NURS 371 Evolve EAQ 4

Which statement by a new mother observing her preterm infant in the neonatal intensive care nursery indicates that she has not yet begun the bonding process? 1. "It's such a tiny baby." 2. "Do you think he'll make it?" 3. "Why does he need to be in an incubator?" 4. "My baby looks so much like my husband."

"It's such a tiny baby."

Which finding would indicate infection in a pregnant client? Select all that apply. One, some, or all responses may be correct. 1. Chills 2. Fever 3. Diarrhea 4. Flank pain 5. Burning on urination

1. Chills 2. Fever 3. Diarrhea 4. Flank pain 5. Burning on urination

Between which weeks of gestation would a client with type 1 diabetes expect to increase her insulin dosage? 1. 10th and 12th weeks of gestation 2. 18th and 22nd weeks of gestation 3. 24th and 28th weeks of gestation 4. 36th and 40th weeks of gestation

24th and 28th weeks of gestation

A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. Which is the immediate nursing action? 1. Administering oxygen 2. Elevating the head of the bed 3. Drawing blood for a hematocrit level 4. Giving an intramuscular analgesic

Administering oxygen

Which assessment would the nurse include in the plan of care for a postpartum client with large, painful varicose veins? 1. Monitoring daily clotting times 2. Assessing for peripheral pulses 3. Monitoring daily hemoglobin values 4. Assessing for signs of thrombophlebitis

Assessing for signs of thrombophlebitis

The nurse admits a client with preeclampsia to the high-risk prenatal unit. Which is the next nursing action after the vital signs have been obtained? 1. Calling the primary health care provider 2. Checking the client's reflexes 3. Determining the client's blood type 4. Establishing an intravenous (IV) line

Checking the client's reflexes

Which technique would the nurse employ for an obstetrical client with a foreign body airway obstruction? 1. Back blows 2. Chest thrusts 3. Suprapubic thrusts 4. Abdominal thrusts

Chest thrusts

A client at 36 weeks' gestation presents with severe abdominal pain, heavy vaginal bleeding, a drop in blood pressure, and an increased pulse rate. Which complication of pregnancy is suggested by these signs and symptoms? 1. Hydatidiform mole 2. Vena cava syndrome 3. Marginal placenta previa 4. Complete abruptio placentae

Complete abruptio placentae

Which is a primary focus of teaching for a pregnant adolescent at her first prenatal clinic visit? 1. Instructing her about the care of an infant 2. Informing her of the benefits of breast-feeding 3. Advising her to watch for danger signs of preeclampsia 4. Encouraging her to continue regularly scheduled prenatal care

Encouraging her to continue regularly scheduled prenatal care

Which would be included in the plan of care for an obstetrical client who has been taking carbamazepine throughout the first trimester of pregnancy? 1. Evaluation for fetal hydramnios 2. Evaluation for a neural tube defect 3. Evaluation for cardiac malformation 4. Chromosomal assessment for Down syndrome

Evaluation for a neural tube defect

Which occurs immediately after birth that increases the risk for cardiac decompensation in a client with a compromised cardiac system? 1. Increased pressure is placed on the veins. 2. Intra-abdominal pressure is significantly increased. 3. The blood flow to the heart is decreased considerable 4. Extravascular fluid is remobilized into the vascular compartment.

Extravascular fluid is remobilized into the vascular compartment

Which intervention would the nurse initiate when a fetal heart pattern signifying uteroplacental insufficiency occurs? 1. Inserting a urinary catheter 2. Administering oxygen by means of nasal cannula 3. Helping the client turn to the side-lying position 4. Encouraging the client to pant with her next contraction

Helping the client turn to the side-lying position

For which complication would the nurse closely monitor a client with a diagnosis of abruptio placentae? 1. Cerebral hemorrhage 2. Pulmonary edema 3. Impending seizures 4. Hypovolemic shock

Hypovolemic shock

Which complication is the result of type 1 diabetes in a pregnant client? 1. Increased risk of hypertensive states 2. Abnormal placental implantation 3. Excessive weight gain because of increased appetite 4. Decreased amount of amniotic fluid as the pregnancy progresses

Increased risk of hypertensive states

Which position increases cardiac output in the obstetrical client with cardiac disease? 1. Trendelenburg 2. Low semi-fowler 3. Lateral positioning 4. Supine with legs elevated

Lateral positioning

A pregnant client with a history of preterm labor is at home on bed rest. Which instruction would be included in this client's teaching plan? 1. Place blocks under the foot of the bed. 2. Sit upright with several pillows behind the back. 3. Lie on the side with the head raised on a small pillow. 4. Assume the knee-chest position at regular intervals throughout the day.

Lie on the side with the head raised on a small pillow

A breast-feeding mother experiences redness and pain in the left breast, a temperature of 100.8°F (38.2°C), chills, and malaise. Which condition would the nurse suspect? 1. Mastitis 2. Engorgement 3. Blocked milk duct 4. Inadequate milk production

Mastitis

A pregnant client's blood test reveals an increased alpha-fetoprotein (AFP) level. Which condition is indicated with this result? 1. Cystic fibrosis 2. Phenylketonuria 3. Down syndrome 4. Neural tube defect

Neural tube defect

Which problem is suggested when a client at 37 weeks' gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity followed by fundal tenderness and a small amount of dark-red bleeding? 1. True labor 2. Placenta previa 3. Partial abruptio placentae 4. Abdominal muscular injury

Partial abruptio placentae

Assessment of a primigravida at 32 weeks' gestation shows a blood pressure of 170/110 mm Hg, 4+ proteinuria, and edema of the face and extremities. With which complication are these findings consistent? 1. Eclampsia 2. Severe preeclampsia 3. Chronic hypertension 4. Gestational hypertension

Severe preeclampsia

Which information would the nurse give a pregnant client about having a chorionic villus sampling (CVS) before the 10th and 12th weeks? 1. The test can cause fetal anomalies. 2. The results are not as accurate. 3. The information it provides is inadequate. 4. It must be done with the use of laparoscopic surgery.

The test can cause fetal anomalies

Which factor will increase the risk for hypotonic uterine dystocia in a postpartum client? 1. Twin gestation 2. Gestational anemia 3. Hypertonic contractions 4. Gestational hypertension

Twin gestation

Which test is used to confirm cephalopelvic disproportion? 1. Ultrasound 2. Fetal scalp pH 3. Amniocentesis 4. Digital pelvimetry

Ultrasound

A client at 36 weeks' gestation has a blood pressure of 140/90. Which additional sign of preeclampsia would the nurse assess for? 1. Urine dipstick positive for protein 2. Mild ankle edema 3. Episodes of dizziness on arising 4. Weight gain of 2 lb (907 g) in 2 weeks

Urine dipstick positive for protein

Which condition is most commonly associated with late decelerations of the fetal heart rate? 1. Head compression 2. Maternal hypothyroidism 3. Uteroplacental insufficiency 4. Umbilical cord compression

Uteroplacental insufficiency