NCLEX OB Study #2

A male born at 28 weeks' gestation weighs 2 pounds, 12 ounces. What does the nurse expect to observe when performing an assessment? 1. Staring eyes 2. Absence of lanugo 3. Descended testicles 4. Transparent red skin (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Transparent red skin is expected because of the absence of subcutaneous fat tissue. 1 Preterm infants born nearer to term have open, staring eyes. 2 Preterm infants generally are born with large amounts of lanugo that begins to thin just before term and by 40 weeks is found only on the shoulders, back, and upper arms. 3 The preterm infant's scrotum is small and the testicles usually are high in the inguinal canal. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A practitioner prescribes penicillin G benzathine suspension (Bicillin L-A) 2.45 million units for a client with a sexually transmitted infection (STI). The medication is available in a multidose vial of 10 mL in which 1 mL = 300,000 units. How many mL should the nurse administer? Answer: _______________mL (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 8.2 mL. Use ratio and proportion: 2,450,000units:300,000units=x mL:1mL300,000x=2,450,000x=8.2mL (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When performing a discharge assessment on a two-day-old neonate, a large amount of meconium is expelled. What does the nurse conclude about this occurrence? 1. Precursor of newborn diarrhea 2. Common finding in two-day-old neonate 3. Pathological condition of the digestive system 4. Immaturity of the autonomic nervous system (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Meconium is passed usually during the first several days of life. 1 Meconium has no relationship to the pathological state of diarrhea. 3 Passing meconium is desired in the newborn in that it indicates patency of the colon and a perforate anus. 4 Although the newborn's autonomic nervous system is not fully developed at birth, gastrointestinal function is adequate to meet digestive, absorption, metabolic, and elimination needs. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A couple is concerned about the risks associated with an in vitro fertilization embryo transfer (IVF-ET). What risk should the nurse's response include? 1. Embryonic HIV 2. Tubal pregnancy 3. Congenital anomalies 4. Hyperemesis gravidarum (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 There is an increased risk of tubal pregnancy with IVF-ET. 1 There is not an increased risk for embryonic HIV with IVF-ET. 3 There is not an increased risk for congenital anomalies with IVF-ET. 4 There is not an increased risk for hyperemesis gravidarum with IVF-ET. (Nugent 380-381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Immediately after birth, a newborn is dried before being placed in skin-to-skin contact with the mother. What type of heat loss does this intervention prevent? 1. Radiation 2. Convection 3. Conduction 4. Evaporation (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Evaporative heat loss is a result of the conversion of moisture into vapor, which is avoided when the newborn is dried. 1 Radiation is the loss of heat to colder solid surfaces not in direct contact. 2 Convective heat loss is a result of contact of the exposed skin with cooler surrounding air currents. 3 Conductive heat loss is a result of direct skin contact with a cold solid object. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Which assessment leads a nurse to suspect that a newborn with a spinal cord lesion has increased intracranial pressure? Select all that apply. 1. ____ Irritability 2. ____ High-pitched cry 3. ____ Depressed fontanels 4. ____ Decreased urinary output 5. ____ Ineffective feeding behavior (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 2, 5 1 Pressure on the cerebral structures influences the central nervous system, resulting in irritability. 2 A high-pitched cry is common in neonates with increased intracranial pressure. 3 The fontanels are bulging, not depressed, with increased intracranial pressure. 4 Decreased urinary output is related to dehydration and kidney problems, not increased intracranial pressure. 5 Ineffective feeding behavior is typical of neonates with increased intracranial pressure. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a pregnant client with thrombophlebitis. Which anticoagulant medication may be prescribed? Select all that apply. 1. _____ Heparin (Hep-Lock) 2. _____ Clopidogrel (Plavix) 3. _____ Warfarin (Coumadin) 4. _____ Enoxaparin (Lovenox) 5. _____ Acetylsalicylic acid (Acuprin) (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 4 1 Heparin (Hep-Lock) can be used during pregnancy because it does not cross the placental barrier and will not cause hemorrhage in the fetus. 2 Clopidrogrel (Plavix) is a platelet aggregation inhibitor. It is not used for thrombophlebitis; it is used to reduce the risk of brain attack, TIA, unstable angina, and myocardial infarction. 3 Warfarin (Coumadin) crosses the placental barrier causing hemorrhage in the fetus. 4 Enoxaparin (Lovenox) does not cross the placental barrier; its classification for pregnancy is B. 5 Acetylsalicylic acid (Acuprin) is a platelet aggregation inhibitor and is not recommended during pregnancy (D category). (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn is diagnosed with a diaphragmatic hernia. What is the immediate nursing intervention after the neonate is admitted to the neonatal intensive care unit (NICU)? 1. Hydrating the infant with isotonic enemas 2. Limiting formula feedings to small amounts 3. Placing the infant in the Trendelenburg position 4. Providing gastric decompression via nasogastric tube (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

390. 4 When a diaphragmatic hernia is present, the intra-abdominal pressure must be minimized; this is accomplished by the use of gastric decompression. 1 Hydrating the infant with isotonic enemas is not beneficial. 2 These infants are not fed orally; intravenous fluids are given with careful measurement of electrolytes and intake and output to guide replacement therapy. 3 The Trendelenburg position is contraindicated; the abdominal organs will increase pressure on the diaphragm. (Nugent 378-379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is assessing a newborn for developmental dysplasia of the hip (DDH). Where does the nurse look for extra skinfolds? 1. Calf muscles 2. Popliteal area 3. Back of the thigh 4. Lower portion of the abdomen (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 With developmental dysplasia of the hip there are extra skinfolds on the affected thigh as a result of the displacement of the head of the femur in the acetabulum. 1 There are no extra folds in this area in developmental dysplasia of the hip. 2 There are no extra folds in this area in developmental dysplasia of the hip. 4 There are no extra folds in this area in developmental dysplasia of the hip. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While inspecting her newborn, a mother asks the nurse if her baby has flat feet. How should the nurse respond? 1. "Flat feet are more common in children than adults." 2. "It is difficult to assess because the feet are so small." 3. "There may be a bone defect that needs further assessment." 4. "Infants' feet appear flat because the arch is covered with a fat pad." (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 A fat pad covers the arch in newborns and infants; the arch develops when the child begins to walk. 1 Flat feet are no more common in children than in adults. 2 The size of the feet is not relevant; arch development is related to walking. 3 Flat feet are not associated with deformities of the bones. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 39-year-old woman who is Rh negative is seen by her primary care provider during the first trimester of pregnancy. Which week of gestation should the nurse teach the client that Rho(D) immune globulin (RhoGAM) will be administered? 1. 12 weeks 2. 28 weeks 3. 36 weeks 4. 40 weeks (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Rho(D) immune globulin (RhoGAM) administration during the 28th week of gestation limits an active antibody response in an Rh-negative woman exposed to the positive blood of the fetus. 1 Week 12 is too early in the pregnancy to administer Rho(D) immune globulin (RhoGAM). 3 Rho(D) immune globulin is given at 28, not 36, weeks in the pregnancy as a preventive measure. 4 Rho(D) immune globulin is given at 28, not 40, weeks in the pregnancy as a preventive measure. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A small-for-gestational-age (SGA) newborn has just been admitted to the nursery. Nursing assessment reveals a high-pitched cry, jitteriness, and irregular respirations. With what condition are these signs associated? 1. Hypervolemia 2. Hypoglycemia 3. Hypercalcemia 4. Hypothyroidism (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 SGA infants may exhibit hypoglycemia, especially during the first 2 days of life because of depleted glycogen stores and inhibited gluconeogenesis. 1 These are not signs of hypervolemia. Hypervolemia usually is the result of excessive intravenous infusion. It is unlikely that a full-term SGA infant will need IV supplementation. 3 Hypercalcemia is uncommon in newborns. 4 These signs are unrelated to hypothyroidism; signs of hypothyroidism are difficult to identify in the newborn. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 12 weeks' gestation arrives in the prenatal clinic complaining of cramping and vaginal spotting. A pelvic examination reveals that the cervix is closed. Which probable diagnosis should the nurse expect? 1. Missed abortion 2. Inevitable abortion 3. Incomplete abortion 4. Threatened abortion (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Because the cervix is closed, the abortion is threatened. 1 The lifeless products of conception are retained with a missed abortion. 2 Once the cervix is dilated the abortion is inevitable. 3 Portions of the products of conception will have to be passed for a diagnosis of incomplete abortion. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a class of premenopausal women how to perform breast self-examination correctly. When is the best time of the month for breast self-examination? 1. When ovulation occurs 2. The first day of every month 3. The day that the menses begins 4. About a week after menses ends (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Breast engorgement has abated at this time, limiting lumps that may occur because of fluid accumulation. 1 Breast engorgement begins before ovulation and does not subside until several days after menses ends; engorgement interferes with accurate palpation. 2 Inaccurate assessment may result because examination occurs at different times of the menstrual cycle; accurate comparisons may not be made from month to month. 3 Breast engorgement begins before ovulation and does not subside until several days after menses ends; engorgement interferes with accurate palpation. (Nugent 382-383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with an abruptio placentae had an emergency cesarean birth. Subsequently the nurse observes that there is bloody urine in the indwelling catheter collection bag. What impending problem does the nurse suspect the client has? 1. Incisional nick in the bladder 2. Urinary infection from the catheter 3. Uterine relaxation with increased lochia 4. Disseminated intravascular coagulopathy (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 During an emergency cesarean birth the urinary bladder may be nicked while attempting to reach the uterus. 2 Bleeding associated with a urinary tract infection is unlikely to develop so soon after a birth. 3 Lochia is expelled from the vagina, not the bladder. 4 With DIC there would be bleeding from other sites such as the incision and the IV, not just the bladder. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse assesses a newborn and observes central cyanosis. What type of congenital heart defect usually causes central cyanosis? 1. Shunting of blood from right to left 2. Shunting of blood from left to right 3. Obstruction of blood flow from the left side of the heart 4. Obstruction of blood flow between left and right sides of the heart (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Right-to-left shunts result in inadequate perfusion of blood; not enough blood flows to the lungs for oxygenation. 2 Left-to-right shunts result in too much blood flowing to the lungs; blood is adequately perfused. 3 Left-sided obstruction to the flow of blood results in decreased peripheral pulses, not cyanosis. 4 This usually occurs with patent ductus arteriosus. There should be no shunting of blood between the right and left sides of the heart after the ductus arteriosus has closed. If the ductus remains open, the shunting is from left to right and cyanosis is not a factor. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who recently was told by her practitioner that she has extensive metastatic carcinoma of the breast, tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. The nurse determines that the client is experiencing the stage of death and dying known as: 1. Anger 2. Denial 3. Bargaining 4. Acceptance (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The client has difficulty accepting the inevitability of death and is attempting to deny the reality of it. 1 In the anger stage the client strikes out with the "why me" and the "how could God do this" type of statements. The client is angry at life and still angrier to be removed from it by death. 3 In this stage the client attempts to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. 4 In the acceptance stage the client accepts the inevitability of death and peacefully awaits it. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 16-year-old adolescent has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do? 1. Ask her partner to withdraw before ejaculating 2. Make certain their relationship is monogamous 3. Insist that her partner use a condom when having sex 4. Seek counseling about various contraceptive methods (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. 1 Pre-ejaculatory fluid carries the HIV in an infected individual. 2 Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV positive, the other person is at risk for acquiring the HIV. 4 The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from the HIV. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse who is monitoring the blood glucose levels of an infant of a diabetic mother (IDM) identifies a blood glucose level of 48 mg/dL. What should the nurse do? 1. Check the cord serum glucose level 2. Initiate oral feedings of 10% dextrose in water 3. Secure an order for an IV infusion of 50% dextrose 4. Continue to monitor the blood glucose for another day (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is within the expected blood glucose level for a neonate (40 to 60 mg/dL) and requires no measures other than continued monitoring for the next 24 hours. 1 Heel sticks are adequate for monitoring the blood glucose levels of a neonate. 2 Oral feedings of 10% dextrose in water are administered if the neonate's blood glucose level is low. 3 Administering 50% dextrose intravenously will cause hyperglycemia in the neonate. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida at 39 weeks' gestation is admitted to the high-risk unit with an acute infection and is to have labor induced. In what sequence should the nurse implement the practitioner's orders? 1. Initiate monitoring via an electronic fetal/maternal monitor 2. Start oxytocin (Pitocin) 30 units in 1000 mL of D5W per protocol 3. Call the anesthesia department to evaluate the client for an epidural 4. Give the client a 2-gram loading dose of ampicillin (Omnipen) followed by 1 gram every 4 hours (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 4, 3, 2 The priority is to continually monitor the response of the fetal heart rate to maternal contractions. Administering the ampicillin (Omnipen) is necessary for fetal safety. Calling the anesthesia department next allows time for a response before severe discomfort ensues or birth becomes imminent. Starting the oxytocin (Pitocin) infusion should be the last step because the maternal-fetal response to the stimulation of labor is not yet known and preparedness is essential. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at the women's health clinic complains of swelling of the labia and throbbing pain in the labial area after sexual intercourse. For what condition does the nurse anticipate the client will be treated? 1. Urethritis 2. Bartholinitis 3. Vaginal hematoma 4. Inflamed Skene's glands (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The Bartholin glands are located beneath the vaginal vestibule; if cysts form and they become infected they cause labial, vaginal, or pelvic pain particularly during or after intercourse (dyspareunia). 1 Urethritis causes painful urination. 3 A vaginal hematoma causes swelling in the vaginal wall, not the labia. 4 Skene's glands are located in the urethra, not the labia. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An amniotomy is performed to stimulate labor in a client who is at 42 weeks' gestation. Place the nursing care in order of priority. 1. Check the fetal heart rate tracings. 2. Evaluate the client for signs of an infection. 3. Assess the characteristics of the amniotic fluid. 4. Observe the perineum for umbilical cord prolapse (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 4, 1, 3, 2 As fluid gushes out of the amniotic sac, it may carry the umbilical cord out of the birth canal before the presenting part. This should be assessed for first because it is an emergency and immediate intervention is necessary to prevent fetal harm. The status of the fetus should be assessed next; there may be temporary tachycardia, but bradycardia and variable decelerations are signs of fetal compromise and emergency action must be taken. The amniotic fluid should be assessed next. It should be clear and not foul smelling; if it is green and/or foul smelling, fetal and maternal well-being may be compromised and medical interventions may be necessary. Finally, the maternal vital signs, particularly the temperature, should be taken routinely. After the amniotic sac is pierced there is danger of microorganisms ascending the vaginal canal, and fetal and maternal well-being may become compromised. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a newborn suspected of drug addiction. What should the nurse do to most accurately confirm that the newborn is addicted? 1. Examine the mother's arms for needle marks 2. Monitor the newborn closely for the first 48 hours 3. Check the mother's medication record for the previous 24 hours 4. Collect the newborn's urine by applying a collection bag to obtain a sample for testing (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

. 4 This is the most reliable method to confirm newborn addiction. 1 Examining the mother's arms for needle marks will not determine the amount of drugs the mother used or the last time the drug was taken. 2 The priority is to determine if the newborn is addicted before clinical signs of withdrawal occur. 3 It is the mother's drug habit that is important, not the prescribed medications she received the previous day. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn's birth was prolonged because the shoulders were very wide. With which reflex does the nurse anticipate a problem? 1. Moro 2. Plantar 3. Babinski 4. Stepping (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 A difficult birth because of broad fetal shoulders may result in a fractured clavicle, as evidenced by a knot or lump, limited arm movement, and a unilateral Moro reflex. 2 Plantar reflex is unrelated to a difficult birth caused by a fetus with broad shoulders. 3 Babinski reflex involves the feet; it is not related to a difficult birth caused by a fetus with broad shoulders. 4 Stepping reflex involves the feet; it is not related to a difficult birth caused by a fetus with broad shoulders. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Why is it important for the nurse to know the infant's gestational age and how it compares with the birthweight? 1. Potential problems may be identified 2. Infants lose weight during the first few days of life 3. Infant's weight must be included on the admission record 4. Health insurance companies need this information for evaluating benefits (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 A preterm, small-for-gestational-age (SGA) infant is at risk for problems not seen in the term small-for-gestational-age infant because of immaturity. This information will help the nurse to anticipate potential problems and aim interventions at prevention. 2 The infant will lose weight, but the comparison of birthweight and gestational age is important for planning appropriate nursing measures. 3 The information is documented in the infant's record, but this is not the overriding reason for obtaining the data. 4 The health insurance company needs this information, but this is not the overriding reason for obtaining the data. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn whose mother has type 1 diabetes is receiving a continuous infusion of fluids with glucose. What should the nurse do when preparing to discontinue the IV? 1. Decrease the rate slowly 2. Monitor for metabolic alkalosis 3. Withhold oral feedings for 4 to 6 hours 4. Check for elevated blood glucose levels every 1 to 2 hours (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Decreasing IV glucose slowly is necessary to prevent a hypoglycemic response. 2 Metabolic alkalosis will not occur with discontinuation of the glucose infusion. 3 Withholding oral feedings while withdrawing IV glucose may result in hypoglycemia. 4 Hyperglycemia is unlikely to occur when decreasing the IV glucose because blood glucose levels will decrease. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should cause the nurse to suspect that a preterm neonate who is receiving gastric feedings may have necrotizing enterocolitis (NEC)? 1. Large amounts of residual formula 2. Increased number of explosive stools 3. Several severe bouts of projectile vomiting 4. Circumoral pallor during the feeding process (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Primary manifestations of NEC are feeding intolerance, increased gastric residual of undigested formula, and bile-stained emesis. 2 This occurs with diarrhea; stools in infants with NEC are generally reduced in number and contain glucose and blood. 3 This occurs with hypertrophic pyloric stenosis. 4 This may occur with a cardiac anomaly, not NEC. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has a modified radical mastectomy because of a malignant tumor of the breast. What does the nurse plan to teach the client during the early postoperative period? 1. Keep the arm in an elevated position 2. Observe the incision site for redness and bleeding 3. Maintain a high Fowler position with the affected arm on a pillow 4. Perform range-of-motion exercises including flexion and abduction of the affected arm (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Elevation promotes drainage by gravity and reduces the risk of developing lymphedema. 2 This is not the responsibility of the client at this time. 3 A high-Fowler's position keeps the arm in a dependent position, thus limiting venous return and promoting lymphedema. 4 Abduction, moving the arm away from the body, increases tension on the suture line and is contraindicated at this time. (Nugent 383-384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After 2 weeks of radiation therapy for cancer of the breast a client develops some erythema over the area being radiated. The area is sensitive but not painful. She states that she has been using tepid water and a soft washcloth when cleansing the area and applying an ice pack three times a day. What does the nurse conclude from this information? 1. Further teaching on skin care is necessary 2. No other intervention is needed at this time 3. The radiation team should be notified of this problem 4. Health teaching on the side effects of radiation is needed (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Further teaching is needed because extremes of temperature should be avoided; ice constricts blood vessels, interfering with circulation. 2 Continued application of cold is contraindicated because it may cause tissue damage. 3 Erythema is an expected reaction; however, pain, vesicle formation, or sloughing of tissue requires intervention. 4 The knowledge deficit relates to skin care, not the side effects of radiation therapy. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the assessment of a preterm neonate the nurse determines that the infant is experiencing hypothermia. What should the nurse do? 1. Rewarm gradually 2. Notify the practitioner 3. Assess for hyperglycemia 4. Record skin temperature hourly (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Gradually rewarming an infant experiencing cold stress is essential to avoid compromising the infant's cardiopulmonary status. 2 It is not necessary to notify the practitioner. It is the nurse's responsibility to rewarm the infant. 3 Infants experiencing cold stress will become hypoglycemic because glycogen and glucose are metabolized to maintain the core temperature. 4 Skin temperatures should be taken at least every 15 minutes until stable. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor, who is at term, is admitted to the birthing room. The fetus is in the left occiput posterior (LOP) position. Her membranes rupture spontaneously. What observation requires the nurse to notify the practitioner immediately? 1. Greenish amniotic fluid 2. Shortened intervals between contractions 3. Clear amniotic fluid with specks of mucus 4. Decreased fetal heart rate at the beginning of contractions (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Greenish amniotic fluid indicates the presence of meconium and is considered a sign that the fetus is compromised. 2 Shortened intervals between contractions should occur as labor progresses. 3 Clear amniotic fluid with specks of mucus describes the expected amniotic fluid. 4 Decreased fetal heart rate at the beginning of contractions is an early deceleration caused by fetal head compression; it is benign. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While a client is being prepared for surgery because of a ruptured tubal pregnancy, the client complains of feeling lightheaded. Her pulse is rapid, and her color is pale. What condition does the nurse suspect the client has? 1. Shock 2. Anxiety 3. Infection 4. Hyperoxia (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Hemorrhage can result from a ruptured tubal pregnancy and shock can ensue. 2 Although the client may be very anxious, the signs and symptoms are those of hemorrhagic shock. 3 There are no data, such as fever or rising white blood cell count, to support the conclusion that the client has an infection. 4 The data do not include information related to respiratory patterns leading to hyperventilation and hyperoxia resulting in respiratory alkalosis. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nonstress test is scheduled for a client with preeclampsia. During the nonstress test the nurse concludes that if nonperiodic accelerations of the fetal heart rate occur with fetal movement, it probably indicates: 1. Fetal well-being 2. Fetal head compression 3. Uteroplacental insufficiency 4. Umbilical cord compression (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Nonperiodic accelerations with fetal movement indicate fetal well-being. 2 Early decelerations are associated with fetal head compression. 3 Late decelerations are associated with uteroplacental insufficiency. 4 Variable decelerations are associated with cord compression. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a client about the oral contraceptive prescribed by the practitioner. Which condition identified by the client indicates understanding about when the drug should be stopped immediately and the practitioner notified? 1. Chest pain 2. Menorrhagia 3. Mittelschmerz 4. Increased leukorrhea (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Oral contraceptives should be discontinued with the presence of any symptom related to a pulmonary embolus. 2 Menorrhagia, painful menstruation, is a side effect related to excessive amounts of estrogen; immediate discontinuance of the oral contraceptive is unnecessary. 3 Mittelschmerz, pain at the time of ovulation, does not occur if the client is taking an oral contraceptive. 4 Increased leukorrhea may be a sign of infection, not a side effect of oral contraceptives. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Immediately after the third stage of labor a nurse administers the prescribed oxytocin (Pitocin) infusion. Why is this medication administered? 1. For contraction of the uterus 2. To lessen uterine discomfort 3. To aid in the separation of the placenta 4. For the stimulation of breast milk production (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Oxytocin (Pitocin) given after the third stage of labor will stimulate the uterus to contract and remain contracted. 2 Oxytocin does not have an analgesic effect. 3 Oxytocin is administered after the placenta is expelled (third stage of labor). 4. Prolactin, not oxytocin, stimulates milk production. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the nurse include in the explanation of this procedure? 1. Pap smears can detect cancer of the cervix 2. Vaginal bleeding is expected after a Pap smear 3. Colposcopy will be used to visualize the cervix 4. Scraping the cervix is the most uncomfortable part (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Pap smears can detect cancer of the cervix by screening for atypical as well as cancerous cells. 2 Scraping the cells can cause a few drops of blood to be expelled; vaginal bleeding does not occur. 3 A colposcopy is not part of a routine Pap smear procedure. 4 Insertion of the speculum usually is the most uncomfortable part of the test. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 36 weeks' gestation arrives at the prenatal clinic for a routine examination. The nurse identifies that the client's blood pressure has increased from 102/60 to 134/88 and is concerned she may be developing mild preeclampsia. What other sign of mild preeclampsia does the nurse anticipate? 1. Proteinuria of 1+ 2. Mild ankle edema 3. Episodes of dizziness on arising 4. Weight gain of 2 pounds in 2 weeks (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Preeclampsia is characterized by an elevated BP and proteinuria. 2 This is commonly seen in the third trimester; it is known as physiological edema. Although no longer a diagnostic criterion for preeclampsia, edema, evidenced by excessive weight gain or edema of the hands and face, may support the diagnosis. 3 This may occur in the third trimester because the enlarged uterus impedes venous return, causing supine hypotension. 4 This weight gain is expected during the third trimester. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When performing a routine physical assessment on a client who is postmenopausal the nurse identifies that the client has enlarged breasts with galactorrhea. For what blood hormone level does the nurse expect the client to be tested? 1. Prolactin 2. Estrogen 3. Oxytocin 4. Progesterone (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Prolactin is a hormone that is produced and secreted by the anterior pituitary. A pituitary tumor is the most probable cause of elevated prolactin levels that result in lactation not associated with childbirth or nursing (galactorrhea). 2 If the client is taking oral contraceptives estrogen levels will increase, causing galactorrhea in some women; this client is postmenopausal. 3 The production of oxytocin is not related to the occurrence of galactorrhea. 4 The production of progesterone is not related to the occurrence of galactorrhea. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a prenatal visit a nurse explains to a client who is Rh negative when Rho(D) immune globulin (RhoGAM) will be administered to her. When is the best time to administer RhoGAM? 1. Within 72 hours after birth if the infant is Rh positive 2. Weekly during the 9th month if the mother is a multipara 3. Immediately after birth if the infant's Coombs' test is positive 4. During the second trimester if an amniocentesis indicates a problem (Nugent 342) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Rho(D) immne globulin (RhoGAM) is given to an Rh-negative mother after birth if the infant is Rh positive and the mother was not previously sensitized. 2 RhoGAM is administered once after birth if the mother was not previously sensitized. 3 The infant's Coombs' test result does not influence the timing of the RhoGAM administration. 4 A small dose of RhoGAM may be given prophylactically in the 28th week of gestation if there is a minimal increase in the antibody titer. If there is a significant increase in the antibody titer, an amniocentesis is performed. Treatment of the fetus is dependent on the results of the amniocentesis. (Nugent 388-389) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What does the nurse teach a client to do when performing breast self-examination? 1. Squeeze the nipples to examine for discharge 2. Use the right hand to examine the right breast 3. Place a pillow under the shoulder opposite the examined breast to raise it 4. Compress breast tissue to the chest wall with the palm of the hand to palpate for lumps (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Serous or bloody discharge from the nipple is pathological and must be reported. 2 The right hand should examine the left breast because this allows the flattened fingers to palpate the entire breast including the tail (upper, outer quadrant toward the axilla) and axillary area. 3 A small pillow or rolled towel should be placed under the scapula of the side being examined because it helps to raise the chest wall and spread and flatten out breast tissue. 4 The flat part of the fingers, not the palm or fingertips, should be used for palpation. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the discharge conference with a client who had a hysterectomy the nurse includes instructions for avoiding the thromboembolic phenomena that can occur as a complication. What should these instructions include? 1. Avoid sitting for long periods of time 2. Limit fluids to less than 2000 mL per day 3. Have a blood coagulation test every 2 weeks 4. Continue with hormone replacement therapy (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Sitting for long periods leads to pooling of blood in the pelvic area, predisposing the client to thrombus formation. 2 Fluids should be increased to 3000 mL daily to decrease blood viscosity, which can lead to thrombus formation. 3 Blood coagulation tests are not done routinely because clotting elements usually are not disturbed by a hysterectomy. 4 Hormone replacement therapy is not considered unless the client is premenopausal and an oophorectomy was performed (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During their initial visit to the fertility clinic a couple tells the nurse that after 2 years of unprotected intercourse they have not been able to conceive. A physical examination reveals that neither person has an abnormality. At their next visit the nurse informs them that laboratory data indicate an adequate quantity and quality of sperm. What question should the nurse ask now? 1. "Do you use any lubrication during intercourse?" 2. "Can both of you reach orgasm at the same time?" 3. "What type of birth control did you use in the past?" 4. "Are you consistent in the manner in which you have intercourse?" (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Some lubricants act as a spermicide; they should be avoided, or only a recommended one should be used. 2 A female orgasm is not necessary for conception; achieving simultaneous orgasms is not relevant. 3 The type of birth control used 2 years prior to trying to conceive is not relevant at this time; some hormonal contraceptives should be discontinued 6 to 18 months before trying to conceive. 4 Consistency in the manner of intercourse usually is not relevant to conception, although a change in position may be recommended. (Nugent 379-380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn is being treated with phototherapy for hyperbilirubinemia. What is the nurse's role when providing phototherapy? 1. Turning the infant every 2 hours 2. Placing a diaper over the naked infant 3. Maintaining the infant on daily 24-hour phototherapy 4. Applying a sterile gauze pad on the infant's umbilical stump (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The infant's position is changed every 2 hours to expose all skin surfaces to the phototherapy for maximum effect. 2 The infant should be kept nude for maximum exposure to the lights. 3 The infant may be removed from the lights for feeding and the eye patches removed to assess the eyes for irritation. 4 The lights will dry the cord more quickly, which is a desired effect. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What characteristic should the nurse identify in a preterm neonate that may be a potential nutrition problem? 1. Inadequate sucking reflex 2. Diminished metabolic rate 3. Rapid digestion of formula 4. Increased absorption of nutrients (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The reflexes and muscles of sucking and swallowing are immature; this may result in oral feedings that are ineffectual and exhausting. 2 The metabolic rate is increased because of fatigue and growth needs. 3 The digestive process is slow, especially in the ability to digest lipids. 4 Absorption of nutrients is decreased because the gastrointestinal tract is immature. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has a cesarean birth. The nurse monitors the newborn's respirations because infants experiencing a cesarean birth are more prone to atelectasis. Why does this occur? 1. The rib cage is not compressed, then released during birth 2. The sudden change in temperature at birth causes aspiration 3. There is usually oxygen deprivation following a cesarean birth 4. There is no gravity during the birth that promotes drainage from the lungs (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The release, following compression of the chest during a vaginal birth, is the mechanism for expansion of the newborn's lungs; because this does not occur during a cesarean birth, lung expansion may be incomplete and atelectasis may result. 2 Temperature change is not implicated in aspiration. 3 The infant is monitored closely to prevent oxygen deprivation. 4 Gravity can be used to promote drainage from the lungs after a cesarean birth by holding the newborn's head lower than the chest. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During discharge teaching, a client who had a hysterectomy states, "After this surgery, I don't expect to be interested in sex anymore." What should the nurse consider before responding? 1. Many women incorrectly equate hysterectomy with loss of libido 2. Surgically forced menopause usually results in a decreased sex drive 3. Loss of estrogen that results from this surgery will cause most women to experience a decrease in libido 4. Body image changes that occur after this surgery prevent many women from resuming sexual activity (Nugent 338-339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The uterus often is erroneously believed necessary for a satisfying sexual life. 2 Sexuality should not be diminished, particularly because the fear of pregnancy no longer exists. 3 Although estrogen levels are reduced, libido is influenced by psychological as well as hormonal factors. 4 Although body image changes can interfere with sexuality, this is not an expectation for most women. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is recovering from a total abdominal hysterectomy calls out to every nursing staff member who passes by the door and asks them to do or get something. The nurse can best manage this behavior by: 1. Having one staff member approach the client regularly and spend time talking with her 2. Closing the door to the room so the client cannot see the staff members as they pass by the room 3. Informing the client that one staff member will come in frequently and answer any questions she may have 4. Arranging for a variety of staff members to take turns going into the room to see whether the client has any requests (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This action provides continuity and demonstrates to the client that the nursing staff is concerned; frequent contact reduces the client's need to call staff members. 2 This will increase the client's anxiety and the need for more contact with staff members. 3 Telling the client is not the same as doing it; the client will not believe that staff members will come in frequently to talk. 4 This will not provide continuity of care. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What does the nurse expect concerning the alveoli in the lungs of a 28-week-gestation neonate? 1. They have a tendency to collapse with each breath 2. There usually is a sufficient supply of pulmonary surfactant 3. Although apparently mature they cannot absorb adequate oxygen 4. Oxygen is not released into the circulation because they overinflate (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This occurs because of a lack of pulmonary surfactant to overcome surface tension in the alveoli. 2 Surfactant is present in sufficient amounts when the birth is closer to term. 3 Fetal alveoli mature closer to term at about 35 to 36 weeks. 4 The alveoli tend to collapse and may stay collapsed resulting in atelectasis. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should be included in the nursing care immediately after a sexual assault? 1. Obtaining the assault history from the client 2. Informing the police before the client is examined 3. Having the client void a clean-catch urine specimen 4. Testing the client's urine for seminal alkaline phosphatase (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This routine screening for information provides a basis for assessing trauma; in a younger client it also is necessary to assess the risk for pregnancy. 2 Examination may precede reporting; the decision to report is mandated by law. 3 Urination may wash away spermatic or bloody evidence. 4 A test for seminal acid phosphate, not seminal alkaline phosphatase, is performed. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After a vaginal hysterectomy and an anterior and posterior repair of the vaginal wall a client is returned to her room. What does the nurse include in the plan of care for this client? 1. Check vaginal packing 2. Elevate lower extremities 3. Observe dressing for bleeding 4. Start sitz baths tomorrow morning (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Vaginal packing supports the repair and provides slight pressure to prevent bleeding; the packing should be checked for possible bleeding. 2 Elevating the legs is unnecessary; leg exercises and a gradual increase in ambulation are encouraged to prevent pulmonary emboli. 3 There is no dressing, only vaginal packing and a sanitary pad. 4 Sitz baths are not instituted until the packing is removed; an ice pack and/or a heat lamp may be used to promote comfort. (Nugent 384-385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted with a diagnosis of stage 0 cervical cancer (carcinoma in situ). What does the nurse emphasize while helping the client to understand her diagnosis and prognosis? 1. Five-year survival rates for this cancer are nearly 100% with early treatment 2. Radiation therapy is as successful as surgery in the treatment of this type of cancer 3. Cancer has probably extended into the vaginal wall and may require a radical hysterectomy 4. Stage 0 indicates that the cancer is invasive and may require surgery in addition to radiation therapy (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 With carcinoma in situ the epithelium is eroded and replaced by rapidly dividing neoplastic cells. There is no distinct tumor; with treatment the prognosis is excellent. 2 Preinvasive lesions of the cervix are treated with cryotherapy, laser therapy, or loop electrosurgical excision procedure (LEEP). Radiation therapy is used for invasive cervical cancer. 3 Stage II involves the vaginal wall; stage 0 is preinvasive. 4 Stages I to IV are considered invasive by increasing degrees; stage 0 is preinvasive. Treatment is based on the staging. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is receiving antibiotics and antifungal medications to treat a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications? 1. Eat yogurt daily 2. Avoid spicy foods 3. Drink more fruit juices 4. Take a multivitamin every day (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Yogurt contains Lactobacillus acidophilus, which replaces the intestinal flora destroyed by antibiotics. 2 This is not relevant to antibiotics or intestinal flora. 3 This is not relevant to antibiotics or intestinal flora. 4 This is not relevant to antibiotics or intestinal flora. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is receiving an epidural anesthetic during labor. For which side effect should the nurse monitor the client? 1. Hypertension 2. Urinary retention 3. Subnormal temperature 4. Decreased level of consciousness (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Anesthesia blocks the sensory pathways so that the mother does not sense bladder distention and may be unable to void. 1 Hypotension, not hypertension, is a side effect of epidural anesthesia. 3 An epidural anesthetic does not influence body temperature. 4 A decreased level of consciousness occurs with general anesthesia, not epidural anesthesia; general anesthesia is used when there is an emergency. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An older female client tells the nurse in the clinic that she has a cystocele, which was diagnosed a year ago. She has urinary frequency and burning on urination. She asks, "The doctor wanted me to have surgery for the cystocele last year, but I can manage using peripads. It won't hurt not to have surgery, will it?" How should the nurse respond? 1. "Not really, but it should be done." 2. "Yes, you are risking kidney damage." 3. "Yes, you are risking bowel obstruction." 4. "Not really, but you will be more comfortable." (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 A cystocele is a herniation of the bladder through the vaginal wall because of weakened pelvic structures; the herniated bladder does not empty effectively and urinary stasis, chronic infection, and renal failure can develop. 1 The surgery improves bladder function and prevents renal failure; it is needed. 3 Bowel obstruction is a complication of a rectocele, not cystocele. 4 Although corrective surgery will reduce perineal pressure, its primary purpose is to improve bladder function and prevent complications. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 32 weeks' gestation is admitted in active labor. Her cervix is effaced and 4 cm dilated. Betamethasone (Celestone) 12 mg IM is prescribed. What should the nurse tell the client about why the medication is given? 1. Cervical dilation is increased 2. Fetal lung maturity is accelerated 3. Risk of a precipitous birth is reduced 4. Potential for maternal hypertension is minimized (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 A steroid such as betamethasone (Celestone) or dexamethasone (Decadron) administered to the mother crosses the placenta and promotes lung maturity in the fetus. 1 Steroids do not cause an increase in cervical dilation. 3 Steroids do not reduce the risk of a precipitous birth. 4 Steroids do not minimize the potential for maternal hypertension. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An infant had surgery for repair of a myelomeningocele. For which early sign of impending hydrocephalus should the nurse monitor the infant? 1. Frequent crying 2. Bulging fontanels 3. Change in vital signs 4. Difficulty with feeding (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 After closure, spinal fluid may accumulate and reach the brain, increasing intracranial pressure and causing the fontanels to bulge. 1 Frequent crying may be a typical pattern for the neonate; it does not of itself indicate changes in intracranial pressure. 3 Changes in vital signs are not among the early signs of increasing intracranial pressure in an infant. 4 Difficulty with feeding can indicate changes in intracranial pressure but is not one of the first signs. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 40 weeks' gestation visits the prenatal clinic. The nurse, knowing that this may be the client's last prenatal visit, performs a breast examination. What adaptation does the nurse identify that requires further assessment? 1. Darkening of the nipple areolae 2. Nodularity in an outer quadrant 3. Clear fluid leaking from a nipple 4. Prominence of the superficial veins (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Although nodularity of the breasts may occur during pregnancy as a response to increased hormone levels, the greatest number of malignant tumors are located in the tail of Spence area, and further assessment is needed. 1 Increased levels of melanotropin, secreted by the anterior pituitary gland, cause darkening of the nipple areolae in all pregnant women. 3 High levels of luteal and placental hormones stimulate the production of colostrum and there may be leakage from one or both nipples at the end of pregnancy; it is a benign occurrence. 4 There is an increased blood supply to the breasts causing vein engorgement; these blood vessels become visible as pregnancy progresses. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who had a child with Tay-Sachs disease is pregnant and is to have an amniocentesis to determine if the fetus has the disease. The nurse counsels her to plan for the procedure at the optimum time during her pregnancy. When is the best time? 1. 6 to 8 weeks' gestation 2. 14 to 16 weeks' gestation 3. 18 to 20 weeks' gestation 4. 22 to 24 weeks' gestation (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 An amniocentesis is done at this time because a therapeutic abortion can be legally and safely performed if desired by the parents. 1 This is too early to perform an amniocentesis because the uterus has not ascended into the abdomen and there is little amniotic fluid present. 3 Although an amniocentesis and therapeutic abortion can be performed at this time, it is preferred that they are done as early as possible. 4 This is too late; the parents should not delay an amniocentesis if they are considering a therapeutic abortion. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A woman is admitted for a hysterectomy and bilateral salpingo-oophorectomy. The nurse reviews the client's gynecological history. What condition does the client have that causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy? 1. Prolapsed uterus 2. Large uterine fibroids 3. Mild dysplasia of the cervical os 4. Urinary incontinence when coughing (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Attempting to remove a uterus with large uterine fibroids vaginally can cause trauma, resulting in hemorrhage. 1 Vaginal hysterectomy is indicated for prolapsed uterus because the uterus is usually collapsed into the vagina. 3 A hysterectomy is not the treatment of choice for mild cervical dysplasia; when a hysterectomy is necessary, the vaginal route is preferred. 4 Urinary incontinence when coughing may be related to stress incontinence, which does not require a hysterectomy. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A postpartum client developed a deep vein thrombosis and an IV infusion of heparin therapy was instituted 2 days ago. Her activated partial thromboplastin time (aPTT) is now 98 seconds. What should the nurse do? 1. Increase the intravenous rate of heparin 2. Interrupt the infusion and notify the practitioner of the aPTT result 3. Document the result on the medical record and recheck the aPTT in four hours 4. Call the practitioner to obtain a prescription for a low-molecular weight heparin (Nugent 340-341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Heparin should not be given because 98 seconds is almost 3 times the normal time it takes a fibrin clot to form (25 to 36 seconds) and prolonged bleeding may result; the therapeutic range for heparin is 1½ to 2 times the normal range. The practitioner should be notified. 1 Heparin must not be increased; the client already has received too much. 3 This is unsafe. Continuing the infusion may result in hemorrhage. 4 The medication does not have to be changed; it should be stopped temporarily until the aPTT is within the therapeutic range. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After the removal of a hydatidiform mole, the nurse monitors the client's laboratory data during a follow-up visit. The nurse identifies that a prolonged elevation of the serum human chorionic gonadotropin (hCG) level is a danger sign. What condition is a possible outcome? 1. Uterine rupture 2. Choriocarcinoma 3. Hyperemesis gravidarum 4. Disseminated intravascular coagulation (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Human chorionic gonadotropin (hCG) increases shortly after the onset of pregnancy, peaks at the end of the second month, then decreases and is sustained at a lower level until the end of pregnancy; a continued elevation indicates retained trophoblastic tissue and possible choriocarcinoma. 1 Uterine rupture is characterized by persistent, localized abdominal pain; it does not have a higher incidence in women with hydatidiform mole. 3 Hyperemesis gravidarum cannot occur after termination of a pregnancy. 4 Disseminated intravascular coagulation is manifested by shock, bleeding, a low platelet count, and elevated PT and PTT levels; it does not have a higher incidence in women with hydatidiform mole. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A neonate born at 39 weeks' gestation is small for gestational age (SGA). What commonly occurring problem should the nurse anticipate when planning care for this infant? 1. Anemia 2. Hypoglycemia 3. Protein deficiency 4. Calcium deficiency (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Hypoglycemia is common in newborns who are small for gestational age because of malnutrition in utero; the nurse can detect this with a blood glucose test and notify the practitioner. 1 Polycythemia, not anemia, is more likely to occur. 3 Although a protein deficiency may occur, it is not life threatening at this time. 4 Although hypocalcemia may occur, it is not as common as hypoglycemia. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What characteristic does the nurse expect in a newborn of a mother with diabetes? 1. Irritability 2. Flushed skin 3. Hyperreflexivity 4. High-pitched cry (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Infants of diabetic mothers (IDMs) are polycythemic and therefore appear flushed; the mechanism underlying this phenomenon is unknown. 1 These infants generally are placid. 3 These infants are limp, not hyperreflexive. 4 A high-pitched cry is a sign of CNS involvement, which is not expected in an IDM. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who has syphilis tells the nurse that it must have been contracted from a toilet seat. The nurse knows that this cannot be true because the causative agent of syphilis is: 1. Immobilized by body contact 2. Chelated by wood and plastic 3. Inactivated when exposed to a dry environment 4. Destroyed when exposed to a warm environment (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A dry environment inactivates the Treponema pallidum, making it incapable of causing disease. 1 The organism is transferred by sexual contact; warm, moist body contact supports growth of the organism. 2 Nothing chelates this organism. 4 A warm, moist environment supports the growth of the organism. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 10 weeks' gestation phones the prenatal clinic to report that she is experiencing some vaginal bleeding and abdominal cramping. The nurse arranges for her to go to the local hospital. The vaginal examination reveals that her cervix is 2 cm dilated. What probable diagnosis should the nurse expect? 1. Septic abortion 2. Inevitable abortion 3. Threatened abortion 4. Incomplete abortion (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Once cervical dilation has begun, the abortion is classified as inevitable. 1 In this type of abortion the cervix is dilated and there is bleeding; also, the discharge is malodorous. 3 Bleeding and cramping may be present, but the cervix is still closed in a threatened abortion. 4 The products of conception have been partially expelled with an incomplete abortion. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a preterm neonate with physiological jaundice who requires phototherapy. What is the action of this therapy? 1. Stimulates the liver to dispose of the bilirubin 2. Breaks down the bilirubin into a conjugated form 3. Facilitates the excretion of bilirubin by activating vitamin K 4. Dissolves the bilirubin, allowing it to be excreted by the skin (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Phototherapy changes unconjugated bilirubin in the skin to conjugated bilirubin bound to protein, permitting excretion via the urine and feces. 1 Phototherapy does not affect liver function; the liver does not dispose of bilirubin. 3 Vitamin K is necessary for prothrombin formation, not bilirubin excretion. 4 The bilirubin is not excreted via the skin. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is an appropriate nursing intervention for a neonate with respiratory distress syndrome (RDS)? 1. Avoid handling to conserve energy 2. Position to promote respiratory efforts 3. Assess for congenital birth defects to enable early treatment 4. Set incubator ten degrees below body temperature to prevent shivering (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Positioning with the head slightly hyperextended and changing the position every 1 to 2 hours helps to drain respiratory secretions; this will increase oxygenation by enhancing respiratory efforts. 1 Extensive handling is not desired, but infants do need to be touched. 3 All newborns are assessed for congenital birth defects, not just those with RDS. 4 This temperature is too low; it may exacerbate the respiratory distress. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What does the nursing care for an infant with necrotizing enterocolitis (NEC) include? 1. Diluting the formula mixture 2. Measuring abdominal girth every 2 hours 3. Giving half-strength formula by gavage feeding 4. Administering oxygen 10 minutes before each feeding (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Prolonged gastric emptying occurs with NEC; an increase in abdominal girth of greater than 1 cm in 4 hours is significant and needs immediate intervention. 1 Formula feedings are stopped and the infant is given parenteral therapy. 3 Formula feedings are stopped and the infant is given parenteral therapy. 4. This will have no therapeutic value for an infant with NEC. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who had a lumpectomy of the breast is to have radiation therapy. What should the nurse do at the client's first visit to the surgeon's office after the surgery? 1. Provide a protective skin lotion 2. Assess the extent of wound healing 3. Teach sterile technique for skin care 4. Demonstrate how to dispose of urine safely (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Radiation will interfere with wound healing if initiated too soon; inadequate healing should be reported to the practitioner. 1 Topical preparations should not be used unless prescribed. 3 Sterile technique is not necessary unless there is a break in the skin. 4 Urine or other excreta of a client receiving radiation to the breast area are not affected by the radiation. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client with an infection tells the nurse that she has taken tetracycline (Tetracyn) for infections on other occasions and prefers to take it now. The nurse tells the client that tetracycline is avoided when treating an infection in pregnant women because it: 1. Affects breastfeeding adversely 2. Influences the fetus' teeth buds 3. Causes fetal allergies to the medication 4. Increases the fetus' tolerance to the medication (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Tetracycline (Tetracyn) has an affinity for calcium; if used during tooth bud development it may cause discoloration of teeth. 1 Tetracycline does not adversely affect breastfeeding. 3 Tetracycline does not cause fetal allergies to the medication. 4 Tetracycline does not increase the fetus's tolerance to the medication. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a breastfeeding client about medications that are safe and unsafe to take. Which medication is contraindicated? 1. Heparin (Hep-Lock) 2. Propylthiouracil (PTU) 3. Gentamicin (Garamycin) 4. Diphenhydramine (Benadryl) (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The concentration of propylthiouracil (PTU) excreted in breast milk is 3 to 12 times higher than its level in maternal serum; this may cause agranulocytosis or goiter in the infant. 1 Heparin (Hep-Lock) is not excreted in breast milk. 3 The amount of breast milk excretion of gentamicin (Garamycin) is unknown, but it can be given to infants directly without adverse effects. 4 Diphenhydramine (Benadryl) is excreted in breast milk, but it does not adversely affect the infant when therapeutic doses are given to the mother. (Nugent 387-388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse teaches a new mother about neonatal weight loss in the first 3 days of life. What does the nurse explain is the cause of this weight loss? 1. An allergy to formula 2. A hypoglycemic response 3. Ineffective feeding techniques 4. Excretion of accumulated excess fluids (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Early weight loss occurs because excess fluid is lost, not body mass. 1 Weight loss is expected; there are no data to support an allergic response. 2 Weight loss is not related to hypoglycemia. 3 Neither breast nor formula feeding will prevent the 10% weight loss that is expected in the first few days of life. (Nugent 373-374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted in active labor at 39 weeks' gestation. During the initial examination the nurse identifies multiple red blister-like lesions on the edge of the client's vaginal orifice. After speaking to the practitioner and receiving orders, the priority nursing action should be to: 1. Begin the IV antibiotic 2. Prepare for a cesarean birth 3. Take a smear of the lesion for testing 4. Document the need for double gloving (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The lesions are probably a herpes infection, which can be fatal to the newborn if it is transmitted during a vaginal birth. 1 Herpes is a viral infection that does not respond to antibiotics. 3 A client in active labor will give birth vaginally before the test results of the smear become available. 4 Standard precautions should be used; double gloving is unnecessary. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Phototherapy is ordered for a preterm neonate with hyperbilirubinemia. Which nursing intervention is appropriate to reduce the potentially harmful side effect of the phototherapy? 1. Covering the trunk to prevent hypothermia 2. Using shields on the eyes to protect them from the light 3. Massaging vitamin E oil on the skin to minimize drying 4. Turning after each feeding to reduce exposure of each surface area (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The lights used for phototherapy can damage the infant's eyes, and eye shields are standard equipment. 1 Maximum effectiveness is achieved when the infant's entire skin surface is exposed to the light. 3 Vitamin E oil is contraindicated because it can cause burns as well as result in an overdose of the vitamin. 4 The infant should be turned every 2 hours irrespective of feeding times so that all body surfaces are exposed to the light and no single body surface is overexposed. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 16 weeks' gestation is being treated for Trichomonas vaginalis. Which statement best indicates to the nurse that the client has learned measures to prevent a recurrence? 1. "After having sex I will insert a vaginal suppository." 2. "My partner must get treated before we have sex again." 3. "I will urinate immediately after having sexual intercourse." 4. "Douching immediately after sexual intercourse will help protect me." (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The male should be treated to prevent the infection from passing back and forth between him and his sexual partner. 1 Inserting a vaginal suppository after having sex is an ineffective remedy and will not prevent a recurrence. 3 The organism usually is present in the partner's urogenital tract; voiding will not prevent a recurrence. 4 A douche is not recommended either during pregnancy or in the nonpregnant state. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse do when an apnea monitor sounds an alarm 10 seconds after cessation of respirations? 1. Assess for changes in skin color 2. Use tactile stimuli on the chest or extremities 3. Check the monitor for signs of a malfunction 4. Resuscitate with a face mask and an Ambu bag (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The nurse applies tactile stimulation after validating that respirations are absent; this action may be sufficient to reestablish respirations in the high-risk neonate with frequent episodes of apnea. 1 Assessment will not interrupt the period of apnea; respirations must be reestablished immediately. 3 The monitor should be assessed for proper functioning before use. 4 These measures are too invasive and aggressive for initial intervention; gentle stimulation should be attempted first. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should be included in the teaching plan for a mother of a newborn with exstrophy of the bladder? 1. Maintaining sterility of the exposed bladder 2. Measuring output from the exposed bladder 3. Protecting the skin surrounding the exposed bladder 4. Applying a pressure dressing to the exposed bladder (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Constant drainage of urine on the skin promotes excoriation and infection; it must be protected. 1 Sterility is impossible to maintain because of the constant leakage of urine. 2 Output will be difficult to measure because of the constant leakage of urine. 4 A pressure dressing is contraindicated because it will traumatize the exposed bladder. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is assessing a female client who is suspected of having primary syphilis. What sign of primary syphilis does the nurse expect the client to exhibit? 1. Flat wartlike plaques around the vagina and anus 2. An indurated painless nodule on the vulva that is draining 3. Glistening patches in the mouth covered with a yellow exudate 4. A maculopapular rash on the palms of the hands and soles of the feet (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 This is a description of a chancre, which is the initial sign of syphilis. 1 These are condylomata, which are typical of the secondary stage of syphilis. 3 This is typical of the secondary stage of systemic involvement, which occurs from 2 to 4 years after the disappearance of the chancre. 4 This is typical of the secondary stage. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has a child with Tay-Sachs disease and wants to become pregnant again. She tells the nurse, "I'm worried it will happen again." How should the nurse respond? 1. "Did you discuss this with your physician?" 2. "Perhaps you should think about genetic counseling." 3. "Can you remember if Tay-Sachs occurred before in your family?" 4. "It is a rare disease that is statistically improbable to happen again." (Nugent 334-335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 This response informs the client of the need for genetic counseling and gives her an option for decision making. 1 This shifts the responsibility to the practitioner; the nurse should be involved in teaching about resources. 3 This response does not address the client's concern and changes the focus of the discussion. 4 Although the disease is rare in the general population, it is an inherited autosomal recessive disorder and there is a 25% probability that it can occur again in the same family. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a pelvic examination of a 24-year-old woman, the nurse suspects a vaginal infection because there is a white curdlike vaginal discharge. What other assessment supports a fungal vaginal infection? 1. A foul odor 2. An itchy perineum 3. An ischemic cervix 4. A forgotten tampon (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 This type of vaginal discharge usually occurs with candidiasis, a fungal infection; pruritus is the most common symptom. 1 An odorous, frothy greenish discharge occurs with trichomoniasis, a protozoal infestation. 3 Ischemia of the cervix is not associated with candidiasis; candidiasis causes vaginal and cervical inflammation. 4 A forgotten tampon may cause a bacterial, not fungal, vaginitis. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 18 weeks' gestation visits the prenatal clinic stating she still is very nauseated and vomits frequently. Physical examination reveals that she has a brown vaginal discharge and her blood pressure is 148/90. What condition does the nurse suspect the client is experiencing? 1. Dehydration 2. Choriocarcinoma 3. Hydatidiform mole 4. Threatened abortion (Nugent 335-336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A hydatidiform mole, in which chorionic villi degenerate into grapelike vesicles, causes these signs and symptoms. 1 Although vomiting may cause dehydration, this conclusion ignores the vaginal discharge and hypertension. 2 Choriocarcinoma is a sequel to a hydatidiform mole; the hCG blood level is monitored for 1 year after removal of the mole. If the hCG blood level decreases to the expected range and remains there for 1 year, the client can plan another pregnancy. 4 Although a vaginal discharge is related to a threatened abortion, an elevated blood pressure and severe nausea and vomiting are not. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

To halt preterm labor, a client is started on terbutaline (Brethine). For which side effect of this medication should the nurse monitor the client? 1. Bradycardia 2. Hyperkalemia 3. Widening pulse pressure 4. Hypotonic uterine contractions (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A widening pulse pressure is a side effect of terbutaline. 1 Tachycardia, not bradycardia, only occurs. 2 Hypokalemia, not hyperkalemia, is a potential side effect. 4 The purpose of terbutaline is to halt contractions, not make them weaker. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse genetic counselor is working with a couple, each of whom is a carrier of an autosomal recessive disorder. Which statement indicates that the couple understood the teaching about this disorder? 1. "Most of our children will have the disorder." 2. "None of our children will have the disorder." 3. "There is a 1 in 4 chance of having a child with the disorder." 4. "There is a 1 in 2 chance of having a child with the disorder." (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 According to Mendelian genetic theory, when both parents are carriers of an autosomal recessive disorder there is a 25% probability that a child will have the disorder. 1 There is a 25% probability that a child will have this disorder. This statement indicates that the couple does not understand Mendel's theory of probability. 2 When both partners are carriers there is a 50% probability that a child will be a carrier and a 25% probability that a child will have the disorder. 4 If one of the parents has the disorder there is a 50% probability that a child will have the disorder. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 24-year-old thin woman who runs 10 miles weekly asks the nurse for advice about preventing osteoporosis. Which vitamin and other dietary supplement should the nurse recommend? 1. E and ginseng tea 2. B and ginkgo biloba 3. D and calcium citrate 4. C and glucosamine/chondroitin (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, then supplements of calcium and vitamin D are recommended. 1 These supplements do not help prevent osteoporosis. 2 These supplements do not help prevent osteoporosis. 4 These supplements maintain cartilage and connective tissue integrity but they do not help prevent osteoporosis. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse in a genetic counseling center determines that a disorder with a 50% occurrence rate in both males and females is: 1. X-linked recessive 2. Autosomal recessive 3. Autosomal dominant 4. Chromosomal trisomy (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 An autosomal dominant disorder is caused by one defective dominant gene passed to an offspring by a parent with the gene and the disorder. 1 An X-linked recessive disorder usually occurs in males; it is not an autosomal disorder. 2 The chance of having this disorder is 25% if both parents carry the same recessive gene. 4 A chromosomal disorder relates to a defective chromosome, not a defective gene. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is admitted for surgery for a ruptured tubal pregnancy tells the nurse that she has shoulder pain. The nurse concludes that the pain is caused by: 1. Anxiety about the diagnosis 2. Cardiac changes from hypovolemia 3. Blood accumulation under the diaphragm 4. Rebound tenderness from the ruptured tube (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Any blood from the rupture will accumulate, causing phrenic nerve irritation and pain. 1 Shoulder pain is not a response to anxiety; it is a typical symptom of phrenic nerve irritation. 2 The cardiac changes caused by hypovolemia do not cause shoulder pain. 4 A ruptured tube can cause rebound tenderness in the abdomen, not the shoulder. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client calls the nurse-midwife in the prenatal clinic complaining of sharp shooting pains in the lower abdomen and vaginal spotting. She is met at the emergency department of the hospital and a diagnosis of ruptured tubal pregnancy is made. At what stage of the pregnancy does the nurse suspect the initial symptoms began? 1. At 16 weeks' gestation 2. Immediately after implantation 3. About 6 weeks into the pregnancy 4. Toward the end of the second trimester (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 At this time the fallopian tube is unable to expand to the size of the growing products of conception. 1 Tubal pregnancies are unable to advance to this stage because of the tube's inability to expand with the growing products of conception. 2 The size of the fertilized egg at this time is minuscule and will cause no problem. 4 Tubal pregnancies are unable to advance to this stage because of the tube's inability to expand with the growing products of conception. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client had a rubella infection (German measles) during the fourth month of pregnancy. At the time of the infant's birth, the nurse places the newborn in the isolation nursery. What type of infection control precautions should the nurse institute? 1. Enteric 2. Contact 3. Droplet 4. Standard (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Because the virus is found in the respiratory tract and the urine, isolation is necessary; rubella is spread by droplets from the respiratory tract. 1 Enteric precautions is an outdated term; the techniques used with this precaution are incorporated under contact precautions. 2 The techniques used with contact precautions are incorporated under standard precautions. 4 The use of standard precautions alone is unsafe; additional precautions must be implemented to protect the nurse from droplet transmitted infection. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 30 weeks' gestation is admitted in preterm labor. An IV solution of the tocolytic agent ritodrine (Yutopar) is started. The nurse prepares to administer an IM injection of betamethasone (Celestone). The client asks why betamethasone is being administered. The nurse responds, "It: 1. enhances uterine relaxation." 2. prevents fetal hypoglycemia." 3. stimulates fetal lung maturity." 4. counteracts adverse reactions." (Nugent 342) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Betamethasone (Celestone) is a glucocorticoid that the National Institutes of Health recommends for all women in preterm labor between 28 and 32 weeks' gestation, unless there is a medical condition that specifically contraindicates its use (e.g., cord prolapse or abruptio placentae). It stimulates the release of enzymes that produce lung surfactant, which promotes fetal lung maturity. 1 Betamethasone is not given to enhance uterine relaxation caused by ritodrine (Yutopar). 2 Although ritodrine may cause fetal hyperglycemia and neonatal hypoglycemia, betamethasone is not given to prevent these side effects. 4 Betamethasone is not given to counteract adverse reactions to ritodrine. (Nugent 389) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An infant is admitted to the nursery after a difficult shoulder birth. For what condition should the nurse assess this newborn? 1. Facial paralysis 2. Cephalhematoma 3. Brachial plexus injury 4. Spinal cord syndrome (Nugent 333-334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Brachial plexus paralysis (Erb-Duchenne palsy) is the most common injury associated with dystocia related to a shoulder presentation; it is caused by pressure and traction on the brachial plexus during the birth process. 1 The newborn's face is not involved with a shoulder presentation. 2 Cephalhematoma is a soft-tissue injury of the head and is not related to a shoulder dystocia. 4 Spinal cord syndrome is associated with a breech presentation and is not related to shoulder dystocia. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a woman how to perform breast self-examination. Which statement indicates that the client needs further teaching? 1. "I examine my breasts about a week after my period starts." 2. "I have been looking for dimpling as well as checking for lumps." 3. "My breasts are so tender right before my period that I hate doing it." 4. "My grandmother examines her breasts on the first Monday of each month." (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Breast self-examination should be performed about a week after menstruation when the breasts are less engorged and tender. 1 This is when menstruating women should examine their breasts. 2 Dimpling may occur when a tumor attaches to the skin or underlying tissues and therefore should be reported. 4 After menopause, selection of a specific time each month for breast self-examination reduces the possibility of forgetting. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What characteristic does the nurse anticipate in an infant born at 32 weeks' gestation? 1. Ear pinnae spring back when folded 2. Palms and soles have definite creases 3. Areolae and nipples are barely visible 4. Square window sign shows a zero-degree angle (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Breast tissue is not palpable in a newborn of less than 33 weeks' gestation. 1 The ear pinnae spring back in an infant at 36 weeks' gestation. 2 Creases in the palms and on the soles of the feet are not clearly defined until after the 37th week of gestation. 4 A zero-degree square window sign is present in an infant at 40 to 42 weeks' gestation. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse administers two serial IM injections of betamethasone (Celestone) to a woman at 32 weeks' gestation, who is admitted in preterm labor. The nurse determines that this medication is given to: 1. Stop the process of labor 2. Increase placental perfusion 3. Facilitate fetal lung maturity 4. Reduce intensity of contractions (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Corticosteroids stimulate surfactant production; they also have been shown to reduce the incidence of intraventricular hemorrhage. 1 Betamethasone (Celestone) does not affect the labor process. 2 Betamethasone does not increase placental perfusion. 4 Betamethasone does not affect the intensity of contractions. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse explain to a newly pregnant client with cardiac disease? 1. Palpitations are expected as pregnancy progresses 2. Other cardiac medications will be substituted for digoxin 3. Maintenance dosages of cardiac medication probably will increase 4. Prophylactic penicillin administration is not safe during pregnancy (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 During the second and third trimesters the blood volume and cardiac output increase, placing a greater workload on the heart. Women with preexisting heart disease may require larger doses of cardiac medication to prevent cardiac decompensation. 1 Palpitations can occur when the heart rate reaches 120 beats per minute. A heart rate of more than 100 beats per minute may be an indicator of cardiac decompensation; further assessment is required and treatment instituted. 2 Digoxin (Lanoxin) is a category C medication and is prescribed during pregnancy. 4 Penicillin is a category B medication and is relatively safe to take during pregnancy. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is interviewing a female client who is tentatively diagnosed with cystitis, pending laboratory results. The nurse anticipates that the causative agent of the cystitis is Escherichia coli. The nurse anticipates this microorganism because it: 1. Thrives in the kidneys 2. Is a virulent bacterium 3. Inhabits the intestinal tract 4. Competes with fungi for host sites (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 E. coli is commonly found in the bowel and, because of anatomical proximity and possibly careless hygiene after bowel movements, may spread to the urethra. 1 E. coli is not found in the kidneys. 2 E. coli is no more virulent than other infective agents. 4 E. coli does not compete with fungal organisms for host sites. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse in the newborn nursery receives a call from the emergency department that a woman with active herpes virus lesions gave birth in a taxicab while coming to the hospital. What does the nurse, who is planning care, consider about the transmission of the herpes virus? 1. Contact precautions are necessary 2. It occurs during sexual intercourse 3. It can be acquired during a vaginal birth 4. Protection is provided via maternal immunity (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Herpesvirus can be fatal to a newborn, and the infant should be admitted to the neonatal intensive care unit (NICU). 1 Although this is a true statement it is not relative to meeting the needs of this neonate who was exposed to the herpesvirus during the birthing process. 2 Although this is a true statement it is not relative to meeting the needs of this neonate who was exposed to the herpesvirus during the birthing process. 4 Although this is a true statement it is not relative to meeting the needs of this neonate who was exposed to the herpesvirus during the birthing process. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When a client who had a mastectomy returns from surgery, a dressing and a portable wound drainage system to the axillary area are in place. The nurse observes an excessive amount of serosanguineous drainage on the mastectomy dressing. What is the nurse's next action? 1. Notifying the surgeon 2. Applying a pressure dressing 3. Checking the function of the drainage system 4. Using additional pillows to elevate the affected arm (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 If the tubing is patent and negative pressure is present, the wound should be free of exudates. 1 Drainage is expected; it is the nurse's responsibility to maintain the drainage system. 2 Pressure dressings are not used with portable wound drainage systems because the latter are effective in removing interstitial fluid. 4 Although elevating the arm may facilitate drainage, it is not the priority in relation to the data presented. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Respiratory acidosis is confirmed in a neonate with respiratory distress syndrome when the nurse identifies that the laboratory report reveals: 1. A pH of 7.35 2. A potassium level of 4.6 mEq/L 3. An increased PaCO2 of 55 mm Hg 4. An arterial O2 pressure of 80 mm Hg (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 In respiratory acidosis, the pH decreases and the carbon dioxide level increases. 1 This is within the expected range of 7.32 to 7.49 for a neonate. 2 This is within the expected range of 3.5 to 5 mEq/L. 4 The arterial oxygen level may or may not change with acidosis. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client with iron deficiency anemia is prescribed a daily iron supplement. What nutrient should the nurse suggest that the client include in her diet to potentiate the effect of the iron supplement? 1. Biotin 2. Lecithin 3. Vitamin C 4. Vitamin B complex (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Iron absorption is pH dependent; therefore, iron should be taken with a source of ascorbic acid to enhance duodenal absorption. 1 Biotin is unrelated to the absorption of iron. 2 Lecithin is unrelated to the absorption of iron. 4 Vitamin B complex is unrelated to the absorption of iron. (Nugent 386-387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse who is teaching a prenatal class is asked why infants of mothers with diabetes (IDM) are larger than those who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response? 1. Taking exogenous insulin stimulates fetal growth 2. Consuming more calories covers the insulin secreted by the fetus 3. Extra circulating glucose causes the fetus to acquire fatty deposits 4. Fetal weight gain increases due to the common response of maternal overeating (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 It is difficult to maintain maternal normoglycemia throughout pregnancy; excess glucose passes into the fetus, where it is converted to fat. 1 The problem is excess glucose, which is why exogenous insulin must be administered. 2 Although all pregnant women consume extra calories to meet the increased metabolism associated with pregnancy, fetal insulin does not pass from the fetus to the mother. 4 This is a stereotypical statement; not all clients with diabetes overeat. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A multipara is admitted to the birthing room in active labor. Her vital signs are temperature, 98° F; pulse, 70 beats per minute; respirations, 18 per minute; and blood pressure, 126/76. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with the vertex presenting at 2+ station. The client is complaining of pain and asks for medication. Which medication should be avoided because it may cause respiratory depression in the newborn? 1. Naloxone (Narcan) 2. Lorazepam (Ativan) 3. Meperidine (Demerol) 4. Promethazine (Phenergan) (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Meperidine (Demerol) is an opioid that can cause respiratory depression in the neonate if administered less than 4 hours before birth. 1 Naloxone (Narcan) is an opioid antagonist that reverses the effects of respiratory depression in the newborn. 2 Lorazepam (Ativan)is a sedative; it does not cause respiratory depression in the newborn, but it does not relieve pain by itself. 4 Promethazine (Phenergan) is a tranquilizer; it does not cause respiratory depression in the newborn. Promethazine does not relieve pain by itself. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse in the newborn nursery is monitoring an infant for jaundice related to ABO incompatibility. What blood type does the mother usually have to cause this incompatibility? 1. A 2. B 3. O 4. AB (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Mothers with type O blood have anti-A and anti-B antibodies that are transferred across the placenta. This is the most common incompatibility because the mother is type O in 20% of all pregnancies. 1 This usually is not a problem. 2 This usually is not a problem. 4 This usually is not a problem. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse evaluates that a client understands the most common side effects of estrogen in oral contraceptives when the client says, "I should notify the physician when I: 1. stop having menstrual periods." 2. feel depressed and lack energy." 3. experience nausea and vomiting." 4. have very light menstrual periods." (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Nausea and vomiting are related to excessive amounts of estrogen; these usually can be controlled by reducing the dosage. 1 When taking oral contraceptives containing estrogen, breakthrough bleeding is more common than amenorrhea. 2 Depression and lethargy are related to both excessive estrogen and excessive progesterone, but are not common side effects. 4 Hypomenorrhea is caused by estrogen deficiency. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The parents of a preterm infant are preparing to take their baby home. What should the nurse do to evaluate the parents' competency in infant care? 1. Ask the parents what they plan to do at home 2. Determine rationales behind the parents' actions 3. Observe the parents while they are giving care to their infant 4. Demonstrate care before having the parents give a return demonstration (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Observing the care that the parents actually give the infant provides direct validation of their skill and comfort levels. 1 This action is helpful for providing anticipatory guidance but it is a small part of a competency evaluation. 2 Although this is helpful in identifying empirical knowledge, it does not test the parents' skill or comfort level. 4 This does not provide enough evidence of the parents' competency. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse instills an antibiotic ophthalmic ointment into a newborn's eyes. What condition does this medication prevent? 1. Herpetic ophthalmia 2. Retrolental fibroplasia 3. Ophthalmia neonatorum 4. Hemorrhagic conjunctivitis (Nugent 331-332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Ophthalmia neonatorum is caused by gonorrheal and/or chlamydial infections present in the vaginal tract. It is preventable by prophylactic use of an antibiotic ophthalmic ointment applied to the neonate's eyes. 1 Herpes affects the neonate systemically. 2 Retrolental fibroplasia (retinopathy of prematurity) occurs from prolonged exposure to an oxygen concentration that is too high. 4 Hemorrhagic conjunctivitis usually is caused by rapid expulsion of the fetus's head from the vagina. (Nugent 376-377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor is receiving an oxytocin (Pitocin) infusion. For which adverse reaction from prolonged administration should the nurse monitor the client? 1. Change in affect 2. Hyperventilation 3. Water intoxication 4. Elevated temperature (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Oxytocin (Pitocin) has an antidiuretic effect, acting to reabsorb water from the glomerular filtrate. 1 Oxytocin does not alter the client's affect. 2 Hyperventilation is caused by inappropriate breathing patterns, not by prolonged use of oxytocin. 4 Fever occurs with infection or dehydration, not with prolonged administration of oxytocin. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is pregnant for the first time expels the products of conception at 12 weeks' gestation. The client's blood type is Rh negative. What should the nurse anticipate concerning the administration of Rho(D) immune globulin (RhoGAM)? 1. RhoGAM is not necessary if the fetus died in utero 2. Administer RhoGAM immediately after the miscarriage 3. Administer RhoGAM within 72 hours after the miscarriage 4. RhoGAM will not be needed because the gestation was less than 20 weeks (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Rho(D) immune globulin (RhoGAM) should be given within 72 hours after a miscarriage or birth to have an effect on future pregnancies. 1 RhoGAM is always indicated at the termination of a pregnancy, whether it is at term or before term and whether the fetus is alive or dead. 2 It is not necessary to administer RhoGAM this early. 4 RhoGAM is always indicated at the termination of a pregnancy, whether it is at term or before term and whether the fetus is alive or dead. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A female client who is undergoing infertility testing is taught how to examine her cervical mucus. After listening to the instructions the client says, "That sounds gross. I don't think I can do it." What does the nurse conclude from this statement? 1. The client is unduly fastidious 2. The client feels that having a baby is not that important 3. Some women are uncomfortable touching their genitals 4. Some women are afraid that they are the cause of the infertility (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Some women find it emotionally stressful to handle their genitals and discharges. 1 The data do not support this conclusion. 2 The data do not support this conclusion. 4 The data do not support this conclusion. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What does the nurse do to elicit the Moro reflex during a newborn assessment? 1. Turns the infant's head quickly to one side 2. Strokes the infant's back alongside the spine 3. Jars the infant's bassinet suddenly but gently 4. Taps the infant's bridge of the nose briskly but lightly (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Sudden movement causes the startle response (Moro reflex) that begins with extension and abduction of the extremities with a C shape formed by the index finger and thumb, followed by flexion and adduction of extremities, and ending with return of the arms to a relaxed position. 1 Turning the infant's head quickly to one side elicits the asymmetric tonic neck reflex that simulates the fencing position. 2 Stroking the infant's back alongside the spine elicits trunk incurvation or the Galant reflex. 4 Tapping the infant's bridge of the nose briskly but lightly causes the eyes to close tightly. This is the Glabellar, not Moro, reflex. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 16-year-old adolescent arrives at the clinic complaining of increased vaginal discharge, intermittent vaginal bleeding, excessive bleeding when menstruating, and pain in the lower abdomen. She relates an active sexual history with multiple partners. What disease does the nurse suspect the client has? 1. Herpes 2. Syphilis 3. Gonorrhea 4. Toxoplasmosis (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The client has signs and symptoms indicative of pelvic inflammatory disease (PID), which is a complication of gonorrhea. 1 Herpes is noted for its painful lesions on the genitals; there are no data to indicate the presence of these lesions. 2 The client does not have the signs and symptoms associated with syphilis. 4 The client does not have the signs and symptoms associated with toxoplasmosis. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 28-year-old woman is diagnosed with cancer of the left breast. A simple mastectomy is performed at the insistence of the client. What should the plan of care include immediately after surgery? 1. Changing the client's pressure dressing as necessary 2. Inviting a member of Reach to Recovery to visit the client 3. Placing the client in the semi-Fowler position with the left arm elevated 4. Waiting for a cessation of drainage before the client resumes any activity (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The semi-Fowler position and elevation of the arm on the affected side minimize edema related to the inflammatory process. 1 Pressure dressings are rarely used because portable wound drainage systems are used to remove accumulated fluid from the operative site. 2 A member from Reach to Recovery will not visit on the day of surgery; the visit will probably be made in the client's home. 4 Activities of daily living that permit only slight flexion of the elbow and avoid abduction of the arm on the affected side are permitted. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a 3-week-old infant who was admitted with untreated phenylketonuria (PKU). How should the nurse document the odor of the infant's urine? 1. Fishy 2. Ammoniacal 3. Mousy or musty 4. Aromatic or pungent (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The term "phenylketonuria" is derived from phenylpyruvic acid, which gives urine a mousy, musty odor. 1 This odor is not present with phenylketonuria. 2 This odor is not present with phenylketonuria. 4 This odor is not present with phenylketonuria. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client comes to the fertility clinic for a hysterosalpingography using radiopaque contrast material to determine whether her fallopian tubes are patent. When preparing for the test, the nurse explains to the client that she: 1. Will receive a local anesthetic and the pain will lessen 2. Will have to rest in bed for 8 hours after the test is completed 3. May have some persistent shoulder pain for 14 hours after the test 4. May become nauseated during the test, but the nausea will subside (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This is referred pain from passage of the contrast medium through the tubes; it usually is indicative of tubal patency. 1 An anesthetic is not given; the client's complaint of pain can be managed with position change and mild analgesics. 2 The client can resume usual activities as soon as the test is over. 4 The client usually does not experience nausea and/or vomiting. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A young client tells the nurse that her mother complains about having dysmenorrhea and asks the nurse what this means. How should the nurse describe dysmenorrhea? 1. Cessation of menstrual periods 2. Spotting between menstrual periods 3. Uterine pain during the menstrual period 4. Scant bleeding at the time of an expected menstrual period (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This is the correct definition of dysmenorrhea. 1 This occurs with menopause and during pregnancy. 2 This is bleeding that occurs at any time other than during the menstrual period; there may or may not be pain. 4 This may occur if the client is taking an oral contraceptive or in the first month or two of pregnancy. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who had a mastectomy because of breast cancer returns to her room on the unit. What does the primary nurse anticipate? 1. Drainage container will be kept level with the affected arm 2. Affected arm will be abducted at the shoulder with the elbow extended 3. Hand and elbow of the affected arm will be elevated above the shoulder 4. Elbow and shoulder of the affected arm will be elevated with the hand resting on the abdomen (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This position supports venous return by gravity and promotes mobility of the arm. 1 The container should be lower, not level, with the affected arm; although portable wound drainage systems work by negative pressure, gravity assists the flow of drainage. 2 Abduction may put unnecessary stress on the suture line at this time; slight flexion of the elbow promotes functional alignment. 4 When the hand is positioned lower than the elbow and shoulder venous stasis and edema of the hand may occur. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 16-year-old high school student is referred to a community health center by a local hotline because of the fear of contracting herpes. The teenager is upset and shares this information with the community health center nurse. What should be the nurse's initial response? 1. "Let me get a brief health history now." 2. "Try not to worry until you know if you have herpes." 3. "You sound worried; let me make arrangements to have you examined." 4. "Herpes has received too much attention in the media; let's be realistic." (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This response immediately identifies the client's fear as real and offers a service to meet the need for information about the client's physical status. 1 This response ignores the client's concern and focuses on the nurse's need to complete the task of obtaining a health history. 2 This response minimizes the client's concern about having a sexually transmitted infection. 4 This response minimizes the client's concern and implies that the client is being unrealistic. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Ten minutes after administering nalbuphine (Nubain) via IV piggyback to a primigravida in active labor, the nurse observes a fetal heart rate of 132 with minimal variability. The client states that the pain is more tolerable and she is able to use her breathing techniques more effectively. Contractions continue every 2 to 3 minutes and are of 60 seconds' duration. What is the nurse's next action? 1. Reposition the client on the left side to increase placental perfusion 2. Administer oxygen via mask to minimize apparent fetal compromise 3. Have an opioid antagonist available to be administered to the infant at the time of birth 4. Document the findings, including the decreased fetal heart rate variability as a result of the opioid infusion (Nugent 339-340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 A common side effect of an opioid analgesic is decreased fetal heart rate variability. Because the fetal heart rate and the length and duration of the contractions remain stable and the analgesic appears to be effective, the only nursing action is to document the findings. 1 Repositioning the client is not necessary because the data do not indicate decreased placental perfusion. 2 It is not necessary to administer oxygen because the data do not indicate fetal compromise. 3 Naloxone (Narcan), an opioid antagonist, may need to be administered to the newborn, but the present data do not indicate that this is necessary. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse takes into consideration that the effect PKU has on the infant's development will depend on: 1. Blood phenylalanine levels in utero 2. Excessive levels of epinephrine at birth 3. Diagnosis within the first 2 days after birth 4. Adherence to a corrective diet instituted early (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Adherence to the diet is necessary for optimal physical growth with little or no adverse effects on mental development; a diet that is instituted late will not reverse brain damage. 1 The fetus does not have an excessive level of phenylalanine. Although PKU can be detected in the fetus via genetic studies, excessive levels of phenylalanine first become measurable several days after the neonate starts feeding. 2 Epinephrine levels are decreased, not increased. Tyrosine, an amino acid produced by the metabolism of phenylalanine is absent in PKU; tyrosine is needed to form epinephrine. 3 Two days after birth is too soon to make a diagnosis. Detection cannot occur until the infant has taken milk or formula that contains phenylalanine for 24 hours and metabolites accumulate in the blood. Behaviors indicating mental retardation and CNS involvement usually are evident by about 6 months of age in the untreated infant. (Nugent 377-378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What factor identified by the nurse in a client's history places the client at an increased risk for breast cancer? 1. Early menopause 2. Low-income background 3. Delayed onset of menarche 4. Late beginning of childbearing (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Advanced age at birth of a first child is one of the risk factors for malignancy of the breast because of prolonged exposure to unopposed estrogen. 1 This is not considered a risk factor. 2 This is not considered a risk factor. 3 This is not considered a risk factor. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is planning care for an older woman who is admitted for a vaginal hysterectomy and an anterior and posterior repair of the vaginal wall. What should the nurse tell the client to expect in the immediate postoperative period? 1. Placement of a pessary 2. Insertion of a rectal tube 3. Use of a douche periodically 4. Presence of a urinary catheter (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 After surgery the urethral orifice may be distorted and edematous; a urinary retention catheter keeps the bladder empty, limiting pressure on the operative site. 1 A pessary placed in the vagina is used for a displaced uterus; following an anteroposterior repair (colporrhaphy), vaginal packing is used to support the surgical repair. 2 A rectal tube is used for abdominal distention caused by flatulence; it rarely is necessary. 3 A cleansing douche may be ordered before, not after, surgery. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn with a myelomeningocele is transferred immediately from the birthing room to the neonatal intensive care unit (NICU). What is the first nursing intervention? 1. Assess for paralysis 2. Start antibiotic prophylaxis 3. Provide routine newborn care 4. Apply a sterile saline dressing (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Applying a sterile saline dressing helps prevent infection while keeping the membranes moist. 1 Although assessing for paralysis should be done, it is not the priority. 2 Antibiotics are not given prophylactically. 3 This newborn needs more than just routine care because of the outpouching of the meninges. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 35-year-old client is scheduled for a vaginal hysterectomy. She asks the nurse about the changes she should expect after surgery. How should the nurse respond? 1. "You will stop ovulating." 2. "A surgical menopause is predicted immediately." 3. "Sexual intercourse will be uncomfortable when resumed." 4. "A hysterectomy does not affect the chronological age when menopause usually occurs." (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 As the term "hysterectomy" implies, only the uterus is removed and the ovaries remain; therefore, the client will experience menopause during the same years as all women who have functioning ovaries. 1 The client will ovulate because the ovaries are not removed with a hysterectomy. 2 The client has not had an oophorectomy; therefore, the client will not experience a surgical menopause. 3 There should be no discomfort if there is an appropriate period of healing before resuming sexual intercourse. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On a return visit to the fertility clinic, a couple has requested fertility drugs because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the female has been unable to conceive. What should the nurse explain to the couple? 1. A laparoscopy will be scheduled 2. An endometrial biopsy will be required 3. A fertility medication will be prescribed 4. An examination of semen will be needed (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Because the client has an ovulatory cyclic pattern, the infertility may be a result of a seminal factor; the partner's semen should be examined before more extensive studies or treatments are begun. 1 A laparoscopy is an invasive procedure that may be needed after all noninvasive tests are completed and the cause of the infertility remains undetermined. 2 An endometrial biopsy is an invasive procedure that may be needed after all noninvasive tests are completed and the cause of the infertility remains undetermined. 3 After all diagnostic and treatment options are exhausted, a fertility medication may be prescribed if it is determined that the medication will enhance the probability of conception. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 31 weeks' gestation is admitted in preterm labor. She asks the nurse if there is any medication that can help stop the contractions. What is the nurse's response? 1. "An oxytocic." 2. "An analgesic." 3. "A corticosteroid." 4. "A beta-adrenergic." (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Beta-adrenergic medications are tocolytic agents that may halt labor, although only temporarily. Other tocolytics that may be used are magnesium sulfate, prostaglandin inhibitors, and calcium channel blockers. 1 Oxytocin is a hormone that is secreted by the posterior pituitary gland; it stimulates contractions and is released after birth to initiate the let-down reflex. 2 Analgesics do not halt preterm labor. 3 Corticosteroids do not halt labor; they are used during preterm labor to accelerate fetal lung maturity, when birth is likely to occur within 24 to 48 hours. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While receiving betamimetic (tocolytic) therapy for preterm labor the client begins to have muscle tremors and signs of nervousness. The client states, "My heart is racing." The nurse identifies that the client's pulse rate is 110 beats per minute and regular. What should the nurse do next? 1. Discontinue the medication as per protocol 2. Notify the practitioner that preterm labor has restarted 3. Obtain the client's laboratory results for electrolyte levels 4. Reassure the client that these are expected side effects of the medication (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Betamimetics have the unpleasant side effects of nervousness, tremors, and palpitations; clients should be informed that these side effects are expected. 1 If contractions are lessened and the maternal heart rate is less than 120 and regular, the medication is performing as expected and does not need to be discontinued. 2 Muscle tremors and palpitations are not signs and symptoms of preterm labor. 3 Electrolyte levels are unrelated to these side effects of the tocolytic agent. (Nugent 385-386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is most important to teach a client who had a mastectomy before she leaves the hospital? 1. Why a breast prosthesis is necessary 2. Which of the more strenuous activities to curtail 3. What household tasks to avoid that require stretching 4. Why self-examination of the remaining breast is important (Nugent 337-338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Clients who have cancer of one breast are at risk for development of cancer in the other breast. 1 A breast prosthesis is not used until healing has occurred. 2 Most clients can resume full activity as strength returns. 3 Stretching activities are considered helpful in regaining full movement. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with severe preeclampsia is admitted to the high-risk unit, and the nurse starts an IV infusion of magnesium sulfate. How is magnesium sulfate classified and what is the mechanism that makes it effective? 1. Hypotensive that relaxes smooth muscles 2. Cholinergic that increases the release of acetylcholine 3. Muscle relaxant that decreases the severity of uterine contractions 4. Central nervous system depressant that blocks neuromuscular transmissions (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Eclamptic seizures may be prevented by giving IV magnesium sulfate, which is a CNS depressant. 1 Although magnesium sulfate is a neuromuscular sedative that relaxes smooth muscles and decreases BP, it is not considered an antihypertensive and is not given for that purpose. 2 Magnesium sulfate is considered a CNS depressant that decreases, not increases, the quantity of acetylcholine. 3 Decreased uterine contractions are not associated with magnesium sulfate administration. (Nugent 367-368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What statement helps the nurse determine that a woman with genital herpes (HSV-2) s her self-care related to this infection? 1. "When I have a baby, I don't want a cesarean." 2. "I can have sex as soon as the herpes sores have healed." 3. "When I finish the acyclovir prescription I will be cured." 4. "I must be careful when I have sex because herpes is a lifelong problem." (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Genital herpes (HSV-2) is characterized by remissions and exacerbations; it cannot be cured. 1 Most pregnant women with HSV-2 have children by cesarean birth to prevent the newborns from contracting the disease while passing through the vagina. 2 Clients should abstain from sex until 10 days after the lesions heal. 3 Herpes can be controlled, not cured. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn male is admitted to the nursery. He weighs 10 pounds, 2 ounces, which is 2 pounds more than the birth weight of any of his siblings. What should the nurse do in relation to the baby's weight? 1. Document the findings 2. Place him in a heated crib 3. Delay starting oral feedings 4. Perform serial glucose readings (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Large newborns may be the result of gestational diabetes; it is necessary to check the neonate for hypoglycemia because maternal glucose is no longer available. 1 The nurse should do more than document the findings; the practitioner should be notified after the serial glucose levels are determined. 2 This is indicated if the temperature is low and the newborn needs additional warmth. 3 The infant may be hypoglycemic and require the glucose in an oral feeding immediately. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with severe preeclampsia is receiving 2 g/hr of IV magnesium sulfate. For what should the nurse assess to confirm the effectiveness of this therapy? 1. Elevated blood pressure 2. Excessive urinary output 3. Decreased respiratory rate 4. Diminished knee-jerk reflex (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Magnesium sulfate is used to depress CNS irritability; diminished reflexes indicate the medication's effectiveness. 1 Magnesium sulfate is a CNS depressant; a decrease in blood pressure, an increase in urinary output, and diminished reflexes indicate that the magnesium sulfate is effective. 2 Magnesium sulfate is not a diuretic; it acts as an anticonvulsant. 3 Decreased respiratory rate is a sign of toxicity. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is taking progesterone oral contraceptives (minipills). The nurse instructs the client to take one pill daily during the: 1. Five days of the ovulatory cycle 2. Latter part of the ovulatory cycle 3. First week of the menstrual cycle 4. Entire time of the menstrual cycle (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Maintenance of serum progesterone levels keeps cervical mucus thick and hostile to sperm at all times. 1 This is inaccurate information; the pill must be taken throughout the menstrual cycle. 2 Progesterone oral contraceptives (Minipills) must be taken throughout the cycle; combined estrogen and progesterone oral contraceptives are taken during the second, third, and fourth weeks of the cycle. 3 Fertility drugs are often taken during the first part of the cycle to encourage ovulation, not for contraception. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 13-year-old adolescent whose menses began 2 years ago complains of lower abdominal pain midway between each period. How should the nurse respond to the adolescent? 1. It requires a physical examination 2. This usually occurs when menses first begin 3. It usually disappears when there is regular ovulation 4. This is a common occurrence known as mittelschmerz (Nugent 336) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Mittelschmerz is pain that sometimes occurs at the time of ovulation when the ovum erupts from the follicle. 1 The pain is mild, cyclic, and characteristic of mittelschmerz; it does not require further evaluation. 2 When menses first begin the girl is anovulatory and does not experience the pain known as mittelschmerz. 3 The pain probably will occur more often in the future when ovulation is well established. (Nugent 381-382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is assessing a 38-year-old female client who was admitted for a biopsy of a lump in her right breast. Which finding may indicate a malignancy? 1. A soft mass that is movable and nontender 2. Hard, hot, reddened areas that are tender and painful 3. Multiple bilateral lesions that are well delineated and movable 4. A lesion in the upper, outer quadrant that is poorly delineated and nonmobile (Nugent 337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Most breast malignancies are painless, fixed, and in the upper outer quadrant; painful, mobile lesions usually are benign. 1 These findings are suggestive of a lipoma. 2 These findings are suggestive of a lactation breast abscess. 3 These findings are suggestive of fibrocystic benign breast tumors. (Nugent 383) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What does the nurse expect the size of a newborn to be if the mother had inadequately controlled type 1 diabetes during her pregnancy? 1. Average for gestational age, term 2. Small for gestational age, preterm 3. Large for gestational age, postterm 4. Large for gestational age, near term (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Newborns of diabetic mothers may be large for gestational age (LGA) because hyperglycemia in the mother precipitates hyperinsulinism in the fetus, resulting in excess deposits of fetal fat; they usually are born at or before term. 1 Although these newborns generally are born at term, usually they are large, not average, for gestational age. 2 These newborns are large, not small, for gestational age. Diabetic mothers with advanced vascular and renal disease may have infants that are small for gestational age. 3 Because of the risk for fetal death, women with diabetes should give birth before the 40th week of gestation, either via induction of labor or if necessary by cesarean birth. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Which sign indicates to the nurse that a neonate is preterm? 1. Flexion of extremities 2. Absent femoral pulses 3. Positive Babinski reflex 4. Numerous superficial veins (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Numerous superficial veins are observed in the preterm infant because of the lack of subcutaneous fat deposits. 1 Flexion of the extremities is the posturing of healthy term infants; preterm infants usually posture with extremities extended and flaccid. 2 Absent femoral pulses are indicative of coarctation of the aorta, a congenital heart defect that is not related to gestational age. 3 A positive Babinski reflex is expected in the full-term, not preterm, newborn. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is at 33 weeks' gestation has contracted gonorrhea and is prescribed probenecid (Benemid) and penicillin therapy. Which statement indicates to the nurse that the client understands the action of probenecid? 1. "My allergy to penicillin is minimized." 2. "The side effects of the disease are reduced." 3. "My immune defense mechanisms are more active." 4. "The amount of penicillin in my blood is increased." (Nugent 340) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Probenecid (Benemid) reduces renal tubular excretion of penicillin. 1 This is unrelated to the concomitant administration of penicillin and probenecid. 2 This is unrelated to the concomitant administration of penicillin and probenecid. 3 This is unrelated to the concomitant administration of penicillin and probenecid. (Nugent 386) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What antidote to the side effects of terbutaline (Brethine) should a nurse have available? 1. Levodopa (L-Dopa) 2. Furosemide (Lasix) 3. Ritodrine (Yutopar) 4. Propranolol (Inderal) (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Propranolol (Inderal) is a beta-blocking agent that reverses the uterine inhibitory responses and cardiovascular effects of terbutaline (Brethine). 1 Levodopa (L-dopa) is not an antidote for terbutaline; it is used for Parkinson's disease. 2 Furosemide (Lasix) is a diuretic; it will not reverse the cardiovascular effects indicated. 3 Ritodrine (Yutopar) may cause responses similar to those of terbutaline; it is sometimes used to halt premature labor because it inhibits beta-2 receptors. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is to have a vacuum curettage abortion because of a fetal demise at 16 weeks' gestation. The practitioner prescribes a dinoprostone (Cervidil) suppository to initiate softening, effacement, and dilation of the cervix (ripening). What should the nurse teach the client about the procedure? 1. "General anesthesia will be used to insert the suppository." 2. "There will be copious bleeding for several hours after the abortion." 3. "Temperature of more than 100° F is common for the first 24 to 48 hours." 4. "After insertion of the suppository you should lie flat in bed for 15 minutes." (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Remaining supine for 10 to 15 minutes permits the suppository to remain in place while it melts to body temperature. 1 General anesthesia is unnecessary when inserting a dinoprostone suppository. 2 The bleeding that occurs after this abortion usually is equivalent to a heavy menstrual period. Excessive bleeding or cramping should be reported to the practitioner. 3 A temperature more than 100° F (37.8° C) is a danger sign and the practitioner should be notified. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse administers the prescribed intravenous dose of magnesium sulfate to a client with severe preeclampsia. What adverse effect should the nurse address when evaluating the client's response to the medication? 1. Visual blurring 2. Epigastric pain 3. Fetal tachycardia 4. Respiratory depression (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Respiratory depression is a late indicator of toxicity; if the respiratory rate decreases below 12 per minute the infusion should be discontinued. 1 Visual blurring is associated with worsening of preeclampsia, which may lead to a seizure; it is not a toxic effect of the magnesium sulfate. 2 Epigastric pain is associated with worsening of preeclampsia, which may lead to a seizure; it is not a toxic effect of the magnesium sulfate. 3 The fetal heart rate is not affected by the infusion of magnesium sulfate. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a preterm infant who is receiving oxygen therapy. What should the nurse do in an attempt to prevent retinopathy of prematurity (ROP)? 1. Covering the neonate's eyes with a shield 2. Placing the neonate in an elevated side-lying position 3. Assessing the neonate every hour with a pulse oximeter 4. Supporting the neonate's respirations while providing minimal oxygenation (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Retinopathy of prematurity (ROP) is a complex disease of the preterm infant; hyperoxemia is one of the numerous causes implicated. Oxygen therapy is maintained at the lowest level necessary to support respiratory status. If the oxygen concentration needs to be increased to maintain life, then ROP may not be preventable. 1 Using a shield over the neonate's eyes will not prevent the development of ROP. 2 Positioning does not prevent ROP. 3 Assessment of the neonate every hour with a pulse oximeter alone will not prevent ROP. If the pulse oximeter results are within an acceptable range, oxygen concentration can be reduced. (Nugent 376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Before the administration of Rho(D) immune globulin (RhoGAM) the nurse reviews the laboratory data of a pregnant client. Which blood type and Coombs' test result must a pregnant woman have to receive RhoGAM after giving birth? 1. Rh positive and Coombs' positive 2. Rh negative and Coombs' positive 3. Rh positive and Coombs' negative 4. Rh negative and Coombs' negative (Nugent 342) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Rho(D) immune globulin (RhoGAM) is given to an Rh-negative mother after birth if the infant is Rh positive and the Coombs' test reveals that the mother was not previously sensitized (negative). 1 An Rh-positive mother will not develop antibodies to a fetus who is either Rh positive or Rh negative; therefore, a Coombs' test is not performed. 2 An Rh-negative mother with a positive Coombs' test indicates that she has Rh-positive antibodies; therefore, Rho(D) immune globulin is not given because it will not be effective. 3 An Rh-positive mother will not develop antibodies to a fetus who is either Rh positive or Rh negative; therefore, a Coombs' test is not performed. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with systemic lupus erythematosus (SLE) is at 39 weeks' gestation. What does the nurse anticipate regarding this client? 1. Large-for-gestational age newborn 2. Postpartum dialysis may be necessary 3. More prominent butterfly-shaped rash 4. Salicylate therapy will be discontinued (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Salicylate therapy is used because clients with SLE have an increased risk for thrombus formation; as the time of birth approaches salicylate therapy should be discontinued to reduce the possibility of bleeding in the newborn. 1 There is a greater probability that the newborn will be small for gestational age. 2 There is no need for dialysis during the postpartum period. 3 The butterfly-shaped rash that can occur with SLE does not become more prominent during late pregnancy. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After an emergency cesarean birth, a neonate born at 35 weeks' gestation is admitted to the neonatal intensive care unit (NICU). The neonate has a Silverman-Anderson score of 6. What nursing intervention is needed? 1. Monitoring cardiac status 2. Assessing neurological reflexes 3. Ensuring increased caloric intake and fluids 4. Administering respiratory support and observation (Nugent 330-331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The Silverman-Anderson score is an index of neonatal respiratory distress. 1 This score does not reflect cardiac function. 2 This score does not reflect neurological status. 3 This score does not reflect caloric needs. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When assessing a newborn the nurse observes the following findings: arms and legs slightly flexed; skin smooth and transparent; abundant lanugo on the back; slow recoil of pinnae; and few sole creases. What complication does the nurse anticipate based on these findings? 1. Polycythemia 2. Hyperglycemia 3. Postmaturity syndrome 4. Respiratory distress syndrome (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The assessment findings are indicative of a preterm infant; therefore, the nurse should monitor the infant for signs of respiratory distress syndrome. 1 Preterm large-for-gestational-age (LGA) infants may develop polycythemia, but there are no data to indicate the infant is LGA. 2 Preterm infants may become hypoglycemic, not hyperglycemic. 3 The neonate is preterm, not postterm. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is a nurse's most important concern when caring for a client with a ruptured tubal pregnancy? 1. Infection 2. Hypervolemia 3. Protein deficiency 4. Diminished cardiac output (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The bleeding is causing decreased circulating blood volume and therefore there is a decreased cardiac output. 1 Infection may occur later but it is not a problem at this time. 2 There will be hypovolemia, not hypervolemia, because of a decrease in circulating blood volume due to hemorrhage. 3 There are no data to justify the conclusion that the client has a protein deficiency. (Nugent 380) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When doing a newborn assessment of a male infant after a scheduled cesarean birth, the nurse identifies that the infant's head circumference is 4 cm smaller than his chest. What does this finding indicate? 1. Expected in male newborns 2. Predicted after cesarean birth 3. Larger than average chest size 4. Smaller than average head size (Nugent 332) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The head circumference usually is 2 cm larger than the chest; a head circumference 4 cm smaller than the chest may indicate microcephaly. 1 According to growth charts, the range of head circumference for boys is just slightly (1.25 cm) larger than the chest. 2 Molding does not occur with cesarean birth; therefore, the head should be about 2.5 cm larger than the chest at birth. 3 The expected ratio of head to chest circumference indicates that the chest is too small, not too large, for the head size. (Nugent 377) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The mother of a newborn with exstrophy of the bladder tells the nurse that the doctor said her child may develop an unusual gait when learning to walk. What does the nurse tell the mother is the cause of waddling gait? 1. Genu varum 2. Tibial torsion 3. Subluxation of the femur 4. Separation of the pubic bones (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The incomplete fetal bladder development may interfere with development of the pelvis. 1 Genu varum (bowlegs) can be congenital or caused by rickets; it is not related to exstrophy of the bladder. 2 Tibial torsion is a rotation of the tibia and is unrelated to exstrophy of the bladder. 3 Subluxation of the femur is a form of hip dislocation and is unrelated to exstrophy of the bladder. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with chronic hypertension and superimposed preeclampsia gives birth, at 39 weeks' gestation, to a 4-pound, 12-ounce infant. What condition does the nurse anticipate when assessing this infant? 1. Prematurity 2. Cardiac anomalies 3. Respiratory infection 4. Intrauterine growth restriction (Nugent 331) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The pathological changes of maternal chronic vascular disease cause uteroplacental insufficiency; vasospasms diminish fetal oxygenation and nutrition, which lead to slow fetal growth. 1 Prematurity is defined as gestational age of less than 37 weeks. 2 There is no greater incidence of cardiac anomalies in infants with intrauterine growth restriction. 3 There is no greater incidence of infection in infants with low birthweight; however, they may have lowered resistance to infection. (Nugent 375-376) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Twelve hours after birth, a nurse observes that the neonate is hyperactive and jittery, sneezes frequently, has a high-pitched cry, and is having difficulty sucking. Further assessment reveals increased deep tendon reflexes and a decreased Moro reflex. What problem does the nurse suspect? 1. Cerebral palsy 2. Neonatal syphilis 3. Fetal alcohol syndrome 4. Opioid drug withdrawal (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 These signs are indicative of withdrawal from an opioid with typical changes occurring in the central nervous system; the newborn should be monitored during the first 24 to 48 hours. 1 The signs of cerebral palsy usually are manifested later in infancy. 2 The signs of syphilis are a low-grade fever with copious serosanguineous discharge from the nose. 3 The signs of fetal alcohol syndrome are growth deficiencies in length, weight, and head circumference, and distinctive facies. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is being discharged after a first-trimester aspiration abortion. Which statement indicates to the nurse that the instructions are understood? 1. "I will be able to have sex in 4 to 5 days." 2. "I can substitute tampons for sanitary pads after 24 hours." 3. "I can expect my menstrual period to resume in 2 to 3 weeks." 4. "I will call you if I must change my pad more than once in 4 hours." (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This indicates that the bleeding is excessive and the practitioner should be notified. 1 Although instructions vary among health care providers, sexual intercourse usually may be resumed in 1 to 3 weeks. 2 Although instructions vary among health care providers, tampons usually are contraindicated for 3 days to 3 weeks. 3 The menstrual period usually resumes in 4 to 6 weeks. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse discuss with new parents to help them prepare for infant care? 1. Allowing crying time to help develop the lungs 2. Establishing a set feeding schedule to promote a steady weight gain 3. Counting the number of wet diapers daily to determine adequate hydration 4. Learning specific behaviors involving states of wakefulness to promote positive interactions (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This information assists parents to understand the unique features of their newborn and promotes interaction and care during periods of wakefulness. 1 A healthy infant's lungs are developed at birth. 2 It is best that infants be on a demand feeding schedule, not a routine schedule. Demand feeding provides for individuality; healthy infants gain weight steadily. 3 This is a form of overprotection; healthy infants are not prone to dehydration. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A female client having presurgical testing prior to a total abdominal hysterectomy says to the nurse, "When I have this surgery I know my husband will never come near me." The nurse's best initial response is, "You're: 1. underestimating his love for you." 2. wondering about the effect on your sexual relations." 3. worried that the surgery will change how others see you." 4. concerned about how your husband will respond to your surgery." (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is an open-ended response that encourages further discussion without focusing on an area that the nurse, not the client, feels is the problem. 1 This response denies the client's feeling and can cause feelings of guilt for questioning the partner's love. 2 This is too specific; the nurse does not have enough information to come to this conclusion. 3 This response shifts the focus from the client's voiced concerns; the client specifically referred to her husband, not others. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Because an infertility workup involves both partners, a male client is to have a semen analysis. What should the nurse include as part of his instructions? 1. Obtain the specimen upon awakening 2. Use a condom to collect the semen specimen 3. Ejaculate at least 4 hours before collection to ensure a pure specimen 4. Deliver the specimen to the laboratory within 2 hours of obtaining it (Nugent 335) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is necessary to keep the sperm viable for determining sperm count and viability. 1 The specimen can be collected at any time. 2 Rubber solvents and preservatives may affect the semen specimen. 3 This may result in an inadequate specimen. (Nugent 381) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A preterm infant is started on digoxin (Lanoxin) and furosemide (Lasix) for persistent patent ductus arteriosus. Which nursing assessment provides the best indication of the effectiveness of the furosemide? 1. Pedal edema is reduced 2. Digoxin toxicity is avoided 3. Fontanels appear depressed 4. Urine output exceeds fluid intake (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is the expected outcome. If output exceeds intake, it indicates that the infant is diuresing from the effect of the furosemide (Lasix). 1 Although it is important to assess whether pedal edema is reduced, this is subjective; intake and output measurements are objective. 2 Furosemide can cause hypokalemia, which can precipitate digoxin toxicity; it is not given to prevent digoxin toxicity. 3 Depressed fontanels are not the desired outcome; this indicates dehydration, which can occur with excessive diuresis. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A woman arrives at the women's health clinic complaining of frequency and burning pain when urinating. The diagnosis is a urinary tract infection. What is important for the nurse to encourage the client to do? 1. Void every two hours 2. Record fluid intake and urinary output 3. Pour warm water over the vulva after voiding 4. Wash the hands thoroughly after urinating and defecating (Nugent 336-337) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This medical aseptic technique should limit the spread of microorganisms and help prevent future urinary tract infections if incorporated into the client's health practices. 1 This is unnecessary, but the client should be encouraged to void when the urge occurs. 2 Intake and output need not be measured. 3 This is unnecessary for cystitis; it may be used as a part of perineal care for other problems. (Nugent 382) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A preterm newborn appears to have a strong sucking reflex. How should the nurse plan to feed the infant to prevent respiratory embarrassment? 1. Via a nasogastric feeding tube 2. Every 4 to 6 hours with a special nipple 3. Every 2 to 3 hours with diluted formula 4. With small amounts of formula at each feeding (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This prevents the neonate's stomach from becoming too distended and pressing upward against possibly compromised lungs. 1 A nasogastric feeding tube will not prevent respiratory embarrassment. The infant with a strong sucking reflex should be fed with a nipple, otherwise the sucking reflex will diminish. 2 Four to 6 hours is too long between feedings; preterm infants should be fed every 2 to 3 hours because it takes this long for the preterm infant's stomach to empty. 3 Preterm infants need the full caloric value of formula. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A male newborn has been exposed to HIV in utero. Which finding supports the diagnosis of HIV infection in the newborn? 1. Delay in temperature regulation 2. Continued bleeding after circumcision 3. Hypoglycemia within the first day of birth 4. Thrush that does not respond readily to treatment (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Thrush, an oral infection caused by Candida albicans, is an opportunistic infection that may be indicative of HIV infection. 1 Delay in temperature regulation is more frequently associated with immaturity of the hypothalamus. 2 Bleeding after a circumcision is associated with a bleeding disorder such as hemophilia. 3 Hypoglycemia usually is associated with the infant of a diabetic mother (IDM). (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Vitamin K 0.5 mg is prescribed for a newborn. The vial on hand is labeled 1 mL = 2 mg. How many mL should the nurse administer? Answer: _______________ mL (Nugent 342) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 0.25 mL. Solve for x by using ratio and proportion. 0.5mg:x mL=2mg:1mL2x=0.5x=0.5÷2x=0.25mL (Nugent 389) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 43 weeks' gestation has just given birth to an infant with typical postmaturity characteristics. Which postmature signs does the nurse identify? Select all that apply. 1. _____ Cracked and peeling skin 2. _____ Long scalp hair and fingernails 3. _____ Red, puffy appearance of face and neck 4. _____ Vernix caseosa covering back and buttocks 5. _____ Creases on entire soles of feet and palms of hands (Nugent 333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 2, 5 1 Dry, peeling skin is related to decreased vernix and prolonged immersion in amniotic fluid. 2 Abundant scalp hair and long fingernails are characteristics of postmaturity. These are typically found in a term newborn who is 2 to 3 weeks old. 3 These are not signs of postmaturity; newborns of diabetic mothers usually have this appearance. 4 Vernix is found on a newborn at about 38 weeks' gestation and disappears after 40 weeks' gestation. 5 These creases are typical of full-term maturity; preterm newborns have few sole and palm creases. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. What does the nurse need to assess when a vaginal infection is suspected? Select all that apply. 1. _____ Abdominal pain 2. _____ Urinary frequency 3. _____ Rising temperature 4. _____ Decreased pulse rate 5. _____ Decreased blood pressure (Nugent 338) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 3 1 A pelvic infection is suspected. A characteristic of this is abdominal pain. 2 Urinary frequency is associated with cystitis, not a vaginal discharge associated with a pelvic infection. 3 A rising temperature is a sign of infection. 4 An increase, not decrease, in pulse rate is expected because the metabolic rate increases in the presence of an elevated temperature. 5 An increase, not decrease, in blood pressure is expected because the metabolic rate increases in the presence of an elevated temperature. (Nugent 384) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A new mother's laboratory results indicate the presence of cocaine and alcohol. Which craniofacial characteristic indicates to the nurse that the newborn has fetal alcohol syndrome (FAS)? Select all that apply. 1. _____ Thin upper lip 2. _____ Wide-open eyes 3. _____ Small upturned nose 4. _____ Larger than average head 5. _____ Smooth vertical ridge in the upper lip (Nugent 332-333) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 3, 5 1 The abnormal facies associated with fetal alcohol syndrome includes a thin upper lip (vermilion), which is distinctive in these infants. 2 Infants with FAS have small eyes with epicanthic folds. 3 The abnormal facies associated with fetal alcohol syndrome includes a small upturned nose, which is distinctive in these infants. 4 Infants with FAS have microcephaly (head circumference less than the tenth percentile). 5 The abnormal facies associated with fetal alcohol syndrome includes a smooth vertical ridge (philtrum) in the upper lip, which is distinctive in these infants. (Nugent 378) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse in a campus health clinic is assessing the female students for risk factors associated with the future development of osteoporosis. What factors are included in this assessment? Select all that apply. 1. _____ Cigarette smoking 2. _____ Moderate exercise 3. _____ Use of street drugs 4. _____ Familial predisposition 5. _____ Inadequate intake of dietary calcium (Nugent 339) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 4, 5 1 Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. 2 Moderate exercise is not considered a risk factor for the development of osteoporosis, although a sedentary life style is. 3 Use of street drugs is not considered a risk factor for osteoporosis. 4 Familial predisposition is considered a risk factor for the development of osteoporosis. 5 Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause. (Nugent 385) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a client with severe preeclampsia who is receiving magnesium sulfate. What side effects indicate that the serum magnesium level may be excessive? Select all that apply. 1. _____ Knee-jerk reflex is +1 2. _____ Urine output is 100 mL/hr 3. _____ Blood pressure is 140/90 mm Hg 4. _____ Apical pulse is 80 beats per minute 5. _____ Respiratory rate is 11 breaths per minute (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 5 1 A knee-jerk reflex that is +1 is a manifestation of hyporeflexia; it is a possible indication of magnesium sulfate toxicity. 2 A urinary output that is 100 mL/hr is an adequate urinary output; a urinary output of less than 30 mL/hr indicates inadequate excretion of magnesium sulfate and the potential for toxicity. 3 The maternal blood pressure is not directly related to magnesium sulfate administration or toxicity; however, if the blood pressure decreases, it indicates treatment is effective. 4 A pulse rate of 80 beats per minute is an expected pulse rate; it is not indicative of toxicity. 5 A respiratory rate of 12 breaths per minute is a cause for concern; fewer than 12 breaths per minute is a sign of magnesium sulphate toxicity. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When a client is receiving an intravenous infusion of magnesium sulfate, the nurse should have its antidote readily available. Which antidote should be available? 1. Protamine sulfate 2. Calcium gluconate 3. Sodium bicarbonate 4. Naloxone hydrochloride (Nugent 341) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Calcium gluconate will reverse the central nervous system depressant action of magnesium sulfate. 1 Protamine sulfate is the antidote for heparin toxicity. 3 Sodium bicarbonate counteracts acidosis. 4 Naloxone hydrochloride is an opiate antagonist. (Nugent 387) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The mother of a neonate with Down syndrome visits the clinic 1 week postpartum. She explains to the nurse that she is having problems feeding her baby. What is the probable cause of these feeding difficulties? 1. Receding jaw 2. Brain damage 3. Tongue thrust 4. Nasal congestion (Nugent 334) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Tongue extrusion, a reflex response to the tip of the tongue being touched, is characteristic of infants with Down syndrome and interferes with feeding; this reflex disappears at approximately 4 months of age. 1 A receding jaw does not interfere with sucking. 2 Down syndrome is caused by a chromosomal defect, not brain damage; the feeding problem is related to the chromosomal defect. 4 Nasal congestion is not a characteristic associated with newborns with Down syndrome. (Nugent 379) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with a large fetus is to have a pudendal block during the second stage of labor. What does the nurse plan to instruct the client about the effectiveness of the block? Select all that apply. 1. _____ Contractions will decrease 2. _____ Perineal pain will not be felt 3. _____ Bladder sensation may be lost 4. _____ Episiotomy may not be needed 5. _____ Bearing down reflex will be diminished (Nugent 341-342) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

nswer: 2, 5 1 The block anesthetizes the perineum, not the cervix or the body of the uterus. 2 The block provides anesthesia to the perineum and therefore pain is not felt. 3 The block affects only the perineum, not the bladder. 4 The block does not influence the decision of whether or not to have an episiotomy. 5 Although the bearing-down reflex is lessened, muscle control is not affected and the client is able to bear down with contractions. (Nugent 388) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn who has remained in the hospital because the mother had a cesarean birth is to be tested for phenylketonuria (PKU) on the morning of discharge. What should the nurse explain to the mother about the purpose of PKU testing? 1. Tests for thyroid deficiency 2. Detects possible retardation 3. Measures protein metabolism 4. Identifies chromosomal damage (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

. 3 Phenylalanine, an essential amino acid necessary for growth and development, cannot be metabolized in infants with PKU; early diagnosis and treatment may prevent mental retardation. 1 This is done at the same time as PKU testing, but there is no relationship between thyroid deficiency and PKU. 2 Recognition and treatment of PKU early in life can help prevent, not detect, mental retardation. 4 Chromosomal damage cannot be detected with a PKU test. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 36 hours' postpartum is being treated with subcutaneous enoxaparin (Lovenox) for left calf deep vein thrombosis. Which client adaptation is of most concern to the nurse who is monitoring the client? 1. Dyspnea 2. Pulse rate of 62 3. Blood pressure of 136/88 4. Positive left leg Homans' sign (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 A complication of deep vein thrombosis is a pulmonary embolism; dyspnea is a significant sign that should be reported immediately. 2 A low pulse rate is common for several days after birth because of the cardiovascular changes that occur during the early postpartum period. 3 This blood pressure is not significant for a client with a deep vein thrombosis. 4 Checking for Homans' sign is contraindicated because the clot may be dislodged. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Which does the nurse conclude is related directly to an infant's survival in the neonatal period? 1. Gestational age and birthweight 2. Reproductive history of the mother 3. Parental health habits and social class 4. Adequacy of the mother's prenatal care (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Adaptation to the extrauterine environment is largely dependent on the functional capacity of vital organ systems, which is established during intrauterine development; this is measurable in terms of gestational age and weight. 2 Although the reproductive history of the mother may influence health, it is not critical to neonatal survival. 3 Although parental health habits and social class may influence health, they are not critical to neonatal survival. 4 Although adequacy of the mother's prenatal care may influence the mother's health and therefore the fetus's health, it is not as critical to neonatal survival as is another option. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a newborn assessment a nurse identifies the absence of the red reflex in the eyes. The nurse should: 1. Notify the practitioner 2. Rinse the eyes with sterile saline 3. Expect edema to subside within a few days 4. Conclude that this is a result of the prescribed eye prophylaxis (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 An absence of the red reflex may be indicative of congenital cataracts. The red reflex is elicited by shining the light of an ophthalmoscope into the newborn's eyes and observing a reddish circle. 2 Rinsing the eyes will not affect the red reflex. 3 The red reflex or its absence is not related to the edema that may occur after eye prophylaxis. 4 The absence of the red reflex is not related to eye prophylaxis. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn male is being discharged 4 hours after having had a circumcision. What should the nurse instruct the mother to do? 1. Apply the diaper loosely for several days 2. Give a crushed baby aspirin if there is irritability 3. Check for bleeding every two hours during the first day home 4. Call the practitioner if there is whitish exudate around the glans (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Applying the diaper loosely is done to avoid pressure on the circumcised area because the glans remains tender for 2 to 3 days. 2 Aspirin may prolong clotting and is contraindicated in children because of its relationship to Reye syndrome. Acetaminophen and comfort measures may be prescribed. 3 The caregiver should check for bleeding every hour for the first 12 hours after the circumcision. 4 Whitish exudate around the glans is expected and does not indicate an infectious process. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A neonate at 34 weeks' gestation is admitted to the neonatal intensive care unit. The nurse reviews the medical record and obtains the neonate's vital signs. What objective should the nurse designate as the priority? 1. Oxygenation will remain adequate 2. Weight will increase by 30 grams per day 3. Body temperature will increase to 98.6° F 4. Heart rate will recover to an acceptable range CLIENT CHART Medical Record Born at 34 week's gestation Weighs 6 pounds, 10 ounces Apgar: 4 and 8 Vital Signs Temperature: 98° F Apical heart rate: 130 Respirations: 58 Blood pressure: 60/20 (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 At 34 weeks' gestation the respiratory system is not fully developed; adequate oxygenation is the priority. Newborn respirations range from 30 to 60/minute. 2 A weight gain of 30 grams is too rapid a weight increase; 20 to 25 grams per day is expected at this gestational age. 3 A temperature of 98° F (36.7o C) is adequate for a newborn; increasing it to 98.6 ° F (37o C) is not necessary at this time. 4 The heart rate of a newborn is 110 to 160 beats per minute; a heart rate of 130 is within the expected range. (Nugent 374-375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The husband of a client in labor asks what the indentation is on his wife's abdomen. The nurse identifies that it is a retraction ring (Bandl's ring). What is the next nursing action? 1. Explain to him what it means and notify the practitioner 2. Advise him that his wife is starting to enter the second stage of labor 3. Inform him that it is a sign that the fetus is descending in the birth canal 4. Tell him that this indentation is expected and reflects the strength of the contractions (Nugent 322) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Bandl's ring is a pathological retraction ring; there is a ridge around the uterus at the junction of the upper and lower uterine segments. The upper segment is distended and thin and the lower segment is thick; it is a sign of impending uterine rupture. 2 Although the ring may occur during the second stage of labor, it is not a sign that the second stage of labor is beginning. 3 A retraction ring impedes the progress of labor; it is associated with premature rupture of the membranes, dystocia, and prolonged labor. 4 A retraction ring is pathological; it is not expected. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 35 weeks' gestation is admitted to the birthing unit with a small amount of bright red vaginal bleeding without contractions. What should the nurse do after placing the client in bed? 1. Check fetal heart tones 2. Obtain an amniotomy pack 3. Take the client's vital signs 4. Perform a vaginal examination (Nugent 322) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Because there is vaginal bleeding, the priority nursing action is ascertaining whether a viable fetus is present. 2 This is contraindicated; bright red bleeding is suggestive of placenta previa. 3 This is the next nursing action after fetal well-being is determined. 4 This is contraindicated; bright red bleeding is suggestive of placenta previa. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse identifies a right cephalhematoma on an otherwise healthy 1-day-old newborn. What should the nurse teach the parents at the time of discharge? 1. How to observe for signs of jaundice 2. To lower the feedings to every 3 hours 3. How to assess the fontanels for tenseness 4. To record the number of wet diapers during the first 24 hours (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Bilirubin is a yellow pigment derived from the hemoglobin released with the breakdown of red blood cells as the hematoma resolves. Signs of jaundice should be reported. 2 This action is not specific for a healthy neonate with a cephalhematoma. 3 This action is not specific for a healthy neonate with a cephalhematoma. 4 This action is not specific for a healthy neonate with a cephalhematoma. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An infusion of oxytocin is administered to a client for induction of labor. After several minutes the uterine monitor indicates contractions lasting 100 seconds with a frequency of 130 seconds. What is the next nursing action? 1. Discontinue the infusion 2. Check the fetal heart rate 3. Slow the oxytocin flow rate 4. Turn the client onto her left side (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Contractions lasting too long and occurring too frequently can lead to fetal hypoxia; stopping the oxytocin infusion should stop the contractions, thus increasing the oxygen flow to the fetus. 2 The fetal heart rate should be monitored, but this is not the priority. 3 Oxytocin (Pitocin) will continue to promote uterine contractions; this is unsafe because the prolonged, frequent contractions decrease oxygen flow to the fetus. 4 This will promote placental perfusion, but it is not the priority at this time. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client gives birth to a full-term male with an 8/9 Apgar score. What should the immediate nursing care of this newborn include? 1. Identifying the infant, assessing respirations, and keeping him warm 2. Applying an antibiotic to the eyes, administering vitamin K, and bathing him 3. Aspirating the oropharynx, rushing him to the nursery, and stimulating him often 4. Weighing him, placing him in a crib, and waiting until the mother is ready to hold him (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Establishing a patent airway, diminishing cold stress, and identification of the newborn are the priorities. 2 Application of eye prophylaxis and administration of vitamin K are often delayed to allow the parents to bond with the infant; a bath at this time will increase the risk of cold stress. 3 These measures are appropriate for a compromised newborn; an 8/9 Apgar score is indicative of a healthy newborn. 4 These nursing interventions are not the priority care for a newborn. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted to the birthing unit with uterine tenderness and minimal, dark red vaginal bleeding. She has a marginal abruptio placentae. The priority assessment includes fetal status, vital signs, skin color, and urine output. What additional assessment is essential? 1. Fundal height 2. Obstetric history 3. Time of the last meal 4. Family history of bleeding disorders (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 It is vital that a baseline measurement be obtained because increasing fundal height is a sign of concealed hemorrhage. 2 This is an appropriate assessment, but it is not a priority at this critical time. 3 This is an appropriate assessment, but it is not a priority at this critical time. 4 This is an appropriate assessment, but it is not a priority at this critical time. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is assessing a newborn of 33 weeks' gestation. Which sign alerts the nurse to notify the practitioner? 1. Flaring nares 2. Acrocyanosis 3. Heartbeat of 140 per minute 4. Respirations of 40 per minute (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Preterm neonates are prone to respiratory distress; flaring nares are a compensatory mechanism in a neonate with respiratory distress syndrome (RDS) that attempts to lessen resistance of narrow nasal passages and increase oxygen intake. 2 Acrocyanosis is not related to respiratory distress but is caused by vasomotor instability; this is an expected occurrence in the newborn. 3 A heartbeat of 140 beats per minute is an expected finding in the newborn. 4 Respirations of 40 breaths per minute is an expected finding in the newborn. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

In specific situations, gloves are used when handling newborns whether they are HIV positive or not. When is it unnecessary for the nurse to wear gloves while caring for newborns? 1. Offering a feeding 2. Changing the diaper 3. Giving an admission bath 4. Suctioning the nasopharynx (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Standard precautions do not include the use of gloves for feeding. 2 Wearing clean gloves for diaper changes in all newborns is a standard protocol. 3 Clean gloves should be worn for all admission baths because the nurse will be exposed to blood and amniotic fluid. 4 Clean gloves should be worn when suctioning an infant. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Shortly after birth, the nurse instills erythromycin ophthalmic ointment into the newborn's eyes. The father asks why an antibiotic is needed because the mother does not have an infection. The nurse explains that it is mandatory in the United States because it protects the newborn from developing eye infections. What are these eye infections? 1. Chlamydia and gonorrhea 2. Syphilis and toxoplasmosis 3. Rubella and retrolental fibroplasia 4. Cytomegalovirus and varicella zoster (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The antibiotic ointment is administered prophylactically to prevent the development of ophthalmia neonatorum, which can be contracted during a vaginal birth if the mother has gonorrhea or chlamydia or both infections. 2 Syphilis and toxoplasmosis are contracted by the fetus in utero, not during birth. 3 Rubella is contracted by the fetus in utero. The term "retrolental fibroplasia" has been replaced by the term "retinopathy of prematurity," which is a complex disorder that affects the retinal vessels of preterm infants, causing blindness. 4 Cytomegalovirus and varicella zoster are contracted by the fetus in utero during various stages of pregnancy, not during birth. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Phenylketonuria (PKU) testing is performed on a newborn. The nurse plans to explain to the mother the purpose of this screening test. What does this test determine? 1. If the infant is positive for PKU 2. If the mother is a carrier for PKU 3. The risk for the mother developing PKU later 4. The risk for the infant developing PKU when older (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The major purpose of this screening test is to determine if the infant has phenylketonuria (PKU), which can be detected after the infant has started ingesting milk. 2 This is not the objective of the test for PKU. 3 Epidemiological information is a purpose of genetic screening; in this instance the most important determination is whether or not the infant has PKU. 4 Risk for later development of the disorder is not the purpose of PKU testing; it is to determine if the neonate has the disorder. (Nugent 372-373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 1-day-old newborn has just had a thick, greenish-black stool. The nurse determines that this is the first stool. What should the nurse do next? 1. Document the stool in the infant's record 2. Assess the infant for an intestinal obstruction 3. Send the stool to the laboratory as per protocol 4. Notify the practitioner that a tarry stool has been passed (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The neonate's first stool is thick and greenish-black and is called meconium; it is an expected occurrence that should be documented. 2 This stool is expected; there is no reason to suspect intestinal obstruction. 3 Meconium stool on the first day of life is expected and does not require further examination. 4 Meconium is not indicative of bleeding; meconium contains bile and other waste products produced by the fetus; it does not require notification of the practitioner. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A preterm newborn is given oxygen via hood. What should the plan of care include for this neonate? 1. Ensuring that the oxygen is continuously warmed and humidified 2. Assessing that the infant's skin and mucous membranes remain bright pink 3. Monitoring the oxygen level in the hood every 4 hours and oxygen saturation continuously 4. Informing the parents that oxygen will be given at 4 L per minute and therefore blindness is not a risk (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The oxygen must be warmed and humidified to avoid hypothermia and drying of the mucous membranes. 2 Bright pink skin and mucous membranes may indicate an excessively high arterial oxygen level, which predisposes to retinopathy of prematurity. 3 Oxygen levels are monitored every 1 to 2 hours and are adjusted in response to the infant's condition. 4 Blindness develops with excessive arterial oxygen levels, which can occur at any percentage of oxygen. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client's history reveals opioid abuse. What is the nurse's initial plan for providing pain relief measures during labor? 1. Scheduling pain medication at regular intervals 2. Administering the medication only when the pain is severe 3. Avoiding the administration of medication unless it is requested 4. Recognizing that less pain medication will be needed compared with other women in labor (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This client will have lower tolerance for pain and greater need for pain relief. 2 Larger doses may be needed if this is done. 3 Delays increase anxiety and discomfort, and larger doses are needed. 4 Individuals who abuse drugs need more medication than do others because of tolerance to the addictive drug. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn's total body response to noise or movement is often distressing to the parents. What should the nurse tell the parents this response represents? 1. A reflex that is expected in the healthy newborn 2. A reflex that remains for the newborn's first year 3. An autonomic reflex indicating that the newborn is hungry 4. An autonomic reflex indicating the newborn's basic insecurity (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This is the Moro reflex, which indicates an intact nervous system. 2 The Moro reflex is present up to the third to sixth month of life; if it persists there may be a neurologic disturbance. 3 The Moro reflex has no relationship to hunger. 4 The Moro reflex is an involuntary response to environmental stimuli. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

At a male newborn's first encounter with his mother the nurse encourages her to undress him. The mother strokes him with her whole hand and while looking at him intently says, "He feels so velvety, and he is going to be just as good looking as his daddy." The baby is alert and responsive while gazing at his mother. What is the nurse's assessment of this first mother-infant encounter? 1. Early parenting behavior 2. Neonatal attachment behavior 3. Newborn consummatory behavior 4. Overprotective parenting behavior (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This is typified by the touch that shows maternal bonding; attachment is manifested when the newborn is compared to the father. 2 Attachment behaviors in the neonate are defined as grasping and sucking the nipple. 3 Consummatory behaviors in the newborn are coordinated sucking and swallowing. 4 The mother's behavior does not demonstrate overprotection. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in the 38th week of gestation develops a slight increase in blood pressure. The practitioner advises her to remain in bed at home in a side-lying position. The client asks why this is important. What is the nurse's response about the advantage of this position? 1. Increases blood flow to the fetus 2. Decreases intra-abdominal pressure 3. Elevates the mean arterial pressure 4. Prevents the development of thromboses (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This position decreases blood pressure and moves the gravid uterus off the great vessels of the lower abdomen, which increases venous return, improves cardiac output, and promotes kidney and placental perfusion. 2 The side-lying position does not influence intra-abdominal pressure. 3 While on bed rest the blood pressure decreases. 4 The side-lying position does not prevent thromboses. Bed rest and immobility may increase the risk of developing thromboses. (Nugent 366-367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn develops jaundice 72 hours after birth. What should the nurse explain to the parents is the probable cause of the jaundice? 1. An allergic response to the feedings 2. The physiologic destruction of fetal red blood cells 3. A temporary bile duct obstruction commonly found in newborns 4. The seepage of maternal Rh-negative blood into the neonate's bloodstream (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 After birth, fetal erythrocytes hemolyze, releasing bilirubin into the circulation, which the immature liver cannot metabolize as rapidly as it is produced, resulting in physiological jaundice. 1 Jaundice is not an allergic response. 3 Bile duct obstruction, which is not common in newborns, is not the cause of the jaundice. 4 The newborn and mother have independent circulations and Rh-negative blood does not enter the fetus's bloodstream. A problem can occur if the mother is sensitized because her antibodies can enter the fetal circulation. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse assess before continuing the administration of IV magnesium sulfate therapy to a client with preeclampsia? 1. Temperature and respirations 2. Plantar reflexes and urinary output 3. Urinary glucose and specific gravity 4. Level of consciousness and funduscopic appearance (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 An adequate urinary output, an indicator of effective renal function, is necessary to prevent toxicity because magnesium sulfate is excreted by the kidneys. Signs of magnesium sulfate toxicity include absent patellar reflexes and reduced respirations; therefore these assessments are essential. 1 Although reduced respirations may indicate magnesium sulfate toxicity, deviations in temperature are not relevant. 3 These are urine tests; they are not relevant to magnesium sulfate therapy. 4 These are assessments that may indicate worsening preeclampsia; they are not determinants of responses to magnesium sulfate therapy. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A mother is breastfeeding her newborn. She asks when she can switch the baby to a cup. The nurse concludes that the mother understands the teaching about feeding when she says she will start to introduce a cup after the baby reaches: 1. 4 months 2. 6 months 3. 12 months 4. 16 months (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 At about 6 months of age infants are able to swallow independently of sucking, and a cup can be introduced. 1 Introducing a cup at 4 months is inappropriate because the infant does not have the ability to swallow independently of sucking at this age. 3 Between 9 and 12 months of age, infants can swallow four or five times consecutively and hold and carry a cup to the mouth; introduction of a cup at age 6 months makes the weaning easier at 9 to 12 months of age. 4 Sixteen months is too late to introduce a cup; by this time the child has teeth, and sucking on a bottle promotes the development of caries as well as a preference for milk over solid foods. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the physical assessment of a recently born neonate, the nurse palpates the infant's femoral pulses. For which cardiac defect is the nurse assessing? 1. Atrial septal defect 2. Coarctation of the aorta 3. Patent ductus arteriosus 4. Ventricular septal defect (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Coarctation of the aorta results in diminished or absent femoral pulses. 1 An atrial septal defect has no effect on the volume of peripheral circulation (minimal shunting occurs in the newborn period). 3 A patent ductus arteriosus has minimal effect on the volume of peripheral circulation (left-to-right shunt). 4 A ventricular septal defect has minimal effect on the volume of peripheral circulation (left-to-right shunt). (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is helping a mother breastfeed her newborn. What is the best indication that the newborn has achieved an effective attachment to the breast? 1. Tongue is securely on top of the nipple 2. Mouth covers most of the areolar surface 3. Loud sucking sounds are heard during the 15 minutes spent at each breast 4. Vigorous sucking occurs for 5 minutes spent at each breast before falling asleep (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Effective attachment involves covering most of the areolar surface of the breast with the newborn's mouth; effective attachment helps compress the milk glands. 1 The nipple must be on top of the newborn's tongue. 3 Loud sucking sounds indicate inadequate attachment. 4 The newborn should suckle for a longer period; the newborn may be sucking only on the nipple. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse recommend to a new mother when teaching her about the care of the umbilical cord area? 1. Remove the cord clamp only after the cord stump has separated 2. Leave the area untouched or clean with soap and water then pat dry 3. Smooth ointment or baby lotion around the cord after the sponge bath 4. Wrap an elastic bandage snugly around the waist area over the cord site (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Healing is optimal when the area is left alone or, if needed, is washed with mild soap and water and then gently dried. 1 The cord clamp is removed when the cord stump is dry, usually at 24 hours. 3 Ointment and other emollients will keep the cord moist; rapid drying of the cord is preferred. 4 This prevents the cord from drying and provides a dark, warm, moist medium for growth of organisms. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On the second day of life, minutes after drinking 2½ ounces of formula, a newborn regurgitates about half an ounce. The mother states, "My baby spits up after every feeding." What should the nurse do next? 1. Reassure the mother that many babies spit up some milk at first 2. Suggest that she hold her baby upright for 30 minutes after feeding 3. Feed a small amount of fresh formula when the baby returns to the nursery 4. Teach the mother how to prop the baby in an infant seat for 1 hour after feeding (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Holding the infant upright enables gravity to move the feeding through the pyloric sphincter, which minimizes regurgitation. 1 Although it is common for infants to regurgitate, this response will not enhance mothering skills. 3 The infant has had enough formula and does not require more during this feeding. 4 A newborn should not be propped after feeding because pressure of the abdomen on the stomach puts pressure on the esophagus, which can precipitate regurgitation. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse provides a list of foods to avoid to a breastfeeding client with phenylketonuria. Which nutrient is in the foods on this list? 1. Lactose 2. Glucose 3. Fatty acids 4. Amino acids (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 PKU is an inborn error of metabolism involving an inability to metabolize phenylalanine, an essential amino acid. 1 This is metabolized in those with PKU. 2 This is metabolized in those with PKU. 3 This is metabolized in those with PKU. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 36 weeks' gestation is admitted to the high-risk unit because she gained 5 pounds in the previous week and there is a pronounced increase in blood pressure. What is the initial intervention in the client's plan of care? 1. Preparing for an imminent cesarean birth 2. Providing a dark, quiet room with minimal stimuli 3. Initiating intravenous furosemide to promote diuresis 4. Administering calcium gluconate to lower the blood pressure (Nugent 323-324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Increasing cerebral edema may predispose the client to seizures; therefore, stimuli of any kind should be minimized. 1 It is too early to plan for a cesarean birth; other therapies will be tried first. 3 The client probably will receive IV magnesium sulfate to prevent a seizure, not furosemide to promote diuresis. 4 Magnesium sulfate will be used; calcium gluconate is its antidote. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A community health nurse visits an infant who was born at home 24 hours ago. When assessing the infant the nurse identifies slight jaundice of the face and trunk. What should the nurse do next? 1. Plan for immediate admission to the hospital 2. Obtain a practitioner's order for a bilirubin level 3. Document this expected finding in the infant's record 4. Arrange for the infant to have phototherapy in the home (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Jaundice that appears within 24 hours may be indicative of a pathological process; if the bilirubin level is elevated, intervention is required. 1 Jaundice is not an indication for admission unless accompanied by a very high serum bilirubin level. 3 Physiologic jaundice does not appear until 72 hours after birth; this observation in 24 hours indicates pathologic hyperbilirubinemia. 4 The infant may require phototherapy after further assessment, but this is not the first action. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 24 weeks' gestation is admitted in early labor. What should the nurse consider regarding this client's problem? 1. If contractions are regular, labor cannot be stopped effectively 2. Birth at this gestational age usually results in a severely compromised neonate 3. Attempts will be made to sustain the pregnancy for 2 or 3 more weeks to ensure neonatal survival 4. Infants born at 30 to 34 weeks' gestation have a low morbidity rate because of advances in neonatal health care (Nugent 329-330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Morbidity and mortality rates of preterm neonates are highest between 24 and 26 weeks' gestation; complications include immature lung tissue, altered cardiac output, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, and infections. 1 Based on the status of cervical effacement and dilation a decision can be made to try to halt labor with the use of tocolytic medications and limited activity. 3 If possible, the pregnancy should be maintained past 37 weeks' gestation. 4 Neonates born at 34 weeks' gestation are still at high risk. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 6 weeks' gestation who has type 1 diabetes is attending the prenatal clinic for the first time. The nurse explains that during the first trimester insulin requirements may decrease because: 1. Body metabolism is sluggish in the first trimester 2. Morning sickness may lead to decreased food intake 3. Fetal requirements of glucose in this period are minimal 4. Hormones of pregnancy increase the body's need for insulin (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Morning sickness, a common occurrence during pregnancy, contributes to decreased food intake; the insulin dosage must be reduced to prevent hypoglycemia. 1 The body's metabolism increases during pregnancy because the needs of the fetus as well as the mother must be met. 3 Rapid organogenesis requires large amounts of glucose. 4 During the first trimester blood glucose levels are reduced and glycemic control is enhanced; glycemic control is more difficult to maintain later in the pregnancy. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse admits a client with preeclampsia to the high-risk prenatal unit. What is the next nursing action after the vital signs have been obtained? 1. Call the practitioner 2. Check the client's reflexes 3. Determine the client's blood type 4. Administer the prescribed intravenous normal saline (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The client is exhibiting signs of preeclampsia. The presence of hyperreflexia indicates central nervous system irritability, a sign of a worsening condition. This assessment will help direct the practitioner to appropriate interventions while alerting the nurse to the possibility of seizures. 1 Although the practitioner will be called, a complete assessment should be done first to obtain the information needed. 3 Determining the client's blood type is not necessary at this time; assessment of the neurological status is the priority. 4 An IV may be started after the assessment, but a more dilute saline solution will be prescribed. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with a history of phenylketonuria (PKU), who was maintained on a low-phenylalanine diet until 9 years of age, is pregnant. What is most important for the nurse to discuss with this client? 1. The infant may be mentally retarded because of her history of PKU 2. Reinstitution of the low-phenylalanine diet will protect her baby from the disorder 3. The fetus is not at risk prenatally but will require immediate care at birth to prevent PKU 4. Phenylalanine should be avoided even when not pregnant so that her body is able to support a pregnancy (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The fetus is at risk for retardation prenatally from a buildup of metabolites in the PKU-affected mother if the prescribed diet is not followed. 1 This will not occur if a low phenylalanine diet is maintained by the mother. 3 The fetus is at risk for mental retardation if the maternal diet is not low in phenylalanine; also, the infant can inherit PKU via an autosomal recessive gene. 4 The client should restart a phenylalanine-restricted diet when planning to become pregnant and continue it throughout pregnancy. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse assures a breastfeeding mother that one way she will know that her infant is getting an adequate supply of breast milk is if the infant gains weight. What behavior does the infant exhibit if an adequate amount of milk is being ingested? 1. Has several firm stools daily 2. Voids six or more times a day 3. Spits out a pacifier when offered 4. Awakens to feed about every four hours (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The presence of at least six to eight wet diapers each day indicates sufficient breast milk intake. 1 Several firm stools daily may indicate an inadequate amount of fluid ingestion; the stools of breastfeeding neonates should be soft to loose. 3 Spitting out a pacifier is not an indication of adequate milk consumption; some infants need extra sucking stimulation. 4 Awakening to feed every four hours is not a reliable indicator of adequate breast milk intake; sleep patterns vary. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client is diagnosed with gestational hypertension. She tells the nurse that she has been following the recommended pregnancy diet. What should the nurse teach her about her diet at this time? 1. Limit proteins 2. Change nothing 3. Restrict sodium 4. Increase carbohydrates (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The recommended diet for a client with gestational hypertension is the same as that recommended for a normotensive pregnant client. 1 Protein intake should be increased during pregnancy. 3 Pregnant clients with gestational hypertension should not restrict their sodium intake. 4 Pregnant clients with gestational hypertension should not increase their carbohydrate intake over the recommended amount. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor, who is 4 cm dilated, is admitted to the birthing room. An electronic fetal monitor is applied. Which assessment should alert the nurse to notify the practitioner? 1. Contractions every 4 minutes that last 50 seconds 2. Contractions every minute that last for120 seconds 3. Fetal heart rate accelerations at the beginning of a contraction 4. Fetal heart rate decelerations to 110 BPM before the peak of a contraction (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 These contractions are too frequent and prolonged for a client who is only 4 cm dilated; the client may become exhausted, which will compromise the fetus. 1 This is an expected finding and does not need further intervention. 3 This is an expected finding and does not need further intervention. 4 This is an expected finding and does not need further intervention. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An assessment of a newborn includes the differentiation between cephalhematoma and caput succedaneum. When making this assessment, the nurse identifies that the newborn with caput succedaneum has scalp edema that: 1. Becomes ecchymotic 2. Crosses the suture line 3. Increases after several hours 4. Is tender in the surrounding area (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 This is the sign that differentiates between these two conditions; with caput succedaneum the swelling crosses the suture line, and it does not with cephalhematoma. 1 Bruising can occur with either condition. 3 The swelling decreases in size; if the swelling increases, the newborn will have to be observed for signs of increased intracranial pressure. 4 Pain is not associated with either condition. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn weighing 9 pounds, 14 ounces has a cesarean birth because of cephalopelvic disproportion. The Apgar score was 7 at 1 minute and 9 at 5 minutes. What should the nurse do after the initial physical assessment? 1. Administer oxygen by hood 2. Determine the blood glucose level 3. Pass a gavage tube for a formula feeding 4. Transfer the newborn to the neonatal intensive care unit (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 This simple measure will detect hypoglycemia in this large-for-gestational-age (LGA) infant. 1 There are no data that indicate a need for oxygen. 3 Formula will not be given at this time, and there are no data that indicate a need for gavage feeding. 4 The situation does not indicate the need for transfer of the newborn to the NICU. The Apgar scores demonstrate that this infant is adapting to extrauterine life. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A mother who is formula feeding her 1-month-old infant asks the nurse whether any vitamin or mineral supplements are required. The nurse bases the reply on the knowledge that infants who are fed with ready-to-use formula do require a supplement. What supplement is required? 1. Iron 2. Fluoride 3. Vitamin K 4. Vitamin B12 (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Unless fluoridated water is used by the manufacturer, fluoride supplementation of 0.25 mg daily is required. 1 Commercial formulas are iron fortified. 3 The supply of vitamin K is adequate after the first week of life. 4 Vitamin B12 is unnecessary; it may be needed if the mother is a vegetarian and is breastfeeding. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

In her 36th week of gestation, a client with type 1 diabetes has a 9-pound, 10-ounce infant by cesarean birth. For which condition should the nurse monitor when caring for this infant of a diabetic mother (IDM)? 1. Meconium ileus 2. Physiologic jaundice 3. Respiratory distress syndrome 4. Increased intracranial pressure (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A 36-week old, large-for-gestational-age (LGA) infant of a mother with diabetes (IDM) may have immature lung tissue, which predisposes to respiratory distress. 1 Meconium ileus is suggestive of cystic fibrosis, which is unrelated to maternal diabetes. 2 Physiologic jaundice is manifested about 24 hours after birth when fetal red blood cells begin to hemolyze; this is unrelated to maternal diabetes. 4 Increased intracranial pressure may be associated with birth injury or hydrocephalus; it is unrelated to maternal diabetes. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

In her 30th week of gestation, a 16-year-old primigravida whose usual blood pressure is 120/70 mm Hg has a blood pressure of 130/88 mm Hg. She is admitted to the birthing unit and says, "I don't know why the doctor is so worried about my blood pressure. According to a book I have, it's normal." The nurse should respond, "Your: 1. physician is being cautious." 2. blood pressure is high for your age group." 3. blood pressure is increased according to pregnancy guidelines." 4. textbook is for older women who have higher blood pressures." (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 An increase of 30 mm Hg in the systolic reading or an increase of 15 mm Hg in the diastolic reading indicates hypertension during pregnancy. 1 This is false reassurance. 2 This response may cause anxiety and elevate the blood pressure even more. 4 There is not enough information about the book to draw this conclusion. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who has undergone a cesarean birth because of the presence of active genital herpes is transferred to the postpartum unit. Which isolation precautions does the nurse plan to institute? 1. Enteric 2. Droplet 3. Contact 4. Airborne (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Contact precautions include wearing a gown, mask, and gloves; these protect the nurse from the virus; the client should be in a private room. 1 The Centers for Disease Control (CDC) guidelines for isolation precautions do not include enteric precautions as a category. 2 These precautions are not necessary for a person with genital herpes. 4 These precautions are not necessary for a person with genital herpes. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse on the high-risk unit assesses a client admitted with severe preeclampsia. The client has audible crackles in the lower left lobe, slight blurring of vision in the right eye, generalized facial edema, and epigastric discomfort. Which client adaptation indicates the potential for a seizure? 1. Audible crackles 2. Blurring of vision 3. Epigastric discomfort 4. Generalized facial edema (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Epigastric discomfort suggests liver edema; it is an ominous symptom that indicates an impending seizure. 1 Audible crackles indicate pulmonary edema; although they are a sign of severe preeclampsia they are not as definitive as epigastric pain. 2 Blurred vision is a sign of retinal edema; although it is a sign of severe preeclampsia it is not as definitive as epigastric pain. 4 Although generalized facial edema is a sign of severe preeclampsia it is not as definitive as epigastric pain. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse places fetal and uterine monitors on the abdomen of a client in labor. When observing the relationship between the fetal heart rate and uterine contractions, the nurse identifies four late decelerations. What condition is most frequently associated with late decelerations? 1. Head compression 2. Maternal hypothyroidism 3. Uteroplacental insufficiency 4. Umbilical cord compression (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Late decelerations are suggestive of fetal hypoxia and occur when there is uteroplacental insufficiency. 1 Head compression results in early decelerations; this is considered benign. 2 Hypothyroidism is unrelated to late decelerations. 4 Umbilical cord compression results in variable decelerations. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse assesses a newborn 1 minute after birth. The body is pink with blue extremities, the heart rate is 122, the legs are withdrawn when the soles are flicked, the respirations are easy with no evidence of distress, and the arms and legs are flexed and vigorously moving. What Apgar score should the nurse document in the newborn's medical record? 1. 7 2. 8 3. 9 4. 10 (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 One point was removed from the Apgar score because the extremities are blue. 1 This score is too low and does not reflect the status of the newborn. 2 This score is too low and does not reflect the status of the newborn. 4 This score is too high and does not reflect the status of the newborn. (Nugent 371-372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Immediately after birth, what is the first nursing intervention for the newborn with a 1 minute Apgar score of 7? 1. Administer oxygen 2. Perform a brief physical assessment 3. Dry and place in a warm environment 4. Cut the umbilical cord and attach a clamp (Nugent 325-326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Preventing heat loss conserves the newborn's oxygen and glycogen reserves; this is a priority. 1 Warming the infant will reduce cyanosis if no respiratory obstruction is present. 2 This is important but not a priority; assessment should be delayed until the infant is warm. 4 This can be done after provisions are made to prevent heat loss. (Nugent 369-370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

At 1 minute after birth the nurse identifies that an infant is crying, has a heart rate of 140, has blue hands and feet, resists the suction catheter, and keeps the legs flexed and the arms extended. What Apgar score should the nurse assign for this infant? 1. 6 2. 7 3. 8 4. 9 (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The Apgar score is 8; 1 point is deducted for lessened muscle tone (the baby's arms do not flex) and 1 point for acrocyanosis, which is manifested by bluish hands and feet. 1 This is too low a score. 2 This is too low a score. 4 This is too high a score. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After the birth of her daughter, a mother tells the nurse, "I was told that my baby has to have an injection of vitamin K. She's so small to be getting a shot. Why does she have to have it?" How should the nurse respond? 1. "Your baby needs the injection to help her develop red blood cells." 2. "An injection of vitamin K will help prevent your baby from becoming jaundiced." 3. "Newborns are deficient in vitamin K. This treatment will protect your baby from bleeding." 4. "A newborn's blood clots extremely rapidly. This injection will help decrease the clotting time." (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The absence of intestinal flora in the newborn results in low levels of vitamin K, causing a transient blood coagulation deficiency; an injection of vitamin K is given prophylactically to infants on the day of birth. 1 Vitamin K has no effect on erythropoiesis. 2 Vitamin K is important for the synthesis of the clotting factor in the liver, but it will not prevent jaundice. 4 Newborns have a blood coagulation deficiency; the blood clots more slowly, not more quickly. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client expresses a desire to breastfeed her preterm infant who is in the neonatal intensive care unit (NICU). How should the nurse respond? 1. Tell the client that this is not possible because the infant will be fed by gavage 2. Discourage the client because of the time and effort it will take to pump her breasts 3. Support the client's decision and explain that her infant may be unable to finish breastfeeding because of exhaustion 4. Explain to the client that breast milk is inadequate for a preterm infant because it does not contain all the necessary nutrients (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The mother should be given an opportunity to breastfeed, knowing that it will be terminated if the infant becomes exhausted. If the infant cannot breastfeed, the mother's breasts can be pumped and the breast milk used for gavage feedings. 1. There is no indication of a plan to feed the infant by gavage. 2 Time and effort are insufficient reasons to discourage pumping the breasts. 4 Breast milk provides optimum nutrition, protects the infant from necrotizing enterocolitis, and provides antibodies. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newborn male is circumcised. What post-circumcision plan of care for her son alerts the nurse that the mother requires additional teaching? 1. There will be frequent diaper changes 2. Practitioner will be called if there is excessive bleeding 3. Tub bath will be given starting on the day after the circumcision 4. Petrolatum gauze will be applied to the penis with each diaper change (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The newborn should not be submerged in a tub. The penis should be gently cleaned with clear, warm water; in addition, sponge baths are given until the cord stump detaches. 1 The diaper should be changed frequently to prevent irritation from the urine. 2 There should be minimal bleeding; excessive bleeding requires immediate attention. 4 Petrolatum gauze prevents the diaper from adhering to the operative site. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Two hours after giving birth, a client's physical assessment includes BP 86/40; TPR 98/100/22; fundus firm, four fingerbreadths above umbilicus; small spots of lochia rubra on perineal pad; and distended bladder. After a urinary catheterization the client's fundus remains firm and four fingerbreadths above the umbilicus. What should the nurse do next? 1. Catheterize the client again 2. Palpate the client's fundus every 2 hours 3. Notify the client's practitioner immediately 4. Recheck the client's vital signs in 30 minutes (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The practitioner should be notified because the increased height of the uterus may be due to accumulation of blood in the uterus from internal hemorrhaging. Also the blood pressure is low and the pulse is rapid, and this may indicate impending shock. 1 Another intervention will delay the immediate, urgent response that is needed. 2 The client may be hemorrhaging; an immediate, urgent response is needed. 4 The client may be hemorrhaging; an immediate, urgent response is needed. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is in labor is admitted 30 hours after her membranes ruptured. For what condition does the nurse anticipate that the client is most at risk? 1. Cord prolapse 2. Placenta previa 3. Chorioamnionitis 4. Abruptio placentae (Nugent 322) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The risk of developing chorioamnionitis (intra-amniotic infection) is increased with prolonged rupture of the membranes; foul-smelling fluid is a sign of infection. 1 A prolapsed cord usually occurs shortly after the membranes rupture, not 1½ days later. 2 This is an abnormally implanted placenta; it is unrelated to ruptured membranes. 4 Premature separation of the placenta is unrelated to ruptured membranes. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On her first postpartum day, a client asks the nurse if her baby had a test for phenylketonuria (PKU) yet. How should the nurse reply? 1. "The test will not be done until your baby reaches 10 pounds." 2. "The test will not be done today because newborns have sluggish circulation." 3. "The test will not be done until your baby has had enough milk for the results to be accurate." 4. "The test will not be done today because a newborn's liver does not produce enough enzymes before 7 days." (Nugent 327-328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The test cannot be done until the newborn has ingested a high phenylalanine (formula or breast milk) diet for at least 48 hours. 1 The test can be done at any weight; the important factor is ingestion of milk for at least 48 hours to obtain a reading. 2 This is not the reason why the test is not being done at this time. 4 Measurable enzymes are produced after the infant has ingested milk for at least 48 hours. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a pregnant client with type 1 diabetes at her first visit to the clinic how to minimize fetal/neonatal complications. What is the most important action that the client should take? 1. Exercise daily 2. Adhere to the prescribed diet 3. Adhere to the management plan 4. Keep the scheduled appointments (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Therapeutic management involves a comprehensive plan that includes diet, exercise, regulation of insulin dosage based on frequent blood glucose testing, and scheduled medical supervision. 1 This is too limited; this alone will not limit fetal/neonatal complications. 2 This is too limited; this alone will not limit fetal/neonatal complications. 4 This is too limited; this alone will not limit fetal/neonatal complications. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

How should the nurse assess a newborn's grasp reflex? 1. Put direct pressure along the sole of the newborn's foot 2. Jar the crib and watch the movement of the newborn's hands 3. Press examining fingers against the palms of the newborn's hands 4. Hold the body upright and allow the newborn's feet to touch a surface (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This action should elicit the grasp reflex of the newborn's hands. 1 This action will cause the toes to hyperextend with dorsiflexion of the big toe (Babinski reflex). 2 This action will elicit symmetric abduction and extension of the arms with the thumb and forefingers forming a C, followed by adduction of the arms, and finally a return of the arms to a relaxed position (Moro reflex). 4 This action will elicit alternating flexion and extension of the feet that simulates walking (stepping reflex). (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse determines that in the healthy full-term neonate, heat production is accomplished by: 1. Oxidizing fatty acids 2. Shivering when chilled 3. Metabolizing brown fat 4. Increasing muscular activity (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This metabolic process releases energy and increases heat production in the newborn. 1 Fatty acids are byproducts of the breakdown of brown fat. 2 Shivering is the mechanism of heat production for an adult, not for a newborn. 4 This will not be successful unless there is an abundance of brown fat. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the second reactive period a newborn becomes more alert and responsive and there is an increase in mucus production and gagging. What should the nurse do first? 1. Report this finding 2. Administer nasal oxygen 3. Lower the head of the cribette 4. Remove secretions from the pharynx (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 An increase in mucus production is expected during the second reactive period; mucus should be removed either by swiping the oral cavity with a gloved finger or via the use of an aspiration device. 1 Reporting this finding is unnecessary; identifying and treating human responses is within the scope of nursing practice. 2 Oxygen administration is useless if mucus is blocking the respiratory passages. 3 Although lowering the head of the cribette may help secretions drain, the newborn cannot remove secretions that block respirations. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A mother asks the neonatal nurse why her infant must be monitored for hypoglycemia when her type 1 diabetes was in excellent control during her pregnancy. How should the nurse respond? 1. "Newborns' glucose levels drop after birth so we are especially cautious with your baby because of your diabetes." 2. "Newborns' pancreases produce increased amounts of insulin during the first day of birth so we are checking to see if hypoglycemia has occurred." 3. "Babies of mothers with diabetes do not have a large supply of glucose stores at birth, so it is difficult for them to maintain their blood glucose levels within an acceptable range." 4. "Babies of mothers with diabetes have a higher than average insulin level because of the excess glucose received from their mothers during pregnancy, so their glucose level may drop." (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 An infant of a diabetic mother (IDM) produces higher levels of insulin in response to the elevated maternal glucose levels; after birth it takes several hours for the newborn to adjust to the loss of the maternal glucose. 1 Healthy newborns' glucose levels do not drop significantly after birth. 2 Newborns' pancreases usually do produce more insulin as a response to maternal glucose levels, but this response is not specific to the IDM. 3 IDMs have the same glucose stores as other newborns; their responses to the loss of maternal glucose levels differ. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is performing the Ortolani test on a newborn. Which finding indicates a positive result? 1. Dorsiflexion then fanning 2. Hypertonia and jitteriness 3. An arched back and crying 4. An audible click on abduction (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 As the head of the femur moves within the acetabulum, sometimes there is an audible click when there is developmental dysplasia of the hip. 1 This is associated with the Babinski test. 2 This is a neurological finding. 3 This is opisthotonic posturing. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When changing her newborn's diaper a new mother notes a reddened area on the infant's buttock and reports it to the nurse. What should the nurse do next? 1. Have nursery staff members change the infant's diaper 2. Use both lotion and powder to protect the involved area 3. Request that the practitioner prescribe a topical ointment 4. Encourage the mother to cleanse the area and change the diaper more often (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Frequent cleansing and diaper changing will limit the presence of irritating substances. 1 Having the nurses change the diaper may lower the mother's self-esteem. 2 Powder and lotion will cake and retain moisture in the area. 3 This is a nursing, not a medical, problem. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client's membranes rupture spontaneously during the latent phase of the first stage of labor, and the fluid is greenish brown. What does the nurse conclude? 1. Infection is present 2. Cesarean birth is necessary 3. Precipitate birth is imminent 4. Fetus may be compromised in utero (Nugent 322) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Greenish-brown amniotic fluid is a sign of meconium in utero, which may indicate that the fetus is compromised. 1 There is not enough information to arrive at this conclusion. 2 This may be necessary if the fetal heart rate becomes nonreassuring, then a cesarean birth will help ensure a viable newborn. 3 Meconium-stained amniotic fluid is not an indication for an imminent birth during the latent phase of labor. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On admission to the nursery a newborn is observed experiencing cold stress. What is the nurse's goal at this time? 1. Minimize shivering 2. Prevent hyperglycemia 3. Limit oxygen consumption 4. Prevent metabolism of fat stores (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 If the newborn is cold there is an increased brown fat metabolism (nonshivering thermogenesis), which elevates fatty acids in the blood, predisposing to acidosis. 1 Newborns do not shiver. 2 Hypoglycemia, not hyperglycemia, can occur because the newborn's glycogen reserves are depleted rapidly when under stress. 3 Although oxygen consumption increases during cold stress, it is not the priority; increased fat metabolism is more serious. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a group of postpartum clients. Which client is at the highest risk for disseminated intravascular coagulation? 1. Gravida III with twins 2. Gravida V with endometriosis 3. Gravida II who had a 9-pound baby 4. Gravida I who had an intrauterine fetal death (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Intrauterine fetal death is one of the risk factors for developing disseminated intravascular coagulation (DIC); other risk factors are abruptio placentae, amniotic fluid embolism, sepsis, and liver disease. 1 A multiple pregnancy is not a risk factor for DIC. 2 Endometriosis is not a risk factor for DIC. 3 A large infant is not a risk factor for DIC. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Where is the best area for the nurse to assess adequate tissue oxygenation in a neonate born of black parents? 1. Heels and buttocks 2. Upper tips of the ears 3. Nail beds on the hands and feet 4. Mucous membranes of the mouth (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Lack of skin pigmentation on the surfaces of the mucous membranes makes this the best area to assess this neonate's tissue oxygenation. 1 These are usually highly pigmented areas and the buttocks often have Mongolian spots. 2 The tips of the ears will indicate the skin color later in life. 3 Because most neonates' hands and feet have acrocyanosis, the nailbeds may be cyanotic as well. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Parents of a newborn are concerned about the pinpoint red dots on their infant's face and neck. How should the nurse respond? 1. They are obstructed sebaceous glands 2. They are excessive superficial capillaries 3. The cause is a decreased vitamin K level in the newborn 4. The cause is an increased intravascular pressure during birth (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Pressure exerted during the birth process causes increased intravascular pressure, which may result in petechiae caused by capillary rupture. 1 These are milia, which are white, not red; they are benign. 2 Superficial capillaries are intact capillaries. They are distinguished from petechiae if they disappear when the area is blanched. 3 Bloody stools or oozing from the umbilicus is the most common sign of vitamin K deficiency, not pinpoint red dots on an infant's face and neck. (Nugent 370-371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After her baby's birth a client wishes to begin breastfeeding. How can the nurse assist the client at this time? 1. Give the infant a bottle first to evaluate the sucking reflex 2. Position the infant to grasp the nipple to express colostrum 3. Leave the infant and parents alone to promote attachment behaviors 4. Touch the infant's cheek adjacent to the nipple to elicit the rooting reflex (Nugent 329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Stimulating the rooting reflex effectively encourages the newborn to turn toward the breast in preparation for suckling. 1 Giving the neonate a bottle may interfere with learning to accept the breast. 2 For milk to be expressed the infant must grasp the entire areola, which contains the secretory ducts. 3 At first the mother should be supervised to help ensure a successful experience. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What are the signs and symptoms of withdrawal that the nurse identifies in a postpartum client with a history of opioid abuse? 1. Paranoia and evasiveness 2. Extreme hunger and thirst 3. Depression and tearfulness 4. Irritability and muscle tremors (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The earliest sign of opioid withdrawal is CNS overstimulation. 1 These are related to opioid drug abuse, not opioid withdrawal. 2 These have no relation to opioid withdrawal; most postpartum women are hungry and thirsty. 3 These are not specific to people who abuse opioids. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A new mother asks the nurse why her baby seems to have a bowel movement after every feeding. When preparing a response to explain why this is an expected occurrence the nurse determines that it indicates an adequate: 1. Fluid intake 2. Cardiac sphincter 3. Pancreatic amylase level 4. Gastrocolic reflex response (Nugent 328) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The gastrocolic reflex is stimulated when the newborn's stomach begins to fill with fluid; this causes an increase in peristalsis resulting in the passage of stool during or after a feeding. 1 Six to 10 voidings a day of pale straw-colored urine are indicative of adequate fluid intake, not the frequency of bowel movements. 2 The cardiac sphincter is unrelated to bowel movements; the cardiac sphincter, located between the esophagus and the stomach, is immature in the newborn and is the reason for the newborn's tendency to regurgitate some of the feedings. 3 Although pancreatic amylase is a digestive enzyme, it does not stimulate bowel movements after feedings. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse do to help parents proceed with bonding behaviors immediately after birth? 1. Assess for typical parenting techniques 2. Demonstrate desired behaviors to the parents 3. Postpone foot printing the newborn until later in the day 4. Delay administering the antibiotic to the newborn's eyes (Nugent 328-329) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The parents need an opportunity for close eye-to-eye contact during the first hour. Prophylactic eye medications may irritate the newborn's eyes, preventing them from opening. 1 Assessment is appropriate but will not facilitate parent-newborn bonding; favorable conditions for bonding should be provided before assessment. 2 The nurse should assess, not demonstrate, behavior at this time. 3 Footprinting should be done immediately to ensure proper identification of the newborn. (Nugent 373) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Two hours after birth a newborn develops an area of soft swelling in the left parietal region. Where should the nurse find the area of involvement? 1. Over the eyes 2. Behind the ears 3. In back of the head 4. On the top of the skull (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The parietal areas behind the frontal bone form the top sides of the cranial cavity. A swelling in one of these areas that does not cross the suture line is a cephalhematoma. 1 The frontal area is the area over the eyes. 2 The temporal area is the area behind the ears. 3 The occipital area is the area at the back of the head. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is planning to use a newborn's foot to obtain blood for the required newborn metabolic testing. What part of the foot is the best site to use for the puncture? 1. Big toe 2. Foot pad 3. Inner sole 4. Outer heel (Nugent 326-327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The site of the outer heel is well perfused and heals quickly. 1 This area is an inappropriate site to use to obtain a blood specimen from a newborn. 2 This area is an inappropriate site to use to obtain a blood specimen from a newborn. 3 This area is an inappropriate site to use to obtain a blood specimen from a newborn. (Nugent 371) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is assessing a postpartum client for signs of an impending hemorrhage secondary to lacerations of the cervix. What other assessment is important, in addition to monitoring for a firm uterus? 1. Decrease in pulse rate 2. Increase in blood pressure 3. Persistent muscular twitching 4. Continuous trickling of blood (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 The trickling of blood indicates continuous bleeding. Close monitoring is required and intervention is necessary if signs of hemorrhagic shock appear. 1 The pulse becomes very rapid, but not until a significant amount of blood is lost. 2 Blood pressure is normotensive; it usually does not drop significantly until a large amount of blood is lost. 3 This is not a sign of impending hemorrhage. (Nugent 368-369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

In her 37th week of gestation, a client with type 1 diabetes has an amniocentesis to determine fetal lung maturity. The L/S ratio is 2:1, phosphatidylglycerol is present, and creatinine is 2 mg/dL. What conclusion should the nurse draw from this information? 1. A cesarean birth will be scheduled 2. A birth must take place immediately 3. The fetus need not be monitored any longer 4. The newborn should be free from respiratory problems (Nugent 324-325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 These test results confirm fetal lung maturity and the neonate should be free from major respiratory problems. 1 These test results are not related to the need for a cesarean birth. 2 There is no indication of fetal compromise; an immediate vaginal or cesarean birth is not necessary. 3 Further fetal monitoring will be necessary in the future, as with any pregnancy. (Nugent 368) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When checking a newborn's reflexes, the nurse is unable to elicit one reflex response that is often absent in neonates born vaginally in the breech presentation. How should the nurse attempt to elicit this response? 1. Move the thumb along the sole of the foot 2. Stroke the ulnar surface of the hand and fifth finger lightly 3. Touch the skinfold of the mouth and cheek on the same side 4. Hold in the upright position while pressing the feet flat on the crib mattress (Nugent 326) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This action elicits the stepping response, which is absent when paresis is present or in neonates born vaginally in the breech presentation. 1 This should elicit the Babinski reflex, which is unrelated to a vaginal breech birth. 2 This should elicit the digital response reflex, which is unrelated to a vaginal breech birth. 3 This should elicit the rooting response reflex, which is unrelated to a vaginal breech birth. (Nugent 370) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is assessing a newborn. Which sign should the nurse report? 1. Temperature of 97.7° F 2. Pale pink, rust-colored stain in the diaper 3. Heart rate that decreases to 115 beats per minute 4. Breathing pattern with recurrent sternal retractions (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This breathing pattern is indicative of respiratory distress; the expected pattern is abdominal with synchronous chest movement. 1 This is within the expected range of 97.6° F (36.4° C) to 99° F (37.2° C) for a newborn. 2 This is caused by uric acid crystals from the immature kidneys; it is a common occurrence. 3 This is within the expected range of 110 to 160 beats per minute for a newborn. (Nugent 375) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a client who is admitted with a tentative diagnosis of placenta previa. What procedure usually confirms this diagnosis? 1. Laparoscopy 2. Nonstress test 3. Amniocentesis 4. Ultrasound exam (Nugent 323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is a noninvasive, relatively harmless way to visualize the location of the placenta. 1 This is an invasive surgical procedure that is not used for this purpose. 2 This provides information about the status of the fetus, not the location of the placenta. 3 This is an invasive procedure that is used to remove amniotic fluid for fetal assessment. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A new mother exclaims to the nurse, "My baby looks like a conehead!" How should the nurse respond? 1. "Are you disappointed in how your baby looks?" 2. "Don't worry, your baby's head will be round in a few days." 3. "Is there anyone in your family whose head shape is similar to your baby's?" 4. "This often happens as the baby's head moves down the birth canal the bones move for easier passage." (Nugent 325) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is accurate information. The mother needs information that is straightforward and understandable. 1 This is an assumed reflection of the mother's feelings and does not address her concern; the nurse should recognize the mother is disappointed and offer an explanation. 2 This may add to the mother's anxiety because the reason for the infant's appearance has not been explained. 3 The shape of the newborn's head is most likely the result of "molding." As the baby's head moves down the birth canal the bones move for easier passage of the head through the birth canal. It will take several days to determine if the head is malformed. This response may add to the mother's anxiety. (Nugent 369) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While a multiparous client is in active labor her membranes rupture spontaneously, and the nurse observes a loop of umbilical cord protruding from her vagina. What is the priority nursing action? 1. Monitoring the fetal heart rate 2. Covering the cord with a saline dressing 3. Pushing the cord back into the vaginal vault 4. Holding the presenting part away from the cord (Nugent 322-323) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This must be done immediately to maintain cord circulation and prevent the fetus from becoming anoxic. 1 The priority is maintaining cord circulation; although monitoring is important, it does not alter the emergency. 2 Keeping the cord moist is secondary; keeping pressure off the cord is the priority. 3 The cord should not be touched because it increases pressure on the cord and further reduces oxygen to the fetus. (Nugent 366) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse assesses that a newborn is in respiratory distress. Which signs confirm this assessment? Select all that apply. 1. ____ Crackles 2. ____ Cyanosis 3. ____ Wheezing 4. ____ Tachypnea 5. ____ Retractions (Nugent 330) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 2, 4, 5 1 Crackles occur in the healthy newborn. 2 Cyanosis occurs because of inadequate oxygenation. 3 Wheezing in the newborn is benign. 4 Tachypnea is a compensatory mechanism to increase oxygenation. 5 Retractions occur in an effort to increase lung capacity. (Nugent 374) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client gives birth to a full-term newborn with an 8/9 Apgar score. List the initial nursing care in order of their priority? 1. Place in heated crib 2. Perform physical assessment 3. Apply identification band to mother and infant 4. Instill antibiotic prophylaxis and administer vitamin K (Nugent 327) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 3, 2, 4 The newborn's thermoregulation mechanism is immature and an exogenous heat source is needed. Once the Apgar score has confirmed a healthy newborn and the infant is warm, the next step is to identify both mother and infant using bands with the same numbers. The newborn is now ready to be protected from contracting ophthalmia neonatorum and Chlamydia with an antibiotic, and hemorrhagic disease of the newborn with vitamin K. (Nugent 372) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with preeclampsia is admitted to the labor and birthing suite. Her blood pressure is 130/90 and she has 2+ protein in her urine and edema of the hands and face. For which signs or symptoms should the nurse assess to determine if the client may be developing HELLP syndrome? Select all that apply. 1. _____ Headache 2. _____ Constipation 3. _____ Abdominal pain 4. _____ Vaginal bleeding 5. _____ Flulike symptoms (Nugent 324) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 3, 5 1 Headache is a symptom of increasing severity of preeclampsia and HELLP syndrome. 2 Constipation is not related to preeclampsia. 3 Abdominal pain is a symptom of increasing severity of preeclampsia and HELLP syndrome. 4 Vaginal bleeding is not related to preeclampsia. 5 Flulike symptoms are related to increasing severity of preeclampsia and HELLP syndrome. (Nugent 367) Nugent, Patricia M. Mosby's Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.