Practice exam ones I got wrong

A nurse is assessing four newborns. Which of the following findings should the nurse report to the provider

18 hour old with an axillary temperature of 37.7 C (99.9F). An axillary temp greater 37.5 (99.5) is above the expected reference range for a newborn and can be an indication of sepsis.

a nurse is teaching a client who is at 24 wks of gestation regarding 1 hr glucose tolerance test. which of the following statements should the nurse include?

A blood glucose of 130-140 is considered a positive screening result

A nurse on an antepartum unit is caring for 4 clients. which of the following clients should the nurse identify as the priority?

A client who is at 34 wks gestation and reports epigastric pain epigastric pain is a manifestation of preeclampsia

A nurse is caring for a client who is at 26 weeks of gestation and has epilepsy. the nurse enters the room and observes the client having a seizure. after turning the clients head to one side, which of the following actions should the nurse take immediately after the seizure?

Administer oxygen via a nonrebreather mask 10 l/min to ensure adequate oxygenation to fetus

a nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. which of the following findings should the nurse report to the provider?

BUN 25 mg/dl elevated BUN can indicated dehydration (6-24)

a nurse is reviewing the lab report of a newborn who is 24 hr old. which of the following results should the nurse report to the provider?

Blood glucose 30 mg/dL newborns less than 24 hr old should have a blood glucose of 40-60

which of the following findings in the clients history should the nurse recognize as a contraindication to oral contraceptives?

Cholecystitis, HTN, migraine headaches

a nurse is performing a physical assessment of a newborn. which findings should the nurse expect?

HR 154/min, 36.5-37.5C, RR30-60, length 45-55 cm, 5.5lbs-8.8lbs

a nurse is caring for a client who is experiencing a PPH. which of the following findings should the nurse identify as a contraindication to the admin of methylergonovine?

HTN HTN, preeclampsia, heart disease are contraindicated

a nurse is reviewing the lab results for a client who is at 10 wks of gestation. which of the following lab findings should the nurse report?

Hemoglobin 10g/dl expected range >11 HCT >33%

A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. which of the following statements by the client indicates an understanding of the teaching?

I will eat foods that taste good instead of balancing my meals. eat foods they like to avoid nausea

a nurse is teaching a client who is in preterm labor about terbutaline. which of the following statements by the client indicates an understanding of the teaching?

I will have blood tests because my potassium may decrease

A nurse is providing teaching to a client about the physiological changes that occur during pregnancy. client is at 10 wks gestation and has a BMI WNL. which of the following client statements indicate understanding?

I will likely need to use alternative positions for sex because of weight gain.

a nurse is teaching a client who is Rh negative about Rh immune globulin. which of the following statements by the client indicates an understanding of the teaching?

I will need this medication if I have an amniocentesis because of the potential of fetal RBCs entering the maternal circulation

a nurse is caring for a client who is at 39 wks of gestation and is in labor. the fetal monitor tracing reveals late decelerations. after placing the client in a lateral position which of the following actions should the nurse take?

Increase the IV fluid rate. providing a fluid bolus can improve fetal hypoxia

A nurse is assessing a newborn 12 hr after birth. which of the following manifestations should the nurse report to the provider?

Jaundice jaundice occurring within the 1st 24 hrs is associated with ABO incompatibility, hemolysis, Rh isoimmunization.

a nurse is caring for a client who is pregnant and is at the end of her 1st trimester. the nurse should place the doppler US stethoscope in which of the following locations to begin assessing for the fetal heart tones?

Just above the symphysis pubis uterus is positioned low in the pelvisaasD

a nurse is caring for a client who is at 24 wks of gestation and has a suspected placental abruption. which lab test should the nurse expect?

Kleihauer- Betke test to determine if fetal blood is in maternal circulation. test is useful to determine if Rh immune globulin therapy should be administered to a client who is Rh negative

A nurse is caring for a client who is to receive oxytocin to augment her labor. Which of the following findings contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

Late decelerations- indicative of uteroplacental insufficiency.

a nurse is observing a new parent caring for her crying newborn who is bottle feeding. which of the following actions by the parent should the nurse recognize as a positive parenting behavior?

Lays the newborn across her lap and gently sways

A nurse is providing education about family bonding to parents who recently adopted a newborn. The nurse should make which of the following suggestions to aid the families 7 y.o to accept the new family member?

Obtain a gift from the newborn to present to the sibling

a nurse is preparing to admit a client who is in labor and has group B streptococcus. which of the following actions should the nurse take>

Prepare to administer prophylactic IV antibiotics

A nurse is creating a plan of care for a client who is postpartum and adheres to traditional hispanic cultural beliefs. Which of the following cultural practices should the nurse include In the plan of care?

Protect the clients head and feet from cold air.

a nurse is assessing a client who has GDM and is experiencing hyperglycemia. which of the following findings should the nurse expect?

Reports increased urinary output N/V, reports of thirst, abdominal pain, constipation, drowsiness, and HA are manifestations of hyperglycemia

a nurse is assessing a late preterm newborn. which of the following manifestations is an indication of hypoglycemia?

Respiratory distress other manifestations are abnormal cry, jitteriness, poor feeding, lethargy, apnea, seizures, hypotonia, hypothermia

a nurse is teaching a client who has a new prescription for combined oral contraceptives about potential adverse effects of the med. for which of the following findings should the nurse instruct the client to notify the provider?

SOB can indicate pulmonary embolus or MI. other complications include abdominal pain, sudden/persistent HA, blurred vision, severe leg pain

a nurse is teaching a new mother how to use a bulb syringe to suction her newborns secretions. which of the following instructions should the nurse include?

Stop suctioning when the newborns cry sounds clear

a nurse is planning care for a client who is in labor and is to have an amniotomy. which of the following assessments is priority?

Temp greatest risk after amniotomy is infection.

a nurse is teaching about the quadruple marker screen to a client who is pregnant. which of the following information should the nurse include in the teaching?

The test is a screening tool for chromosomal syndromes

a nurse is caring for a client who is experiencing preterm labor at 29 wks of gestation and has a script for betamethasone. which of the following statements should the nurse make about the indication for med admin?

This medication stimulates fetal lung maturity

a nurse is providing discharge teaching to a client who is postpartum. for which of the following manifestations should the nurse instruct the client to monitoring report?

Unilateral breast pain sudden onset of chills, fever, malaise, body, body aches, headaches, and unilateral breast pain can be indications of mastitis, and infection of the breast tissue.

A nurse is assessing the newborn of a client who took a SSRI during pregnancy. which of the following manifestations should the nurse identify as an indication of withdrawal from an SSRI?

Vomiting irritability, agitation, tremors, diarrhea

a nurse is teaching a client who has preeclampsia and is to receive a continuous IV infusion of mag sulfate about expected adverse effects of the med. which of the following statements should the nurse include?

You should expect this med to make you feel hot. mag sulfate causes flushing and feeling of warmth, hypotension, anorexia, nausea, diaphoresis, and sedation

a nurse is teaching a client who is at 36 wks of gestation and has a prescription for a non stress test. which of the following statements should the nurse include in the teaching?

You will be offered orange juice to drink during the test non stress test is performed to measure fetal activity. having the client drink orange juice or another beverage high in glucose, will stimulate fetal movements during the procedure

a nurse is caring for a client who is anemic at 32 wks gestation and is in preterm labor. the provider prescribed betamethasone 12 mg IM. which of the following outcomes should the nurse expect?

a reduction in respiratory distress in the newborn betamethasone is a glucocorticoid that is given to stimulate fetal lung maturity and prevent respiratory distress

a nurse is admitting a client who is in labor. the client admits to recent cocaine use. for which complication should the nurse assess?

abruptio placenta cocaine use increases risk for vasoconstriction

a nurse is assessing a client who has gestational diabetes. manifestations of hyperglycemia are

acetone breath odor fruity breath odor, increased thirst, abdominal pain, polyuria, flushed, dry skin, rapid breathing, drowsiness, weak rapid pulse

which of the following should the nurse expect upon physical assessment of a newborn upon admission to the nursery?

acrocyanosis, positive babinski, 2 umbilical arteries visible

a nurse is caring for a client who has mild hyperemesis gravidarum. which action?

administer pyridoxine to correct the fluid and electrolyte imbalances

a nurse is providing care for a client who has HIV and her newborn. which action should the nurse take?

bathe the newborn remove amniotic fluid and maternal blood prior to admin IM injections or heel sticks

A nurse is teaching a client who is at 18 wks of gestation about exercise during pregnancy. which of the following information should the nurse include?

check your pulse every 10 mins during exercise. If greater than 140, stop and rest.

a nurse is administering oxytocin for augmentation of labor. uterine contractions every 1-2 mins with a duration of 70- 80 secs. which action?

discontinue the oxytocin more than 5 contractions in 10 mins is indicative of uterine hyper stimulation

a nurse is providing medication teaching to a client who is at 14 wks of gestation and has a new prescription for ferrous sulfate. which information should the nurse include?

drink 2 L fluids daily while taking ferrous sulfate and increase fiber as this med can cause constipation

a nurse is providing dietary teaching to a client who has hyperemesis gravidarum. which of the following instructions should the nurse include in the teaching?

eat a snack high in protein at bedtime avoid having an empty stomach. foods high in fat and high in protein can minimize N/V

A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. Which of the following statements should the nurse include in the teaching?

ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen.

a nurse is discussing common discomforts that may occur during the 1st trimester of pregnancy with a client who is at 6 wks of gestation.

epistaxis nasal stuffiness

a nurse is assessing a newborn following birth. which of the following manifestations should the nurse identify as a complication?

generalized petechiae can indicate clotting factor deficiency or infection

a nurse is reviewing the lab results of a newborn who is 22 hr old. which of the following findings should the nurse report?

hemoglobin 12g/dl expected range 14-24

a nurse is assessing a client who received carboprost for PPH. which of the following findings is an adverse effect of this med?

hypertension carboprost is a vasoconstrictor that can cause hypertension

A nurse is assessing a newborn who was born at 26 wks of gestation using the new Ballard score. which of the following findings should the nurse expect?

minimal arm recoil. 26 weeks newborn should have decreased muscular tone/minimal arm recoil

a nurse is planning care for a client who is in labor and is requesting epidural for pain control. which action should the nurse take?

monitor the clients BP every 5 mins following the first dose

Leopold maneuver

palpate fundus to identify fetal parts locate the fetal back palpate fetal part presenting inlet palpate cephalic prominence to identify attitude of head

a nurse is providing teaching about breast care to a postpartum client who is bottle feeding her newborn. which of the following instructions should the nurse include?

periodically apply ice pacts to the breasts.

A nurse is assessing a newborn who was delivered vaginally and experienced a tight nuchal cord. Which of the following findings should the nurse expect?

petechiae over the head nuchal cord, or the umbilical cord being wrapped tightly around the neck, can cause bruising and petechiae over face, head, neck

a nurse is reviewing the lab results for a client who is at 32 wks gestation. for which of the following results should the nurse notify the provider? WBC 12,000, HBG 11.2, Platelets 100,000, BUN 20

platelets 100,000 expected range 150,000-400,000. decreased platelet count may indicate preeclampsia or HELLP syndrome

A nurse is caring for a client who is at 22 wks of gestation and is HIV positive. which of the following actions should the nurse take?

report the clients condition to the local health department. HIV is one of the conditions on the list of nationally notifiable infectious conditions that is required to be reported

a nurse is caring for a prenatal client who has parvovirus B19 (5th disease) which of the following actions should the nurse take?

schedule a US exam US exam to monitor the fetus during the pregnancy to detect the possible development of fetal hydros. the virus can cause miscarriage, intrauterine growth restriction, fetal anemia, or stillbirth.

a nurse is providing teaching for pp client who has a new script for carboprost tromethamine. which statement should the nurse make?

this med can cause diarrhea. given to control pp bleeding and prevent hemorrhage by causing uterine contractions and vasoconstriction adverse effects: N/V, HA, tachycardia, HTN, fever, chills

a nurse is preparing to admin medroxyprogesterone to a client. which action?

vigorously shake the contents of the vial before drawing up the dose

A nurse is assessing a client who is at 38 wk gestation during a weekly prenatal visit. which of the following findings should the nurse report to the provider??

weight gain of 2.2 kg (4.8lbs)

a nurse is teaching a client who is at 8 wks of gestation about nutrition during pregnancy. which of the following statements should the nurse include in the teaching?

you should consume 6 ounces of protein foods daily

A nurse is discussing an oral glucose tolerance test with a client at 22 wk gestation. what statement should the nurse say?

you should not eat or drink anything after midnight the night prior to the test

a nurse is caring for a client who is in active labor and has had no cervical change in the last 4 hr. which of the following statements should the nurse make make?

your provider will insert an intrauterine pressure catheter to monitor the strength of your contractions. determines uterine contraction intensity, frequency, and duration whether the contractions are adequate for progression of labor.