanation of infection suits a school-age child and does not address the child's guilt.
- C Incorrect: asking why the child yelled reinforces the belief that the yelling caused the illness.
- D Incorrect: postponing the conversation leaves the child's guilt unaddressed.
Learn this topic: Growth and development milestones from birth to adolescence 6-minute lesson
Source: Open RN Nursing Health Promotion, 13.2 Developmental Theories · Open RN Nursing Health Promotion, 13.3 Stages of Child Development ·
History
Priya Raman, 26 years old, G1 P0, 33 weeks' gestation. Routine prenatal visit. No history of high blood pressure or kidney disease. Prenatal course normal until today.
Nurses' Notes
Prenatal clinic, 1000: Client reports a headache since last evening that rest and acetaminophen have not relieved. States she has been "seeing spots" since waking this morning. Reports her rings feel tight and her face looks puffy. Also reports mild ankle swelling at the end of the day for the past 2 weeks. Denies vaginal bleeding, leaking of fluid or contractions. Reports fetal movement as usual. Swelling noted around both eyes and in both hands. Fundal height 33 cm. Fetal heart rate 144/min by Doppler.
Vital Signs
Time BP Pulse Resp Temp SpO2 31 weeks (last visit) 116/72 mm Hg 80/min 16/min 98.2°F (36.8°C) 99% Today 1000 152/98 mm Hg 88/min 18/min 98.4°F (36.9°C) 98% Today 1015 (repeat, seated) 154/100 mm Hg 86/min 18/min — 98% Laboratory Results (collected 1030)
Test Result Normal range Urine protein (dipstick) 2+ Negative Urine glucose (dipstick) Negative Negative Hemoglobin 12.4 g/dL 12–15 g/dL Platelets 168,000/mm³ 150,000–400,000/mm³ AST 26 U/L 5–30 U/L ALT 24 U/L 5–30 U/L Creatinine 0.9 mg/dL 0.8–1.3 mg/dL Click to highlight the findings from today's clinic visit that require immediate follow-up.
1000–1030: Client reports . States she has been since waking. Reports . Also reports for the past 2 weeks. Reports . Fetal heart rate . Repeat blood pressure . Urine dipstick .
Click each part of the text to highlight it. Click again to remove the highlight.
Correct answer: a headache since last evening that rest and acetaminophen have not relieved; "seeing spots"; her rings feel tight and her face looks puffy; 154/100 mm Hg; protein 2+
Recognizing cues means picking out the findings that are new, abnormal and dangerous. A headache that will not go away, vision changes, swelling of the face or hands, a blood pressure of 140/90 mm Hg or higher after 20 weeks and protein in the urine are all warning signs of a hypertensive disorder of pregnancy. Dependent ankle swelling, usual fetal movement and a fetal heart rate within 110–160/min are expected.
- a headache since last evening that rest and acetaminophen have not relieved Highlight: a headache that does not go away is an urgent maternal warning sign.
- "seeing spots" Highlight: vision changes such as seeing spots are a warning sign of preeclampsia.
- her rings feel tight and her face looks puffy Highlight: swelling of the hands and face is a warning sign, unlike ankle swelling.
- mild ankle swelling at the end of the day Do not highlight: some swelling of the feet and ankles is normal in pregnancy.
- fetal movement as usual Do not highlight: usual fetal movement is reassuring.
- 144/min Do not highlight: 144/min is within the expected fetal range of 110–160/min.
- 154/100 mm Hg Highlight: a new blood pressure of 140/90 mm Hg or higher after 20 weeks needs prompt follow-up.
- protein 2+ Highlight: protein in the urine after 20 weeks with high blood pressure suggests preeclampsia.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: CDC Hear Her: Urgent Maternal Warning Signs · Open RN Nursing Health Promotion, 9.9 Second Trimester Prenatal Care · MedlinePlus Medical Encyclopedia: Preeclampsia · Open RN Nursing Health Promotion, 19.5 High Blood Pressure Disorders of Pregnancy ·
History
Priya Raman, 26 years old, G1 P0, 33 weeks' gestation. Routine prenatal visit. No history of high blood pressure or kidney disease. Prenatal course normal until today.
Nurses' Notes
Prenatal clinic, 1000: Client reports a headache since last evening that rest and acetaminophen have not relieved. States she has been "seeing spots" since waking this morning. Reports her rings feel tight and her face looks puffy. Also reports mild ankle swelling at the end of the day for the past 2 weeks. Denies vaginal bleeding, leaking of fluid or contractions. Reports fetal movement as usual. Swelling noted around both eyes and in both hands. Fundal height 33 cm. Fetal heart rate 144/min by Doppler.
Vital Signs
Time BP Pulse Resp Temp SpO2 31 weeks (last visit) 116/72 mm Hg 80/min 16/min 98.2°F (36.8°C) 99% Today 1000 152/98 mm Hg 88/min 18/min 98.4°F (36.9°C) 98% Today 1015 (repeat, seated) 154/100 mm Hg 86/min 18/min — 98% Laboratory Results (collected 1030)
Test Result Normal range Urine protein (dipstick) 2+ Negative Urine glucose (dipstick) Negative Negative Hemoglobin 12.4 g/dL 12–15 g/dL Platelets 168,000/mm³ 150,000–400,000/mm³ AST 26 U/L 5–30 U/L ALT 24 U/L 5–30 U/L Creatinine 0.9 mg/dL 0.8–1.3 mg/dL The nurse analyzes the client's data. For each finding, indicate whether it supports or does not support preeclampsia.
Supports preeclampsia Does not support preeclampsia Blood pressure rise from 116/72 to 154/100 mm Hg at 33 weeks Ankle swelling at the end of the day Urine protein 2+ Fetal heart rate 144/min Swelling around the eyes and in both hands Platelets 168,000/mm³ Select one option in each row.
Correct answer: Blood pressure rise from 116/72 to 154/100 mm Hg at 33 weeks: Supports preeclampsia; Ankle swelling at the end of the day: Does not support preeclampsia; Urine protein 2+: Supports preeclampsia; Fetal heart rate 144/min: Does not support preeclampsia; Swelling around the eyes and in both hands: Supports preeclampsia; Platelets 168,000/mm³: Does not support preeclampsia
Preeclampsia develops after 20 weeks of gestation and shows as high blood pressure (often 140/90 mm Hg or higher) with signs of organ involvement such as protein in the urine, plus symptoms such as headache, vision changes and swelling of the face and hands. Findings that are normal for pregnancy, such as end-of-day ankle swelling, a fetal heart rate of 110–160/min and a platelet count within 150,000–400,000/mm³, do not support the diagnosis.
- Blood pressure rise from 116/72 to 154/100 mm Hg at 33 weeks Supports: a new blood pressure of 140/90 mm Hg or higher after 20 weeks is the key sign of preeclampsia.
- Ankle swelling at the end of the day Does not support: some swelling of the feet and ankles is normal in pregnancy.
- Urine protein 2+ Supports: proteinuria reflects kidney involvement in preeclampsia.
- Fetal heart rate 144/min Does not support: the fetal heart rate is within the expected 110–160/min.
- Swelling around the eyes and in both hands Supports: swelling of the face, around the eyes and of the hands is a sign of preeclampsia.
- Platelets 168,000/mm³ Does not support: the platelet count is normal; a low count would suggest worsening disease.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: MedlinePlus Medical Encyclopedia: Preeclampsia · OpenStax Maternal-Newborn Nursing, 12.2 Conditions Limited to Pregnancy · Open RN Nursing Health Promotion, 9.9 Second Trimester Prenatal Care · Open RN Nursing Health Promotion, Appendix A Normal Reference Ranges · Open RN Nursing Health Promotion, 19.5 High Blood Pressure Disorders of Pregnancy ·
History
Priya Raman, 26 years old, G1 P0, 33 weeks' gestation. Routine prenatal visit. No history of high blood pressure or kidney disease. Prenatal course normal until today.
Nurses' Notes
Prenatal clinic, 1000: Client reports a headache since last evening that rest and acetaminophen have not relieved. States she has been "seeing spots" since waking this morning. Reports her rings feel tight and her face looks puffy. Also reports mild ankle swelling at the end of the day for the past 2 weeks. Denies vaginal bleeding, leaking of fluid or contractions. Reports fetal movement as usual. Swelling noted around both eyes and in both hands. Fundal height 33 cm. Fetal heart rate 144/min by Doppler.
Vital Signs
Time BP Pulse Resp Temp SpO2 31 weeks (last visit) 116/72 mm Hg 80/min 16/min 98.2°F (36.8°C) 99% Today 1000 152/98 mm Hg 88/min 18/min 98.4°F (36.9°C) 98% Today 1015 (repeat, seated) 154/100 mm Hg 86/min 18/min — 98% Laboratory Results (collected 1030)
Test Result Normal range Urine protein (dipstick) 2+ Negative Urine glucose (dipstick) Negative Negative Hemoglobin 12.4 g/dL 12–15 g/dL Platelets 168,000/mm³ 150,000–400,000/mm³ AST 26 U/L 5–30 U/L ALT 24 U/L 5–30 U/L Creatinine 0.9 mg/dL 0.8–1.3 mg/dL The client is most likely experiencing , as shown by . Without treatment, the nurse is most concerned that the client will develop .
Choose the best option from each list to complete the sentence.
Correct answer: preeclampsia; new hypertension with proteinuria after 20 weeks; seizures (eclampsia)
The client had a normal blood pressure at 31 weeks and now has a pressure above 140/90 mm Hg with proteinuria, headache, vision changes and facial swelling, which fits preeclampsia rather than chronic hypertension. The priority concern is the most life-threatening complication: untreated preeclampsia can damage vital organs and progress to seizures (eclampsia). Nurses detect and report high blood pressure early so it can be managed before convulsions occur.
- Preeclampsia is correct; chronic hypertension would be present before 20 weeks, the urine glucose is negative, and a migraine does not explain the blood pressure and proteinuria.
- New hypertension with proteinuria after 20 weeks defines the picture; ankle swelling and a normal fetal heart rate are expected, and the blood pressure was normal at 31 weeks.
- Seizures (eclampsia) are the feared progression of untreated preeclampsia; Rh sensitization, hyperemesis gravidarum and placenta previa are not complications of preeclampsia.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: OpenStax Maternal-Newborn Nursing, 12.2 Conditions Limited to Pregnancy · MedlinePlus Medical Encyclopedia: Preeclampsia · Open RN Nursing Health Promotion, 9.6 Prenatal Care and Reducing Maternal Mortality · Open RN Nursing Health Promotion, 9.9 Second Trimester Prenatal Care · Open RN Nursing Health Promotion, 19.5 High Blood Pressure Disorders of Pregnancy ·
History
Priya Raman, 26 years old, G1 P0, 33 weeks' gestation. Routine prenatal visit. No history of high blood pressure or kidney disease. Prenatal course normal until today.
Nurses' Notes
Prenatal clinic, 1000: Client reports a headache since last evening that rest and acetaminophen have not relieved. States she has been "seeing spots" since waking this morning. Reports her rings feel tight and her face looks puffy. Also reports mild ankle swelling at the end of the day for the past 2 weeks. Denies vaginal bleeding, leaking of fluid or contractions. Reports fetal movement as usual. Swelling noted around both eyes and in both hands. Fundal height 33 cm. Fetal heart rate 144/min by Doppler.
Vital Signs
Time BP Pulse Resp Temp SpO2 31 weeks (last visit) 116/72 mm Hg 80/min 16/min 98.2°F (36.8°C) 99% Today 1000 152/98 mm Hg 88/min 18/min 98.4°F (36.9°C) 98% Today 1015 (repeat, seated) 154/100 mm Hg 86/min 18/min — 98% Laboratory Results (collected 1030)
Test Result Normal range Urine protein (dipstick) 2+ Negative Urine glucose (dipstick) Negative Negative Hemoglobin 12.4 g/dL 12–15 g/dL Platelets 168,000/mm³ 150,000–400,000/mm³ AST 26 U/L 5–30 U/L ALT 24 U/L 5–30 U/L Creatinine 0.9 mg/dL 0.8–1.3 mg/dL The client is admitted to labor and delivery. The provider suspects preeclampsia with severe features. Which actions should the nurse include in the plan of care? Select all that apply.
Select all that apply.
Correct answer: A, C, E
A client with preeclampsia with severe features is hospitalized and monitored until blood pressure is stable or birth occurs. The nurse plans frequent vital signs and neurologic checks, because hyperreflexia and clonus warn of seizure risk, and continuous electronic fetal monitoring of the fetal heart rate and contractions as ordered. Sending the client home ignores a potentially life-threatening condition.
- A Correct: frequent blood pressure and neurologic checks detect worsening preeclampsia.
- B Incorrect: severe features require hospital monitoring, not a routine follow-up visit.
- C Correct: hyperreflexia and clonus are warning signs of seizure risk.
- D Incorrect: the glucose challenge screens for gestational diabetes and does not address this problem.
- E Correct: electronic fetal monitoring evaluates fetal heart rate and uterine contractions.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: OpenStax Maternal-Newborn Nursing, 12.2 Conditions Limited to Pregnancy · MedlinePlus Medical Encyclopedia: Preeclampsia · Open RN Nursing Health Promotion, 19.5 High Blood Pressure Disorders of Pregnancy ·
History
Priya Raman, 26 years old, G1 P0, 33 weeks' gestation. Routine prenatal visit. No history of high blood pressure or kidney disease. Prenatal course normal until today.
Nurses' Notes
Prenatal clinic, 1000: Client reports a headache since last evening that rest and acetaminophen have not relieved. States she has been "seeing spots" since waking this morning. Reports her rings feel tight and her face looks puffy. Also reports mild ankle swelling at the end of the day for the past 2 weeks. Denies vaginal bleeding, leaking of fluid or contractions. Reports fetal movement as usual. Swelling noted around both eyes and in both hands. Fundal height 33 cm. Fetal heart rate 144/min by Doppler.
Vital Signs
Time BP Pulse Resp Temp SpO2 31 weeks (last visit) 116/72 mm Hg 80/min 16/min 98.2°F (36.8°C) 99% Today 1000 152/98 mm Hg 88/min 18/min 98.4°F (36.9°C) 98% Today 1015 (repeat, seated) 154/100 mm Hg 86/min 18/min — 98% Laboratory Results (collected 1030)
Test Result Normal range Urine protein (dipstick) 2+ Negative Urine glucose (dipstick) Negative Negative Hemoglobin 12.4 g/dL 12–15 g/dL Platelets 168,000/mm³ 150,000–400,000/mm³ AST 26 U/L 5–30 U/L ALT 24 U/L 5–30 U/L Creatinine 0.9 mg/dL 0.8–1.3 mg/dL Magnesium sulfate IV is prescribed to prevent seizures. Which actions should the nurse take? Select all that apply.
Select all that apply.
Correct answer: B, D, E
Magnesium sulfate is a high-alert medication given to prevent preeclampsia from progressing to seizures, and its main danger is toxicity. Safe care uses an infusion pump to control the dose and rate, monitors respirations, deep tendon reflexes and urine output, and keeps calcium gluconate, the antidote, readily available. If toxicity signs appear, the nurse stops the infusion and notifies the provider; any significant change in the client or the fetal heart rate is reported right away.
- A Incorrect: a gravity infusion cannot control the rate safely; a pump is required.
- B Correct: an infusion pump sets limits and ensures the correct dose and rate.
- C Incorrect: significant fetal heart rate changes must be reported immediately, not held until the end of the shift.
- D Correct: respirations, deep tendon reflexes and urine output are monitored because respiratory depression, loss of reflexes and decreased urine output are signs of magnesium toxicity.
- E Correct: calcium gluconate is the antidote for magnesium toxicity and should be readily available, usually at the bedside.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: OpenStax Maternal-Newborn Nursing, 12.2 Conditions Limited to Pregnancy · Open RN Nursing Health Promotion, 19.5 High Blood Pressure Disorders of Pregnancy ·
History
Priya Raman, 26 years old, G1 P0, 33 weeks' gestation. Routine prenatal visit. No history of high blood pressure or kidney disease. Prenatal course normal until today.
Nurses' Notes
Prenatal clinic, 1000: Client reports a headache since last evening that rest and acetaminophen have not relieved. States she has been "seeing spots" since waking this morning. Reports her rings feel tight and her face looks puffy. Also reports mild ankle swelling at the end of the day for the past 2 weeks. Denies vaginal bleeding, leaking of fluid or contractions. Reports fetal movement as usual. Swelling noted around both eyes and in both hands. Fundal height 33 cm. Fetal heart rate 144/min by Doppler.
Vital Signs
Time BP Pulse Resp Temp SpO2 31 weeks (last visit) 116/72 mm Hg 80/min 16/min 98.2°F (36.8°C) 99% Today 1000 152/98 mm Hg 88/min 18/min 98.4°F (36.9°C) 98% Today 1015 (repeat, seated) 154/100 mm Hg 86/min 18/min — 98% Laboratory Results (collected 1030)
Test Result Normal range Urine protein (dipstick) 2+ Negative Urine glucose (dipstick) Negative Negative Hemoglobin 12.4 g/dL 12–15 g/dL Platelets 168,000/mm³ 150,000–400,000/mm³ AST 26 U/L 5–30 U/L ALT 24 U/L 5–30 U/L Creatinine 0.9 mg/dL 0.8–1.3 mg/dL Four hours after the magnesium sulfate infusion and a prescribed antihypertensive medication were started, the nurse reassesses the client. For each finding, indicate whether it shows the plan is effective or requires immediate follow-up.
Effective Requires immediate follow-up Blood pressure 138/88 mm Hg Respiratory rate 10/min Headache rated 2/10, down from 7/10 Patellar reflexes absent States the spots in her vision are gone Fetal heart rate baseline 140/min Select one option in each row.
Correct answer: Blood pressure 138/88 mm Hg: Effective; Respiratory rate 10/min: Requires immediate follow-up; Headache rated 2/10, down from 7/10: Effective; Patellar reflexes absent: Requires immediate follow-up; States the spots in her vision are gone: Effective; Fetal heart rate baseline 140/min: Effective
Evaluating outcomes means comparing new data with the goals: a lower blood pressure, relief of headache and vision changes and a fetal heart rate within 110–160/min show the plan is working. At the same time the nurse watches for magnesium toxicity. A respiratory rate below 16/min and absent deep tendon reflexes are toxicity signs: the nurse stops the infusion, notifies the provider and has calcium gluconate ready.
- Blood pressure 138/88 mm Hg Effective: blood pressure has fallen below 140/90 mm Hg from 154/100 mm Hg with antihypertensive treatment.
- Respiratory rate 10/min Requires immediate follow-up: respirations should be at least 16/min during magnesium therapy, so 10/min signals respiratory depression from magnesium toxicity.
- Headache rated 2/10, down from 7/10 Effective: the headache, a warning sign of worsening preeclampsia, is easing.
- Patellar reflexes absent Requires immediate follow-up: loss of deep tendon reflexes is the first sign of magnesium toxicity.
- States the spots in her vision are gone Effective: resolution of vision changes shows improvement.
- Fetal heart rate baseline 140/min Effective: the fetal heart rate is within the expected 110–160/min.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: OpenStax Maternal-Newborn Nursing, 12.2 Conditions Limited to Pregnancy · Open RN Nursing Health Promotion, 9.9 Second Trimester Prenatal Care · Open RN Nursing Health Promotion, 19.5 High Blood Pressure Disorders of Pregnancy ·
During an annual wellness visit, the nurse assesses a 78-year-old client. For each finding, indicate whether it is an expected age-related change or requires follow-up.
Expected age-related change Requires follow-up Holds the menu at arm's length to read it Reports a sudden shower of new floaters in the right eye Has trouble following conversation in a noisy restaurant Respiratory rate 26/min at rest, with visible effort to breathe Pulse takes longer than before to slow down after climbing stairs Thin skin that bruises more easily than it did years ago Select one option in each row.
Correct answer: Holds the menu at arm's length to read it: Expected age-related change; Reports a sudden shower of new floaters in the right eye: Requires follow-up; Has trouble following conversation in a noisy restaurant: Expected age-related change; Respiratory rate 26/min at rest, with visible effort to breathe: Requires follow-up; Pulse takes longer than before to slow down after climbing stairs: Expected age-related change; Thin skin that bruises more easily than it did years ago: Expected age-related change
Many changes are expected with aging: trouble focusing on near objects (presbyopia), loss of high-frequency hearing with trouble hearing over background noise (presbycusis), a slower heart-rate recovery after exercise and thinner skin with fragile vessels that bruise easily. A sudden increase in floaters can signal retinal detachment, and breathing rate usually does not change with age, so a fast, labored rate at rest needs follow-up. Separate expected aging from new or sudden changes.
- Holds the menu at arm's length to read it Expected: presbyopia, difficulty focusing on close-up objects, is the most common vision change with aging.
- Reports a sudden shower of new floaters in the right eye Requires follow-up: floaters that appear suddenly or rapidly increase can indicate a retinal detachment.
- Has trouble following conversation in a noisy restaurant Expected: presbycusis often makes conversation hard to follow when there is background noise.
- Respiratory rate 26/min at rest, with visible effort to breathe Requires follow-up: breathing rate usually does not change with age, and 26/min with effort is above the adult range of 12–20/min.
- Pulse takes longer than before to slow down after climbing stairs Expected: with aging, the pulse takes longer to rise and to slow back down after exercise.
- Thin skin that bruises more easily than it did years ago Expected: the outer skin thins and dermal blood vessels become more fragile, so older adults bruise more easily.
Source: MedlinePlus Medical Encyclopedia: Aging changes in the senses · MedlinePlus Medical Encyclopedia: Aging changes in vital signs · MedlinePlus Medical Encyclopedia: Aging changes in skin · Open RN Nursing Skills 2e, 10.3 Respiratory Assessment ·
A client in active labor is receiving an oxytocin infusion. The nurse notes repeated decreases in the fetal heart rate that begin during each contraction and return to baseline only after the contraction ends. Which action should the nurse take?
Correct answer: A
Decelerations that start during a contraction and recover only after it ends are late decelerations, which signal uteroplacental insufficiency and fetal hypoxia. Oxytocin can cause tachysystole, which reduces blood flow to the placenta. Nursing actions are to stop the oxytocin, turn the client to her left side, give fluids for maternal hypotension and notify the provider.
- A Correct: for late decelerations, the nurse stops the oxytocin and changes the client to a left lateral position, then notifies the provider.
- B Incorrect: more oxytocin can cause tachysystole and further reduce blood flow to the placenta.
- C Incorrect: early decelerations from head compression mirror the contraction; these start late and recover after it ends.
- D Incorrect: a left side-lying position improves placental blood flow; lying flat on the back does not.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: Open RN Nursing Health Promotion, 10.5 Fetal Heart Rate Monitoring ·
On the first day after a vaginal birth, the nurse expects lochia . To check the fundus, the nurse places one hand on the fundus and uses the other hand to . A peripad saturated within is a heavy amount that the nurse reports promptly.
Choose the best option from each list to complete the sentence.
Correct answer: rubra, red; support the lower uterus above the pubic bone; 1 hour
Lochia rubra (red) is expected for the first 1 to 3 days, followed by pinkish-brown lochia serosa and then yellow-white lochia alba. During a fundal check, one hand supports the lower uterus near the symphysis pubis while the other locates the fundus. Saturating a peripad within 1 hour, or clots larger than a golf ball, is a heavy amount that suggests postpartum hemorrhage.
- Rubra: lochia rubra, bright to dark red, is expected during the first 1 to 3 days after birth.
- Support the lower uterus: the second hand supports the uterus near the symphysis pubis during the fundal check.
- 1 hour: a peripad saturated in 1 hour or clots larger than a golf ball are reported as suspected postpartum hemorrhage.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: Open RN Nursing Health Promotion, 11.2 Postpartum Physiological Adaptations · Open RN Nursing Health Promotion, 11.5 Applying the Nursing Process and the Clinical Judgment Model to Postpartum Care ·
The nurse cares for a client in the active phase of labor at 7 cm. For each finding, indicate whether it is expected or requires follow-up.
Expected Requires follow-up Contractions every 3 minutes, lasting 60 seconds Fetal heart rate baseline 135/min with moderate variability Cannot talk during contractions and is focused inward Green-tinged amniotic fluid after the membranes rupture Gradual decelerations that mirror each contraction Fetal heart rate baseline of 172/min for the past 15 minutes Select one option in each row.
Correct answer: Contractions every 3 minutes, lasting 60 seconds: Expected; Fetal heart rate baseline 135/min with moderate variability: Expected; Cannot talk during contractions and is focused inward: Expected; Green-tinged amniotic fluid after the membranes rupture: Requires follow-up; Gradual decelerations that mirror each contraction: Expected; Fetal heart rate baseline of 172/min for the past 15 minutes: Requires follow-up
In the active phase (6 to 10 cm), contractions last 40 to 90 seconds and come every 2 to 5 minutes, and clients often turn inward and cannot talk through contractions. A baseline of 110 to 160/min with moderate variability is reassuring, and early decelerations from head compression are common in active labor. Amniotic fluid should be clear; green or yellow fluid suggests meconium, and a baseline above 160/min for 10 minutes is fetal tachycardia, often from maternal fever.
- Contractions every 3 minutes, lasting 60 seconds Expected: active-phase contractions last 40 to 90 seconds and occur every 2 to 5 minutes.
- Fetal heart rate baseline 135/min with moderate variability Expected: a baseline of 110 to 160/min with moderate variability indicates a well-oxygenated fetus.
- Cannot talk during contractions and is focused inward Expected: becoming inwardly focused and unable to talk during contractions are signs of active labor.
- Green-tinged amniotic fluid after the membranes rupture Requires follow-up: amniotic fluid should be clear; green or yellow fluid is associated with meconium.
- Gradual decelerations that mirror each contraction Expected: early decelerations from head compression mirror contractions and are common in active labor.
- Fetal heart rate baseline of 172/min for the past 15 minutes Requires follow-up: a baseline above 160/min for 10 minutes is fetal tachycardia, and maternal fever is the most common cause.
Learn this topic: Labor and postpartum care: the stages, the fetal heart rate and the checks after birth 6-minute lesson
Source: Open RN Nursing Health Promotion, 10.3 Labor · Open RN Nursing Health Promotion, 10.5 Fetal Heart Rate Monitoring · Open RN Nursing Health Promotion, 10.10 Applying the Nursing Process and Clinical Judgment Model to Labor and Delivery Care ·
Four clients are due for a vaccine at a clinic today. Which finding is a reason for the nurse to withhold the vaccine and notify the provider?
Correct answer: B
A contraindication is a condition that increases the risk of a serious adverse reaction, and a severe allergic reaction such as anaphylaxis after a previous dose or to a vaccine component is a contraindication. Mild acute illness with or without fever, current antimicrobial therapy and allergies to nonvaccine substances such as penicillin are not reasons to withhold a vaccine. Moderate or severe acute illness is a precaution, and vaccination is usually deferred.
- A Incorrect: a mild acute illness with or without fever is not a contraindication or precaution.
- B Correct: a severe allergic reaction such as anaphylaxis after a previous dose is a contraindication.
- C Incorrect: current antimicrobial therapy is not a reason to withhold a vaccine.
- D Incorrect: a penicillin allergy or other nonvaccine allergy is not a contraindication.
Learn this topic: Immunizations and adult screening: what to give, when to hold it and who to screen 6-minute lesson
Source: CDC: Contraindications and Precautions (General Best Practice Guidelines for Immunization) ·
The nurse reviews the CDC adult immunization schedule with a group of adult clients. Which teaching points are correct? Select all that apply.
Select all that apply.
Correct answer: B, C, E
The CDC adult schedule gives influenza vaccine once a year, a Td or Tdap booster every 10 years, 1 dose of Tdap during each pregnancy (preferably early in weeks 27 to 36) and 2 doses of recombinant zoster vaccine 2 to 6 months apart for adults 50 and older. MMR and varicella are live vaccines that are contraindicated during pregnancy; a nonimmune client receives them after the birth, before discharge.
- A Incorrect: MMR is contraindicated during pregnancy; it is given after birth, before discharge.
- B Correct: after the primary series and a Tdap dose, Td or Tdap is given every 10 years.
- C Correct: adults receive 1 dose of an age-appropriate influenza vaccine every year.
- D Incorrect: 1 dose of Tdap is recommended during each pregnancy.
- E Correct: adults 50 and older receive a 2-dose series of recombinant zoster vaccine 2 to 6 months apart.
- F Incorrect: varicella vaccine is contraindicated during pregnancy.
Learn this topic: Immunizations and adult screening: what to give, when to hold it and who to screen 6-minute lesson
Source: CDC: Adult Immunization Schedule Notes · CDC: Adult Immunization Schedule by Age ·
The nurse plans care for several clients. For each intervention, indicate the level of prevention it represents.
Primary Secondary Tertiary Giving a healthy adult the yearly influenza vaccine Offering hepatitis C screening to a 40-year-old with no symptoms Teaching a client with heart failure to limit sodium to avoid readmission Teaching a teen soccer team to apply sunscreen before practice Measuring blood pressure in a 30-year-old at a routine visit Showing a client with long-standing COPD how to pace daily activities Select one option in each row.
Correct answer: Giving a healthy adult the yearly influenza vaccine: Primary; Offering hepatitis C screening to a 40-year-old with no symptoms: Secondary; Teaching a client with heart failure to limit sodium to avoid readmission: Tertiary; Teaching a teen soccer team to apply sunscreen before practice: Primary; Measuring blood pressure in a 30-year-old at a routine visit: Secondary; Showing a client with long-standing COPD how to pace daily activities: Tertiary
Primary prevention stops illness before it starts, through immunizations and healthy behaviors. Secondary prevention finds disease early through screening, often before symptoms appear. Tertiary prevention reduces the severity and effects of a disease the client already has, such as by teaching self-management of a chronic condition.
- Giving a healthy adult the yearly influenza vaccine Primary: immunizations prevent disease before it occurs.
- Offering hepatitis C screening to a 40-year-old with no symptoms Secondary: screening adults aged 18 to 79 for hepatitis C detects infection early, before symptoms.
- Teaching a client with heart failure to limit sodium to avoid readmission Tertiary: teaching self-management of existing heart failure reduces the severity of established disease.
- Teaching a teen soccer team to apply sunscreen before practice Primary: sunscreen use is a healthy behavior that prevents skin damage before disease develops.
- Measuring blood pressure in a 30-year-old at a routine visit Secondary: blood pressure screening of adults 18 and older finds hypertension early.
- Showing a client with long-standing COPD how to pace daily activities Tertiary: helping a client manage an existing chronic disease maintains function and quality of life.
Learn this topic: Immunizations and adult screening: what to give, when to hold it and who to screen 6-minute lesson
Source: Open RN Nursing Health Promotion, 2.2 Health, Wellness, and Disease Prevention · Open RN Nursing Health Promotion, 2.4 Secondary Prevention · Open RN Nursing Health Promotion, 2.5 Tertiary Prevention · USPSTF: A and B Recommendations ·
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NCLEX-RN format
| Client needs category | Share of the exam |
|---|---|
| Management of Care | 15–21% |
| Safety and Infection Prevention and Control | 10–16% |
| Health Promotion and Maintenance | 6–12% |
| Psychosocial Integrity | 6–12% |
| Basic Care and Comfort | 6–12% |
| Pharmacological and Parenteral Therapies | 13–19% |
| Reduction of Risk Potential | 9–15% |
| Physiological Adaptation | 11–17% |
The exam has 85 to 150 questions in up to 5 hours, including 15 unscored pretest questions and three unfolding case studies. An on-screen calculator is provided.
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