Unit 1: Working with Patients: Education, Interaction, and Management of Care

A G2P1 woman with type 1 diabetes is determined to be at 8 weeks' gestation by her health care provider. The nurse should point out which factor will help the client maintain glycemic control? 1 Vitamin supplements 2 Oral hypoglycemic agents 3 Exercise 4 Plenty of rest

3

The nurse encourages a woman with gestational diabetes to maintain an active exercise period during pregnancy. Prior to this exercise period, the nurse would advise her to take which action? 1 Inject a bolus of insulin. 2 Eat a high-carbohydrate snack. 3 Eat a sustaining-carbohydrate snack. 4 Add a bolus of long-acting insulin.

3

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment finding? 1 absent grasp reflex 2 hand weakness 3 absent Moro reflex 4 facial asymmetry

3

The nurse is aware of three different phases in the cycle of violence. Which is not one of those phases? 1 honeymoon phase 2 tension-building phase 3 battering incident 4 hopeless stage

4

The nurse is scheduling a female patient for a hysterosalpingogram. Which question would be most important to ask the patient before scheduling the procedure? 1 When did you have coitus last? 2 Are you allergic to any sedatives? 3 What is your blood type and Rh factor? 4 When do you expect your next menstrual flow?

4

A client is concerned that she did something to cause the molar pregnancy. Which response by the nurse is accurate? 1 It is a result of a genetic error during fertilization. 2 It is a result of arrested development of the embryo. 3 It is a result of exposure to a teratogen. 4 It is a result of a mutation during cell meiosis.

1

A nurse is assessing an infant born at 33 weeks' gestation. What finding would alert the nurse that the infant is having respiratory distress? 1 Flaring nostrils 2 Decreased pulse rate 3 Ineffective cough 4 Sporadic crying

1

Which change in insulin is most likely to occur in a woman during pregnancy? 1 enhanced secretion from normal 2 not released because of pressure on the pancreas 3 unavailable because it is used by the fetus 4 less effective than normal

4

A client in active labor receives nalbuphine at 5 p.m. The client gives birth at 6:45 p.m. At birth the neonate's vital signs are: T- 97.7°F (36.5°C), HR 86, RR 32. The infant is lethargic and floppy. What medication does the neonatal nurse anticipate will be given to the infant? 1 Naloxone 2 Vitamin K 3 Glucose 4 Calcium gluconate

1

A client at 30 weeks' gestation is admitted. Betamethasome, an IM steriod, is prescribed. What does the nurse teach the client about the administration of this medication? 1 You will receive two doses 24 hours apart repeated every 7 days. 2 You will receive one dose every week until delivery. 3 You will receive four doses in 24 hours every 3 days until 36 weeks' gestation. 4 You will receive one dose every 24 hours until 34 weeks' gestation.

1

A client at 32 weeks' gestation is admitted to labor and delivery with vaginal bleeding and contractions. The physician orders a course of two steroid injections. The client asks why she needs steriods. What is the best explanation by the nurse? 1 The steroids speed up the development of the lungs. 2 The steroids will help to slow the development of infection. 3 The steroids will increase the baby's muscle mass. 4 The steroids will create a layer of fat to help with temperature regulation.

1

A client receives general anesthesia for an emergency cesarean birth. The nurse should monitor the client for which postpartum complication during the first 2 hours after birth? 1 Uterine atony 2 Endometriosis 3 Pneumonia 4 Urinary retention

1

A female client shares that her partner often comes home in the evening after a couple of beers, and is jealous, tense and verbally abusive. He sometimes destroys thing, such as breaking a vase of flowers. The client says this makes her feel embarrassed, but she tries to be submissive to her partner to calm him down. The nurse recognizes this interaction as which phase of a relationship with intimate partner violence? 1 Tension-building phase 2 Honeymoon phase 3 Remorseful phase 4 Violent episode phase

1

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that which result indicates good glucose control? 1 88 mg/dL 2 100 mg/dL 3 110 mg/dL 4 120 mg/dL

1

At 37 weeks' gestation, a woman presents to labor and delivery complaining of intense, knife-like abdomen pain that started suddenly about 1 hour ago and has not subsided. On palpation, the abdomen is rigid and board-like and no vaginal bleeding is evident. What should the nurse do next? 1 Assess fetal heart rate 2 Administer oxygen by face mask 3 Insert a Foley catheter 4 Prepare the client for an epidural

1

On day 3 after a cesarean birth, the client is complaining of soreness in her left leg. On examination the nurse notes the left leg is swollen, and the calf is red, tender and warm to touch. These findings indicate: 1 deep vein thrombosis. 2 venous insufficiency. 3 varicose veins. 4 peripheral artery disease.

1

The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by: 1 group B beta-hemolytic streptococci. 2 Candida albicans. 3 Escherichia coli. 4 Chlamydia trachomatis.

1

The nurse cared for a client who delivered. The duration of labor from the onset of contractions until the birth of the baby was 2 hours. How will the nurse document the client's labor in the health record? 1 Precipitous labor 2 Prolonged labor 3 Prodromal labor 4 False Labor

1

The nurse is caring for a client with HELLP syndrome. When the blood pressure cuff is removed, the nurse notices petechiae on the client's arm where the BP cuff was placed. What is the mostimportant action for the nurse to do next? 1 Check the client's platelet count. 2 Call the provider. 3 Obtain a fingerstick hematocrit. 4 Ask the client if these were there before.

1

The nurse is teaching a client how to use cervical mucus to identify fertile periods. The nurse teaches the client that which characteristics of cervical mucus are associated with her fertile period? 1 Stretchy and slippery 2 Dry 3 Thick and stringy 4 Cloudy white and sticky

1

The nurse is teaching a female to take her basal body temperature daily to assess the time of ovulation. What will the patient's body temperature reflect at the day of ovulation? 1 Increase a degree. 2 Decrease a degree. 3 Fluctuate a degree daily. 4 Spike one degree then drop.

1

The nurse teaches a client how to time the frequency of uterine contractions. Which statement by the client indicates she understands the teaching? 1 "I time from the beginning of one contraction to the beginning of the next contraction." 2 "I time from the end of one contraction to the beginning of the next contraction." 3 "I time from the beginning of the contraction to the end of the contraction." 4 "I count the number of contractions in the hour and divide by 60."

1

Why does the nurse perform the Apgar testing? 1 The score indicates the status of the infant at that time. 2 The score determines what care to provide. 3 The score determines the baby's long-term prognosis. 4 The score indicates which level of respiratory care is needed.

1

The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dL (8.10 mmol/L), hemoglobin 13 g/dL (130 g/L), and hematorcrit 37% (0.37). Based on these results which instruction should the nurse prioritize? 1 Check blood sugar levels daily. 2 The signs and symptoms of urinary tract infection. 3 Include iron-enriched foods in the diet. 4 Take daily iron supplements.

1 An elevated blood glucose is concerning for diabetes. A fasting blood glucose level of greater than 140 mg/dL (7.77 mmol/L) or random level of greater than 200 mg/dL (11.10 mmol/L) is concerning; this must be followed up to ensure the client is not developing gestational diabetes. The hemoglobin and hematocrit are within normal limits for this client. The values should be hemoglobin greater than 11 g/dL (110 g/L) and hematocrit greater than 33% (0.33). Values lower than that are possible indications of anemia and would necessitate further evaluation.

During active labor the provider ruptures the client's membranes. The fluid flowing out of the client's vagina is green-colored. The nurse recognizes that this finding is evidence of which condition? 1 Fetal hypoxia 2 Placenta abruption 3 Rupture of the umbilical vessel 4 Fetal bleeding

1 Green-colored amniotic fluid indicates the presence of "old" meconium. The fetus relaxes the anal sphincter and passes meconium when he or she becomes hypoxic in utero.

Migraine headaches during menstruation are most likely caused by which hormone alteration? 1 Low estrogen 2 Low progesterone 3 High progesterone 4 High estrogen

1 Low estrogen levels are seen just before the woman's menses, and are associated with migraine headaches.

A client in active labor receives nalbuphine at 5 p.m. The client gives birth at 6:45 p.m. For what effect should the neonatal nurse assess for in the neonate? 1 Sleepiness 2 Tachycardia 3 Hypoglycemia 4 Transient tachypnea

1 Neonates may be groggy/sleepy if nalbuphine is administered 4 hours or less before birth. Rapid nursing assessment and implementation of appropriate action is necessary to prevent a poor outcome. If nalbuphine is in the neonate's system the baby may exhibit bradycardia. Nalbuphine does not cause hypoglycemia or transient tachypnea. Nalbuphine is used for severe pain and is an opioid.

During a postpartum hemorrhage, the nurse anticipated administering which medication to cause vasoconstriction of the uterine vessels? 1 Methylergonovine 2 Magnesium sulfate 3 Misoprostol 4 Fentanyl

1 Oxytocin, methylergonovine and misoprostol all stimulate the uterine muscle to contract. Methylergonovine is the only medication that also stimulates vasoconstriction of the uterine vessels, thereby decreasing bleeding. Fentanyl is a pain medication. Magnesium sulfate is a smooth muscle relaxant

A client complaining of right-sided abdominal pain and intermittent vaginal bleeding over the past 2 hours comes to the urgent care center. Based on her last menstrual period and a home pregnancy test she is 8 weeks' pregnant. A blood test confirms the pregnancy but the hCG level is low for 8 weeks' gestation. This client's presentation is consistent with what condition? 1 Ectopic pregnancy 2 Implantation bleeding 3 Threatened abortion 4 Premature placental separation

1 These symptoms are consistent with an ectopic pregnancy. In addition to the cramping and intermittent bleeding, the low levels of hCG from the blood test are a sign that the pregnancy is not growing (as happens when the embryo is developing in the confined space of the fallopian tube). With implantation bleeding or a threatened abortion, the hCG level would be consistent with an 8 week gestation pregnancy. At 8 weeks' gestation, the placenta is not adequately formed to prematurely separate.

A patient at 36 weeks' gestation tells the nurse, "I was at my desk and suddenly felt a pop and then my pants were wet." Based on the client's presentation, what procedures does the nurse anticipate being performed? Select all that apply. 1 Sterile speculum examination 2 Nitrazine test 3 Ferning 4 Nonstress test 5 Biophysical profile

1, 2, 3

During a prenatal visit at 28 weeks' gestation, the client tells the nurse, "I am always hot now, and usually I am the one wearing an extra sweater. And I normally run a low temperature, around 98.2°F (36.7°C). But when they take it at the clinic, it is between 98.6 and 98.9°F (37 and 37.2°C). Do you think I have an infection?" Which responses by the nurse are appropriate in this situation? Select all that apply. 1 Pregnant women typically are 0.4-0.6°F (0.275°C) warmer than their baseline temperatures. 2 The increased metabolic rate during pregnancy makes some women feel warmer. 3 Do you have any signs of an infections, such as painful urination? 4 Let's do an ultrasound and see if the fetus is growing and developing as expected. 5 I will order some blood work to see if you have an infection.

1, 2, 3

The nurse enters the room and finds a frightened and anxious client saying, "I can't breathe and my chest and leg hurt." Place the actions in the order they would be initiated, assuming the previous action did not resolve the problem. Use all options. 1 Call for help 2 Start oxygen 3 Raise the head of the bed to a sitting position 4 Obtain results of compression ultrasound 5 Administer anticoagulation medication

1, 2, 3, 4, 5,

An ultrasound examination is performed in the second trimester. What are the purposes of this examination? Select all that apply. 1 To calculate the volume of amniotic fluid 2 to locate the placenta 3 To survey the fetus for anomalies 4 To measure the size of the uterus 5 To determine uterine muscle thickness

1, 2,3,

The nurse is leading a preconception education session at the community center. A participant asks: "I heard you shouldn't eat unpasteurized milk or cheese while pregnant. Is that true?" The nurse respond that these foods should be avoided because they may be contaminated with which substance that is harmful during pregnancy? Select all that apply. 1 Listeria 2 Mercury 3 Toxoplasmosis 4 Salmonella 5 E. Coli

1, 4, 5

A 40-year-old client comes to the clinic with reports of excessive nausea and vomiting and vaginal bleeding. The client reports that this is her third pregnancy and, based on a regular menstrual cycle and a positive home pregnancy test, she is 17 weeks' pregnant. The client is concerned because she has not felt the baby move yet. On examination, the client's uterus is found to be larger than expected for dates. No fetal heart tone can be heard on Doppler examination. Which condition may be present? 1 Hyperemesis gravidarum 2 Gestational trophoblastic disease 3 Abdominal pregnancy 4 Ectopic pregnancy

2

The nurse is leading a discussion with a group of pregnant women who have diabetes. The nurse should point out which situation can potentially occur during their pregnancy? 1 Small for gestation age infant 2 Polyhydramnios 3 Post-term birth 4 Hypotension of pregnancy

2 Polyhydramnios is an increase, or excess, in amniotic fluid and is a pregnancy-related complication associated with diabetes.

A nurse is counseling a pregnant woman with rheumatoid arthritis about medications that can be used during pregnancy. Which drug would the nurse emphasize as being contraindicated at this time? 1 hydroxychloroquine 2 nonsteroidal anti-inflammatory drugs 3 glucocorticoid 4 methotrexate

4 It can cause abortion of pregnancy