NCLEX - MATERNITY Day2

Which postpartum finding requires immediate intervention?

• Lochia soaking pad every 2 hours
• Persistent headache and blurred vision
• Red, painful nipple
• Strong-smelling vaginal discharge
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Which finding in a client hospitalized for preeclampsia requires immediate follow-up?

• Dark red vaginal bleeding
• Edema of the hands and face
• Elevated liver enzymes
• Urine output of 150 mL in 4 hours
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Which lab test should be ordered for a client at 20 weeks who reports eating powdered cornstarch?

• Urine culture and sensitivity
• Serum hCG
• Hematocrit and hemoglobin
• Fecal occult blood test
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Which statement by client at 8 weeks gestation shows correct understanding of pregnancy weight gain?

• I should gain 10–15 lb during first trimester
• I should gain about 30 lb total during pregnancy
• I should gain no more than 0.5 lb per week in third trimester
• Less than 20 lb total will be easier to lose after birth
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Which statement about glucose challenge test at 24 weeks requires follow-up?

• I need to fast for 12 hours before the test
• I'll drink a 50-g glucose solution
• The test requires no food intake for 1 hour afterward
• A 3-hour glucose tolerance test may follow
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Which findings indicate positive signs of pregnancy?

• Cervical softening
• Fetal heart tones via Doppler
• Positive hCG test
• Client report of fetal movement
• Fetal visualization via ultrasound

What should be included in teaching after cervical cerclage placement?

• The cerclage will be removed at 28 weeks
• Report back pain or discomfort
• Check the strings weekly
• Weekly contraction stress tests will be needed
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Post-epidural birth client has fundus 2 cm above umbilicus, deviated to right, and no urge to void. Best action?

• Change pad and provide perineal care
• Encourage fluid intake
• Request tocolytic medication
• Perform intermittent urinary catheterization
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What instructions should nurse give client with mastitis?

• Apply warm compresses
• Stop breastfeeding until resolved
• Increase fluid intake
• Take ibuprofen PRN
• Wear tight-fitting bra

Which statement about diabetes and preconception health is accurate?

• I'll need more insulin during first trimester
• Elevated hemoglobin A1c increases birth defect risk
• I'm at risk of miscarriage even if controlled
• Less monitoring needed in third trimester
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