NCLEX-RN
Maternity NCLEX RN Questions Questions
Extract:
Question 1 of 5
A neonate born at 29 weeks' gestation received nasal continuous positive airway pressure. The neonate is receiving oxygen at 1 L/minute via nasal cannula at a fraction of inspired oxygen (FiO₂) of 0.23. The pulse oximetry reading is 70% saturation. In which order of priority from first to last should the nurse take these actions?
Correct Answer: B,C,D,A
Rationale: First, ensure the pulse oximeter is accurate (
B).
Then, assess clinical signs like color (
C) and respiratory effort (
D). Finally, adjust $\mathrm{FiO}_2$ (
A) if needed based on findings.
Question 2 of 5
A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks' gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breast-feed the neonate. Which of the following instructions about breast-feeding would be most appropriate?
Correct Answer: D
Rationale: Gavage feedings with breast milk allow the neonate to receive the benefits of breast milk while accommodating their immature sucking and swallowing reflexes.
Question 3 of 5
The physician determines that outlet forceps are needed to assist in the delivery of a primigravid client in active labor with a large-for-gestational-size fetus. The nurse reinforces the physician's explanation for using forceps based on the understanding about which of the following concerning the location of the fetus?
Correct Answer: A
Rationale: Outlet forceps are used when the fetal head is at the pelvic outlet, visible at the perineum, allowing safe assisted delivery. Higher fetal positions require different interventions.
Question 4 of 5
As a nurse begins her shift on the obstetrical unit, there are several new admissions. The client with which of the following conditions would be a candidate for induction?
Correct Answer: A
Rationale: Pregnancy-induced hypertension (PIH) is an indication for induction to prevent maternal-fetal complications. Active herpes, face presentation, or late decelerations are contraindications due to risks of infection, dystocia, or fetal distress.
Question 5 of 5
A multigravid client at term is admitted to the hospital for a trial labor and possible vaginal birth. She has a history of previous cesarean delivery because of fetal distress. When the client is 4 cm dilated, she receives nalbuphine (Nubain) intravenously. While monitoring the fetal heart rate, the nurse observes minimal variability and a rate of 120 bpm. The nurse should explain the decreased variability is most likely caused by which of the following?
Correct Answer: D
Rationale: Nalbuphine, an opioid, can reduce fetal heart rate variability by depressing the central nervous system, a common side effect. Maternal fatigue, malposition, or small-for-gestational-age fetus are less likely causes.