NCLEX-PN maternity practice questions

Question 1

The nurse at a prenatal clinic is reviewing the blood results and blood pressure recorded at three visits for a client who is now at 32 weeks of an uncomplicated pregnancy. Which of the following changes needs follow-up with the registered nurse (RN)?

Accepted Answer

B: The hemoglobin, which has fallen to 10.1 g/dL by 32 weeks. Anemia in pregnancy is a hemoglobin below 11 g/dL in the first and third trimesters and below 10.5 g/dL in the second. Some fall is expected. Plasma volume rises by about 40 to 50 percent in pregnancy while the red cell mass rises by only about 20 to 30 percent, so the blood is diluted and the hemoglobin drops. That is called physiologic anemia of pregnancy, and the cutoffs above already allow for it.

This client's first two results are fine. A hemoglobin of 12.6 at 10 weeks is normal, and 11.2 at 20 weeks is above the second-trimester cutoff of 10.5. At 32 weeks, 10.1 is below the third-trimester cutoff of 11, so dilution no longer explains it. The usual cause is iron deficiency, because the fetus draws heavily on the client's iron stores in the third trimester. The nurse reports it so the provider can order iron studies and treatment, and asks about tiredness, breathlessness and cravings for ice or other things that are not food.

Question 2

A client at 10 weeks of gestation tells the nurse at a prenatal clinic, "I'm running to the bathroom all day, so I've cut way back on how much I drink." She has no burning or pain when she urinates. Which of the following instructions should the nurse reinforce? Select all that apply.

Accepted Answer

A: Keep drinking about 8 to 10 cups (2 to 2.5 L) of fluid over the course of the day; C: Empty the bladder as soon as the urge comes rather than holding the urine in; E: Cut back on coffee, tea and cola, which make the kidneys pass more urine. Urinary frequency is one of the most common first-trimester discomforts. The growing uterus is still inside the pelvis, pressing on the bladder, and the kidneys filter about half as much blood again as before pregnancy, so more urine is made. It eases in the second trimester when the uterus rises out of the pelvis and comes back near term.

Cutting fluids is the wrong answer to it. Pregnancy already raises the risk of urinary tract infection, because progesterone relaxes the ureters and urine moves more slowly, and a dehydrated client has concentrated urine that sits in the bladder longer. Dehydration also brings constipation and headaches. So she keeps her fluids up, about 8 to 10 cups a day (Option A), and drinks most of it earlier in the day, with less in the hour or two before bed, to cut down on night trips.

Holding urine gives bacteria time to multiply, so she empties her bladder when the urge comes (Option C). Caffeine makes the kidneys pass more urine and is limited in pregnancy anyway, so cutting back on coffee, tea and cola eases the frequency safely (Option E). Burning, fever, blood in the urine or pain in the side or back is reported.

Question 3

A client at 39 weeks of gestation on a hospital labor unit is receiving an oxytocin infusion for induction of labor. Her cervix is 6 cm dilated. The registered nurse (RN) reports that the fetal heart rate baseline has been 95 beats per minute for 12 minutes and asks the nurse to help. Which of the following actions would the nurse expect the team to take? Select all that apply.

Accepted Answer

A: The RN stops the oxytocin infusion running on the pump; C: The client is turned onto her side with pillows for support; D: The RN gives an intravenous fluid bolus as prescribed; E: The primary health care provider is told about the heart rate. A baseline of 95 for 12 minutes is fetal bradycardia, and the response to it is aimed at getting more oxygenated blood to the placenta as fast as possible. Each correct action does that in a different way.

Oxytocin makes the uterus contract, and a contracting uterus squeezes the vessels that supply the placenta. Stopping the infusion lets the uterus relax between contractions so the placenta can refill (Option A). Oxytocin is a high-alert drug running on a pump, so the RN stops it.

Turning the client onto her side lifts the weight of the uterus off the vena cava and aorta, so more blood returns to her heart and more is pumped to the placenta (Option C). This is the part the nurse does.

An intravenous (IV) fluid bolus fills the mother's circulation and raises her blood pressure, which pushes more blood through the placenta (Option D). The RN gives it on the provider's prescription. Oxygen is applied per the unit protocol at the same time.

The provider is notified because a persistent low baseline may mean the baby has to be born quickly, and only the provider can decide that (Option E).

Question 4

The nurse is helping care for a client at 38 weeks of gestation whose membranes ruptured 22 hours ago. Labor is being induced with an oxytocin infusion. Which of the following findings should the nurse report to the registered nurse (RN) as possible signs of intraamniotic infection?

Accepted Answer

A: Maternal temperature of 101.2 F (38.4 C); C: Amniotic fluid that is cloudy and has a foul odor; E: Fetal heart rate baseline of 170/min. Infection is the main danger after the membranes rupture, and the risk rises the longer the interval to birth. Intraamniotic infection (chorioamnionitis) shows as maternal fever, a fetal heart rate baseline above 160/min, cloudy or foul-smelling fluid, maternal tachycardia and uterine tenderness. Fetal tachycardia can appear before the mother has a fever. These findings are reported promptly, because the client needs broad-spectrum antibiotics and the newborn will need to be examined closely after birth.

Question 5

A client at 32 weeks gestation tells the nurse at a prenatal clinic that her lower back aches by the end of each workday and feels better after she rests. She has no cramping, no pelvic pressure and no urinary symptoms. Which of the following measures should the nurse reinforce? Select all that apply.

Accepted Answer

A: Do pelvic tilt exercises several times a day; C: Wear low-heeled shoes with good arch support; D: Lie on her side with a pillow between her knees; E: Apply a warm, not hot, compress to her lower back. The low back ache of pregnancy comes from a shifting center of gravity and loosening joints. As the uterus grows, the curve of the lower spine deepens, and the hormone relaxin softens the ligaments of the pelvis, so the back muscles work overtime to keep her upright. An ache that builds through the day and eases with rest, with no cramping or pressure, is this ordinary ache.

Each of the correct measures (pelvic tilts, low-heeled supportive shoes, side-lying with a pillow between the knees and a warm compress) takes strain off those muscles. Pelvic tilt exercises flatten the curve of the lower back and strengthen the abdominal muscles that support it (Option A). Low-heeled, supportive shoes keep the pelvis level, where high heels tip it forward and deepen the curve (Option C). Lying on her side with a pillow between her knees keeps the hips and spine lined up while she rests, and keeps the uterus off the vena cava (Option D). Warmth relaxes tight muscle, and warm rather than hot matters, because very hot baths, hot tubs and high heat raise her core temperature, which is avoided in pregnancy (Option E).

If she needs a pain reliever, acetaminophen is the one used in pregnancy, taken as the provider directs.

Question 6

An infant is delivered at 36 weeks gestation to a client who had no prenatal care and whose rapid plasma reagin (RPR) test was reactive on admission to labor and delivery. Which of the following findings in the newborn are consistent with congenital syphilis?

Accepted Answer

A: Persistent clear nasal discharge that recurs after suctioning; B: Liver edge palpable 4 cm below the right costal margin; C: Peeling, copper-colored rash on the palms and soles; E: Jaundice within 24 hours after birth. Treponema pallidum crosses the placenta and infects the liver, spleen, skin, bones and nasal mucosa of the fetus. Early congenital syphilis can cause persistent rhinitis (snuffles), which is highly infectious, and hepatosplenomegaly. A rash that peels, often on the palms and soles, is common. Liver involvement and hemolysis cause jaundice that may appear on the first day of life. The newborn's blood is tested with a nontreponemal test, and treatment with IV aqueous penicillin G is based on the maternal history and the infant's findings.

Question 7

The nurse on a hospital postpartum unit is reviewing the lochia recorded for four clients. For each description, specify whether it is lochia rubra, lochia serosa or lochia alba.

Accepted Answer

Day 6 after birth, pinkish brown, light amount: Lochia serosa; Day 1 after birth, bright red, moderate amount: Lochia rubra; Day 15 after birth, yellowish white, scant amount: Lochia alba; Day 2 after birth, dark red with a few small clots: Lochia rubra. Lochia is the discharge from the uterus after birth as the lining where the placenta was attached heals. It changes color in one direction as the bleeding slows.

Lochia rubra is red, mostly blood with small bits of tissue, and lasts about the first 3 days. A few small clots, especially on first standing, fit here. Lochia serosa is pink to brown, with less blood and more serum and white cells, and runs from about day 4 to day 10. Lochia alba is yellowish white, mostly white cells and mucus, and starts around day 10. It can last 4 to 8 weeks.

The amount drops along with the color, from moderate in the first days to light and then scant.

Question 8

A client in labor on a hospital unit has just been told by the registered nurse (RN) that her cervix is fully dilated. She asks the nurse which stage of labor starts now and when it ends. Which of the following statements by the nurse is accurate?

Accepted Answer

C: "This stage starts now that you are fully dilated, and it ends when your baby is born.". The second stage of labor begins when the cervix is fully dilated at 10 cm and ends with the birth of the baby. It is the pushing stage. In a first labor it can last up to a few hours, and in a client who has given birth before it is often much shorter.

The boundaries are set by events in the cervix and the birth, not by what the client feels. That matters, because the two can come apart. Some clients feel a strong urge to push before they are fully dilated, when the head is low and pressing on the rectum, and some feel no urge at all for a while after they reach 10 cm, particularly with an epidural.

Question 9

During a 37-week prenatal visit, the nurse is reinforcing teaching with a 23-year-old nulliparous client who plans to give birth at a hospital birth center 30 minutes from home. Which of the following should the nurse include as reasons for the client to come to the birth center?

Accepted Answer

A: Regular contractions every 5 minutes for 1 hour; B: A gush or steady trickle of fluid from the vagina; D: Bright red vaginal bleeding heavier than spotting; E: Fewer fetal movements than the baby's usual pattern. A nulliparous client is usually told to come in when contractions are regular, about every 5 minutes, for 1 hour, because early labor in a first birth is long and a client sent home in the latent phase tends to receive more interventions. Rupture of membranes needs to be checked at the birth center whatever the contraction pattern, because of the risk of cord prolapse and infection. Bright red bleeding, more than spotting, may signal placental abruption or placenta previa. A drop in fetal movement can be an early sign of fetal compromise and needs monitoring the same day.

Question 10

At a prenatal clinic, the nurse is reinforcing teaching with a 22-year-old client who is 8 weeks pregnant. Which statement by the client indicates a need for further teaching?

Accepted Answer

A: "I should start to feel the baby move sometime in the next 2 or 3 weeks.". Quickening, the first fetal movement the client feels, usually occurs between 16 and 20 weeks, so a client at 8 weeks should not expect it within 3 weeks. The first trimester covers weeks 1 to 13 and is when the organs form, which makes it the period of greatest risk from teratogens such as alcohol, isotretinoin and some antiseizure medications. Nausea and vomiting are common in the first trimester, and small, frequent, dry carbohydrate snacks before rising often help. Increased thin, white vaginal discharge is an expected effect of high estrogen levels.

NCLEX-PN maternity practice questions.