NCLEX Final Exam Readiness Study Guide 2025 | 100% Correct Verified Answers with Rationales | A+ Graded | Guaranteed Pass

2023/2024 NCLEX FINAL EXAM
READINESS STUDY GUIDE WITH 100%
CORRECT ANSWERS & RATIONALE
GRADED A+ (GUARANTEED PASS)
Question: 1

Correct Answer: 2
What intervention is essential prior to starting a client on atorvastatin therapy?
1. Assessing for muscle strength
2. Assessing the client's dietary intake
3. Determining if the client is on digoxin therapy
4. Monitoring liver function tests
Rationale
The client's central venous pressure (CVP) is elevated (normal value 2-8 mm Hg), indicating
increased systemic circulation volume and increased right ventricular preload. Pulmonary artery
wedge pressure (PAWP) is also elevated (normal value 6-12 mm Hg), indicating increased left
ventricular preload. In the presence of increased CVP and PAWP, coarse crackles indicate left-
sided failure. The treatment goal is to decrease fluid volume and preload. Furosemide is a loop
diuretic that will decrease both left- and right-sided preload.
(Option 1) A fluid bolus of 500 mL of sodium chloride is contraindicated in a client with
increased left and right ventricular preload as it would exacerbate fluid overload.
(Option 3) Beta blockers (eg, metoprolol, atenolol, esmolol) will decrease both blood pressure
and afterload. However, they will not decrease preload.
(Option 4) Vancomycin is an antibiotic used to treat gram-positive bacterial infections (eg,
methicillin- resistant Staphylococcus aureus); it has no effect on fluid status.
Educational objective:
Loop diuretics (eg, furosemide, bumetanide, torsemide) are effective in decreasing both right
ventricular preload and left ventricular preload.




Question: 2
Correct Answer: 2
The nurse provides discharge instructions to a client at 14 weeks gestation who has received a
prophylactic cervical cerclage. Which client statement indicates an understanding of teaching?
1. "I need to be on bed rest for the duration of my pregnancy."
2. "I will notify my health care provider if I start having low back aches."
3. "Pelvic pressure is to be expected after cerclage placement."
4. "The cerclage will be removed once my baby is at 28 weeks."

,Rationale




A cervical cerclage is placed to prevent preterm delivery, usually in clients with histories
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ofsecond trimester loss or premature birth. A heavy suture is placed transvaginally or
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transabdominally to keep the internal cervical os closed. Placement occurs at 12–14 weeks
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gestation for clients with a history of cervical insufficiency (ie, painless, premature
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cervical dilation and miscarriage or preterm delivery) or up to 23 weeks gestation if signs
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of cervical insufficiency (eg, short cervix) are noted.
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Discharge instructions include activity restriction and recognition of signs of preterm
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labor (eg, low back aches, contractions, pelvic pressure) and rupture of membranes
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Q(Option2). Q




(Option 1) Bed rest is usually recommended for a few days after the procedure. Long-term
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Qbedrest is individualized but uncommon and increases the risk for complications (eg, deep
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Qvein thrombosis). Pelvic rest (eg, avoiding sexual intercourse) is determined by the health
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Qcare provider. Q




(Option 3) Mild abdominal cramping following cerclage placement is common; however,
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regular contractions, pelvic pressure, and low back aches may indicate preterm labor.
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(Option 4) The cerclage remains in place until 36–37 weeks gestation. Early removal is
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Qindicated by rupture of membranes (to prevent infection) or preterm labor (to prevent
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Qdamage tothe cervix as it dilates).
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Educational objective: Q


Following cerclage placement, discharge teaching includes recognizing and reporting signs
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of preterm labor (eg, low back aches, contractions, pelvic pressure) or rupture of
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membranes and understanding activity restrictions (eg, bed rest for a short time after
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placement)
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,Question: 3
Q

, Correct Answer: 1 Q Q




During the first prenatal assessment, the client reports the last normal menstrual period
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starting on March 1 and ending on March 5, but also slight spotting on March 23. The client
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had unprotected intercourse on March 15. Using Naegele's rule, what is the estimated date
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of birth?
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1. December 8 Q


2. December 12 Q


3. December 22 Q


4. December 30 Q


Rationale
Various methods to determine the estimated date of birth (EDB) include use of Naegele's
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rule,ultrasound, uterine height measurement (McDonald's measurement), and auscultation of
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fetal heart rate with a Doppler device. The most accurate dating of pregnancy involves use
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of ultrasound around the 16th-18th week of pregnancy. However, Naegele's rule can be
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used to quickly determine an EDB early in the pregnancy. This calculation uses the date of
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the first dayof the last normal menstrual period (LMP) for determination of EDB.
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• EDB = (LMP minus 3 months) + 7 days
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This client's LMP is March 1, minus 3 months = December 1. Add 7 days to obtain EDB =
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December 8.
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Clients who conceive in January, February, and most of March will deliver in the current
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year. Those who conceive after March will deliver in the following year; as a result, a third
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Qstepis adding 1 to the current year to determine the estimated date of birth. For example,
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QLMP of May 10, 2014, would have an EDB of February 17, 2015.
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It is important to note that Naegele's rule is based on a client having a menstrual cycle of 28
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Qdays. It therefore may not be as accurate if the client has a shorter or longer menstrual
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Qcycle.
(Option 2) Using the last day of the LMP to calculate EDB provides an inaccurate due date
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Qasclients may have varying lengths of menstrual bleeding.
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(Option 3) Conception occurs around the time of ovulation and is about 14 days from the
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Qbeginning of the LMP. Eggs are fertile for about 12-24 hours after ovulation with sperm able
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Qtoremain fertile for 24-72 hours. Implantation of the trophoblast occurs about 7-10 days after
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Qfertilization. Using the conception date calculates the gestational age of the embryo
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Qapproximately 2 weeks later than the true gestational age. Q Q Q Q Q Q Q Q




(Option 4) Spotting around the time the next menstrual period is due may be considered
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Qnormaland is probably caused by implantation of the trophoblast into the uterine endometrial
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lining. This is not considered a problem, but using this occurrence to date the pregnancy
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Qerroneously delays the EDB by 4 weeks. It is important to calculate EDB from the beginning
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Qofthe last normal menstrual period.
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Educational objective: Q


Naegele's rule provides a quick determination of the estimated date of birth (EDB). EDB =
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(LMP minus 3 months) + 7 days. If the LMP occurs in January, February, or March, the
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EDBwill be in the current year. If the LMP occurs after March, the EDB will be in the
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next year.
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