NCLEX-PN
Maternal NCLEX Questions Questions
Extract:
Question 1 of 5
When one participant asks the nurse what can be done to relieve leg cramps while working, which instruction by the nurse is correct?
Correct Answer: C
Rationale: Pointing toes toward the head (dorsiflexion) relieves leg cramps by stretching the calf muscles, unlike the other options.
Question 2 of 5
The nurse is caring for the 30-weeks-pregnant client who is having contractions every 1½ to 2 minutes with spontaneous rupture of membranes 2 hours ago. Her cervix is 8 cm dilated and 100% effaced. The nurse determines that delivery is imminent. What intervention is the most important at this time?
Correct Answer: C
Rationale: The most important intervention is to notify the neonatal team of the delivery because the team members will be needed for respiratory support and possible resuscitation.
Tocolytic agents, such as nifedipine (Procardia), can be used for short-term intervention to slow down contractions and delay birth, but it is too late to administer a tocolytic agent. Teaching is important but is not appropriate at this time. A cesarean birth is indicated if there are other obstetrical needs.
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
While assessing the postpartum client who is 10 hours post—vaginal delivery, the nurse notes a perineal pad that is totally saturated. To determine the significance of this finding, which question should the nurse ask the client first?
Correct Answer: B
Rationale: Once the nurse has determined the length of time the pad has been in place, the nurse could decide if asking about uterine cramping is appropriate. The amount of lochia on a perineal pad is influenced by the individual client’s pad changing practices. Thus, the nurse should ask about the length of time the current pad has been in place before making a judgment about whether the amount is concerning. Although bladder incontinence could cause pad saturation, it is more important to ask about the length of time the pad has been in place. Based on the client’s answer, the nurse could decide if asking about bladder urgency or frequency needs further assessment. Passing clots may require more frequent pad change, but first the nurse should determine if the reason for the saturated pad is the length of time it has been in place.
Question 5 of 5
When one participant asks the nurse what can be done to relieve leg cramps while working, which instruction by the nurse is correct?
Correct Answer: C
Rationale: Pointing toes toward the head (dorsiflexion) relieves leg cramps by stretching the calf muscles, unlike the other options.