Final Review

Priority when a patient has shock?

Start and IV line to give fluids

A 30-year-old woman asks the nurse if she should continue to have a Papanicolau test every year. How should the nurse respond? 1- "You can now start getting screened with a Papanicolau test every 3 years." 2- "You will need Papanicolau and human papillomavirus (HPV) tests every 2 years." 3- "You will need to have a Papanicolau test every 2 years until you are 50." 4- "You are at low risk for cervical cancer so you will only need human papillomavirus (HPV) testing every year."

1

A nurse is assessing a 20-year-old female. Which data finding taken during the history would indicate endometrial cancer? 1- vaginal bleeding that is painless and abnormal 2- diagnosis of diabetes mellitus 3- diagnosis of liver disease 4. severe back pain

1

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately? 1 a sudden drop in hemocrit 2 soft, flat anterior fontanels 3 pink skin with noted blue extremities 4 intake and output for 8 hours

1

A nurse is educating a 25-year-old client with a family history of cervical cancer. Which test should the nurse inform the client about to detect cervical cancer at an early stage? 1- Papanicolaou test 2- blood tests for mutations in the BRCA genes 3- CA-125 blood test 4- transvaginal ultrasound

1

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because with increased lung tension, the: 1 ductus arteriosus remains open. 2 foramen ovale closes prematurely. 3 aorta or aortic valve strictures. 4 pulmonary artery closes.

1

A woman is being seen in the gynecologist's office for her annual well-woman exam. As the nurse is preparing the woman for the exam, the woman suddenly becomes anxious and tearful. The nurse suspects this behavior could be attributed to sexual assault. What should the nurse do first? 1- Provide reassurance 2- Have the woman confirm the suspicion 3- Notify the gynecologist 4- Refer the woman to a counselor

1

The nurse is assessing a small-for-gestational age (SGA) newborn, 12 hours of age, and notes the newborn is lethargic with cyanosis of the extremities, jittery with handling, and a jaundiced, ruddy skin color. The nurse expects which diagnosis as a result of the findings? 1 polycythemia 2 hyperglycemia 3 hypercalcemia 4 hyponatremia

1

A newborn is experiencing cold stress. Which findings would the nurse expect to assess? Select all that apply. 1 respiratory distress 2 decreased oxygen needs 3 hypoglycemia 4 metabolic alkalosis 5 jaundice

1, 3. 5

A 47-year-old woman is being seen at the local clinic reporting irregular menstrual cycles. The nurse would explain to the client that the irregularity is most likely due to: 1- pregnancy. 2- menopause. 3- hormonal fluctuations. 4- an underlying endocrine problem.

2

A nurse is conducting a teaching session with a group of adolescent females at a local women's health clinic. When describing appropriate screening guidelines for cervical cancer, at which age would the nurse would instruct the group to have their first Papanicolau test? 1- 18 2- 21 3- 25 4- 30

2

A preterm newborn receives oxygen therapy to treat respiratory distress syndrome (RDS). Which complication should the nurse consider a result of oxygen administration at a high concentration? 1 Bronchopulmonary dysplasia 2 Retinopathy of prematurity 3 Diminished erythropoiesis 4 Necrotizing enterocolitis

2

Which description would the nurse include when teaching a client about a scheduled colposcopy? 1- "A gel will be applied to your abdomen and a microphone-like device will be moved over the area to identify problem areas." 2- "A solution will be wiped on your cervix to identify any abnormal cells, which will be visualized with a magnifying instrument." 3- "Scrapings of tissue will be obtained and placed on slides to be examined under the microscope." 4- "After you receive anesthesia, a small device will be inserted into your abdomen near your belly button to obtain tissue samples."

2

What findings should the nurse report to the doctor for a postpartum client who delivered 12 hours ago? Select all that apply. 1- Lochia rubra 2- Fundal height level of one fingerbreadth above the umbilicus 3- Episiotomy appears edematous 4- Temperature of 101.8°F (38.8°C) 5- White blood cell count of 28,000

2, 4

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply. 1 hyperthermia 2 hemolysis 3 elevated liver enzymes 4 leukocytosis 5 low platelet count

2,3,5

A nurse is assessing a postterm newborn. Which finding would the nurse correlate with this gestational age variation? 1 moist, supple, plum skin appearance 2 abundant lanugo and vernix 3 thin umbilical cord 4 absence of sole creases

3

A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which additional assessment finding should the nurse identify as an indication of respiratory distress syndrome (RDS)? 1 Deep inspiration 2 Expiratory lag 3 Sternal retraction 4 Inspiratory grunt

3

The nurse is conducting a physical assessment on a 25-year-old client who identifies as transgender man. The client states the cervix is intact. The nurse instructs the client that cervical screenings should occur on what schedule? 1- Every year 2- Every two years 3- Every three years 4- Every four years

3

Which sign appears early in a neonate with respiratory distress syndrome? 1 Bilateral crackles 2 Pale gray skin color 3 Tachypnea more than 60 breaths/minute 4 Poor capillary filling time (3 to 4 seconds)

3

A woman at 10 weeks gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize? 1 report of frequent mild nausea 2 blood pressure of 120/84 mm Hg 3 history of bright red spotting 6 weeks ago 4 fundal height measurement of 18 cm

4

A woman has been diagnosed as having gestational hypertension. Which symptom for this condition is the most typical? 1 increased perspiration 2 weight loss 3 susceptibility to infection 4 blood pressure elevation

4

When reviewing the history of a woman diagnosed with endometrial cancer, the nurse would identify which factor as increasing the woman's risk? 1- vaginal birth of 4 children 2- menarche at age 14 years 3- menopause at age 47 years 4- use of tamoxifen

4

Which approach would be most appropriate when counseling a client who is a suspected victim of intimate partner violence? 1- Offer the client a pamphlet about the local shelter for victims of intimate partner violence. 2- Call the client at home to ask some questions about the marriage. 3- Wait until the client comes in a few more times to make a better assessment. 4- Ask, "Have you ever been physically hurt by your partner?"

4

moderate variability measurement

6-25 bpm. blades of grass

How would we diagnose neural tube defect in utero? what equipment is needed?

Amniocentesis ultrasound to guide needle

Bluish purple discoloration of the cervix, vagina, and labia during pregnancy as a result of increased vascular congestion.

Chadwicks sign

If abnormal pap exam do a _________?

Colposcopy

Newborn Medications include ___________ to lower canthus of the eye so that the baby wont get gonorrhea or chlamydia of the eye. _____________ injection- to help with clotting factor because their gut does not have the bacteria to produce it yet. ___________- vaccination that should be given within 12 hours of birth

Erythromycin eye ointment - the lower canthus of the eye so that the baby won't get gonorrhea or Chlamydia. Vitamin K injection - Clotting factors (because their guts don't have bacteria to produce it) Hepatitis B

Obesity risk factors in pregnancy

Gestational diabetes, macrosomnia

softening of the cervix is called

Goodell's sign

softening of the uterus is _______ sign?

Hegar's sign

Second trimester when hemoglobin is low can indicate?

Hemodilution and low blood pressure because of growing placenta and increased circulation

First intervention for new onset diagnosis of gestational diabetes?

How to do a blood sugar check. Keeping a glucose log

breastmilk gives immunoglobulin ______ for immune system

IgA

Signs of blood loss from 1000-1500 mL.

Lower BP, weakness, diaphoresis, RR of 20-24 breaths/min, HR of 100-120 bpm

effleuage means?

Massage technique of light and deep stroking with the heels and palms of the hands.

Causes of placental abruption

Maternal HTN blunt trauma Cocaine having lots of babies (high paridy) AMA vascular abnormalities in placental bed

Medication given to Neonatal abstinence syndrome babies?

Morphine

periventricular leukomalacia

Necrosis of white matter adjacent to ventricles of the brain due to systemic hypotension or ischemia

If serum alpha-fetoprotein level is increased it can indicate what?

Neural tube defect

chorionic villus sampling differs from amniocentesis in that it does not test for _________ defects

Neural tube defects

Postpartum hemorrhage Medications

Oxytocin, methylergonovine (Methergine), misoprostol (Cytotec), and Carboprost tromethamine (Hemabate)

Signs of blood loss from 1500-2000 mL

Systolic BP Less than 90, Restlessness, confusion, pallor, oliguria, delayed cap refill, Heart rate of 120-140 bpm

ductus arteriosus

a blood vessel in a fetus that bypasses pulmonary circulation by connecting the pulmonary artery directly to the ascending aorta

When would you not want to give carbopost

asthmatic patients

Endometrial cancer diagnostic __________ to confirm

biopsy

Antidote for Magnesium Toxicity

calcium gluconate

Fetal bradycardia indicates

fetal hypoxia (bradycardia lasting 10 minutes or more)

with DIC there is a decrease in ________ and ________. would want to give __________

fibrogen and platelets Cryoprecipitate

HELLP signs and symptoms

hyperbilirubinemia, Right upper quadrant pain, gastric pain

when would you not want to give methylergonovine?

in hypertensive patients

What to give for patent ductus arteriosus

indomethacin

signs of menopause

lack of period, breast tenderness, hot flashes, flushes, palpitations, night sweats, and irritability and mood swings increases adipose tissue by slowing down metabolic state.

medication given IV to prevent seizures and neurological protection to fetus when preeclampsia is present

magnesium sulfate

Homan's sign test for ?

pain in calf or popliteal region related to DVT

Risk factors for gestational diabetes?

previous large for age gestational infant, Hypertension obesity 4 or more babies family hx of diabetes

Tocodynamometer is used to record?

records the frequency and duration of the contractions

how is magnesium sulfate given?

secondary line (not piggy back) with a loading dose of 4 to 6 g over 15-30 minutes

what to assess for magnesium toxicity?

serum concentration respiratory depression clonus deep tender reflexes loss of consciousness lethargy

Iron deficiency anemia is usually not diagnoses until __________ trimester and hemoglobin of ____

third trimester, and hemoglobin of less than 10.5

The nurse is conducting a presentation about urinary incontinence for a local women's group. During the presentation, which statement by a member of the group would the nurse need to clarify? 1- "It's normal for a woman to develop incontinence as she ages." 2- "There are ways to prevent urinary incontinence." 3- "Urinary incontinence is a treatable condition." 4- "Incontinence can be cured in some cases."

1

The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which finding would the nurse expect when assessing the client's fundus? 1- cannot be palpated 2- 2 cm below the umbilicus 3- 6 cm below the umbilicus 4- 10 cm below the umbilicus

1

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement? 1 "If I have changes in my vision, I will lie down and rest." 2 "I will weigh myself every morning after voiding before breakfast." 3 "I will count my baby's movements after each meal." 4 "If I have a severe headache, I'll call the clinic."

1

saturating how many pads in a hour is considered to much bleeding?

1 pad every hour

A client has been referred for a colposcopy by the primary care provider. The client wants to know more about the examination. Which information regarding a colposcopy should the nurse give to the client? 1- Client may feel pain in the vaginal area during the examination. 2- The test is conducted because of abnormal results in a Papanicolau test. 3- Intercourse should be avoided for at least 1 week afterward. 4- Client may experience pain during urination for a week following the test.

2

Guidelines for pap smears

21-29 every 3 years screening for cervical cancer 30+ test for HPV

A client has an abnormal Papanicolau test result that is classified as ASC-US. Based on the nurse's understanding of this classification, the nurse would expect which procedure? 1- immediate colposcopy 2- testing for human papillomavirus (HPV) 3- repeat Papanicolau test in 4 to 6 months 4- cone biopsy

3

In which clients is it most important to understand the importance of an annual Papanicolaou test? 1- clients with a history of recurrent candidiasis 2- clients with a pregnancy before age 20 3- clients infected with the human papillomavirus (HPV) 4- clients with a long history of hormonal contraceptive use

3

Why is a Papanicolau test done at the first prenatal visit? 1- It predicts whether cervical cancer will occur. 2- It helps to date the pregnancy. 3- It detects if uterine cancer is present. 4- It identifies abnormal cervical cells.

4

Measuring contractions

Frequency= time from the start of one contraction to the start of the next. Duration- from start of one contraction to the end of that same contraction

Which of these cardiac variations, if found in the client who is pregnant, should the nurse recognize as a normal finding in pregnancy? 1- Split S1S2 2- Premature ventricular contractions 3- S4 (atrial gallop) 4- Soft systolic murmur

4

Which two tests are generally performed on urine at a prenatal visit? 1- protein and sodium 2- pH and glucose 3- occult blood and protein 4- protein and glucose

4

You are the senior LVN/LPN on the unit and you are orienting a new graduate LVN/LPN. One of the subjects you want to cover today is a postpartum assessment for a vaginal delivery. What would you know to cover during this assessment? 1- Nagal sign 2- Hagar sign 3- Chadwick sign 4- Homans sign

4

A nurse is reviewing the history of a postpartum woman. The nurse determines that the woman is at low risk for uterine subinvolution based on which findings? Select all that apply. 1- uterine infection 2- prolonged labor 3- hydramnios 4- breastfeeding 5- early ambulation

4, 5

serum magnesium level when Preeclampsia is present

4-7 mEq/L

A client with a prepregnant BMI of 26 is concerned about gaining weight during pregnancy. Which statement by the client indicates an appropriate goal for this pregnancy? 1- "I need to consume at least 1,500 nutrient-dense calories each day." 2- "I will eliminate carbohydrates from my diet to control my weight." 3- "I will eat two large meals with high protein content each day." 4- "I am eating for two now, so the baby will burn the extra calories."

1

A nurse is assessing a woman who gave birth vaginally approximately 24 hours ago. Which finding would the nurse report to the primary care provider immediately? 1- oral temperature 100.8° F (38.2° C) 2- pulse rate 75 beats per minute 3- respiratory rate 16 breaths/minute 4- uterine fundus 1 cm below umbilicus

1

A pregnant client is scheduled to undergo chorionic villi sampling (CVS) to rule out any birth defects. Ideally, when should this testing be completed? 1- 10 to 12 weeks of gestation 2- 7 to 9 weeks of gestation 3- 5 to 6 weeks of gestation 4- 4 to 5 weeks of gestation

1

A pregnant client is undergoing a fetal biophysical profile. Which parameter of the profile helps measure long-term adequacy of the placental function? 1- amniotic fluid volume 2- fetal heart rate 3- fetal breathing record 4- fetal reactivity

1

A pregnant woman's pulse fluctuates throughout pregnancy and the early postpartum period. When assessing a 1-day postpartum woman's pulse, what is the first action a nurse should take in response to a rate of 56 bpm? 1- Compare the pulse rate of 56 bpm with her pulse rate on the first prenatal care visit. 2- Advise that the woman not get out of bed until the nurse returns with assistance. 3- Do nothing, this is normal. 4- Ask the woman what she has had to eat today.

1

A woman comes to the clinic. She gave birth about 2 months ago to a healthy term male newborn. During the visit, the woman tells the nurse, "I've noticed that I'm a bit uncomfortable now when we have sexual intercourse. Is there anything that I can do?" The woman's menstrual period has not yet resumed. Which suggestion by the nurse would be most appropriate? 1- "You might try using a water-soluble lubricant to ease the discomfort." 2- "It takes a while to get your body back to its normal function after having a baby." 3- "This is entirely normal, and many women go through it. It just takes time." 4- "Try doing Kegel exercises to get your pelvic muscles back in shape."

1

A woman in early pregnancy asks you why she has palmar erythema. Your reply would be based on the principle that palmar erythema is most likely caused by which of the following? 1- An increased estrogen level 2- An allergy to fetal protein 3- Reduced serum protein 4- Chorionic gonadotropin hormone secretion

1

The nurse is preparing discharge for a client who plans to bottle-feed her infant. Which instruction should the nurse prioritize for this client in the discharge teaching? 1- Run warm water over the breast in the shower. 2- Massage the breasts when they are painful. 3- Wear a tight, supportive bra. 4- Express small amounts of milk when they are too full.

3

A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which role do Braxton Hicks contractions play in aiding labor? 1- These contractions help in softening and ripening the cervix. 2- These contractions increase the release of prostaglandins. 3- These contractions increase oxytocin sensitivity. 4- These contractions make maternal breathing easier.

1

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? 1- visualization of the fetus by ultrasound 2- laboratory test of a urine specimen for hCG 3- laboratory test of a blood serum specimen for hCG 4- absence of a period

1

A woman in her third trimester complains to the nurse of significant back pain. The nurse questions the client carefully and records a detailed account of her back symptoms. What is the best rationale for the nurse evaluating the client's back symptoms with such care? 1- Back pain could be a sign of bladder or kidney infection 2- Back pain could be a sign of degenerated discs 3- Back pain could be a result of a soft mattress 4- Back pain could be a result of improper lifting

1

During a routine antepartal visit, a pregnant woman reports a white, thick vaginal discharge. What would the nurse do next? 1- Ask the woman if she is having any itching or irritation. 2- Tell the woman that this is entirely normal. 3- Advise the woman about the need to culture the discharge. 4- Check the discharge for evidence of ruptured membranes.

1

In a client's seventh month of pregnancy, she reports feeling "dizzy, like I'm going to pass out, when I lie down flat on my back." The nurse explains that this is due to: 1- pressure of the gravid uterus on the vena cava. 2- a 50% increase in blood volume. 3- physiologic anemia due to hemoglobin decrease. 4- pressure of the presenting fetal part on the diaphragm.

1

It has been 8 hours since a woman gave birth vaginally to a healthy newborn. When assessing the woman's fundus, the nurse would expect to find it at: 1- the level of the umbilicus. 2- between the umbilicus and symphysis pubis. 3- 1 cm below the umbilicus. 4- 2 cm below the umbilicus.

1

The nurse teaches a pregnant patient the manifestations associated with complications while pregnant. Which statement indicates that additional patient teaching is needed? 1- "Pain with urination is expected during pregnancy." 2- "I should call the doctor if I have any vaginal bleeding." 3- "A sudden rush of fluid means that my membranes ruptured. 4- "I should not worry if I vomit once a day for the first 12 weeks."

1

Which condition in a postpartum client may cause fever not caused by infection? 1- Breast engorgement 2- Endometritis 3- Mastitis 4- Uterine involution

1

Which intervention would be helpful to a bottle-feeding client who's experiencing hard or engorged breasts? 1- applying ice 2- restricting fluids 3- applying warm compresses 4- administering bromocriptine

1

A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply. 1- increase in heart rate 2- increase in blood pressure 3- increase in respiratory rate 4- slight decrease in body temperature 5- increase in gastric emptying and pH

1, 2, 3

A nurse is talking to a group of young couples who wish to conceive. One young woman asks the nurse if any tests predict fetal abnormalities. Which of the following tests should the nurse include in the discussion? (Select all that apply.) 1- MSAFP 2- CVS (chorionic villus sampling) 3- Amniocentesis 4- CBC 5- Lipid panel

1, 2, 3

After teaching a class of newly pregnant women about the many changes the female body undergoes during pregnancy, the nurse determines that the teaching was successful when the class identifies which hormones as being secreted by the placenta? Select all that apply. 1- hCG 2- relaxin 3- estrogen 4- testosterone 5- cortisol

1, 2, 3

A nurse is assessing a client with postpartal hemorrhage; the client is presently on IV oxytocin. Which interventions should the nurse perform to evaluate the efficacy of the drug treatment? Select all that apply. 1- Assess the client's uterine tone. 2- Monitor the client's vital signs. 3- Assess the client's skin turgor. 4- Get a pad count. 5- Assess deep tendon reflexes

1, 2, 5

The nurse is instructing on maternal hormones which may impact the onset of labor. Which hormones are included in the discussion? Select all that apply. 1- Oxytocin 2- Thyroxin 3- Progesterone 4- Prostaglandins 5- Insulin

1, 3, 4

The nurse who works on a postpartum floor is mentoring a new graduate. She informs the new nurse that a postpartum assessment of the mother includes which assessments? Select all that apply. 1- vital signs of mother 2- newborn's vital signs 3- pain level 4- head-to-toe assessment 5- head-to-toe assessment of newborn

1, 3, 4,

A client at 16 weeks' gestation is scheduled for prenatal testing. Which of the following would the nurse anticipate as the most likely screening test for congenital anomalies based on the current age of this pregnancy? 1- Cardocentesis. 2- Amniocentesis. 3- Nuchal translucency testing. 4- Chorionic villi sampling.

2

A client who is 32 weeks gestation tells the nurse that she has been experiencing shortness of breath when walking up the steps at home. She is concerned that something is wrong. What is the nurse's best response? 1- "You only have a few more weeks until the birth and then you will breathe fine again" 2- "The enlarging uterus pushes against your diaphragm and this makes breathing shallow" 3- "Oxygen requirements are increasing in your body because the fetus is growing" 4- "Don't worry about this because it is a normal change that occurs with pregnancy"

2

A gravida 4 para 4 mother calls the nurse's station reporting uterine pain following delivery. When the nurse responds to the call, the mother reports that she is having what feels like labor pains again off and on. What would be the nurse's response? 1- Tell her that you will notify the doctor of the unusual pain and see what he wants to do. 2- Explain to her that women who have had several babies prior to this delivery often experience afterpains, which is where the uterus is contracting and relaxing at intervals. 3- Recommend that the client ambulate more to help relieve the pain. 4- Encourage the mother to breast-feed to help relax the uterus.

2

A mother delivered 90 minutes ago and has just arrived on the postpartum unit. Her initial set of vital signs reveals blood pressure of 138/86 mm Hg. Her blood pressure during labor never rose above 128/74. mm Hg. What is a possible explanation for this increase in blood pressure? 1- She is having an allergic reaction to Pitocin. 2- Her stroke volume has increased after delivery of the placenta, and a physiologic response in blood pressure is evident. 3- Her stroke volume should decrease after delivery; this reflects a pathologic adjustment of her blood pressure. 4- The patient is excited to have a chance to sleep after the labor and delivery experience.

2

A new mother asks the nurse what she is allowed to do when she goes home from the hospital. Which statement by the nurse would be correct? 1- You should be able to resume normal activities after 2 weeks. 2- You should not lift anything heavier than your infant in its carrier. 3- Only clean half of the house per day to allow yourself more rest. 4- You need to hire a maid for the first month after delivery to help out around the house.

2

A nurse is caring for a client on the second day postpartum. The client informs the nurse that she is voiding a large volume of urine frequently. Which factor should the nurse identify as a potential cause for urinary frequency? 1- urinary overflow 2- postpartum diuresis 3- urinary tract infection 4- trauma to pelvic muscles

2

A nurse is caring for a client with uterine displacement. The nurse knows that the uterine displacement can block the flow of blood, lymph, and nerve impulses through the pelvic structures. The nurse would assess the client for which of the following signs and symptoms of this altered circulation due to uterine displacement? 1- Rectal bleeding 2- Urinary incontinence 3- Abdominal rigidity 4- Hypofibrinogenemia

2

A nurse is making a home visit to a postpartum woman who gave birth to a healthy newborn 4 days ago. The woman's breasts are swollen, hard, and tender to the touch. The nurse documents this finding as: 1- involution. 2- engorgement. 3- mastitis. 4- engrossment.

2

A nurse on the postpartum floor is conducting a class on danger signs for postpartum women after discharge. The nurse recognizes that further teaching is needed when a new mother makes which statement? 1- "I need to let the doctor know if my lochia begins to have a foul smell." 2- "I am breast-feeding so I can anticipate that there will be reddened, painful areas in my breasts when I am engorged." 3- "My episiotomy should begin to heal and feel better over the next few weeks" 4- "If I develop chills or my fever goes above 100.4℉ (38℃), I need to let someone know."

2

A postpartum client who is bottle feeding her newborn asks, "When should my period return?" Which response by the nurse would be most appropriate? 1- "It's difficult to say, but it will probably return in about 2 to 3 weeks." 2- "It varies, but you can estimate it returning in about 7 to 9 weeks." 3- "You won't have to worry about it returning for at least 3 months." 4- "You don't have to worry about that now. It'll be quite a while."

2

A woman who delivered her newborn by cesarean birth is admitted to the postpartum unit. During the delivery, the mother received two doses of morphine sulfate. The nurse notes that the client's respiratory rate is 11 and her oxygen saturation is 93%. What should the nurse do first? 1- Call the Medical Response Team to her room. 2- Notify the doctor of your findings. 3- Have another nurse come listen to the client's respirations and count the rate. 4- Ask the charge nurse to look in on the client before the end of the shift.

2

During an assessment, the nurse notes that the client has been unable to urinate properly since she gave birth and is still bleeding more than expected. The nurse suspects which condition? 1- uterine atony 2- urinary retention 3- postpartum diaphoresis 4- urinary tract infection

2

Elevation of a client's temperature is a crucial first sign of infection. However, when is elevated temperature not a warning sign of impending infection? 1- when the white blood cell count is less than 10,000/mm³ 2- during the first 24 hours after birth owing to dehydration from exertion 3- after any period of decreased intake 4- when the elevated temperature exceeds 100.4° F (38° C)

2

The client, G5 P5, is resting comfortably with her infant after 14 hours of labor. The nurse is conducting an assessment and notes the uterine fundus is two fingers above the umbilicus and feels soft and spongy. Which action should the nurse prioritize after noting the delivery was completed 12 hours ago? 1- Put on the call button to summon help 2- Gently massage the fundus until it tones up 3- Administer oxytocics to prevent uterine atony 4- Teach the woman to perform periodic self-fundal massage

2

The nurse assesses a postpartum patient's discharge as being moderate in amount and red in color. How should the nurse document the appearance of the lochia? 1- Lochia alba 2- Lochia rubra 3- Lochia serosa 4- Lochia normalia

2

The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse? 1- There is not enough fiber in your diet. 2- The intestines are displaced by the growing fetus. 3- This shouldn't be happening. 4- hCG is delaying peristalsis.

2

The nurse is assessing a primipara's fundal height at 36 weeks' gestation and notes the fundus is now located at the xiphoid process of the sternum. The client asks if this is normal. Which response to the client would be best? 1- "By this time, the fundus should drop down lower because the baby is moving towards the pelvic inlet." 2- "At 36 weeks' gestation, the fundus is in the normal expected location." 3- "To be honest, the fundus should be lower since you have gained minimal weight." 4- "Just get prepared, the fundus might actually get a little higher until a few days before you go into labor."

2

The nurse is preparing a client for a chorionic villi sampling procedure. Which factor should the nurse point out in the teaching session to the client? 1- "The results should be available in about 2 weeks." 2- "You'll have an ultrasound first and then the test." 3- 'Afterward, you can resume your exercise program." 4- "This test is very helpful for identifying spinal defects."

2

The nurse notes that the client has a moderate amount of bleeding after birth. Which instruction is anticipated to control bleeding? 1- Have the client bear down to expel any clots. 2- Put the newborn to the breast to suck. 3- Provide intravenous clotting factors. 4- Do nothing as this is normal after delivery.

2

When assessing a client's uterine fundus during the fourth stage of labor, the nurse palpates a soft, uncontracted fundus. Which of the following would the nurse do next? 1- Instruct the client to exercise 2- Gently massage the boggy fundus 3- Suggest complete bed rest 4- Suggest avoiding lifting weight

2

When assessing a postpartum woman, the nurse suspects the woman is experiencing a problem based on which finding? 1- elevated white blood cell count 2- acute decrease in hematocrit 3- increased levels of clotting factors 4- pulse rate of 60 beats/minute

2

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal? 1- Trace of glucose 2- 2+ Protein in urine 3- Specific gravity of 1.010 4- Straw-like color

2 May indicate preeclampsia

The nurse palpates a postpartal woman's fundus 2 hours after birth and finds it located to the right of midline and somewhat soft. What is the correct interpretation of this finding? 1- The uterine placement is normal. 2- The soft fundus indicates that the woman's uterus is filling up with blood. 3- The clien's bladder is distended and is causing the uterus to deviate to the right. 4- The uterus is soft because there is an infection inside the uterus.

3

A 27-year-old client is in the first trimester of an unplanned pregnancy. She acknowledges that it would be best if she were to quit smoking now that she is pregnant, but states that it would be too difficult given her 13 pack-year history and circle of friends who also smoke. She asks the nurse, "Why exactly is it so important for me to quit? I know lots of smokers who have happy, healthy babies." What can the nurse tell the client about the potential effects of smoking in pregnancy? 1- "Smoking is unhealthy for anyone's heart, but your baby faces an especially high risk of heart trouble if you smoke while you're pregnant." 2- "Smoking during pregnancy places your baby at an increased risk of intellectual disability." 3- "Babies of women who smoke tend to weigh significantly less than other infants." 4- "Smoking during pregnancy means that your child will be born with a dependence on nicotine and will have to endure a period of withdrawal in his or her first days of life."

3

A 29-week-gestation client is admitted with moderate vaginal discharge. The nurse performs a nitrazine test to determine if the membranes have ruptured. The nitrazine tape remains yellow to olive green, with pH between 5 and 6. What should the nurse do next? 1- Prepare the client for birth. 2- Assess the client's cervical status. 3- Notify the health care provider. 4- Perform Leopold's maneuver.

3

A client at 16 weeks' gestation comes to the office for a routine exam. At what location within the abdomen would the nurse anticipate the uterus to be found? 1- At the level of the umbilicus 2- At the xiphoid process 3- Halfway between the symphysis pubis and the umbilicus 4- Below the symphysis pubis

3

A client is reporting considerable postpartum abdominal and perineal pain at a 7 on a scale of 1 to 10. The nurse will prioritize which action after noting the client is currently receiving ibuprofen 600 mg every 8 hours? 1- Offer a hot pad for the abdomen. 2- Apply a cold pack to the perineum. 3- Administer acetaminophen with codeine. 4- Assist the client to change position.

3

A nurse at the health care facility assesses a client in the 20th week of gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client? 1- at the top of the symphysis pubis 2- halfway between the symphysis pubis and the umbilicus 3- at the level of the umbilicus 4- at the xiphoid process

3

A nurse is teaching a postpartum client how to do muscle-clenching exercises for the perineum. The client asks the nurse, "Why do I need to do these exercises?" Which reason would the nurse most likely incorporate into the response? 1- reduces lochia 2- promotes uterine involution 3- improves pelvic floor tone 4- alleviates perineal pain

3

A postpartum patient has a history of thrombophlebitis. What should the nurse do to determine if the patient is developing this after delivery? 1- Assess for warmth in the legs. 2- Assess temperature every 4 hours. 3- Assess for calf redness and edema. 4- Palpate the feet for tingling or numbness.

3

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? 1- "You should refrain from any sexual activity." 2- "You need to be assessed for a fungal infection." 3- "This discharge is normal during pregnancy." 4- "Use a local antifungal agents regularly."

3

In recording a postpartum mother's urinary output, the nurse notes that she is voiding between 100 to 200 mL with each void. How would the nurse interpret this finding? 1- The urinary output is inadequate and the mother needs to drinks more fluids. 2- The urinary output is inadequate suggestive of urinary retention. 3- The urinary output is normal. 4- The urinary output is above expected levels.

3

Prior to discharge from the hospital, a nurse is checking the fundal height for a new mother who delivered 2 days ago. The nurse would anticipate which finding? 1- Level with the umbilicus 2- One fingerbreadth below the umbilicus 3- Two fingerbreadths below the umbilicus 4- At the pubic bone

3

Seven hours ago, a multigravida woman gave birth to a 4133-g male infant. She has voided once and calls for a nurse to check because she states that she feels "really wet" now. Upon examination, her perineal pad is saturated. The immediate nursing action is to: 1- inspect the perineum for lacerations. 2- increase the flow of an IV. 3- assess and massage the fundus. 4- call the primary care provider or the nurse-midwife.

3

The nurse is assessing a pregnant client at her 12 weeks' gestation and the client reports some new bumps on the dark part of her nipples. What is the best response from the nurse when questioned by the client as to what they are? 1- Normal bumps of pregnancy; they do nothing 2- Might be sign of cancer; need to speak with provider 3- Montgomery tubercles; secrete lubricant for the nipples 4- Striae, stretching of the breast tissue

3

The nurse is aware that labor pain and contractions can lead to all of the following EXCEPT 1- Hyperventilation 2- Decreased blood flow to the uterus 3- Respiratory acidosis 4- Fatigue and sleep deprivation

3

The nurse is conducting a postparum examination on a client who reports pain and is unable to sit comfortably. The perineal exam reveals an episiotomy appropriately approximated without signs of a hematoma. Which action should the nurse prioritize? 1- Notify a primary care provider. 2- Apply a warm washcloth. 3- Place an ice pack. 4- Put on a witch hazel pad.

3

The nurse is conducting discharge teaching with a postpartum woman. What would be an important instruction for this client? 1- Call her caregiver if amount of lochia decreases. 2- Call her caregiver if lochia moves from serosa to alba. 3- Call her caregiver if lochia moves from serosa to rubra. 4- Call her caregiver if lochia moves from rubra to serosa.

3

The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation? 1- Uteruine atony 2- Full bowel 3- Bladder distention 4- Poor bladder tone

3

The nurse is preparing a nursing care plan for an immediate postpartum client. Which nursing diagnosis should the nurse prioritize? 1- Acute pain related to afterpains or episiotomy discomfort 2- Risk for infection related to multiple portals of entry for pathogens 3- Risk for injury: postpartum hemorrhage related to uterine atony 4- Risk for injury: falls related to postural hypotension and fainting

3

The nursing instructor is illustrating the circulatory flow between the mother and fetus. The instructor determines the session is successful when the class correctly chooses which structure with which route? 1- The one umbilical artery carries oxygen-rich blood to the fetus from the placenta. 2- The two umbilical arteries carry waste products from the placenta to the fetus. 3- The one umbilical vein carries oxygen-rich blood to the fetus from the placenta. 4- The two umbilical veins carry waste products from the fetus to the placenta.

3

The postpartum client is reporting her left calf hurts and it is making it difficult for her to walk. The nurse predicts which factor is contributing to this situation after finding an area of warmth and redness? 1- increased white blood cell count 2- stirrup injury during birth 3- increased coagulation factors 4- decreased red blood cell count

3

The school nurse is presenting a lecture to adolescents to teach them how conception occurs. Which statement by the nurse would accurately describe this process? 1- "Human life begins with the union of two cells: the zygote and the sperm." 2- "At the time of conception, the ovum determines the sex of the baby." 3- "Conception usually occurs when the ovum is in the outer third of the fallopian tube." 4- "The ovum carries the Y chromosome, and the sperm carries an X or Y chromosome."

3

When assessing a woman with pelvic organ prolapse, which of the following would the nurse be least likely to find? 1- Feeling of dragging in the vagina 2- Stress incontinence 3- Diarrhea 4- Dyspareunia

3

When assessing the uterus of a 2-day postpartum client, which finding would the nurse evaluate as normal? 1- a scant amount of lochia alba 2- a moderate amount of lochia alba 3- a moderate amount of lochia rubra 4- a scant amount of lochia serosa

3

Which change related to the vital signs is expected in pregnant women? 1- Pulse decreases. 2- Lung space increases. 3- Blood pressure decreases. 4- Temperature decreases.

3

You are discussing weight gain with a group of pregnant women at the clinic. One woman is very thin and her prepregnancy weight falls below the normal weight range for her height. What is her recommended weight gain during her pregnancy? 1- 40 to 50 pounds 2- 35 to 50 pounds 3- 28 to 40 pounds 4- 20 to 30 pounds

3

A client who gave birth about 12 hours ago informs the nurse that she has been voiding small amounts of urine frequently. The nurse examines the client and notes the displacement of the uterus from the midline to the right. What intervention would the nurse perform next? 1- Insert a 20 gauge IV. 2- Administer oxytocin IV. 3- Notify the healthcare provider. 4- Perform urinary catheterization.

4

A postpartum client comes to the clinic for her 6-week postpartum check up. When assessing the client's cervix, the nurse would expect the external cervical os to appear: 1- shapeless. 2- circular. 3- triangular. 4- slit-like.

4

A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the client? 1- 10 weeks 2- 24 weeks 3- 30 weeks 4- 16 weeks

4

A woman who delivered her infant 2 days ago asks the nurse why she wakes up at night drenched in sweat. She is concerned that this is a problem. The nurse's best reply would be: 1- "Many women sweat after delivery but you seem to be perspiring far more than normal. I'll call the doctor." 2- "Often, when a postpartum woman perspires like you are reporting, it means that they have an infection." 3- "I need to get your vital signs and check your fundus to be sure you are not going into shock." 4- "Sweating is very normal for the first few days after childbirth because your body needs to get rid of all the excess water from pregnancy."

4

How does fetal circulation differ from circulation after birth? 1- Fetal blood flow bypasses the right atrium and goes directly to the right ventricle. 2- In utero, blood through the pulmonary artery is only 50% of the post-delivery blood flow. 3- The ductus arteriosus carries the majority of the blood circulating from the left atrium to the left ventricle directly to the aorta. 4- The umbilical vein carries oxygenated blood, while deoxygenated blood is carried by the umbilical arteries.

4

The nurse is assessing a postpartum woman and is concerned the client may be hemorrhaging. Which assessment finding is the nurse finding most concerning? 1- increased blood pressure 2- increased cardiac output 3- increased hematocrit level 4- increased heart rate

4

The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? 1- dyspnea 2- lower abdominal pressure 3- swelling of extremities 4- excessive vomiting

4

When completing the morning postpartum data collection, the nurse notices the client's perineal pad is completely saturated. Which action should be the nurse's first response? 1- Vigorously massage the fundus. 2- Immediately call the primary care provider. 3- Have the charge nurse review the assessment. 4- Ask the client when she last changed her perineal pad.

4

Which assessment finding 1 hour after birth should be reported to the health care provider? 1- Fundus of uterus is palpable at the level of the umbilicus. 2- Fundus is displaced to the right, and bladder is hard. 3- Large, bruised hemorrhoids are protruding from the anal opening. 4- Lochia rubra is saturating a pad every 45 to 60 minutes.

4

Which genetic condition is caused by a small gene mutation that affects protein structure, producing hemoglobin S? 1- Marfan syndrome 2- hemophilia 3- Tay-Sachs disease 4- sickle cell anemia

4

gestational hypertension criteria

After 20 weeks without proteinuria or other signs of preeclampsia 140 or higher 4 hours apart

main cause of miscarriage

chromosomal abnormalies