NCLEX PREP
SELECT ALL THAT APPLY QUESTIONS:
Pregnant Client Receiving Prenatal Care:
1. A 40-year old gravida 4 client at 10 weeks
gestation and her husband are coming into the
clinic to discuss tests that are available during the
first or early second trimester to diagnose an
abnormality of the fetus. Which of the following
tests are appropriate? SATA.
o Electrocardiogram
o Chorionic Villi Sampling (CVS)
o Amniocentesis
o Triple Screen
o External Fetal Monitoring (EFM)
2. The nurse is discussing dietary concerns with
pregnant teens. Which of the following choices are
convenient for teens yet nutritious for both the
mother and the fetus? SATA.
o Milkshake or yogurt with fresh fruit or
granola bar
o Chicken nuggets with tater tots
o Cheese pizza with spinach and mushroom
topping
o Peanut butter with crackers and a juice
drink
o Buttery light popcorn with diet cola
o Cheeseburger with tomato, lettuce, pickle,
ketchup, baked potato
3. A primigravid client at 32weeks gestation is
enrolled in a breastfeeding class. Which of the
following statements indicate that the client
understands the breastfeeding education? SATA.
o ‘My milk supply will be adequate since I
have increased a whole bra size during
pregnancy’
o ‘I can hold my baby several different
ways during feedings’
o ‘if my infant latches on properly, I won’t
develop mastitis’
o ‘If I breastfeed, my uterus will return to
pregnancy size more quickly’
o ‘Breastmilk can be expressed and stored at
room temperature since it is natural’
o ‘I need to feed my baby when I see
feeding cues and not wait until she is
crying’
Complication of Pregnancy:
1. After reinforcing the danger signs to report with a
client, gravida 2 at 32 weeks gestation with an
elevated blood pressure, which client statement
would demonstrate her understanding of when to
call the physician’s office? SATA
o ‘If I get up in the morning and feel dizzy,
even if it goes away’
o I need to call the hospital right away if I
see any bleeding, even if I have no pain’
o ‘I have a pounding headache that doesn’t
go away’
o ‘I notice the veins in my legs getting bigger’
o ‘The leg cramps at night are waking me up’
o ‘The baby seems to be more active than
usual’
2. A primiparous client has just delivered her baby.
The physician has informed the labor nurse that he
believes the uterus has inverted. Which signs or
symptoms would help to confirm this diagnosis?
SATA
o Hypotension
o Gush of blood from the vagina
o Intense severe tearing type of abdominal
pain
o Uterus is hard and in a constant state of
contraction
o Inability to palpate uterus
o Diaphoresis
3. The nurse assesses a primiparous client in labor for
20 hours. The nurse identifies late decelerations on
the monitor and initiates standard procedures for
the labor client with this wave pattern including
which of the following? SATA
o Administering oxygen via mask to the
client
o Questioning the client about the
effectiveness of pain relief
o Placing the client on her side
o Readjusting the monitor to a more
comfortable position
o Applying an internal fetal monitor to help
identify the cause of the decelerations.
4. While a client is being admitted to the birthing unit
she states, “My water broke last night, but my
labor started two hours ago” Which of the
following assessment findings would be cause for
concern? SATA
o Maternal VS: T99.5, HR80, R24, BP130/80
 o Blood and mucus on perineal pad
o Baseline FHR of 140 with a range
between 110 and 160 with contractions
o Peripad stained with green fluid
o The client states ‘this baby wants out-he
keeps kicking me’

5. The nurse has obtained a urine specimen from a

gravida 6 para 5 client admitted to the labor unit.
The woman asks to go to the bathroom and reports
that she feels she has to move her bowels. Which
action is appropriate? SATA
o Assisting her to the bathroom
o Applying an external fetal monitor to obtain
fetal heart rate
o Assessing her stage of labor
o Asking if she had back labor pains like this
with any of her other deliveries
o Allowing her support person to take her to
the bathroom to maintain privacy
o Checking the degree of fetal descent

Postpartal Care

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