NCLEX-PN
NCLEX Maternity Questions Questions
Extract:
Question 1 of 5
How many factors in this scenario place the client at risk for nutritional deficiencies and the need for dietary guidance and counseling?
Correct Answer: C
Rationale: Five risk factors: adolescence, skipping meals, fast food diet, alcohol consumption, and weight gain concerns increase nutritional deficiency risk.
Question 2 of 5
While assessing the prenatal client, the nurse found a number of concerning problems. Place the concerning problems in the sequence that they should be addressed by the nurse.
Order the Items
Source Container
Correct Answer: D,A,C,B
Rationale: Has intense pelvic pain is most concerning and should be addressed first by the nurse. It could be a symptom of a serious medical condition, such as a miscarriage, ectopic pregnancy, or appendicitis. This symptom represents a possible pathology that could warrant immediate surgical intervention. Currently bleeding and cramping should be addressed next. It could be associated with the pelvic pain and could be a symptom of a serious medical condition, such as a miscarriage or ectopic pregnancy. Currently using tobacco can put the client at risk for multiple adverse outcomes and should be addressed, although it is not an immediately concerning factor. Previous varicella infection is important to document but poses no risk to the client or the fetus, so it is the least important to address.
Question 3 of 5
Which food provides the best alternative source of calcium?
Correct Answer: C
Rationale: Leafy green vegetables, such as kale and spinach, are rich in calcium and a good alternative for those who dislike milk.
Question 4 of 5
The nurse observes the postpartum multiparous client rubbing her abdomen. When asked if she is having pain, the client says, “It feels like menstrual cramps.” Which intervention should the nurse implement?
Correct Answer: B
Rationale: Heat application to the abdomen should be avoided; it may cause uterine muscle relaxation. Multiparous women frequently experience intermittent uterine contractions called afterpains. Lying in a prone position applies pressure to the uterus, stimulating continuous uterine contraction. When the uterus maintains a state of contraction, the afterpains will cease. Ambulation has been shown to decrease muscle pain and should not be avoided. Afterpains are not a symptom of potential postpartum hemorrhage.
Question 5 of 5
The nurse is caring for the antepartum client with a velamentous cord insertion. The client asks what symptom she would most likely experience first if one of the vessels should tear. The nurse should respond that she would most likely experience which symptom first?
Correct Answer: A
Rationale: In a velamentous cord insertion, vessels of the cord divide some distance from the placenta in the placental membrane. Thus, the most likely first symptom would be vaginal bleeding. Abdominal cramping is unlikely to occur; velamentous cord insertion is not related to uterine activity. Contractions are unlikely to occur; velamentous cord insertion is not related to uterine activity. An abruption, when the placenta comes off the uterine wall, results in severe abdominal pain.