NSG 3500 MATERNAL EXAM 3 QUESTIONS COMPLETE
WITH 100% VERIFIED ANSWERS
1. A postpartum nurse is caring for a client who is 12 hours post-
delivery and reports heavy, bright red bleeding with large clots. The
nurse notes the uterus is boggy and displaced to the right. What is the
nurse's priority action?
A. Massage the uterine fundus firmly
B. Encourage the client to void
C. Administer prescribed oxytocin
D. Notify the healthcare provider immediately
Answer: B. Encourage the client to void
Rationale: A boggy uterus displaced to the right indicates a full bladder
displacing the uterus, preventing effective contraction. The priority is to
have the client void, which often allows the uterus to contract and
reduces bleeding. Massaging the fundus, administering oxytocin, and
notifying the provider may be necessary if voiding does not resolve the
issue, but addressing the bladder distension is the initial priority.
2. A client with type 1 diabetes who just delivered a healthy newborn
has a blood glucose level of 94 mg/dL. She has received no insulin
since delivery. The nurse understands that the decrease in which
pregnancy hormone is primarily responsible for this glucose level?
A. Estrogen
B. Progesterone
C. Human placental lactogen (hPL)
,D. Human chorionic gonadotropin (hCG)
Answer: C. Human placental lactogen (hPL)
Rationale: Human placental lactogen (hPL) is an insulin antagonist
produced by the placenta. After delivery, the placenta is expelled, and
hPL levels drop rapidly, reducing insulin resistance and causing blood
glucose levels to decrease. This is why insulin requirements often
decrease significantly after delivery.
3. A client who is 6 weeks postpartum and breastfeeding is scheduled
for a hemorrhoidectomy. What is the most appropriate intervention
regarding infant feeding?
A. Have the woman wean the baby to formula
B. Have the baby stay in the hospital room with the mother
C. Have the woman pump and dump her milk for two weeks
D. Have the baby bottle-fed milk that the mother has stored
Answer: B. Have the baby stay in the hospital room with the mother
Rationale: Allowing the baby to stay in the hospital room with the
mother supports continued breastfeeding and bonding. The mother can
breastfeed on demand, which helps maintain milk supply. Weaning,
pumping and dumping, or using stored milk are unnecessary and may
disrupt breastfeeding.
4. A client is being discharged on warfarin (Coumadin) after a
pulmonary embolism following a cesarean delivery. Which laboratory
value indicates the medication is effective?
A. Prothrombin time (PT): 12 seconds (normal 10-13 seconds)
B. International normalized ratio (INR): 2.5 (normal 1-1.4)
C. Hematocrit: 55%
D. Hemoglobin: 10 g/dL
Answer: B. International normalized ratio (INR): 2.5 (normal 1-1.4)
,Rationale: Warfarin therapy is monitored using the INR. A therapeutic
INR range for warfarin is typically 2.0 to 3.0. An INR of 2.5 indicates the
medication is effective. A PT of 12 seconds is within normal limits and
does not indicate a therapeutic effect. Hematocrit and hemoglobin
levels are not used to monitor warfarin therapy.
5. A client who is G10 P6226 is 1 day postpartum after a spontaneous
vaginal delivery complicated by significant postpartum hemorrhage.
What is the priority nursing diagnosis?
A. Alteration in comfort related to afterbirth pains
B. Risk for altered parenting related to grand multiparity
C. Fluid volume deficit related to blood loss
D. Risk for sleep deprivation related to mothering role
Answer: C. Fluid volume deficit related to blood loss
Rationale: A significant postpartum hemorrhage puts the client at high
risk for hypovolemic shock. Fluid volume deficit is the most immediate
and life-threatening concern, making it the priority nursing diagnosis.
6. A client has just delivered a macrosomic baby after a 12-hour labor.
For which complication should the nurse carefully monitor?
A. Uterine atony
B. Hypoprolactinemia
C. Infection
D. Mastitis
Answer: A. Uterine atony
Rationale: A macrosomic baby (large for gestational age) can
overdistend the uterus, leading to uterine atony (failure of the uterus to
contract effectively after delivery). Uterine atony is a leading cause of
postpartum hemorrhage.
, 7. On admission to the labor and delivery suite, the nurse assesses the
discharge needs of a primipara who will be discharged home 3 days
after a cesarean delivery. Which question should the nurse ask the
client?
A. "Have you ever had anesthesia before?"
B. "Do you have any allergies?"
C. "Do you scar easily?"
D. "Are there many stairs in your home?"
Answer: D. "Are there many stairs in your home?"
Rationale: Assessing the home environment, including the presence of
stairs, is crucial for discharge planning after a cesarean delivery. The
client will need to limit physical activity and may require assistance
navigating stairs. The other questions are relevant to the immediate
preoperative or intraoperative period, not discharge planning.
8. A client is receiving paroxetine (Paxil) for postpartum depression. To
prevent a drug-food interaction, the client must be advised to refrain
from consuming which of the following?
A. Alcohol
B. Grapefruit
C. Dairy products
D. Leafy green vegetables
Answer: B. Grapefruit
Rationale: Grapefruit juice can inhibit the metabolism of certain
selective serotonin reuptake inhibitors (SSRIs), including paroxetine,
potentially leading to increased drug levels and toxicity. Alcohol should
be avoided with SSRIs due to additive central nervous system
depression, but grapefruit is the specific drug-food interaction of
concern with paroxetine.
WITH 100% VERIFIED ANSWERS
1. A postpartum nurse is caring for a client who is 12 hours post-
delivery and reports heavy, bright red bleeding with large clots. The
nurse notes the uterus is boggy and displaced to the right. What is the
nurse's priority action?
A. Massage the uterine fundus firmly
B. Encourage the client to void
C. Administer prescribed oxytocin
D. Notify the healthcare provider immediately
Answer: B. Encourage the client to void
Rationale: A boggy uterus displaced to the right indicates a full bladder
displacing the uterus, preventing effective contraction. The priority is to
have the client void, which often allows the uterus to contract and
reduces bleeding. Massaging the fundus, administering oxytocin, and
notifying the provider may be necessary if voiding does not resolve the
issue, but addressing the bladder distension is the initial priority.
2. A client with type 1 diabetes who just delivered a healthy newborn
has a blood glucose level of 94 mg/dL. She has received no insulin
since delivery. The nurse understands that the decrease in which
pregnancy hormone is primarily responsible for this glucose level?
A. Estrogen
B. Progesterone
C. Human placental lactogen (hPL)
,D. Human chorionic gonadotropin (hCG)
Answer: C. Human placental lactogen (hPL)
Rationale: Human placental lactogen (hPL) is an insulin antagonist
produced by the placenta. After delivery, the placenta is expelled, and
hPL levels drop rapidly, reducing insulin resistance and causing blood
glucose levels to decrease. This is why insulin requirements often
decrease significantly after delivery.
3. A client who is 6 weeks postpartum and breastfeeding is scheduled
for a hemorrhoidectomy. What is the most appropriate intervention
regarding infant feeding?
A. Have the woman wean the baby to formula
B. Have the baby stay in the hospital room with the mother
C. Have the woman pump and dump her milk for two weeks
D. Have the baby bottle-fed milk that the mother has stored
Answer: B. Have the baby stay in the hospital room with the mother
Rationale: Allowing the baby to stay in the hospital room with the
mother supports continued breastfeeding and bonding. The mother can
breastfeed on demand, which helps maintain milk supply. Weaning,
pumping and dumping, or using stored milk are unnecessary and may
disrupt breastfeeding.
4. A client is being discharged on warfarin (Coumadin) after a
pulmonary embolism following a cesarean delivery. Which laboratory
value indicates the medication is effective?
A. Prothrombin time (PT): 12 seconds (normal 10-13 seconds)
B. International normalized ratio (INR): 2.5 (normal 1-1.4)
C. Hematocrit: 55%
D. Hemoglobin: 10 g/dL
Answer: B. International normalized ratio (INR): 2.5 (normal 1-1.4)
,Rationale: Warfarin therapy is monitored using the INR. A therapeutic
INR range for warfarin is typically 2.0 to 3.0. An INR of 2.5 indicates the
medication is effective. A PT of 12 seconds is within normal limits and
does not indicate a therapeutic effect. Hematocrit and hemoglobin
levels are not used to monitor warfarin therapy.
5. A client who is G10 P6226 is 1 day postpartum after a spontaneous
vaginal delivery complicated by significant postpartum hemorrhage.
What is the priority nursing diagnosis?
A. Alteration in comfort related to afterbirth pains
B. Risk for altered parenting related to grand multiparity
C. Fluid volume deficit related to blood loss
D. Risk for sleep deprivation related to mothering role
Answer: C. Fluid volume deficit related to blood loss
Rationale: A significant postpartum hemorrhage puts the client at high
risk for hypovolemic shock. Fluid volume deficit is the most immediate
and life-threatening concern, making it the priority nursing diagnosis.
6. A client has just delivered a macrosomic baby after a 12-hour labor.
For which complication should the nurse carefully monitor?
A. Uterine atony
B. Hypoprolactinemia
C. Infection
D. Mastitis
Answer: A. Uterine atony
Rationale: A macrosomic baby (large for gestational age) can
overdistend the uterus, leading to uterine atony (failure of the uterus to
contract effectively after delivery). Uterine atony is a leading cause of
postpartum hemorrhage.
, 7. On admission to the labor and delivery suite, the nurse assesses the
discharge needs of a primipara who will be discharged home 3 days
after a cesarean delivery. Which question should the nurse ask the
client?
A. "Have you ever had anesthesia before?"
B. "Do you have any allergies?"
C. "Do you scar easily?"
D. "Are there many stairs in your home?"
Answer: D. "Are there many stairs in your home?"
Rationale: Assessing the home environment, including the presence of
stairs, is crucial for discharge planning after a cesarean delivery. The
client will need to limit physical activity and may require assistance
navigating stairs. The other questions are relevant to the immediate
preoperative or intraoperative period, not discharge planning.
8. A client is receiving paroxetine (Paxil) for postpartum depression. To
prevent a drug-food interaction, the client must be advised to refrain
from consuming which of the following?
A. Alcohol
B. Grapefruit
C. Dairy products
D. Leafy green vegetables
Answer: B. Grapefruit
Rationale: Grapefruit juice can inhibit the metabolism of certain
selective serotonin reuptake inhibitors (SSRIs), including paroxetine,
potentially leading to increased drug levels and toxicity. Alcohol should
be avoided with SSRIs due to additive central nervous system
depression, but grapefruit is the specific drug-food interaction of
concern with paroxetine.
