Question #1
The LPN/LVN assists the RN in the care of a client during a routine prenatal check up at 34-weeks gestation. Abdominal palpation reveals the fetal position is right occipital anterior (ROA). The LPN/LVN observes the RN places the fetal monitor to pick up the fetal heart tones at which position?
Below the umbilicus, on the client’s left side.
Below the umbilicus, on the client’s right side.
Above the umbilicus, on the client's left side.
Above the umbilicus, on the client’s right side.
Answer:
The correct answer is B.
The fetus is ROA.
Where should FHT be heard the loudest?
Strategy: Picture the situation described. It may be helpful for you to draw this out so that you can imagine where the heartbeat would be found.
Needed Info: Describing fetal position: practice of defining position of baby relative to mother’s pelvis. The point of maximum intensity (PMI) of the fetus: point on the mother’s abdomen where the FHT is the loudest, usually over the fetal back. Divide the mother’s pelvis into 4 parts or quadrants: right and left anterior, which is the front, and right and left posterior, which is the back. Abbreviated: R and L for right and left, and A and P for anterior and posterior. The head, particularly the occiput, is the most common presenting part, and is abbreviated O. LOA is the most common fetal position and FHT heard on the left side. In a vertex presentation, FHT is heard below the umbilicus. In a breech presentation, FHT is heard above the umbilicus.
Below the umbilicus, on the client’s left side - found on right not left side
Below the umbilicus, on the client’s right side - CORRECT: occiput and back are pressing against right side of client’s abdomen; FHT would be heard below umbilicus on right side
Above the umbilicus, on the client’s left side - found in breech presentation
Above the umbilicus, on the client’s right side - found in breech presentation
Question #2
The LPN/LVN in an outpatient clinic supervises LPN/LVN students administering influenza vaccinations. The LPN/LVN questions administration of the vaccine to which client?
A middle-age client allergic to shellfish.
An older client who reports a sore throat.
A client who lives in a group home.
An older client diagnosed with heart failure.
Answer:
The correct answer is B.
What is a contraindication to receiving flu vaccine?
Strategy: Think about what each answer choice means.
Needed Info: Influenza vaccine: given yearly, preferably Oct.-Nov.; recommended for people age 65 or older; people under 65 with heart disease, lung disease, diabetes, immuno-suppression, chronic care facility residents.
A 45-year-old client who is allergic to shellfish - allergy to eggs is a contraindication
A 60-year-old client who says she has a sore throat - CORRECT: vaccine deferred in presence of acute respiratory disease
A 66-year-old client who lives in a group home - vaccine deferred only if patient has an active immunization
A 70-year-old client with congestive heart failure - no contraindication
Question #3
The home health LPN/LVN visits a post-partum client who delivered a healthy newborn 2 days ago. The client tells the LPN/LVN that the newborn is bottle-feeding. The LPN/LVN notes white curd-like patches on the newborn's oral mucous membranes. Which action by the LPN/LVN is appropriate?
Determine the baby's blood glucose level.
Suggest that the newborn's formula be changed.
Remind the caretaker not to let the infant sleep with the bottle.
Explain that the newborn will need to receive some medication.
Answer:
The correct answer is D.
What is the treatment for thrush?
Strategy: Determine the outcome of each answer choice.
Needed Info: Thrush (oral candidiasis): white plaque on oral mucous membranes, gums, or tongue; treatment includes good handwashing, nystatin (Mycostatin).
Determine the baby's blood glucose level - thrush in newborns caused by poor handwashing or exposure to an infected vagina during birth
Suggest that the newborn's formula be changed - not related to thrush
Remind the caretaker not to let the infant sleep with the bottle - not related to thrush
Explain that the newborn will need to receive some medication - CORRECT: thrush most often treated with nystatin (Mycostatin)
Question #4
A two-month-old infant is brought by the parent for a well-baby visit to the health care provider's office. During the exam, congenital subluxation of the left hip is suspected. The LPN/LVN identifies which symptom associated with congenital subluxation?
Lengthening of the limb on the affected side.
Deformities of the foot and ankle.
Asymmetry of the gluteal and thigh folds.
Plantar flexion of the foot.
Answer:
The correct answer is C.
What will you see with congenital hip dislocation?
Strategy: Form a mental image of the deformity.
Needed Info: Subluxation: most common type of congenital hip dislocation. Head of femur remains in contact with acetabulum but is partially displaced. Diagnosed in infant less than 4 weeks old S/S: unlevel gluteal folds, limited abduction of hip, shortened femur affected side, Ortolani's sign (click). Treatment: abduction splint, hip spica cast, Bryant’s traction, open reduction.
lengthening of the limb on the affected side - inaccurate
deformities of the foot and ankle - inaccurate
asymmetry of the gluteal and thigh folds - CORRECT: restricted movement on affected side
plantar flexion of the foot - seen with clubfoot
Question #5
The LPN/LVN monitors a primigravida client in labor. Which statement describes the frequency of uterine contractions?
The time from the beginning of one contraction to the end of the next contraction.
The beginning of one contraction to the end of the same contraction.
The quality of the strength of the contraction at its peak.
The number of contractions that occur within a given time period.
Answer:
The correct answer is D.
How do you determine the frequency of uterine contractions?
Needed Info: There must be at least 3 contractions to establish frequency.
from the beginning of one contraction to the end of the next contraction - not accurate
from the beginning of one contraction to the end of the same contraction - defines duration
by the strength of the contraction at its peak - describes intensity
by the number of contractions that occur within a given period of time - CORRECT
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