The nurse is continuing to care for the client.

Exhibits

The nurse is reviewing the assessment findings.

For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.

Blood pressure

Elevated alanine aminotransferase (ALT)

Platelet count

Hemoglobin

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"B"}}

Finding	Preeclampsia	HELLP syndrome
Blood pressure	✓	✓
Elevated alanine aminotransferase (ALT)		✓
Platelet count		✓
Hemoglobin		✓

Rationale:

Preeclampsia: Characterized by hypertension and proteinuria.

HELLP syndrome: A severe form of preeclampsia, characterized by hemolysis, elevated liver enzymes (ALT, AST), and low platelet count.

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Correct Answer is C

Explanation

A. Widened pulse pressure (not narrowed) is associated with increased ICP.

B. Bradycardia (not tachycardia) is commonly seen in increased ICP due to Cushing’s triad.

C. An increasingly severe headache is a key sign of rising ICP due to increased pressure on pain-sensitive structures.

D. Hypertension, not hypotension, is a characteristic of increased ICP.

A. Complete an incident report and place it in the client's medical record. B. Compare the current infusion with the prescription in the client's medication record. C. Contact the charge nurse to see if the prescription was changed. D. Submit a written warning for the nurse involved in the incident.

Correct Answer is B

Explanation

A. An incident report is appropriate but should not be placed in the client’s medical record.

B. The nurse should first compare the current infusion with the prescription in the client's medication record to ensure the client is receiving the correct medication and dosage.

C. The nurse should verify the prescription before contacting the charge nurse.

D. Submitting a written warning is not the nurse's responsibility and is not appropriate in this situation.

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The nurse is continuing to care for the client. Exhibits The nurse is reviewing the assessment findings. For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who experienced a traumatic brain injury 72 hr ago. Which in the client's findings are potential indication of increased intracranial pressure?

Correct Answer is C

Explanation

A nurse is conducting an initial assessment of a client and notices a discrepancy between the client's current IV infusion and the report received during the shift report. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is reviewing the medical history of a client who asks about the use of warfarin. The nurse should identify which of the following findings as a contraindication for the administration of this medication?

A nurse is assessing the fontanels of an 8-month-old infant. Which of the following findings should the nurse recognize as an expected finding?

A nurse is caring for a neonate in the neonatal intensive care unit. Exhibits Complete the following sentence by using the lists of options. The neonate is most at risk for _____ due to ______

A nurse is preparing to collect a sputum specimen from a client. Which of the following actions should the nurse take?

A nurse is caring for a client who has a stool culture that is positive for Clostridium difficile. Which of the following infection control precautions should the nurse take?

A nurse enters a client's room and sees a small fire in the client's bathroom. Identify the sequence of steps the nurse should take. (Move the steps, placing them in the order of performance. Use all the steps.)

A nurse is caring for a client whose child died from cancer. The client states, "It's hard to go on without him." Which of the following questions should the nurse ask the client first?

A charge nurse is monitoring a newly licensed nurse who is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following statements by the newly licensed nurse indicates an understanding of the procedure?

The nurse is continuing to care for the client.

Exhibits

The nurse is reviewing the assessment findings.

For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.