NCLEX-RN
NCLEX RN Practice Questions Maternity Questions
Extract:
Question 1 of 5
A 6-lb, 8-oz neonate was delivered vaginally at 38 weeks' gestation. At 5 minutes of life, the neonate has the following signs: heart rate 110 , intermittent grunting with respiratory rate of 70 , flaccid tone, no response to stimulus, overall pale white in color. The Apgar score is:
Correct Answer: B
Rationale: Heart rate 110 (2 points), respiratory effort with grunting (1 point), flaccid tone (0 points), no response to stimulus (0 points), pale white color (0 points).
Total Apgar score = 3.
Question 2 of 5
For the past 8 hours, a 20-year-old primigravid client in active labor with intact membranes has been experiencing regular contractions. The fetal heart rate is 136 bpm with good variability. After determining that the client is still in the latent phase of labor, the nurse should observe the client for:
Correct Answer: A
Rationale: Prolonged latent phase (8 hours) in a primigravid client can lead to maternal exhaustion due to sustained effort and lack of progress, impacting labor stamina. Chills/fever, fluid overload, or meconium-stained fluid are less likely without specific risk factors.
Question 3 of 5
A client asks about the effectiveness of natural family planning methods. Which of the following responses by the nurse is most accurate?
Correct Answer: B
Rationale: The effectiveness of natural family planning depends on consistent monitoring and abstinence during fertile periods. It is less effective than oral contraceptives or barrier methods due to variability in ovulation and user adherence.
Question 4 of 5
A primiparous client with a neonate who is 36 hours old asks the nurse, "Why does my baby spit up a small amount of formula after feeding?" The nurse explains that the regurgitation is thought to result from which of the following?
Correct Answer: A
Rationale: An immature cardiac sphincter in newborns can cause regurgitation of formula.
Question 5 of 5
While caring for a multiparous client 4 hours after vaginal delivery of a term neonate, the nurse notes that the mother's temperature is 99.8°F (37.2°C), the pulse is 66 bpm, and the respirations are 18 breaths/minute. Her fundus is firm, midline, and at the level of the umbilicus. The nurse should:
Correct Answer: A
Rationale: A slightly elevated temperature (99.8°F) within the first 24 hours is normal; continued monitoring is appropriate with otherwise normal findings.