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NCLEX-RN Exam Questions - Part 32
1. MgSO4 is ordered IV following the established protocol for a client with severe PIH. The anticipated effects of this therapy are anticonvulsant and:
A) Vasoconstrictive
B) Vasodilative
C) Hypertensive
D) Antiemetic
2. A nurse should carefully monitor a client for the following side effect of MgSO4:
A) Visual blurring
B) Tachypnea
C) Epigastric pain
D) Respiratory depression
3. MgSO4 blood levels are monitored and the nurse would be prepared to administer the following antidote for MgSO4 side effects or toxicity:
A) Magnesium oxide
B) Calcium hydroxide
C) Calcium gluconate
D) Naloxone (Narcan)
4. A client with severe PIH receiving MgSO4 is placed in a quiet, darkened room. The nurse bases this action on the following understanding:
A) The client is restless.
B) The elevated blood pressure causes photophobia.
C) Noise or bright lights may precipitate a convulsion.
D) External stimuli are annoying to the client with PIH.
5. A 26-year-old client is admitted to the labor, delivery, recovery, postpartum unit. The nurse completes her assessment and determines the client is in the first stage of labor. The nurse should instruct her:
A) To hold her breath during contractions
B) To be flat on her back
C) Not to push with her contractions
D) To push before becoming fully dilated
A) Vasoconstrictive
B) Vasodilative
C) Hypertensive
D) Antiemetic
2. A nurse should carefully monitor a client for the following side effect of MgSO4:
A) Visual blurring
B) Tachypnea
C) Epigastric pain
D) Respiratory depression
3. MgSO4 blood levels are monitored and the nurse would be prepared to administer the following antidote for MgSO4 side effects or toxicity:
A) Magnesium oxide
B) Calcium hydroxide
C) Calcium gluconate
D) Naloxone (Narcan)
4. A client with severe PIH receiving MgSO4 is placed in a quiet, darkened room. The nurse bases this action on the following understanding:
A) The client is restless.
B) The elevated blood pressure causes photophobia.
C) Noise or bright lights may precipitate a convulsion.
D) External stimuli are annoying to the client with PIH.
5. A 26-year-old client is admitted to the labor, delivery, recovery, postpartum unit. The nurse completes her assessment and determines the client is in the first stage of labor. The nurse should instruct her:
A) To hold her breath during contractions
B) To be flat on her back
C) Not to push with her contractions
D) To push before becoming fully dilated
1. Right Answer: B
Explanation: (A) An anticonvulsant effect is the goal of drug therapy for PIH. However, we would not want to increase the vasoconstriction that is already present. This would make the symptoms more severe. (B) An anticon-vulsant effect and vasodilation are the desired outcomes when administering this drug. (C) An anticonvulsant effect is the goal of drug therapy for PIH; however, hypertensive drugs would increase the blood pressure even more. (D) An anticonvulsant effect is the goal of drug therapy for PIH. MgSO4is not classified as an antiemetic. Antiemetics are not indicated for PIH treatment.
2. Right Answer: D
Explanation: (A, C) The nurse should provide good distractors because these symptoms indicate that PIH has become more severe and may precede the convulsive or eclamptic phase. (B) This is the oppositeside effect of this medication. (D) This is a common side effect of this medication and needs to be monitored and recorded frequently.
3. Right Answer: C
Explanation: (A, B) These drugs are not antidotes for MgSO4. (C) This drug is the standard antidote and should always be readily available when MgSO4is being administered.(D) This drug is an antidote for narcotics, not MgSO4.
4. Right Answer: C
Explanation: (A) The client may be anxious and hyperresponsive to stimuli but not necessarily restless. (B) This is not a physiological response to an elevated blood pressure inPIH. (C) The nurse must know the nursing measures that decrease the potential for convulsions. A quiet, darkened room decreases stimuli and promotes rest. (D)External stimuli might induce a convulsion but are not annoying to the client with PIH.
5. Right Answer: C
Explanation: (A) This nursing action may cause hyperventilation. (B) This nursing action could cause inferior vena cava syndrome. (C) The client is allowed to push only after complete dilation during the second stage of labor. The nurse needs to know the stages of labor. (D) If the client pushes before dilation, it could cause cervical edema and/or edema to the fetal scalp; both of these could contribute to increased risk of complications.
Explanation: (A) An anticonvulsant effect is the goal of drug therapy for PIH. However, we would not want to increase the vasoconstriction that is already present. This would make the symptoms more severe. (B) An anticon-vulsant effect and vasodilation are the desired outcomes when administering this drug. (C) An anticonvulsant effect is the goal of drug therapy for PIH; however, hypertensive drugs would increase the blood pressure even more. (D) An anticonvulsant effect is the goal of drug therapy for PIH. MgSO4is not classified as an antiemetic. Antiemetics are not indicated for PIH treatment.
2. Right Answer: D
Explanation: (A, C) The nurse should provide good distractors because these symptoms indicate that PIH has become more severe and may precede the convulsive or eclamptic phase. (B) This is the oppositeside effect of this medication. (D) This is a common side effect of this medication and needs to be monitored and recorded frequently.
3. Right Answer: C
Explanation: (A, B) These drugs are not antidotes for MgSO4. (C) This drug is the standard antidote and should always be readily available when MgSO4is being administered.(D) This drug is an antidote for narcotics, not MgSO4.
4. Right Answer: C
Explanation: (A) The client may be anxious and hyperresponsive to stimuli but not necessarily restless. (B) This is not a physiological response to an elevated blood pressure inPIH. (C) The nurse must know the nursing measures that decrease the potential for convulsions. A quiet, darkened room decreases stimuli and promotes rest. (D)External stimuli might induce a convulsion but are not annoying to the client with PIH.
5. Right Answer: C
Explanation: (A) This nursing action may cause hyperventilation. (B) This nursing action could cause inferior vena cava syndrome. (C) The client is allowed to push only after complete dilation during the second stage of labor. The nurse needs to know the stages of labor. (D) If the client pushes before dilation, it could cause cervical edema and/or edema to the fetal scalp; both of these could contribute to increased risk of complications.
80% DISCOUNT: NCLEX-RN PRACTICE EXAMS
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