NCLEX-RN
Maternity RN NCLEX Questions Questions
Extract:
Question 1 of 5
A primigravid client at 41 weeks' gestation is admitted to the hospital's labor and delivery unit in active labor. After 25 hours of labor with membranes ruptured for 24 hours, the client delivers a healthy neonate vaginally with a midline episiotomy. Which of the following nursing diagnoses should the nurse identify as the priority for the client?
Correct Answer: D
Rationale: Prolonged rupture of membranes (>24 hours) and episiotomy increase infection risk, making this the priority post-delivery. Activity intolerance, sleep deprivation, and self-esteem are less urgent.
Question 2 of 5
One week after her prenatal visit, a primigravid client at 38 weeks' gestation diagnosed with mild preeclampsia calls the clinic nurse complaining of a continuous headache for the past 2 days accompanied by nausea. The client does not want to take aspirin. The nurse should tell the client:
Correct Answer: B
Rationale: Continuous headache and nausea are signs of worsening preeclampsia requiring evaluation.
Question 3 of 5
While assessing a neonate weighing 3,175 g (7 lb) who was born at 39 weeks' gestation to a primiparous client who admits to cocaine use during pregnancy, which of the following would alert the nurse to possible cocaine withdrawal?
Correct Answer: B
Rationale: A high-pitched cry is a common sign of cocaine withdrawal in neonates, indicating neurological irritability.
Question 4 of 5
A client visits the clinic seeking a prescription for oral contraceptives. Which of the following would alert the nurse to further assess the client before the contraceptives are prescribed?
Correct Answer: C
Rationale: Smoking at age 37 is a significant risk factor for cardiovascular complications with combined oral contraceptives, requiring further assessment. Fibrocystic breast disease and irregular cycles are not contraindications, and family history of ovarian cancer is less relevant.
Question 5 of 5
The nurse assigns an individual who is an unlicensed assistive personnel (UAP) to care for a client. Which of the following would be appropriate to delegate to this person? Select all that apply.
Correct Answer: A,D,F
Rationale: UAPs can perform tasks like changing pads, reinforcing hygiene, and assisting with ambulation, but tasks requiring clinical judgment (e.g., fundal checks, breastfeeding assistance, or counseling) are reserved for licensed personnel.