Submissions Here are your latest answers: Question 1 4. A primigravid client visits the clinic for a routine examination at 35 weeks gestation. The client’s blood pressure is near the baseline of 120/74 mm Hg with no proteinuria or evidence of facial edema. The client asks the nurse “What should I take if I get an occasional headache after looking at my computer at work all day?” the nurse instructs the client that she can occasionally take which of the following? Response: Acetaminophen (Tylenol). Correct answer: Acetaminophen (Tylenol). Score: 1 out of 1 Yes Question 2 36. The nurse is caring for a pregnant woman who is also diabetic. The nurse knows that she understands the management of her diabetes during pregnancy when she says, “ My blood sugar level should be: Response: 80 to 110 mg/dl.” Correct answer: 80 to 110 mg/dl.” Score: 1 out of 1 Yes Question 3 45. Ms. C., 40 weeks pregnant, is admitted to the labor suite. While the nurse is assessing Ms. C., her membranes rupture. The nurse immediately performs a vaginal exam. During the exam the nurse feels a loop of cord protruding into the vagina. The best immediate action for the nurse to take is: Response: Attempt to lift the fetal head off the cord. Correct answer: Attempt to lift the fetal head off the cord. Score: 1 out of 1 Yes Question 4 3. A nulligravid client with gestational diabetes tells the nurse that she had a reactive non – stress test 3 days ago and asks “What does that mean?” the nurse explains that a reactive non – stress test indicates which of the following about the fetus? Response: Fetal well – being at this point in the pregnancy. Correct answer: Fetal well – being at this point in the pregnancy. Score: 1 out of 1 Yes Question 5 1. A multigravid client visiting the pre – natal clinic at 16 weeks gestation exhibits facial swelling, a brownish vaginal discharge and fundal height of 22 cm. The client’s blood pressure is 160/90 mmHg and her pulse is 80 bpm. The nurse interprets these findings as suggestive of which of the following? Response: Gestational thropoblastic diseas Correct answer: Gestational thropoblastic diseas Score: 1 out of 1 Yes Question 6 35. The nurse in an infertility clinic explains to a couple under evaluation that a semen analysis is done to evaluate for: Response: Sperm motility Correct answer: Sperm motility Score: 1 out of 1 Yes Question 7 6. A 17 – year – old client visits the clinic at 36 weeks gestation. The clients blood pressure is 130/90 mmHg. On previous visits her blood pressure ranged from 100 to 110 mmHg systolic, 70 to 80 mmHg diastolic. Further assessment reveals slight edema of her hands and 1+ proteinuria. The nurse anticipates that the physician will most likely order which of the following? Response: Bed rest with bathroom privileges Correct answer: Bed rest with bathroom privileges Score: 1 out of 1 Yes Question 8 39. A client who is 25 weeks pregnant with no previous medical or obstetrical problems is admitted to the hospital in premature labor. The nurse can expect that orders for this client, in addition to bed rest, will include which of the following? Response: A fetal monitor and a tocolytic. Correct answer: A fetal monitor and a tocolytic. Score: 1 out of 1 Yes Question 9 10. A physician prescribes clomiphene citrate (clomid) for a woman with a history of infertility. She should be informed that a side effect of this medication may be? Response: Multiple gestation Correct answer: Multiple gestation Score: 1 out of 1 Yes Question 10 7. A client at a follow up appointment after having a miscarriage 2 weeks previously yells at the nurse, “How could God do this to me? I’ve never done anything wrong”. Which of the following responses by the nurse would be most appropriate at this time? Response: “I know you are angry. It’s so hard to lose your baby” Correct answer: “I know you are angry. It’s so hard to lose your baby” Score: 1 out of 1 Yes Question 11 23. The nurse is caring for a woman in labor who suddenly complains of dizziness, becomes pale, and has a 30-point drop in her blood pressure with an increase in pulse rate. The most appropriate initial nursing action is to: Response: Turn her to her left side. Correct answer: Turn her to her left side. Score: 1 out of 1 Yes Question 12 17. A 36 year old is admitted with a possible ruptured ectopic pregnancy. When planning the clients care, which of the following procedures should the nurse anticipate preparing the client for soon after admission? Response: Culdocentesis Correct answer: Culdocentesis Score: 1 out of 1 Yes Question 13 38. A pregnant woman asks the nurse if there are any special problems that she might encounter during labor and delivery because she has diabetes. The nurse responds that during labor and delivery, diabetic mothers may develop? Response: Hypoglycemia. Correct answer: Hypoglycemia. Score: 1 out of 1 Yes Question 14 43. Ms. S. has been in labor for 8 hours. She has been pushing for an hour and a half without making progress. The fetus remains at minus one station. Ms. S. is extremely tired and discouraged. The nurse suggests changing to a nontraditional position. Which assessment is most important to make before proceeding? Response: Status of maternal bladder. Correct answer: Status of maternal bladder. Score: 1 out of 1 Yes Question 15 28. The nurse is assessing a pregnant woman for sexually transmitted diseases. Which symptom would be most apt to be present in a woman with a trichomonas vaginalis vaginal infection? Response: A profuse foul-smelling bubbly discharge. Correct answer: A profuse foul-smelling bubbly discharge. Score: 1 out of 1 Yes Question 16 18. The nurse is caring for a woman four hours following a cesarean birth. Because there are surgical effects that hinder the woman’s resumption of eating, the nurse should include which of the following in the plan of care? Response: Listening for bowel sounds. Correct answer: Listening for bowel sounds. Score: 1 out of 1 Yes Question 17 27. A client who is having a saline abortion is being cared for on the labor floor. The client’s vital sign are temperature 101oF, pulse 100, respirations 24, and blood pressure 120/90. The nurse most appropriately interprets these data to mean: Response: The client is at extreme risk for shock. Correct answer: The client may be develop an infection, such as chorioamnionitis. Score: 0 out of 1 No Question 18 13. On the morning after delivery, a woman complains that excessive perspiring kept her awake all night. She is worried that there is a problem. Select an appropriate response to the client. Response: “Fluids that were retained during pregnancy are normally lost in this manner." Correct answer: “Fluids that were retained during pregnancy are normally lost in this manner." Score: 1 out of 1 Yes Question 19 30. A woman delivered a healthy baby 18 hours ago has just been given Rho (D) immune globulin. Which finding indicates the need for administration of this medication? Response: The infant is Rho (D) positive. Correct answer: The infant is Rho (D) positive. Score: 1 out of 1 Yes Question 20 48. A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy (DIC). Which assessment finding is least likely to be associated with DIC? Response: Swelling of the calf of one leg. Correct answer: Swelling of the calf of one leg. Score: 1 out of 1 Yes Question 21 37. The nurse is assessing a pregnant diabetic for signs and symptoms of hyperglycemia. Which symptom does not indicate hyperglycemia? Response: Sweating Correct answer: Sweating Score: 1 out of 1 Yes Question 22 9. A primiparous client who is breast – feeding develops endometritis on the third postpartum day. Which of the following instructions would the nurse give to the mother? Response: The condition typically is treated with intravenous antibiotic therapy. Correct answer: The condition typically is treated with intravenous antibiotic therapy. Score: 1 out of 1 Yes Question 23 19. The pregnant diabetic on insulin needs to be evaluated for correct medication dosage. What is the most effective method to assist the nurse in determining the client’s need for insulin management? Response: Home serum glucose testing. Correct answer: Home serum glucose testing. Score: 1 out of 1 Yes Question 24 26. The nurse is caring for a woman who had a vaginal delivery an hour ago without complications. She has a boggy fundus after voiding 500 ml. The nurse caring for this woman should give highest priority to: Response: Massaging the fundus until it is firm. Correct answer: Massaging the fundus until it is firm. Score: 1 out of 1 Yes Question 25 34. The nurse is caring for a woman with a placenta previa who has been hospitalized for several weeks. She is now at 38 weeks gestation and her membranes have ruptured. The amniotic fluid has a greenish color and the woman has started to bleed again. The nurse should plan to: Response: Call the physician and prepare for a cesarean birth. Correct answer: Call the physician and prepare for a cesarean birth. Score: 1 out of 1 Yes Question 26 49. A nurse is caring for a client who is experiencing precipitous birth. The nurse is waiting for the physician to arrive. When the infant’s head crowns, the nurse would instruct the client to: Response: Breathe rapidly. Correct answer: Breathe rapidly. Score: 1 out of 1 Yes Question 27 44. The following condition is classic sign of engorgement. A postpartum client complains of sore nipples, a sore bottom, cramping, fatigue, and lack of ability to satisfy her newborn, who is crying. Based in these data, which of the following condition should the nurse suspect? Response: Sore nipples, sore bottom, warm to touch. Correct answer: Sore nipples, sore bottom, warm to touch. Score: 1 out of 1 Yes Question 28 47. A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of slowing labor. The nurse is reviewing the physician’s order and would expect to note which of the following prescribed treatments for this condition? Response: Oxytocin (Pitocin) infusion. Correct answer: Oxytocin (Pitocin) infusion. Score: 1 out of 1 Yes Question 29 21. The nurse is caring for a woman who is having labor induced with an oxytocin (Pitocin) drip. Which assessment of the client indicates there is a problem? Response: The woman has three contractions in five minutes. Correct answer: The woman has three contractions in five minutes. Score: 1 out of 1 Yes Question 30 11. A patient has vaginal bleeding in the 10th week of pregnancy. When bleeding stops and the hCG levels remained elevated, discharge planning should include which of the following instructions? Response: “Call the doctor if you experience abdominal pain or cramping.” Correct answer: “Call the doctor if you experience abdominal pain or cramping.” Score: 1 out of 1 Yes Question 31 41. A cerclage procedure is performed on a client at 20 weeks gestation who is diagnosed with cervical incompetence. When preparing the discharge teching plan , the nurse would expect to instruct the client to monitor herself for which of the following? Response: Symptoms of infection. Correct answer: Symptoms of infection. Score: 1 out of 1 Yes Question 32 8. A multigravid client at 38 weeks gestation is admitted to the hospital’s birthing center with dark, scant vaginal bleeding and abdominal pain. The nurse observes frequent low – amplitude uterine activity while the client’s contraction pattern is externally monitored. Which of the following would the nurse suspect? Response: Abruptio placenta Correct answer: Abruptio placenta Score: 1 out of 1 Yes Question 33 25. A 23-year-old woman is 25% over her ideal weight of 140 pounds. She would like to lose weight before becoming pregnant. The woman is two months into her weight loss program. Which indicates she is following proper weight management principles? The woman: Response: Goes to beginning aerobics three times a week. Correct answer: Goes to beginning aerobics three times a week. Score: 1 out of 1 Yes Question 34 32. A woman with severe pregnancy-induced hypertension was delivered two hours ago. Which nursing action should be included in the plan of care for her postpartum hospital stay? Response: Continuing to monitor blood pressure respirations, and reflexes. Correct answer: Continuing to monitor blood pressure respirations, and reflexes. Score: 1 out of 1 Yes Question 35 29. The nurse realizes that the discharge instructions given to a woman with placenta previa are understood when the nurse overhears the client tell her husband: Response: “We can’t have sex.” Correct answer: “We can’t have sex.” Score: 1 out of 1 Yes Question 36 24. A client on the labor and delivery unit has spontaneous rupture of membranes at 2 cm dilation. The nurse notes that the fetal heart rate has dropped to 80 and suspects a prolapsed cord. The most appropriate immediate action for the nurse is to: Response: Place the woman in knee chest position. Correct answer: Place the woman in knee chest position. Score: 1 out of 1 Yes Question 37 2. After explaining to a multigravid client at 36 week’s gestation who is diagnosed with severe hydramnions about the possible complications of this condition, which of the following client statements indicates that the client needs further instruction? Response: “I can continue to work at my job at the automobile factory until labor starts Correct answer: “I can continue to work at my job at the automobile factory until labor starts Score: 1 out of 1 Yes Question 38 33. The nurse is caring for a woman who is 35 weeks pregnant. She comes to the emergency department with painless vaginal bleeding. This is her third pregnancy and she states that this has never happened to her before. In caring for this woman, the nurse should avoid: Response: Performing a vaginal examination. Correct answer: Performing a vaginal examination. Score: 1 out of 1 Yes Question 39 20. Mrs. B.’s physician has prescribed tetracycline 500 mg p.o q6h. While assessing Mrs. B.’s nursing history for allergies, the nurse notes that Mrs. B. is also taking oral contraceptives. What is the most appropriate initial nursing intervention? Response: Notify the physician that Mrs. B. is taking oral contraceptives. Correct answer: Notify the physician that Mrs. B. is taking oral contraceptives. Score: 1 out of 1 Yes Question 40 46. A nurse in a labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which of the following assessment findings would alert the nurse to a compromise? Response: Persistent nonreassuring fetal heart rate. Correct answer: Persistent nonreassuring fetal heart rate. Score: 1 out of 1 Yes Question 41 42. Ms. T. is admitted to the antepartal unit with pregnancy-induced hypertension. She is 34 weeks gestation and is admitted with a blood pressure of 160/100, 3+ protein in her urine, generalized edema, and headache, and is seeing spots before her eyes. She is concerned about her two preschool children being cared for by a neighbor. The priority nursing diagnosis for Mrs. T. at this time is: Response: Alteration in tissue perfusion Correct answer: Alteration in tissue perfusion Score: 1 out of 1 Yes Question 42 40. A client who is 24 hours post cesarean delivery has orders to advance diet as tolerated. She has been on full liquids and asks if she can have real food. Which question is most appropriate for the nurse to ask before changing her to a regular diet? Response: “ Are you passing gas.” Correct answer: “ Are you passing gas.” Score: 1 out of 1 Yes Question 43 31. In evaluating the effectiveness of IV pitocin for a client with secondary dystocia (uterine inertia), the nurse should expect? Response: Progressive cervical dilation with contractions lasting less than 90 seconds. Correct answer: Progressive cervical dilation with contractions lasting less than 90 seconds. Score: 1 out of 1 Yes Question 44 12. A 31 – year – old gravid 5 para 4 delivered a 9 – pound, 10 ounce baby after a 20 – hour labor. Based on the data, this woman is at high risk for: Response: Postpartal hemorrhage Correct answer: Postpartal hemorrhage Score: 1 out of 1 Yes Question 45 5. A woman is taking oral contraceptives. The nurse teaches the client to report which of the following danger signs? Response: Severe calf pain. Correct answer: Severe calf pain. Score: 1 out of 1 Yes Question 46 16. At a first prenatal visit, the woman reports she had bladder infections during past pregnancies. Which of the following statements is true? Response: Pregnancy predisposes a woman to bladder infections because of dilatation of the ureters and decreased bladder tone. Correct answer: Pregnancy predisposes a woman to bladder infections because of dilatation of the ureters and decreased bladder tone. Score: 1 out of 1 Yes Question 47 22. A woman 30 weeks pregnant is admitted to the hospital with a diagnosis of placenta previa. She and the fetus are stable. To help achieve the goal of avoiding premature delivery, the nurse anticipates the client will: Response: Avoid sexual intercourse upon discharge. Correct answer: Be placed on bed rest. Score: 0 out of 1 No Question 48 15. A pregnant couple is told that the fetus suffers from intrauterine growth retardation. After the physician explains what this means, the woman cries and tells the nurse, “I don’t think I can cope with a retarded baby”. Which response is most appropriate? Response: “Are there other retarded children in either family?” Correct answer: “Let’s talk about what the doctor said to us all." Score: 0 out of 1 No Question 49 50. A new mother received epidural anesthesia during labor and had a forceps delivery after pushing 2 hours. At 6 hours PP, her systolic blood pressure has dropped 20 points, her diastolic BP has dropped 10 points, and her pulse is 120 beats per minute. The client is anxious and restless. On further assessment, a vulvar hematoma is verified. After notifying the health care provider, the nurse immediately plans to: Response: Reassure the client. Correct answer: Prepare client for surgery. Score: 0 out of 1 No Question 50 14. A pregnant client in the 10th week of pregnancy comes to the clinic complaining of vague flulike symptoms. Which of the following statements made by the client indicates that she has learned what was taught at the early antepartal visits? Response: “I know I shouldn’t take any over – the – counter remedies now.” Correct answer: “I know I shouldn’t take any over – the – counter remedies now.”
