2022-05-25 NCLEX Exam Question: The nurse is teaching childbirth education about the different stages of labor.
Which of the following stages varies the most during labor?
Select an Answer: Third
Fourth
First
Second
Rationale:
Nulliparous and multiparous woman have different time durations in the stages of labor. The first stage of labor starts with the onset of contractions. The first stage of labor may be 20 hours for a nulliparous woman.
The second stage of labor begins when the cervix is fully dilated until the birth of the baby. This stage can last 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman.
The third stage of labor begins with the birth of the baby until the placenta is delivered.
The fourth stage of labor lasts for 2 hours after the delivery of the placenta and is the beginning of the postpartum period.
2022-05-24 NCLEX Exam Question: A one-month-old newborn has been diagnosed with congestive heart failure.
The nurse is aware that which of the following clinical manifestations is common with this condition?
Rationale:
Poor feedings are related to the newborn being fatigued. Feedings require a lot of energy for the newborn. Newborns with congestive heart failure have fatigue.
All of the other vital signs are within normal limits for the newborn.
2022-05-23 NCLEX Exam Question: The nurse identifies that further education is needed when a pregnant woman states:
"Childbirth education:
Select an Answer: will increase my confidence." will teach me how to find a focal point." will help me to learn different distraction techniques." will teach me to feel no pain in labor."
Rationale:
Childbirth education will provide support for the pregnant woman and her support person. The education classes can increase a woman's confidence about the labor experience and teach them how to find a focal point and distraction techniques to be used in labor.
The childbirth education classes cannot teach a patient to feel no pain during labor.
2022-05-22 NCLEX Exam Question: A 3-month-old has returned to the cardiac unit after a cardiac catherization.
Which of the following assessments by the nurse is a priority?
Select an Answer: keeping the bed at 90 degrees decreasing fluids by mouth elevating the extremity for 4 hours post-procedure assessing pulse of the affected extremity
Rationale:
The pulse must be checked to assess for arterial occlusion.
Patients will have intravenous fluids and can have fluid by mouth. Fluids are increased to help with the intravenous dye excretion.
The head of the bed must be flat for 4-6 hours post-procedure.
The affected extremity must be flat with no elevation for 4-6 hours post-procedure to help with the healing of the cannulated vessels.
2022-05-21 NCLEX Exam Question: The nurse is assessing a fetal heart rate (FHR) pattern over a 10-minute period during labor and obtains a FHR of 140.
The nurse is aware that this fetal heart rate is considered to be which of the following?
Select an Answer: tachycardia accelerations bradycardia a normal baseline fetal heart rate
Rationale:
A fetal heart rate baseline is measured over a 10-minute period. The normal fetal heart rate range is 110 to 160 beats/min.
Bradycardia is a FHR less than 110 beats/min.
Tachycardia is a FHR more than 160 beats/min.
Accelerations are normal findings when the fetal heart rate exceeds 15 beats from the baseline for 15 seconds.
