Maternity and Newborn NCLEX RN Questions
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Question 1 of 5.
The nurse is caring for a pregnant client who is experiencing late decelerations while labor is being induced with oxytocin. Which of the following actions should the nurse take? Select all that apply.
A. Initiate intravenous magnesium sulfate
B. Reposition the client on her left side
C. Administer oxygen via face mask
D. Discontinue oxytocin infusion
E. Prepare for an amnioinfusion
Explanation: Late decelerations indicate placental insufficiency. Repositioning to the left side (B) improves placental perfusion, administering oxygen (C) enhances fetal oxygenation, and discontinuing oxytocin (D) reduces uterine contractions to prevent further distress. Magnesium sulfate (A) is used for preeclampsia or preterm labor, not late decelerations. Amnioinfusion (E) is used for variable decelerations.
Question 2 of 5.
The nurse is caring for a client in the third trimester of pregnancy. Which of the following assessment findings would be expected? Select All That Apply.
A. Persistent abdominal pain
B. Increased fetal movement
C. Swollen ankles and feet
D. Weight loss
E. Decreased frequency of urination
Explanation: Increased fetal movement and swollen ankles/feet are normal due to fetal growth and fluid retention. Persistent abdominal pain, weight loss, and decreased urination are concerning and require investigation.
Question 3 of 5.
Your pregnant client has been hospitalized with hyperemesis gravidarum. She is given ondansetron to treat this illness. What serious side effects should the hospital nurses be watching for?
A. Continued nausea and vomiting
B. Prolonged QT interval
C. Respiratory distress
D. Constipation
Explanation: Ondansetron can cause prolonged QT interval, a serious cardiac risk, requiring monitoring.
Question 4 of 5.
The nurse is performing an obstetrics history on a client who is pregnant at 25 gestational weeks. The client reports giving birth to twins at 31 weeks of gestation. She had a stillborn infant at 23 weeks gestation and a spontaneous abortion at 12 weeks gestation. The nurse is correct in documenting her GTPAL as
A. G4-T0-P2-A1-L2
B. G4-T0-P1-A2-L2
C. G4-T0-P1-A2-L3
D. G4-T1-P1-A1-L2
Explanation: GTPAL: G4 (4 pregnancies), T0 (no term births), P2 (twins at 31 weeks, preterm), A1 (spontaneous abortion), L2 (two living children from twins).
Question 5 of 5.
The nurse is caring for a pregnant client who has a rubella infection. Which of the following issues is the client's fetus at risk of developing? Select all that apply.
A. intrauterine growth restriction (IUGR)
B. hemolytic disease
C. hydrocephaly
D. large for gestational age (LGA)
E. stillbirth
Explanation: Rubella can cause congenital rubella syndrome, leading to IUGR, hydrocephaly, and stillbirth. Hemolytic disease and LGA are unrelated.
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