NCLEX-PN
Maternal NCLEX Questions Questions
Extract:
Question 1 of 5
The nurse is caring for the client with a grade 3 placental abruption. Prioritize the prescribed interventions that the nurse should implement.
Correct Answer: C,D,F,A,B,E
Rationale: Start oxygen at 2—4 liters per nasal cannula is priority to maximize fetal oxygenation. Administer lactated Ringer’s at 200 mL/hr to treat hypovolemia, increase blood flow, and maximize oxygenation. Continuous external fetal monitoring should be performed to identify fetal distress early. Obtain serum blood draw for clotting disorders, specifically DIC. Administer 1 unit whole blood is next and will depend on the amount of blood loss. Prepare for cesarean delivery if fetal distress would be last because it would depend on the client and fetal status.
Question 2 of 5
The nurse is caring for the client with a grade 3 placental abruption. Prioritize the prescribed interventions that the nurse should implement.
Order the Items
Source Container
Correct Answer: C,D,F,A,B,E
Rationale: Start oxygen at 2—4 liters per nasal cannula is priority to maximize fetal oxygenation. Administer lactated Ringer’s at 200 mL/hr to treat hypovolemia, increase blood flow, and maximize oxygenation. Continuous external fetal monitoring should be performed to identify fetal distress early. Obtain serum blood draw for clotting disorders, specifically DIC. Administer 1 unit whole blood is next and will depend on the amount of blood loss. Prepare for cesarean delivery if fetal distress would be last because it would depend on the client and fetal status.
Question 3 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.
Question 4 of 5
After gathering further information about the edema, the nurse advises the client to limit the intake of which substance?
Correct Answer: A
Rationale: Limiting sodium intake helps reduce fluid retention, which contributes to edema in pregnancy.
Question 5 of 5
Which nursing instruction given to the client complaining about shortness of breath is most appropriate?
Correct Answer: D
Rationale: Sleeping with the upper body elevated reduces pressure on the diaphragm, easing shortness of breath.