NCLEX Practice Set 8 (Case Study #2) Time limit: 0 Exam Summary 0 of 6 Questions completed Questions: Information You have already completed the exam before. Hence you can not start it again. Exam is loading… You must sign in or sign up to start the exam. You must first complete the following: Results Exam complete. Results are being recorded. Results Your time: Time has elapsed You have reached 0 of 0 point(s), (0) Earned Point(s): 0 of 0, (0) 0 Essay(s) Pending (Possible Point(s): 0) Categories NCLEX Clinical Judgement 0% You have just completed NCLEX Practice Set 8. Take more practice sets or try our full-length exam and see how you do. Return to NCLEX Practice Sets Take Our Full-Length NCLEX Exam 1 2 3 4 5 6 Current Review Answered Correct Incorrect Question 1 of 6 1. Question Case Study Question 1 of 6 A 24-year-old G2P1 at 32 1/7 weeks gestation presents to the triage area of labor and delivery, complaining of abdominal and back pain. Nurses Notes: 1200. Client brought to triage and placed on fetal monitor/tocodynamometer. Fetal heart rate 145 baseline with moderate variability, 15×15 accelerations, no decelerations. Client complains of abdominal tightening every 5 minutes for the past 2 hours. Fetal fibronectin collected. ROMPlus collected to check for ruptured membranes. Cervical exam reveals cervical dilation of 1cm. Client reports history of cesarean section 5 years ago at 35 weeks gestation secondary to labor and breech presentation. 1230. Client continuing to have contractions, complaining of increasing pain. Toco shows contractions every 3-5 minutes. Fetal heart rate 155 baseline with moderate variability, 15×15 accelerations, no decelerations. Abdomen palpated during and after contractions, with uterus relaxing fully after contraction. Moderate amount of bloody mucus-like discharge noted upon exam. Cervical dilation 2.5cm. L&D Flowsheet: Time 1200 1230 Blood pressure 120/70 125/72 Heart rate 72 74 Respirations 18 18 Pulse oximetry 99% on RA 99% on RA Pain 5/10 7/10 Cervical dilation 1cm 2.5cm Labs: Lab Results Reference range Hematocrit 32% Males: 42-52% Females: 35-47% Hemoglobin 10 g/dL Males: 13-18 g/dL Females:12-16 g/dL WBC 9,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Fetal fibronectin Positive Negative ROMPlus Negative Negative >Which 4 findings are most significant? a. Increasing abdominal pain b. ROMPlus negative c. Fetal fibronectin positive d. Bloody discharge e. Fetal baseline 155bpm f. Cervical dilation of 2.5cm g. Hemoglobin level Correct Incorrect Question 2 of 6 2. Question Case Study Question 2 of 6 A 24-year-old G2P1 at 32 1/7 weeks gestation presents to the triage area of labor and delivery, complaining of abdominal and back pain. Nurses Notes: 1200. Client brought to triage and placed on fetal monitor/tocodynamometer. Fetal heart rate 145 baseline with moderate variability, 15×15 accelerations, no decelerations. Client complains of abdominal tightening every 5 minutes for the past 2 hours. Fetal fibronectin collected. ROMPlus collected to check for ruptured membranes. Cervical exam reveals cervical dilation of 1cm. Client reports history of cesarean section 5 years ago at 35 weeks gestation secondary to labor and breech presentation. 1230. Client continuing to have contractions, complaining of increasing pain. Toco shows contractions every 3-5 minutes. Fetal heart rate 155 baseline with moderate variability, 15×15 accelerations, no decelerations. Abdomen palpated during and after contractions, with uterus relaxing fully after contraction. Moderate amount of bloody mucus-like discharge noted upon exam. Cervical dilation 2.5cm. L&D Flowsheet: Time 1200 1230 Blood pressure 120/70 125/72 Heart rate 72 74 Respirations 18 18 Pulse oximetry 99% on RA 99% on RA Pain 5/10 7/10 Cervical dilation 1cm 2.5cm Labs: Lab Results Reference range Hematocrit 32% Males: 42-52% Females: 35-47% Hemoglobin 10 g/dL Males: 13-18 g/dL Females:12-16 g/dL WBC 9,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Fetal fibronectin Positive Negative ROMPlus Negative Negative >For each client finding, click to indicate if the finding is consistent with placental abruption, preterm labor, uterine rupture, or placenta previa. Each finding may support more than one type of condition. a. b. c. d. Correct Incorrect Question 3 of 6 3. Question Case Study Question 3 of 6 A 24-year-old G2P1 at 32 1/7 weeks gestation presents to the triage area of labor and delivery, complaining of abdominal and back pain. Nurses Notes: 1200. Client brought to triage and placed on fetal monitor/tocodynamometer. Fetal heart rate 145 baseline with moderate variability, 15×15 accelerations, no decelerations. Client complains of abdominal tightening every 5 minutes for the past 2 hours. Fetal fibronectin collected. ROMPlus collected to check for ruptured membranes. Cervical exam reveals cervical dilation of 1cm. Client reports history of cesarean section 5 years ago at 35 weeks gestation secondary to labor and breech presentation. 1230. Client continuing to have contractions, complaining of increasing pain. Toco shows contractions every 3-5 minutes. Fetal heart rate 155 baseline with moderate variability, 15×15 accelerations, no decelerations. Abdomen palpated during and after contractions, with uterus relaxing fully after contraction. Moderate amount of bloody mucus-like discharge noted upon exam. Cervical dilation 2.5cm. L&D Flowsheet: Time 1200 1230 Blood pressure 120/70 125/72 Heart rate 72 74 Respirations 18 18 Pulse oximetry 99% on RA 99% on RA Pain 5/10 7/10 Cervical dilation 1cm 2.5cm Labs: Lab Results Reference range Hematocrit 32% Males: 42-52% Females: 35-47% Hemoglobin 10 g/dL Males: 13-18 g/dL Females:12-16 g/dL WBC 9,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Fetal fibronectin Positive Negative ROMPlus Negative Negative Select the option that completes the following sentence. >The nurse should recognize that the client is most likely experiencing (choose a, b, c, or d). a. Placental abruption b. Preterm Labor c. Uterine Rupture d. Placenta previa Correct Incorrect Question 4 of 6 4. Question Case Study Question 4 of 6 A 24-year-old G2P1 at 32 1/7 weeks gestation presents to the triage area of labor and delivery, complaining of abdominal and back pain. Nurses Notes: 1200. Client brought to triage and placed on fetal monitor/tocodynamometer. Fetal heart rate 145 baseline with moderate variability, 15×15 accelerations, no decelerations. Client complains of abdominal tightening every 5 minutes for the past 2 hours. Fetal fibronectin collected. ROMPlus collected to check for ruptured membranes. Cervical exam reveals cervical dilation of 1cm. Client reports history of cesarean section 5 years ago at 35 weeks gestation secondary to labor and breech presentation. 1230. Client continuing to have contractions, complaining of increasing pain. Toco shows contractions every 3-5 minutes. Fetal heart rate 155 baseline with moderate variability, 15×15 accelerations, no decelerations. Abdomen palpated during and after contractions, with uterus relaxing fully after contraction. Moderate amount of bloody mucus-like discharge noted upon exam. Cervical dilation 2.5cm. L&D Flowsheet: Time 1200 1230 Blood pressure 120/70 125/72 Heart rate 72 74 Respirations 18 18 Pulse oximetry 99% on RA 99% on RA Pain 5/10 7/10 Cervical dilation 1cm 2.5cm Labs: Lab Results Reference range Hematocrit 32% Males: 42-52% Females: 35-47% Hemoglobin 10 g/dL Males: 13-18 g/dL Females:12-16 g/dL WBC 9,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Fetal fibronectin Positive Negative ROMPlus Negative Negative >The client has been diagnosed with preterm labor. For each nursing intervention, click to specify whether the intervention is indicated or not indicated. a. b. c. d. Correct Incorrect Question 5 of 6 5. Question Case Study Question 5 of 6 A 24-year-old G2P1 at 32 1/7 weeks gestation presents to the triage area of labor and delivery, complaining of abdominal and back pain. Nurses Notes: 1200. Client brought to triage and placed on fetal monitor/tocodynamometer. Fetal heart rate 145 baseline with moderate variability, 15×15 accelerations, no decelerations. Client complains of abdominal tightening every 5 minutes for the past 2 hours. Fetal fibronectin collected. ROMPlus collected to check for ruptured membranes. Cervical exam reveals cervical dilation of 1cm. Client reports history of cesarean section 5 years ago at 35 weeks gestation secondary to labor and breech presentation. 1230. Client continuing to have contractions, complaining of increasing pain. Toco shows contractions every 3-5 minutes. Fetal heart rate 155 baseline with moderate variability, 15×15 accelerations, no decelerations. Abdomen palpated during and after contractions, with uterus relaxing fully after contraction. Moderate amount of bloody mucus-like discharge noted upon exam. Cervical dilation 2.5cm. 1245. Terbutaline 0.25mg subcutaneous administered. 1255. Betamethasone 12mg intramuscular to left ventrogluteal administered. Magnesium sulfate 6gram bolus started. Patient education on medications and side effects provided. L&D Flowsheet: Time 1200 1230 1255 Blood pressure 120/70 125/72 122/75 Heart rate 72 74 96 Respirations 18 18 20 Pulse oximetry 99% on RA 99% on RA 99% on RA Pain 5/10 7/10 5/10 Cervical dilation 1cm 2.5cm ——- Labs: Lab Results Reference range Hematocrit 32% Males: 42-52% Females: 35-47% Hemoglobin 10 g/dL Males: 13-18 g/dL Females:12-16 g/dL WBC 9,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Fetal fibronectin Positive Negative ROMPlus Negative Negative >For each medication, select the appropriate option for Role in Preterm Labor and Common Side Effects Sort elements Magnesium sulfate Terbutaline Betamethasone Main Role in Preterm Labor: Protects against fetal neurologic morbidities such as cerebral palsy Common Side Effects: Flushing, diaphoresis, nausea Main Role in Preterm Labor: Beta adrenergic receptor agonist; helps suppress uterine contractility Common Side Effects: Tachycardia, palpitations, tremor Main Role in Preterm Labor: Promotes fetal lung maturity Common Side Effects: Trouble sleeping, increased blood glucose Correct Incorrect Question 6 of 6 6. Question Case Study Question 6 of 6 A 24-year-old G2P1 at 32 1/7 weeks gestation presents to the triage area of labor and delivery, complaining of abdominal and back pain. Nurses Notes: 1200. Client brought to triage and placed on fetal monitor/tocodynamometer. Fetal heart rate 145 baseline with moderate variability, 15×15 accelerations, no decelerations. Client complains of abdominal tightening every 5 minutes for the past 2 hours. Fetal fibronectin collected. ROMPlus collected to check for ruptured membranes. Cervical exam reveals cervical dilation of 1cm. Client reports history of cesarean section 5 years ago at 35 weeks gestation secondary to labor and breech presentation. 1230. Client continuing to have contractions, complaining of increasing pain. Toco shows contractions every 3-5 minutes. Fetal heart rate 155 baseline with moderate variability, 15×15 accelerations, no decelerations. Abdomen palpated during and after contractions, with uterus relaxing fully after contraction. Moderate amount of bloody mucus-like discharge noted upon exam. Cervical dilation 2.5cm. 1245. Terbutaline 0.25mg subcutaneous administered. 1255. Betamethasone 12mg intramuscular to left ventrogluteal administered. Magnesium sulfate 6gram bolus started. Patient education on medications and side effects provided. 1330. Magnesium sulfate bolus complete, now infusing at 2grams/hour. Patient reports contraction frequency has slowed, and pain has decreased. Contractions noted every 15 minutes per toco. Fetal heart rate 160 baseline with moderate variability, accelerations, no decelerations. Vaginal exam repeated and cervix unchanged. L&D Flowsheet: Time 1200 1230 1255 1330 Blood pressure 120/70 125/72 122/75 115/70 Heart rate 72 74 96 86 Respirations 18 18 20 18 Pulse oximetry 99% on RA 99% on RA 99% on RA 99% on RA Pain 5/10 7/10 5/10 2/10 Cervical dilation 1cm 2.5cm ——- 2.5cm Labs: Lab Results Reference range Hematocrit 32% Males: 42-52% Females: 35-47% Hemoglobin 10 g/dL Males: 13-18 g/dL Females:12-16 g/dL WBC 9,000 cell/mm3 4.5 – 10.5 x 103 cells/mm3 Fetal fibronectin Positive Negative ROMPlus Negative Negative >Complete the following sentence by choosing from the list of options. The nurse determines the client’s status is (choose a, b, or c). The nurse should now (choose d, e, or f). a. improving b. deteriorating c. unchanged d. stop the magnesium sulfate infusion e. administer a second dose of terbutaline f. continue monitoring fetus and contraction pattern Correct Incorrect
