Comprehensive Review for the NCLEX-PN® Exam, 8e

left cataract surgery with lens implant interventions after surgery

"I will not sleep lying on my left side." "I will sit at the table to eat breakfast." "I will sit in my recliner with my feet elevated." "I will not lift anything heavier than 10 pounds."

A contraction stress test

"The uterus is stimulated to contract by either small amounts of oxytocin or by nipple stimulation."

vitamin K

(phytonadione)

signs associated with respiratory distress syndrome (RDS)

The nurse would monitor for which signs associated with respiratory distress syndrome (RDS) in a preterm newborn?

Uterine tenderness accompanies

abruptio placentae, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board-like during palpation as the blood penetrates the myometrium and causes uterine irritability. A sustained tetanic contraction can occur if the client is in labor and the uterine muscle cannot relax.

Intravenous (IV) lactated Ringer's (LR) solution is prescribed for a postoperative abdominal surgery client. A nursing student is caring for the client, and the nursing instructor asks the student about why this IV solution is prescribed. Which student r...

✓ "LR is isotonic to plasma and contains electrolytes"

The nurse considers the universal protocol for preventing wrong site, wrong procedure, and wrong person surgery. Which are correct about this protocol? Select all that apply.

✓ 1.The surgeon is the person that marks the area of the operative procedure. 2.The site marking is done before the client is brought to the surgical suite in t...

Rho(D) immune globulin to an Rh-negative woman

As described in the question, it is accepted practice to administer Rho(D) immune globulin to an Rh-negative woman at 28 weeks' gestation, with a second injection within 72 hours of delivery. This prevents sensitization, which could jeopardize a future pregnancy. For subsequent pregnancies or abortions, the injections must be repeated, because the immunity is passive.

The nurse is checking a client's record for probable signs of pregnancy. Which are the probable signs of pregnancy that the nurse would note

Ballottement(the rebounding of the fetus against the examiner's fingers on palpation); Chadwick's sign Uterine enlargement Braxton Hicks contractions

The nurse is collecting data from a client who has been diagnosed with placenta previa. Which findings would the nurse expect to note? Select all that apply.

Bright red vaginal bleeding Soft, relaxed, nontender uterus

The nurse is assisting with caring for a client who has a placenta previa. The nurse understands that a cervical examination would not be performed on the client primarily because it could have which consequence?

Cause hemorrhage

The pregnant woman complains of being awakened frequently by leg cramps. The nurse reinforces instructions to the client's partner and would tell the client to perform which measure?

Dorsiflex the client's foot while extending the knee.

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse would monitor for which adverse effects of this medication? Select all that apply.

Flushing Depressed respirations Extreme muscle weakness

Which findings indicate to the nurse that placental separation has occurred? Select all that apply.

Lengthening of umbilical cord Sudden trickle or spurt of blood Fetal membranes are seen at the introitus

signs of preeclampsia?

Proteinuria Hypertension

The nurse palpates the fundus and checks the character of the lochia of a postpartum client who is in the fourth stage of labor. Which lochia characteristic would the nurse expect to note?

Red

The nurse is preparing a list of self-care instructions for a postpartum client who has been diagnosed with mastitis. Which instructions would be included on the list? Select all that apply.

Rest during the acute phase. Wear a supportive, nonunderwire bra. Maintain a fluid intake of at least 3000 mL. Continue to breast-feed if the breasts are not too sore.

The arcuate uterus is a form of a uterine anomaly or variation where the uterine cavity displays a concave contour towards the fundus.

Signs of placental separation include the lengthening of the umbilical cord, a sudden gush of dark blood from the introitus, a firmly contracted uterus, and the uterus changing from a discoid to a globular shape. The client may experience vaginal fullness, but not sudden and sharp abdominal pain

The client is undergoing an amniocentesis at 16 weeks' gestation to detect the presence of biochemical or chromosomal abnormalities. Which instructions would the nurse reinforce to the client?

The bladder must be full during the examination.

The client received epidural anesthesia during labor and had a forceps delivery after pushing for 2 hours. At 6 hours postpartum, the client's systolic blood pressure (BP) dropped 20 points, the diastolic BP dropped 10 points, and her pulse is 120 beats per minute. The client is very anxious and restless. The nurse is told that the client has a vulvar hematoma. Based on this diagnosis, the nurse would plan which action?

The information provided in the question indicates that the client is experiencing blood loss. Surgery would be indicated for this complication to stop the bleeding.