Grade A+ Labor and Delivery Nclex style questions and answers 2025
The nurse is assessing a pregnant client in the second trimester
of pregnancy who was admitted to the maternity unit with a sus-
pected diagnosis of abruptio placentae. Which assessment finding
should the nurse expect to note if this condition is present?
2. Uterine tenderness
1. Soft abdomen
2. Uterine tenderness
3. absence of abdominal pain
4. painless, bright red vaginal bleeding
The maternity nurse is preparing for the admission of a client
in the third trimester of pregnancy who is experiencing vaginal
bleeding and has a suspected diagnosis of placenta previa. The
nurse reviews the health care provider's prescriptions and should
question which prescription?
2. Obtain equipment for a manual pelvic examination.
1. Prepare the client for an ultrasound.
2. Obtain equipment for a manual pelvic examination.
3. Prepare to draw a hemoglobin and hematocrit blood sample
4. Obtain equipment for external electronic fetal heart rate moni-
toring
An ultrasound is preformed on a client at term gestation who is
experiencing moderate vaginal bleeding. The results of the ultra-
sound indicate that abruption placentae is present. On the basis
of these findings, the nurse should prepare the client for which
anticipated prescription?
1. Delivery of the fetus 1. Delivery of the fetus.
2. Strict monitoring of intake and output
3. Complete bed rest for the remainder of the pregnancy
4. The need for weekly monitoring of coagulation studies until the
time of delivery
The nurse is preforming an initial assessment on a client who has
just been told that a pregnancy test is positive. Which assessment
finding indicates that the client is at risk for preterm labor?
1. The client is a 35 year old primigravida
2. The client has a history of cardiac disease
2. The client has a history of cardiac disease
3. The client's hemoglobin level is 13.5 g/dL
4. The client is a 20 year old primigravida of average weight and
height
The nurse is monitoring a client in active stage of labor. The client
has been experiencing contractions that are short, irregular, and
weak. The nurse documents that the client is experiencing which
type of labor dystocia?
1. Hypotonic 1. Hypotonic
2. Precipitous
3. Hypertonic
4. Preterm labor
After a precipitous delivery, the nurse notes that the new mother
is passive and only touches her newborn infant briefly with her
fingertips. What should the nurse do to help the woman process
the delivery?
2. Support the mother in her reaction to the newborn infant 1. Encourage the mother to breastfed soon after birth
2. Support the mother in her reaction to the newborn infant
3. Tell the mother that it is important to hold the newborn infant.
4. document a complete account of the mother's reaction on the
birth record.
The nurse in a labor room is monitoring a client with dysfunctional
labor for signs of fetal or maternal compromise. Which assessment
finding would alert the nurse to a compromise?
4. Persistent nonreassuring fetal heart rate 1. Maternal fatigue
2. coordinated uterine contractions
3. Progressive changes in the cervix
4. Persistent nonreassuring fetal heart rate
3.
The cervix is completely dilated 1/7
, The nurse is caring for a client in labor. Which assessment finding
indicates to the nurse that the client is beginning the second stage
of labor?
1. The contractions are regular.
2. The membranes have ruptured
3. The cervix is completely dilated
4. The client starts to expel clear vaginal fluid
The nurse is preforming an assessment of a client who is sched-
uled for a cesarean delivery. Which assessment finding would
indicate the need to contact the health care provider?
2. Fetal heart rate of 180 beats/minute 1. Hemoglobin of 11g/dL
2. Fetal heart rate of 180 beats/minute
3. Maternal pulse rate of 85 beats/minute
4. White blood cell count of 12,000 cells/mm3
The nurse is reviewing the record of a client in the labor room
and notes that the health care provider had documented the
fetal presenting part is at the -1 station. This documented finding
indicates that the fetal presenting part is located at which area?
3.1 cm above the ischial spine
1.1 inch below the coccyx
2.1 inch below the iliac crest
3.1 cm above the ischial spine
4.1 fingerbreadth below the symphysis pubis
A client arrives at birthing center in active labor. Her membranes
are still intact, and the health care provider prepares to perform
an amniotomy. What will the nurse relay to the client as the most
likely outcome of the amniotomy?
3. Increased efficiency of contractions 1. less pressure on her cervix
2. decreased number of contractions
3. increased efficiency of contractions
4. the need for increased maternal blood pressure monitoring
A postpartum nurse is taking the vital signs of a client who deliv-
ered a healthy infant 4 hours ago. The nurse notes that the client's
temperature is 100.2 degrees Farenheit. Which of the following
actions would be appropriate?
4. Increase hydration by encouraging oral fluids.
1. Notify the physician.
2. Document the findings.
3. Retake the temperature in 15 minutes.
4. Increase hydration by encouraging oral fluids.
A nurse is assessing a client who is 6 hours post-partum after
delivering a full-term healthy infant. The client complains to the
nurse of feelings of faintness and dizziness. Which nursing action
would be most appropriate?
1. Elevate the client's legs.
3. Instruct the client to request help when getting out of bed.
2. Determine the hemoglobin and hematocrit levels.
3. Instruct the client to request help when getting out of bed.
4. Inform the nursery room nurse to avoid bringing the newborn
infant to the client until the feelings of faintness and dizziness have
subsided.
A postpartum nurse is providing instructions to a client after de-
livery of a healthy infant. The nurse instructs the client that she
should expect normal bowel elimination to return:
1. 3 days postpartum 1. 3 days postpartum
2. 7 days postpartum
3. On the day of delivery
4. Within 2 weeks postpartum
A nurse is planning care for a postpartum client who had a vaginal
delivery 2 hours ago. The client had a midline episiotomy and has
1. Acute pain several hemorrhoids. What is the priority nursing diagnosis for this
client?
1. Acute pain
2/7
The nurse is assessing a pregnant client in the second trimester
of pregnancy who was admitted to the maternity unit with a sus-
pected diagnosis of abruptio placentae. Which assessment finding
should the nurse expect to note if this condition is present?
2. Uterine tenderness
1. Soft abdomen
2. Uterine tenderness
3. absence of abdominal pain
4. painless, bright red vaginal bleeding
The maternity nurse is preparing for the admission of a client
in the third trimester of pregnancy who is experiencing vaginal
bleeding and has a suspected diagnosis of placenta previa. The
nurse reviews the health care provider's prescriptions and should
question which prescription?
2. Obtain equipment for a manual pelvic examination.
1. Prepare the client for an ultrasound.
2. Obtain equipment for a manual pelvic examination.
3. Prepare to draw a hemoglobin and hematocrit blood sample
4. Obtain equipment for external electronic fetal heart rate moni-
toring
An ultrasound is preformed on a client at term gestation who is
experiencing moderate vaginal bleeding. The results of the ultra-
sound indicate that abruption placentae is present. On the basis
of these findings, the nurse should prepare the client for which
anticipated prescription?
1. Delivery of the fetus 1. Delivery of the fetus.
2. Strict monitoring of intake and output
3. Complete bed rest for the remainder of the pregnancy
4. The need for weekly monitoring of coagulation studies until the
time of delivery
The nurse is preforming an initial assessment on a client who has
just been told that a pregnancy test is positive. Which assessment
finding indicates that the client is at risk for preterm labor?
1. The client is a 35 year old primigravida
2. The client has a history of cardiac disease
2. The client has a history of cardiac disease
3. The client's hemoglobin level is 13.5 g/dL
4. The client is a 20 year old primigravida of average weight and
height
The nurse is monitoring a client in active stage of labor. The client
has been experiencing contractions that are short, irregular, and
weak. The nurse documents that the client is experiencing which
type of labor dystocia?
1. Hypotonic 1. Hypotonic
2. Precipitous
3. Hypertonic
4. Preterm labor
After a precipitous delivery, the nurse notes that the new mother
is passive and only touches her newborn infant briefly with her
fingertips. What should the nurse do to help the woman process
the delivery?
2. Support the mother in her reaction to the newborn infant 1. Encourage the mother to breastfed soon after birth
2. Support the mother in her reaction to the newborn infant
3. Tell the mother that it is important to hold the newborn infant.
4. document a complete account of the mother's reaction on the
birth record.
The nurse in a labor room is monitoring a client with dysfunctional
labor for signs of fetal or maternal compromise. Which assessment
finding would alert the nurse to a compromise?
4. Persistent nonreassuring fetal heart rate 1. Maternal fatigue
2. coordinated uterine contractions
3. Progressive changes in the cervix
4. Persistent nonreassuring fetal heart rate
3.
The cervix is completely dilated 1/7
, The nurse is caring for a client in labor. Which assessment finding
indicates to the nurse that the client is beginning the second stage
of labor?
1. The contractions are regular.
2. The membranes have ruptured
3. The cervix is completely dilated
4. The client starts to expel clear vaginal fluid
The nurse is preforming an assessment of a client who is sched-
uled for a cesarean delivery. Which assessment finding would
indicate the need to contact the health care provider?
2. Fetal heart rate of 180 beats/minute 1. Hemoglobin of 11g/dL
2. Fetal heart rate of 180 beats/minute
3. Maternal pulse rate of 85 beats/minute
4. White blood cell count of 12,000 cells/mm3
The nurse is reviewing the record of a client in the labor room
and notes that the health care provider had documented the
fetal presenting part is at the -1 station. This documented finding
indicates that the fetal presenting part is located at which area?
3.1 cm above the ischial spine
1.1 inch below the coccyx
2.1 inch below the iliac crest
3.1 cm above the ischial spine
4.1 fingerbreadth below the symphysis pubis
A client arrives at birthing center in active labor. Her membranes
are still intact, and the health care provider prepares to perform
an amniotomy. What will the nurse relay to the client as the most
likely outcome of the amniotomy?
3. Increased efficiency of contractions 1. less pressure on her cervix
2. decreased number of contractions
3. increased efficiency of contractions
4. the need for increased maternal blood pressure monitoring
A postpartum nurse is taking the vital signs of a client who deliv-
ered a healthy infant 4 hours ago. The nurse notes that the client's
temperature is 100.2 degrees Farenheit. Which of the following
actions would be appropriate?
4. Increase hydration by encouraging oral fluids.
1. Notify the physician.
2. Document the findings.
3. Retake the temperature in 15 minutes.
4. Increase hydration by encouraging oral fluids.
A nurse is assessing a client who is 6 hours post-partum after
delivering a full-term healthy infant. The client complains to the
nurse of feelings of faintness and dizziness. Which nursing action
would be most appropriate?
1. Elevate the client's legs.
3. Instruct the client to request help when getting out of bed.
2. Determine the hemoglobin and hematocrit levels.
3. Instruct the client to request help when getting out of bed.
4. Inform the nursery room nurse to avoid bringing the newborn
infant to the client until the feelings of faintness and dizziness have
subsided.
A postpartum nurse is providing instructions to a client after de-
livery of a healthy infant. The nurse instructs the client that she
should expect normal bowel elimination to return:
1. 3 days postpartum 1. 3 days postpartum
2. 7 days postpartum
3. On the day of delivery
4. Within 2 weeks postpartum
A nurse is planning care for a postpartum client who had a vaginal
delivery 2 hours ago. The client had a midline episiotomy and has
1. Acute pain several hemorrhoids. What is the priority nursing diagnosis for this
client?
1. Acute pain
2/7
