NCLEX-PN
NCLEX Maternal Newborn Questions
Extract:
Question 1 of 5
A baby boy was born at 2:45 A.M. after a 35-week gestation. He weighed 1170 g. Upon admission to the premature nursery, he had slight respiratory distress, nasal flaring, grunting, intercostal retractions, and slight cyanosis. Apgar score at one minute was 4, and at five minutes, it was 6. Apical pulse is 164, respirations are 44, and axillary temperature is 96°F. What was the most likely cause of the baby's cyanosis?
Correct Answer: B
Rationale: Cyanosis in a preterm infant with respiratory distress is due to inadequate oxygenation from immature lungs.
Question 2 of 5
The parents of a newborn with hypospadias ask the nurse why the doctor told them the baby could not be circumcised. What is the best response?
Correct Answer: C
Rationale: The foreskin is often used in surgical repair of hypospadias, necessitating its preservation.
Question 3 of 5
Which factor would most likely be a cause of epiglottitis?
Correct Answer: C
Rationale: Haemophilus influenzae, type B is the most common cause of epiglottitis, leading to rapid airway swelling.
Question 4 of 5
Which of the following is the most important nursing assessment during the fourth stage of labor?
Correct Answer: B
Rationale: Assessing bladder distention is critical to prevent uterine displacement and postpartum hemorrhage.
Question 5 of 5
The nurse is caring for a woman who had a hysterectomy. Which vascular complication should the nurse be especially alert for because of the location of the surgery?
Correct Answer: A
Rationale: Pelvic surgery, like a hysterectomy, increases the risk of thrombophlebitis due to venous stasis and surgical trauma.