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These 15 items are written at NCLEX-PN level, emphasizing routine maternal and newborn data collection, safe basic care, reinforcement of teaching, and recognizing findings that must be reported promptly to the registered nurse or provider. Options are numbered; the answer key gives the number and the corresponding letter (1 = A, 2 = B, and so on). Scope of practice for the LPN and LVN varies by state, so always follow the state nurse practice act and facility policy. Core content for this subject is at [[Maternal and Newborn Nursing]].

==Question 1==
An LPN checks a client 4 hours after a vaginal birth and finds the fundus firm but located 2 cm above the umbilicus and displaced to the right. Which action should the LPN take '''first'''?
# Massage the fundus until it descends to the midline.
# Assist the client to the bathroom to empty her bladder.
# Report a possible postpartum hemorrhage to the registered nurse.
# Document the finding as an expected postpartum change.

'''Answer:''' 2 (B). Assist the client to the bathroom to empty her bladder.

''Rationale:'' A fundus that is firm but high and displaced to one side, usually the right, is the classic picture of a '''full bladder'''. A distended bladder pushes the uterus up and out of the midline and prevents it from contracting fully, which increases bleeding. Having the client void is a safe, independent nursing action, and the fundus is then reassessed. Option 1 is unnecessary because the fundus is already firm, and massage will not correct a bladder problem. Option 3 is premature; the LPN takes the simple corrective step first and reports if the fundus does not return to midline afterward. Option 4 is wrong because a displaced fundus is not an expected finding and needs action.

==Question 2==
An LPN is collecting data on a client who is 3 days postpartum. Which finding should the LPN report to the registered nurse?
# Pinkish-brown vaginal discharge with a fleshy odor
# Dark red vaginal discharge with a strong foul odor
# Temperature of 99.2 degrees F (37.3 degrees C)
# Pulse of 62 beats per minute

'''Answer:''' 2 (B). Dark red vaginal discharge with a strong foul odor.

''Rationale:'' A '''foul odor''' to lochia suggests endometritis and is always reported. In addition, lochia rubra normally transitions to lochia serosa by about day 4, so still-dark-red flow on day 3 combined with a foul smell is doubly concerning. Option 1 describes lochia serosa with its normal fleshy or musty odor, which is expected around day 3 to 4. Option 3 is within normal limits; a temperature of 100.4 degrees F (38 degrees C) or higher on two occasions after the first 24 hours is the reportable threshold. Option 4 is expected, because postpartum bradycardia of 50 to 70 beats per minute is normal; '''tachycardia''' would be the warning sign.

==Question 3==
An LPN obtains vital signs on a 6-hour-old newborn. Which finding requires prompt reporting to the registered nurse?
# Axillary temperature 98.4 degrees F (36.9 degrees C)
# Heart rate 148 beats per minute while awake
# Respiratory rate 74 breaths per minute with grunting
# Blue hands and feet with a pink trunk and face

'''Answer:''' 3 (C). Respiratory rate 74 breaths per minute with grunting.

''Rationale:'' Normal newborn respirations are 30 to 60 per minute. A sustained rate above 60 combined with '''grunting''' indicates respiratory distress and must be reported immediately; other danger signs are nasal flaring, retractions, central cyanosis, and apnea longer than 20 seconds. Option 1 is within the normal axillary range of 97.7 to 99.5 degrees F. Option 2 is within the normal awake heart rate of 110 to 160. Option 4 describes acrocyanosis, a normal finding in the first 24 to 48 hours caused by immature peripheral circulation; '''central''' or circumoral cyanosis would be abnormal.

==Question 4==
An LPN is assisting with the care of a newborn immediately after birth. Which action best prevents heat loss by '''evaporation'''?
# Moving the crib away from the exterior window
# Drying the infant thoroughly and removing the wet blankets
# Prewarming the scale before weighing the infant
# Closing the door to reduce air currents in the room

'''Answer:''' 2 (B). Drying the infant thoroughly and removing the wet blankets.

''Rationale:'' Evaporation is heat loss as moisture on the skin converts to vapor, so drying the newborn and removing damp linens is the direct countermeasure and is the single most important immediate action after birth. Option 1 addresses '''radiation''', heat transfer to a nearby cooler surface without direct contact. Option 3 addresses '''conduction''', direct contact with a cooler surface. Option 4 addresses '''convection''', loss to moving air. Newborns cannot shiver and depend on brown fat metabolism, so cold stress quickly leads to hypoglycemia and respiratory difficulty.

==Question 5==
An LPN reinforces breastfeeding teaching with a new mother. Which statement by the mother indicates a need for '''further''' teaching?
# "I should feed my baby 8 to 12 times in 24 hours."
# "I will wait until my baby cries before I offer the breast."
# "My baby's mouth should be open wide and take in part of the areola."
# "I will break the suction with my finger before taking the baby off the breast."

'''Answer:''' 2 (B). "I will wait until my baby cries before I offer the breast."

''Rationale:'' Crying is a '''late''' hunger cue. A crying, distressed infant latches poorly, and waiting for crying leads to fewer effective feedings and more nipple trauma. Mothers are taught to watch for early cues such as rooting, hand-to-mouth movement, lip smacking, and increased alertness. Options 1, 3, and 4 are all correct: newborns feed 8 to 12 times per 24 hours, a deep latch includes a wide-open mouth and a good portion of the areola with flanged lips, and breaking suction with a clean finger at the corner of the mouth prevents nipple injury.

==Question 6==
An LPN is reinforcing infant safe sleep teaching with parents before discharge. Which instructions should be included? '''Select all that apply.'''
# Place the infant on the back for every sleep, including naps
# Use a firm, flat sleep surface with a fitted sheet
# Place a rolled blanket beside the infant to prevent rolling
# Keep the infant's crib or bassinet in the parents' room for the first months
# Use a crib bumper pad to protect the infant's head
# Avoid overheating and keep the sleep area free of smoke exposure

'''Answer:''' 1, 2, 4, 6 (A, B, D, F).

''Rationale:'' Safe sleep guidance is supine positioning for every sleep, a firm flat surface in the infant's own sleep space, room sharing without bed sharing, and avoidance of overheating and tobacco smoke. Options 3 and 5 are incorrect and dangerous: rolled blankets, positioners, bumper pads, pillows, and soft toys all create suffocation, entrapment, and rebreathing hazards and are kept out of the sleep space entirely. Note the distinction between sleep and supervised awake tummy time, which is encouraged.

==Question 7==
An LPN takes vital signs on a client who is 36 hours postpartum and obtains a temperature of 100.8 degrees F (38.2 degrees C). The client's fundus is firm, and she reports mild perineal soreness. What should the LPN do?
# Encourage additional oral fluids and recheck in 4 hours.
# Report the temperature to the registered nurse.
# Document the finding as normal postpartum dehydration.
# Administer an as-needed antipyretic and continue routine care.

'''Answer:''' 2 (B). Report the temperature to the registered nurse.

''Rationale:'' A temperature of 100.4 degrees F (38 degrees C) or higher '''after''' the first 24 hours postpartum suggests puerperal infection and must be reported so the RN can complete a full assessment and notify the provider. Sources of postpartum infection include endometritis, urinary tract infection, wound or episiotomy infection, and mastitis. Option 1 delays evaluation. Option 3 is incorrect because dehydration is only an accepted explanation for a mildly elevated temperature within the '''first''' 24 hours. Option 4 treats a symptom and may mask a developing infection without the RN or provider knowing.

==Question 8==
An LPN reinforces umbilical cord care teaching with new parents. Which statement is correct?
# "Cover the cord with the diaper to keep it from being bumped."
# "Clean the cord with alcohol after every diaper change."
# "Keep the cord clean and dry, and fold the diaper below it."
# "Pull gently on the cord once it begins to loosen."

'''Answer:''' 3 (C). "Keep the cord clean and dry, and fold the diaper below it."

''Rationale:'' Current practice is dry cord care: keep the stump clean and dry, expose it to air, and fold the diaper down so urine does not saturate it. The stump typically detaches in about 7 to 14 days. Option 1 traps moisture and urine against the stump. Option 2 reflects outdated routine alcohol use, which is no longer recommended and can delay separation. Option 4 risks bleeding and infection; the stump is allowed to fall off on its own. Parents should report spreading redness on the abdomen, purulent drainage, foul odor, or fever.

==Question 9==
An LPN is providing perineal care to a client 6 hours after a vaginal birth with a second-degree laceration repair. Which action is appropriate?
# Apply a warm compress to the perineum to promote circulation.
# Apply an ice pack to the perineum for the first 24 hours.
# Instruct the client to wipe from back to front after voiding.
# Insert a rectal suppository if the client reports constipation.

'''Answer:''' 2 (B). Apply an ice pack to the perineum for the first 24 hours.

''Rationale:'' Cold produces vasoconstriction that limits edema and hematoma formation and numbs the area, so ice is used for roughly the first 24 hours. '''Heat, including sitz baths, is used after that period''' to promote circulation and healing, so option 1 is applied too early. Option 3 is backward: the client is taught to cleanse and wipe '''front to back''' to avoid moving rectal flora toward the urethra and the healing suture line, and a peri-bottle of warm water is used rather than rubbing. Option 4 is incorrect because no suppository has been ordered and constipation on the first postpartum day is reported and managed with fluids, fiber, ambulation, and stool softeners; rectal suppositories and enemas are '''contraindicated''' with a third- or fourth-degree laceration.

==Question 10==
An LPN is caring for postpartum clients on a mother-baby unit. Which findings should be reported to the registered nurse? '''Select all that apply.'''
# A client who saturated a perineal pad in 45 minutes
# A client with a pulse of 118 beats per minute and cool, clammy skin
# A client reporting severe, unrelieved rectal pressure and perineal pain
# A client with profuse sweating overnight who has voided large amounts
# A client reporting a severe headache with blurred vision
# A client with painful uterine cramping while breastfeeding

'''Answer:''' 1, 2, 3, 5 (A, B, C, E).

''Rationale:'' Saturating a perineal pad in an hour or less signals excessive bleeding. Tachycardia with cool, clammy skin is an early sign of hypovolemia, and blood pressure falls only late. Severe, unrelieved perineal or rectal pain suggests a '''hematoma''', which can conceal significant blood loss. Headache with visual changes raises concern for '''postpartum preeclampsia''', which can develop or worsen after birth and up to 6 weeks later. Option 4 describes normal postpartum diuresis and diaphoresis as the extra plasma volume of pregnancy is excreted. Option 6 describes afterpains, which are expected and are more intense in multiparas and during breastfeeding because oxytocin release stimulates contraction; these are treated with analgesia and reassurance.

==Question 11==
An LPN reviews the record of a newborn who is 28 hours old and notes that the infant has not yet had a wet diaper since birth. Which action is most appropriate?
# Report the finding to the registered nurse.
# Document it as an expected newborn finding.
# Offer the newborn sterile water between feedings.
# Apply a warm compress over the bladder to stimulate voiding.

'''Answer:''' 1 (A). Report the finding to the registered nurse.

''Rationale:'' A newborn is expected to void within the '''first 24 hours''' of life, and the first meconium stool is expected within 24 to 48 hours. No void by 28 hours must be reported so the infant can be evaluated for dehydration, inadequate intake, or a urinary tract anomaly or obstruction. Option 2 is incorrect because this is outside the expected window. Option 3 is unsafe: newborns are never given plain or sterile water, which can cause hyponatremia, water intoxication, and seizures; the correct response to poor intake is more frequent breast or formula feeding. Option 4 is not an evidence-based newborn intervention and delays reporting.

==Question 12==
An LPN reinforces discharge teaching for parents of a newborn who had a circumcision with a Plastibell device. Which statement by a parent indicates '''correct''' understanding?
# "I will remove the plastic ring after 24 hours."
# "I will call the doctor if I see any yellow film on the tip of the penis."
# "The ring will fall off on its own in about a week."
# "I will clean the area vigorously with alcohol wipes at each diaper change."

'''Answer:''' 3 (C). "The ring will fall off on its own in about a week."

''Rationale:'' The Plastibell ring separates and falls off on its own in roughly 5 to 8 days and is never removed by a caregiver, which makes option 1 incorrect and potentially injurious. Option 2 is incorrect because a yellowish exudate or film on the glans appearing within a day or two is normal granulation tissue and healing; it is '''not''' wiped away and is not a sign of infection. Option 4 is incorrect; alcohol is painful and damaging, and the area is cleaned gently with warm water. Parents should report bleeding more than a few drops, failure to void within 6 to 8 hours, foul odor, or swelling with fever.

==Question 13==
An LPN is reinforcing formula-feeding teaching with a mother. Which statement indicates a need for further teaching?
# "I will hold my baby semi-upright and keep the nipple full of formula."
# "I can add extra water to make the formula last longer."
# "I will never heat the bottle in the microwave."
# "I will throw away formula left in the bottle after a feeding."

'''Answer:''' 2 (B). "I can add extra water to make the formula last longer."

''Rationale:'' Overdiluting formula causes inadequate calorie and protein intake and can cause '''water intoxication with hyponatremia and seizures'''; underdiluting stresses immature kidneys with an excessive solute load. Formula is mixed exactly as the manufacturer directs. If cost is the underlying concern, the nurse reports it so the family can be connected with assistance programs. Options 1, 3, and 4 are correct: semi-upright positioning with a full nipple reduces air swallowing and choking risk, microwaving creates uneven hot spots that can burn the mouth, and leftover formula is discarded because saliva contaminates it with bacteria.

==Question 14==
An LPN observes yellow discoloration of the skin and sclerae in a newborn who is 14 hours old. What should the LPN do?
# Report the finding to the registered nurse immediately.
# Document it as physiologic jaundice and place the infant near a sunny window.
# Offer the infant sterile water between feedings to flush out bilirubin.
# Recheck the infant's color at the end of the shift.

'''Answer:''' 1 (A). Report the finding to the registered nurse immediately.

''Rationale:'' Jaundice appearing within the '''first 24 hours of life is pathologic until proven otherwise''' and suggests hemolysis such as Rh or ABO incompatibility, infection, or a metabolic cause. It requires prompt bilirubin measurement because rapidly rising unconjugated bilirubin can cross the blood-brain barrier and cause permanent injury. Physiologic jaundice appears '''after''' 24 hours, so option 2 misidentifies the finding, and placing an infant in direct sun is unsafe because of burn and temperature risks. Option 3 is incorrect: water does not lower bilirubin, and frequent breast or formula feeding is what promotes bilirubin excretion in the stool. Option 4 delays care.

==Question 15==
An LPN is reinforcing discharge teaching with a client who is Rh negative and gave birth to an Rh-positive newborn. The client asks why she is receiving an injection before going home. Which response is most accurate?
# "It will protect this baby from developing jaundice."
# "It prevents your body from making antibodies that could harm a future baby."
# "It boosts your immunity so you do not get an infection after delivery."
# "It replaces the blood you lost during the birth."

'''Answer:''' 2 (B). "It prevents your body from making antibodies that could harm a future baby."

''Rationale:'' Rho(D) immune globulin is given within 72 hours of birth when an Rh-negative person delivers an Rh-positive newborn. It destroys fetal Rh-positive red cells that entered the maternal circulation before the maternal immune system can be '''sensitized''' and form permanent anti-D antibodies, which would attack the red cells of a future Rh-positive fetus and cause hemolytic disease of the newborn. It is also given at about 28 weeks of pregnancy and after events such as miscarriage, ectopic pregnancy, amniocentesis, or abdominal trauma. Options 1, 3, and 4 are incorrect: it does nothing for the current infant, it is not a vaccine against infection, and it is not a blood volume replacement.

[[Category:Maternal and Newborn Nursing]]
[[Category:Licensed Practical Nurse (NCLEX-PN)]]
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