NCLEX-PN
NCLEX Maternity Questions Questions
Extract:
Question 1 of 5
The 29-weeks-pregnant client presents to triage with decreased fetal movement. Her initial BP is 140/90 mm Hg. She states she “doesn’t feel well” and her vision is “blurry.” Additional assessment findings include: normal reflexes, +2 proteinuria, trace pedal edema, and puffy face and hands. What is the most important information that the nurse should obtain from the client’s prenatal record?
Correct Answer: B
Rationale: The pregnant client with a BP that is greater than 140/90 mm Hg with the presence of proteinuria may have preeclampsia. New-onset hypertension is associated with preeclampsia. Generalized vasospasm in preeclampsia would result in reduced blood flow to the liver and elevated, not depressed, liver enzymes. The urine dip from the last visit should be reviewed but is not the most important to review because the significant information is the client’s elevated BP. The weight gain pattern should be reviewed but is not the most important to review because the significant information is the client’s elevated BP.
Question 2 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 3 of 5
The nurse prepares the client for which pain management option during labor?
Correct Answer: A
Rationale: Epidural anesthesia is a common and effective pain management option during labor, tailored to the client's needs.
Question 4 of 5
The nurse monitors which vital sign closely in a client with gestational diabetes?
Correct Answer: A
Rationale: Blood pressure monitoring is crucial in gestational diabetes, as it increases the risk of preeclampsia.
Question 5 of 5
The nurse advises the client to perform which exercise to strengthen pelvic floor muscles?
Correct Answer: A
Rationale: Kegel exercises strengthen pelvic floor muscles, aiding postpartum recovery and preventing incontinence.