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Exam (elaborations)

OB Postpartum NCLEX Questions with 100% Correct Answers

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OB Postpartum NCLEX Questions with 100% Correct Answers

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Nursing nclex
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Uploaded on
August 15, 2024
Number of pages
37
Written in
2024/2025
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©PREP4EXAMS@2024/2025 [ REAL-EXAM-DUMPS] Monday, August 5, 2024 1: 54 PM


WEST VIRGINIA UNIVERSIRTY-WV26506

OB Postpartum NCLEX Questions with 100% Correct Answers


A postpartum nurse is preparing to care for a woman who has just delivered a healthy

newborn infant. In the immediate postpartum period the nurse plans to take the

woman's vital signs:


A) Every 30 minutes during the first hour and then every hour for the next two hours.


B) Every 15 minutes during the first hour and then every 30 minutes for the next two

hours.


C) Every hour for the first 2 hours and then every 4 hours


D) Every 5 minutes for the first 30 minutes and then every hour for the next 4 hours. -

✔️✔️B) Every 15 minutes during the first hour and then every 30 minutes for the next two

hours.




Rationale: Every 15 minutes during the first hour and then every 30 minutes for the next

two hours.


A postpartum nurse is taking the vital signs of a woman who delivered a healthy

newborn infant 4 hours ago. The nurse notes that the mother's temperature is 100.2*F.

Which of the following actions would be most appropriate?




1

,©PREP4EXAMS@2024/2025 [ REAL-EXAM-DUMPS] Monday, August 5, 2024 1: 54 PM


WEST VIRGINIA UNIVERSIRTY-WV26506
A) Retake the temperature in 15 minutes


B) Notify the physician


C) Document the findings


D) Increase hydration by encouraging oral fluids - ✔️✔️D) Increase hydration by

encouraging oral fluids




Rationale: The mother's temperature may be taken every 4 hours while she is awake.

Temperatures up to 100.4 (38 C) in the first 24 hours after birth are often related to the

dehydrating effects of labor. The most appropriate action is to increase hydration by

encouraging oral fluids, which should bring the temperature to a normal reading.

Although the nurse would document the findings, the most appropriate action would be

to increase the hydration.


The nurse is assessing a client who is 6 hours PP after delivering a full-term healthy

infant. The client complains to the nurse of feelings of faintness and dizziness. Which of

the following nursing actions would be most appropriate?


A) Obtain hemoglobin and hematocrit levels


B) Instruct the mother to request help when getting out of bed


C) Elevate the mother's legs




2

,©PREP4EXAMS@2024/2025 [ REAL-EXAM-DUMPS] Monday, August 5, 2024 1: 54 PM


WEST VIRGINIA UNIVERSIRTY-WV26506
D) Inform the nursery room nurse to avoid bringing the newborn infant to the mother

until the feelings of lightheadedness and dizziness have subsided - ✔️✔️B) Instruct the

mother to request help when getting out of bed




Rationale: Orthostatic hypotension may be evident during the first 8 hours after birth.

Feelings of faintness or dizziness are signs that should caution the nurse to be aware of

the client's safety. The nurse should advise the mother to get help the first few times the

mother gets out of bed. Obtaining an H/H requires a physicians order.


A nurse is preparing to perform a fundal assessment on a postpartum client. The initial

nursing action in performing this assessment is which of the following?


A) Ask the client to turn on her side


B) Ask the client to lie flat on her back with the knees and legs flat and straight


C) Ask the mother to urinate and empty her bladder


D) Massage the fundus gently before determining the level of the fundus. - ✔️✔️C) Ask

the mother to urinate and empty her bladder




Rationale: Before starting the fundal assessment, the nurse should ask the mother to

empty her bladder so that an accurate assessment can be done. When the nurse is

performing fundal assessment, the nurse asks the woman to lie flat on her back with the


3

, ©PREP4EXAMS@2024/2025 [ REAL-EXAM-DUMPS] Monday, August 5, 2024 1: 54 PM


WEST VIRGINIA UNIVERSIRTY-WV26506
knees flexed. Massaging the fundus is not appropriate unless the fundus is boggy and

soft, and then it should be massaged gently until firm.


The nurse is assessing the lochia on a 1 day PP patient. The nurse notes that the lochia

is red and has a foul-smelling odor. The nurse determines that this assessment finding

is:


A) Normal


B) Indicates the presence of infection


C) Indicates the need for increasing oral fluids


D) Indicates the need for increasing ambulation - ✔️✔️B) Indicates the presence of

infection




Rationale: Lochia, the discharge present after birth, is red for the first 1 to 3 days and

gradually decreases in amount. Normal lochia has a fleshy odor. Foul smelling or

purulent lochia usually indicates infection, and these findings are not normal.

Encouraging the woman to drink fluids or increase ambulation is not an accurate

nursing intervention


When performing a PP assessment on a client, the nurse notes the presence of clots in

the lochia. The nurse examines the clots and notes that they are larger than 1 cm.

Which of the following nursing actions is most appropriate?




4

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