NCLEX-PN
Maternal NCLEX Questions Questions
Extract:
Question 1 of 5
The nurse advises a client with a history of miscarriage to monitor which symptom?
Correct Answer: B
Rationale: Vaginal spotting may indicate a threatened miscarriage, requiring close monitoring and medical evaluation.
Question 2 of 5
The pregnant client asks the nurse, who is teaching a prepared childbirth class, when she should expect to feel fetal movement. The nurse responds that fetal movement usually can first be felt during which time frame?
Correct Answer: C
Rationale: Subtle fetal movement (quickening) can be felt as early as 18 to 20 weeks of gestation, and it gradually increases in intensity. Eight to 12 weeks of pregnancy is too early to expect the first fetal movement to be felt. Twelve to 16 weeks of pregnancy is too early to expect the first fetal movement to be felt. Twenty-two to 26 weeks of pregnancy is later than expected to feel the first fetal movement.
Question 3 of 5
The laboring client’s amniotic membranes have just ruptured. Which nursing action should be priority?
Correct Answer: D
Rationale: The priority nursing action is to assess the FHR pattern for several minutes immediately after membrane rupture to determine fetal well being. The umbilical cord may prolapse as a result of the rupture, causing life-threatening changes in the FHR. The maternal temperature should be monitored during labor and at least every two hours after the membranes rupture to assess for possible infection. However, this is not the priority nursing action. Characteristics of the fluid (color, odor, and estimated amount) should be assessed and documented after rupture, but this is not the priority at this time. A vaginal exam that assesses the progress of labor does need to be performed right after membrane rupture, but it is not the priority.
Question 4 of 5
The RN and the student nurse are caring for the postpartum client who is 16 hours postdelivery. The RN evaluates that the student needs more education about uterine assessment when the student is observed doing which activity?
Correct Answer: A
Rationale: For uterine assessment, the client should be positioned in a supine position so the height of the uterus is not influenced by an elevated position. When beginning the assessment, one hand should be placed at the base of the uterus just above the symphysis pubis to support the lower uterine segment. This prevents the inadvertent inversion of the uterus during palpation. Once the lower hand is in place, the fundus of the uterus can be gently palpated. The abdomen should be observed prior to palpation for contour to detect distention and for the appearance of striae or a diastasis.
Question 5 of 5
The nurse explains that true labor contractions are characterized by which feature?
Correct Answer: B
Rationale: True labor contractions increase in intensity and frequency, distinguishing them from false labor.