Health Promotion and Maintenance — NCLEX-RN practice questions

The nurse is providing prenatal teaching to a pregnant client. Which supplement should be specifically emphasized to prevent neural tube defects?

1. Vitamin C daily, to strengthen the connective tissue supporting fetal spinal development
2. Iron daily, to support the expanded maternal red cell mass and fetal neural growth
3. Vitamin B12 daily, to support myelination of the developing fetal nervous system
4. Folic acid, 400-800 mcg daily started before conception and during early pregnancy

Answer: D — Folic acid, 400-800 mcg daily started before conception and during early pregnancy

D) Correct: folic acid 400-800 mcg/day before conception and through the first trimester prevents NTDs. A) Vitamin C is not implicated in NTD prevention. C) B12 is important but is not the NTD-prevention vitamin. B) Iron prevents anemia, not NTDs.

Which statement by a parent of a 2-year-old indicates a need for further teaching about lead poisoning prevention?

1. "I'll have my child's blood lead level checked at the next well-child visit"
2. "Older homes with peeling or chipping paint are the biggest risk in our neighborhood"
3. "A little lead exposure is fine as long as my child eats a balanced diet"
4. "I'll wash my child's hands and toys frequently, especially before meals"

Answer: C — "A little lead exposure is fine as long as my child eats a balanced diet"

C) Correct (needs teaching) — there is no safe level of lead exposure in children; any detectable level warrants investigation and follow-up. A) Correct understanding — screening is appropriate. B) Correct understanding of the highest-risk source. D) Correct understanding — reduces hand-to-mouth transfer.

A community health nurse is conducting a windshield survey of a neighborhood. What is the PRIMARY purpose of this activity?

1. To diagnose individual residents' health conditions during brief home visits
2. To administer immunizations door to door to residents who lack a primary provider
3. To assess the community's environment, resources, and needs from observation
4. To collect billing and insurance information for a new neighborhood clinic

Answer: C — To assess the community's environment, resources, and needs from observation

C) Correct — a windshield survey is a broad observational community assessment tool identifying environment, housing, resources, and apparent needs. A) Not an individual clinical diagnostic tool. B) Not the purpose of this method. D) Unrelated purpose.

A client at 38 weeks gestation reports decreased fetal movement over the past 24 hours. What should the nurse recommend FIRST?

1. Wait another week to see if movement increases
2. Come in for evaluation, including a nonstress test
3. This is a normal finding near term requiring no action
4. Increase caffeine intake to stimulate the fetus

Answer: B — Come in for evaluation, including a nonstress test

B) Correct — decreased fetal movement warrants prompt evaluation (NST, further assessment) to assess fetal well-being. A) Delaying evaluation risks missing a significant problem. C) Decreased movement near term still warrants assessment. D) Not an appropriate or evidence-based recommendation.

A child with a cyanotic congenital heart defect suddenly becomes more cyanotic, agitated, and assumes a squatting position. What is this finding known as, and what does squatting accomplish?

1. A "tet spell"; squatting increases systemic vascular resistance, improving pulmonary blood flow
2. A normal daily variation in a child with a cyanotic defect; squatting reflects fatigue and needs no assessment
3. A sign of improving oxygenation; squatting increases venous return and raises the systemic oxygen saturation
4. An unrelated musculoskeletal finding; squatting relieves the hip and knee discomfort common at this age

Answer: A — A "tet spell"; squatting increases systemic vascular resistance, improving pulmonary blood flow

A) Correct — this describes a hypercyanotic "tet" spell (classically in tetralogy of Fallot); squatting increases systemic vascular resistance, which paradoxically improves pulmonary blood flow and oxygenation. B) This is an acute event requiring prompt assessment. C) The child is experiencing worsening oxygenation before the compensatory squatting response. D) It is a cardiac compensatory mechanism, not musculoskeletal.

A nurse preparing a client for a colonoscopy provides:

1. A high-fiber meal on the morning of the procedure to promote one final bowel movement, followed by clear liquids in the hour before the client is transported to the endoscopy suite for sedation
2. Procedural sedation given by the nurse before the provider arrives so the client is already comfortable, with vital signs recorded at the start of the procedure
3. Reassurance that no bowel preparation is required beforehand because insufflation during the procedure clears any residual stool from the walls of the colon
4. Bowel preparation (per provider order), clear liquid diet typically the day before, NPO before the procedure, and post-procedure monitoring for bleeding and perforation

Answer: D — Bowel preparation (per provider order), clear liquid diet typically the day before, NPO before the procedure, and post-procedure monitoring for bleeding and perforation

D) Standard prep and monitoring. A) Fiber leaves residue and is stopped before the prep. B) Procedural sedation requires a provider order and monitoring, not independent nursing action. C) Bowel prep is essential for adequate visualization.

The nurse is providing teaching about the influenza vaccine. Which client requires further evaluation BEFORE receiving the inactivated influenza vaccine?

1. A pregnant client in the second trimester who has not yet received an influenza vaccine this season
2. A 70-year-old with stable COPD who uses a daily inhaled corticosteroid and had no reaction last year
3. A client with a history of severe anaphylactic reaction to a previous influenza vaccine
4. A 6-month-old infant who is receiving the influenza vaccine for the first time this season

Answer: C — A client with a history of severe anaphylactic reaction to a previous influenza vaccine

C) Correct: a history of severe anaphylaxis to a previous dose is a contraindication and requires evaluation. A) Pregnancy is an indication (inactivated vaccine recommended in any trimester). B) Older adults with chronic lung disease are high priority for vaccination. D) Infants ≥6 months are eligible.

Which finding in an older adult client should the nurse recognize as delirium rather than baseline dementia?

1. A slow, gradual decline in memory and word-finding ability over several years, with alertness preserved
2. Acute onset of fluctuating confusion and inattention over the past day, with a new urinary tract infection
3. Cognitive function that has remained stable over the past year, with no new medical, infectious, or metabolic problems
4. Consistent long-term memory loss with no recent change in attention, alertness, or level of consciousness

Answer: B — Acute onset of fluctuating confusion and inattention over the past day, with a new urinary tract infection

B) Correct — acute, fluctuating onset associated with a physiologic trigger is the hallmark of delirium, which is often reversible. A) Describes the gradual course typical of dementia. C) Suggests baseline stability, not delirium. D) A chronic pattern consistent with dementia.

A client with a history of preterm birth is being counseled about progesterone supplementation in a subsequent pregnancy. What is the purpose of this therapy?

1. To induce labor early once fetal lung maturity has been documented
2. To treat gestational diabetes by improving maternal insulin sensitivity
3. To help reduce the risk of a recurrent preterm birth in this pregnancy
4. To manage preeclampsia by lowering maternal blood pressure late in pregnancy

Answer: C — To help reduce the risk of a recurrent preterm birth in this pregnancy

C) Correct — progesterone supplementation is used in select clients with a prior preterm birth to help reduce recurrence risk. A) The opposite of the intended purpose. B) Not used for glucose management. D) Not the mechanism for preeclampsia management.

Which laboratory value change is a normal expected finding with aging, rather than a sign of pathology?

1. A slightly decreased creatinine clearance due to reduced muscle mass and renal function
2. A markedly elevated troponin level attributed to reduced cardiac reserve with aging
3. New onset of significant proteinuria attributed to age-related nephron loss
4. A rapidly rising white blood cell count attributed to age-related changes in immune function

Answer: A — A slightly decreased creatinine clearance due to reduced muscle mass and renal function

A) Correct — a gradual, mild decline in renal function/creatinine clearance is a recognized normal aging change, though still clinically relevant for dosing. B), C), D) All reflect pathologic findings requiring investigation.

Erikson — young adult stage?

Intimacy vs isolation.

Piaget — sensorimotor stage?

Birth-2yr. Object permanence develops.

First-trimester danger signs?

Vaginal bleeding, severe cramping — possible miscarriage or ectopic pregnancy.

Erikson — adolescent stage?

Identity vs role confusion (12-18yr). Peer group is central to identity formation.