OB Comprehensive Review for the
NCLEX-PN Exam, 6th Edition
During a routine prenatal visit, a female at 38 weeks' gestation tells the practical nurse (PN) that
both her cousin and her cousin's 1-year-old daughter have phenylketonuria (PKU). The client is
concerned that her unborn child may also have PKU and become mentally retarded. Which
information should the PN provide?
b. PKU screening is performed after the newborn ingests milk.
Rationale: PKU is an inborn error of metabolism resulting in an elevated serum amino acid,
phenylalanine, which causes mental retardation; therefore, it’s important to PKU screening after
the newborn has ingested breast milk or formula milk protein.
The practical nurse (PN) is caring for a gravida 4, para 3, with a history of rheumatic heart
disease, admitted to the antepartum unit in preterm labor at 32 weeks' gestation. Which
assessment findings indicate the onset of cardiac failure requiring immediate intervention?
a. Edema, adventitious lung sounds, and tachycardia
Rationale: Edema, adventitious lung sounds, and an irregular pulse indicate cardiac
decompensation and require immediate intervention.
The nurse is taking the temperature of a client who is 6 hours postpartum. The nurse notes that
the client's temperature is 38° C (100.4° F). Which intervention should the nurse implement?
a. Encourage fluids to increase hydration.
Rationale: It is normal for the postpartum client to have a temperature up to 38° C (100.4° F)
because of dehydration caused by labor. The most appropriate intervention is to encourage
fluids to rehydrate the patient.
Which parental behavior is a warning to the practical nurse that there may be negative bonding
between parents and a newborn infant?
c. Parents frequently leave the newborn infant wrapped in blankets.
Rationale: Attachment/bonding theory indicates that parents have an extreme interest in
visualizing every part of the newborn in a head to toe examination and exploration process.
,A client who is 40 weeks into pregnancy is having a vaginal examination at the clinic when the
nurse notes a sudden gush of yellowish, clear fluid from the vaginal area. What should be the
nurse's first action?
a. Measure the fetal heart rate.
Rationale: When the amniotic sac ruptures, there is a risk that the umbilical cord could prolapse,
causing fetal bradycardia and decreased blood supply to the fetus. The nurse should measure
the fetal heart rate immediately when the amniotic sac ruptures. If the cord has prolapsed, the
fetus needs to be delivered immediately. It is important to note the color and odor of the fluid for
signs of infection and to assess for uterine contractions; however, the priority is assessing for a
prolapsed cord by assessing the fetal heart rate. Placing a dry pad under the client is not a
priority action.
What nursing intervention does the nurse expect to see in the plan of care to aid in preventing
postpartum thrombophlebitis for a client who has had a Caesarean delivery?
d. Encourage early ambulation after delivery.
Rationale: Early ambulation increases venous return and prevents thrombophlebitis. Clotting
factors are normally elevated in the postpartum period to heal the placental site, thereby
predisposing clients to thrombus formation.
The nurse has reinforced education for a client who is 11 weeks pregnant and has had no
pregnancy complications. Which client comment indicates adequate understanding of the
instructions?
c. “I can expect my nausea to be reduced in the next few weeks.”
Rationale: Pregnancy-related nausea usually resolves by the 13th week. If the client travels via
airplane, the client should take additional fluids to prevent deep vein thrombosis. The healthy
client can exercise as long as she is able to converse easily while exercising. No level of alcohol
is considered safe while pregnant.
Following a vaginal delivery, a postpartum client complains of severe cramping after
breastfeeding her newborn. Which explanation describes the most likely reason for the client's
pain?
c. The release of oxytocin hormone
, Rationale: During breastfeeding, oxytocin is released and will cause uterine contractions and
cramping.
A mother who is positive for the HIV virus delivers a 7-pound boy. Which intervention should the
practical nurse initiate to prevent transfer of the virus to the infant?
b. Prevent breastfeeding but encourage rooming-in.
Rationale: Rooming-in should be allowed, but transmission of the mother’s body fluids (breast
milk) should be prevented. Standard precautions should be instituted.
The nurse is assisting the health care provider who will be performing an amniocentesis on a
client who is 37 weeks pregnant. Which is the priority action for the nurse to take prior to the
procedure?
d. Instruct the client to empty her bladder prior to the procedure.
Rationale: The client who is in late pregnancy should empty her bladder before the procedure to
prevent injury to the bladder. It is not necessary to give the client fluids prior to the procedure, or
to turn the client to the left lateral position. It is not normal to experience contractions after this
procedure, if these happen, the health care provider should be notified.
The nurse is assisting with data collection for a 16-year-old client who is 12 weeks pregnant.
Which client statement indicates instruction is necessary to ensure a safe pregnancy? (Select
all that apply.)
a. “I hate milk.”
b. “I only want to gain 10 pounds.”
c. “I will never have sex again.”
d. “My sister is pregnant too.”
e. “My mom smokes cigarettes when she was pregnant with me, so I can smoke too then.”
a. “I hate milk.”
b. “I only want to gain 10 pounds.”
NCLEX-PN Exam, 6th Edition
During a routine prenatal visit, a female at 38 weeks' gestation tells the practical nurse (PN) that
both her cousin and her cousin's 1-year-old daughter have phenylketonuria (PKU). The client is
concerned that her unborn child may also have PKU and become mentally retarded. Which
information should the PN provide?
b. PKU screening is performed after the newborn ingests milk.
Rationale: PKU is an inborn error of metabolism resulting in an elevated serum amino acid,
phenylalanine, which causes mental retardation; therefore, it’s important to PKU screening after
the newborn has ingested breast milk or formula milk protein.
The practical nurse (PN) is caring for a gravida 4, para 3, with a history of rheumatic heart
disease, admitted to the antepartum unit in preterm labor at 32 weeks' gestation. Which
assessment findings indicate the onset of cardiac failure requiring immediate intervention?
a. Edema, adventitious lung sounds, and tachycardia
Rationale: Edema, adventitious lung sounds, and an irregular pulse indicate cardiac
decompensation and require immediate intervention.
The nurse is taking the temperature of a client who is 6 hours postpartum. The nurse notes that
the client's temperature is 38° C (100.4° F). Which intervention should the nurse implement?
a. Encourage fluids to increase hydration.
Rationale: It is normal for the postpartum client to have a temperature up to 38° C (100.4° F)
because of dehydration caused by labor. The most appropriate intervention is to encourage
fluids to rehydrate the patient.
Which parental behavior is a warning to the practical nurse that there may be negative bonding
between parents and a newborn infant?
c. Parents frequently leave the newborn infant wrapped in blankets.
Rationale: Attachment/bonding theory indicates that parents have an extreme interest in
visualizing every part of the newborn in a head to toe examination and exploration process.
,A client who is 40 weeks into pregnancy is having a vaginal examination at the clinic when the
nurse notes a sudden gush of yellowish, clear fluid from the vaginal area. What should be the
nurse's first action?
a. Measure the fetal heart rate.
Rationale: When the amniotic sac ruptures, there is a risk that the umbilical cord could prolapse,
causing fetal bradycardia and decreased blood supply to the fetus. The nurse should measure
the fetal heart rate immediately when the amniotic sac ruptures. If the cord has prolapsed, the
fetus needs to be delivered immediately. It is important to note the color and odor of the fluid for
signs of infection and to assess for uterine contractions; however, the priority is assessing for a
prolapsed cord by assessing the fetal heart rate. Placing a dry pad under the client is not a
priority action.
What nursing intervention does the nurse expect to see in the plan of care to aid in preventing
postpartum thrombophlebitis for a client who has had a Caesarean delivery?
d. Encourage early ambulation after delivery.
Rationale: Early ambulation increases venous return and prevents thrombophlebitis. Clotting
factors are normally elevated in the postpartum period to heal the placental site, thereby
predisposing clients to thrombus formation.
The nurse has reinforced education for a client who is 11 weeks pregnant and has had no
pregnancy complications. Which client comment indicates adequate understanding of the
instructions?
c. “I can expect my nausea to be reduced in the next few weeks.”
Rationale: Pregnancy-related nausea usually resolves by the 13th week. If the client travels via
airplane, the client should take additional fluids to prevent deep vein thrombosis. The healthy
client can exercise as long as she is able to converse easily while exercising. No level of alcohol
is considered safe while pregnant.
Following a vaginal delivery, a postpartum client complains of severe cramping after
breastfeeding her newborn. Which explanation describes the most likely reason for the client's
pain?
c. The release of oxytocin hormone
, Rationale: During breastfeeding, oxytocin is released and will cause uterine contractions and
cramping.
A mother who is positive for the HIV virus delivers a 7-pound boy. Which intervention should the
practical nurse initiate to prevent transfer of the virus to the infant?
b. Prevent breastfeeding but encourage rooming-in.
Rationale: Rooming-in should be allowed, but transmission of the mother’s body fluids (breast
milk) should be prevented. Standard precautions should be instituted.
The nurse is assisting the health care provider who will be performing an amniocentesis on a
client who is 37 weeks pregnant. Which is the priority action for the nurse to take prior to the
procedure?
d. Instruct the client to empty her bladder prior to the procedure.
Rationale: The client who is in late pregnancy should empty her bladder before the procedure to
prevent injury to the bladder. It is not necessary to give the client fluids prior to the procedure, or
to turn the client to the left lateral position. It is not normal to experience contractions after this
procedure, if these happen, the health care provider should be notified.
The nurse is assisting with data collection for a 16-year-old client who is 12 weeks pregnant.
Which client statement indicates instruction is necessary to ensure a safe pregnancy? (Select
all that apply.)
a. “I hate milk.”
b. “I only want to gain 10 pounds.”
c. “I will never have sex again.”
d. “My sister is pregnant too.”
e. “My mom smokes cigarettes when she was pregnant with me, so I can smoke too then.”
a. “I hate milk.”
b. “I only want to gain 10 pounds.”
