NCLEX-RN
NCLEX RN Practice Questions Maternity Questions
Extract:
Question 1 of 5
A client is induced with oxytocin (Pitocin). The fetal heart rate is showing accelerations lasting 15 seconds and exceeding the baseline with fetal movement. What action associated with this finding should the nurse take?
Correct Answer: D
Rationale: Fetal heart rate accelerations with movement indicate fetal well-being, requiring no intervention beyond documentation. Repositioning, oxygen, or notification are unnecessary.
Question 2 of 5
When caring for a multiparous client who is human immunodeficiency virus (HIV)-positive and asking to breast-feed her neonate as soon as possible, which of the following instructions about breast milk should the nurse include in the teaching plan?
Correct Answer: D
Rationale: Breast milk from an HIV-positive mother can transmit the virus to the neonate, so breastfeeding is contraindicated to prevent HIV transmission.
Question 3 of 5
A multigravid client is admitted at 4-cm dilation and requesting pain medication. The nurse gives the client Nubain 15 mg and Phenergan 25 mg slow I.V. push. Within 5 minutes, the client tells the nurse she feels like she needs to have a bowel movement. The nurse should first:
Correct Answer: B
Rationale: A sudden urge to have a bowel movement in labor often indicates rapid progression to full dilation or fetal descent. A vaginal examination confirms dilation and station to guide next steps (e.g., preparing for delivery). Naloxone, preparation, or documentation are premature without assessment.
Question 4 of 5
A 30-year-old multigravid client at 8 weeks' gestation has a history of insulin-dependent diabetes since age 20. When explaining about the importance of blood glucose control during pregnancy, the nurse should tell the client that which of the following will occur regarding the client's insulin needs during the first trimester?
Correct Answer: B
Rationale: Insulin needs typically decrease in the first trimester due to increased insulin sensitivity.
Question 5 of 5
The nurse is explaining to a primagravida in labor that her baby is in a breech presentation, with the baby’s presenting part in a left, sacrum, posterior (LSP) position. Which illustration should the nurse use to help the client understand how her baby is positioned?
Correct Answer: A
Rationale: This figure shows the client’s baby in a breech presentation with the baby facing the pelvis on the left, the sacrum as the presenting part, and the presenting part (sacrum) is posterior in the pelvis. Figure 2 shows a vertex presentation with the baby in a left, occiput, anterior position (LO
A). Figure 3 shows a vertex presentation, left, occipit, posterior (LOP). Figure 4 shows a face position with the babyin a left, mentum, transverse position (LMT).