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Summary OB Postpartum NCLEX Style Exam Questions & Answers, With Rationales
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Summary OB Postpartum NCLEX Style Questions & Answers, With Rationales-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 ...

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  • December 1, 2022
  • September 27, 2024
  • 20
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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Summary OB Postpartum NCLEX Style
Questions & Answers, With Rationales
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?
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
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 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?
A) Document the findings
B) Notify the physician
C) Reassess the client in 2 hours
D) Encourage increased intake of fluids - B) Notify the physician

Rationale: Normally, one may find a few small clots in the first 1 to 2 days after birth
from pooling of blood in the vagina. Clots larger than 1 cm are considered abnormal.
The cause of these clots, such as uterine atony or retained placental fragments, needs to
be determined and treated to prevent further blood loss. Although the findings would
be documented, the most appropriate action is to notify the physician.

A nurse in a PP unit is instructing a mother regarding lochia and the amount of
expected lochia drainage. The nurse instructs the mother that the normal amount of
lochia may vary but should never exceed the need for:
A) One peripad per day
B) Two peripads per day
C) Three peripads per day
D) Eight peripads per day - D) Eight peripads per day

Rationale: The normal amount of lochia may vary with the individual but should never
exceed 4 to 8 peripads per day. The average number of peripads is 6 per day.

A PP nurse is providing instructions to a woman after delivery of a healthy newborn
infant. The nurse instructs the mother that she should expect normal bowel elimination
to return:
A) One the day of the delivery
B) 3 days PP
C) 7 days PP
D) within 2 weeks PP - B) 3 days PP

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