Questions 81

NCLEX-RN

NCLEX-RN Test Bank

Maternity NCLEX RN Questions Questions

Extract:


Question 1 of 5

A 29-year-old multigravida at 37 weeks' gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/hour. The nurse has determined the priority nursing diagnosis to be: risk for central nervous system injury related to hypertension, edema of cerebrum. To maintain safety for this client, the nurse should:

Correct Answer: C

Rationale: Monitoring signs of CNS irritability such as reflexes, clonus, visual disturbances, and headache helps detect worsening preeclampsia.

Question 2 of 5

When developing the plan of care for a multigravid client with class III heart disease, which of the following areas should the nurse expect to assess frequently?

Correct Answer: D

Rationale: Class III heart disease indicates significant cardiac limitation, making tachycardia a critical sign of cardiac stress during labor. Frequent assessment ensures early detection of decompensation. Dehydration, nausea, or anemia are less immediate concerns.

Question 3 of 5

While the nurse is assessing the fundus of a multiparous client who delivered 24 hours ago, the client asks, "What can I do to get rid of these stretch marks?" Which of the following responses would be most appropriate?

Correct Answer: B

Rationale: Stretch marks typically fade to a silvery-white color over time without specific intervention.

Question 4 of 5

A client asks about the effectiveness of the vaginal contraceptive ring. Which of the following responses by the nurse is accurate?

Correct Answer: B

Rationale: The vaginal contraceptive ring is highly effective when used correctly, with a low failure rate. It is not 100% effective, requires a prescription, and is generally more effective than condoms.

Question 5 of 5

Which of the following indicates successful latch-on during a breast-feeding session?

Correct Answer: A

Rationale: Flanged lips indicate a proper latch, ensuring effective milk transfer and preventing nipple trauma.

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