NUR 335 EXAM 2 PRACTICE
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT RATED A+ NEWLY
UPDATED 2026
Question 1
A pregnant patient at 10 weeks gestation is admitted to the emergency department
with severe, unremitting vomiting, a 6% reduction in pre-pregnancy body weight,
and ketonuria. Which secondary clinical finding should the nurse anticipate as a
direct metabolic consequence of hyperemesis gravidarum? A. Metabolic acidosis
due to severe starvation B. Metabolic alkalosis resulting from the loss of gastric
hydrochloric acid C. Respiratory acidosis secondary to shallow breathing D.
Respiratory alkalosis caused by hyperventilation and pain
✔✔ B. Metabolic alkalosis resulting from the loss of gastric hydrochloric acid
Rationale: The continuous, severe loss of acidic stomach contents (hydrochloric
acid) during intractable vomiting depletes hydrogen and chloride ions in the body.
This specific loss shifts the maternal acid-base balance toward metabolic
alkalosis. If the condition progresses to severe starvation where the body burns fat
stores for energy, it can concurrently trigger ketosis, but the primary, immediate
hazard from direct gastric loss is metabolic alkalosis accompanied by hypokalemia
and hypochloremia.
Question 2
When planning the discharge education for a pregnant client who has just been
stabilized following an episode of hyperemesis gravidarum, which dietary and
lifestyle strategies should the nurse reinforce to minimize the recurrence of nausea
and vomiting? A. Consuming three large, nutrient-dense meals daily with plenty of
water during the meals B. Eating small, frequent, dry meals high in protein and
complex carbohydrates, while consuming fluids mainly between meals C.
Maintaining an empty stomach between meals to prevent digestive overload D.
Incorporating high-fat, highly seasoned comfort foods to quickly replace lost
calories
,✔✔ B. Eating small, frequent, dry meals high in protein and complex
carbohydrates, while consuming fluids mainly between meals
Rationale: To manage hyperemesis and prevent gastric distension or irritation,
patients should eat small, frequent meals (every 2 to 3 hours) that are high in
protein and complex carbohydrates, as these are easier to tolerate and stabilize
blood sugar. Avoiding large meals keeps the stomach from becoming overly full.
Crucially, fluids should be consumed between meals rather than with food to
prevent an overfilled stomach, and an empty stomach should be avoided because
hunger can actively trigger or worsen nausea. High-fat, heavily seasoned foods
delay gastric emptying and should be completely avoided.
A client at 30 weeks' gestation is admitted to the maternity unit with vaginal
bleeding. What should be the nurse's initial nursing action?
a. Count and weigh peripads.
b. Start an intravenous infusion drip.
c. Assess blood pressure and pulse.
d. Observe for pallor, clammy skin, and perspiration. - ANSWER......c. Assess
blood pressure and pulse.
Rationale: The nurse's initial action for a client with vaginal bleeding at 30 weeks
would be to assess blood pressure and pulse. Counting and weighing peripads;
observing for pallor, clammy skin, and perspiration; and starting an intravenous
infusion drip are all important actions for this client; they are just not the initial
action.
A prenatal client at 16 weeks' gestation presents to the clinic with unexplained
bright red bleeding, cramping, and backache, which she has had for the past two
days. A pelvic exam reveals a closed cervix. What type of abortion does this
indicate?
a. Threatened.
b. Incomplete.
c. Missed.
,d. Imminent. - ANSWER......a. Threatened.
Rationale: A threatened abortion (miscarriage) has symptoms of vaginal bleeding
and backache without cervical dilation. In an imminent abortion, the internal
cervical os is dilated. Although the cervix is closed in a missed abortion, other
symptoms would include a regression in breast changes and a brownish vaginal
discharge. Diagnosis is made based on history, pelvic exam, and a negative
pregnancy test. With an incomplete abortion, the embryo has passed out of the
uterus, but the placenta remains, and the internal os is slightly dilated.
The client asks for information about ectopic pregnancy. The nurse correctly
responds by saying ectopic pregnancy is caused by: (Select all that apply.)
a. Pelvic inflammatory disease (PID).
b. Presence of an IUD.
c. In utero exposure to diethylstilbestrol (DES).
d. Endometriosis. - ANSWER......a. Pelvic inflammatory disease (PID).
d. Endometriosis.
b. Presence of an IUD.
c. In utero exposure to diethylstilbestrol (DES).
Rationale: Ectopic pregnancy can be caused by tubal damage from pelvic
inflammatory disease (PID), previous tubal surgery, congenital anomalies of the
tube, endometriosis, previous ectopic pregnancy, presence of an IUD, and in utero
exposure to diethylstilbestrol (DES).
A client presents to the physician's office with complaints of right-sided abdominal
pain, dizziness, and vaginal bleeding. A pelvic exam determines adnexal
tenderness. What diagnosis should the nurse suspect?
a. Cholelithiasis.
b. Appendicitis.
c. Threatened abortion.
, d. Ectopic pregnancy. - ANSWER......d. Ectopic pregnancy.
Rationale: A client with an ectopic pregnancy would present to the physician's
office with complaints of one-sided abdominal pain, dizziness, and vaginal
bleeding, and would have adnexal tenderness on exam. Clients with a threatened
abortion would have complaints of unexplained bleeding, cramping, or backache.
A pelvic exam would reveal a closed cervix. Clients with appendicitis would have
complaints of lower right-sided tenderness, low-grade fever, nausea, and often
vomiting. Clients with cholelithiasis would have complaints of epigastric distress,
such as fullness, distention, and vague pain in the right upper quadrant of the
abdomen.
A client at 15 weeks' gestation presents to the prenatal clinic with "prune juice"-
like vaginal bleeding. Other assessment data include a hematocrit of 10 and
complaints of severe nausea and vomiting. What diagnosis should the nurse
suspect?
a. Prolapsed cord.
b. Hydatidiform mole.
c. Placenta previa.
d. Abruptio placentae. - ANSWER......b. Hydatidiform mole.
Rationale: In hydatidiform mole, vaginal bleeding occurs almost universally. It is
often brownish due to liquefaction of the uterine clot. In addition, because serum
hCG levels are higher with molar pregnancy than with normal pregnancy, the
woman might experience hyperemesis gravidarum. Anemia occurs frequently due
to blood loss and poor nutrition secondary to hyperemesis. Placenta previa
symptoms include painless bright red vaginal bleeding, usually in the third
trimester of pregnancy. Prolapsed cord symptoms include a trickle of bright red
vaginal blood and possibly a visible cord at the vaginal opening. Abruptio
placentae symptoms include vaginal bleeding (bright red or dark red), abdominal
pain, and uterine tenderness.
A client is being maintained at home with a diagnosis of mild pre-eclampsia.
Which of the following complaints require further evaluation? Select all that apply.
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT RATED A+ NEWLY
UPDATED 2026
Question 1
A pregnant patient at 10 weeks gestation is admitted to the emergency department
with severe, unremitting vomiting, a 6% reduction in pre-pregnancy body weight,
and ketonuria. Which secondary clinical finding should the nurse anticipate as a
direct metabolic consequence of hyperemesis gravidarum? A. Metabolic acidosis
due to severe starvation B. Metabolic alkalosis resulting from the loss of gastric
hydrochloric acid C. Respiratory acidosis secondary to shallow breathing D.
Respiratory alkalosis caused by hyperventilation and pain
✔✔ B. Metabolic alkalosis resulting from the loss of gastric hydrochloric acid
Rationale: The continuous, severe loss of acidic stomach contents (hydrochloric
acid) during intractable vomiting depletes hydrogen and chloride ions in the body.
This specific loss shifts the maternal acid-base balance toward metabolic
alkalosis. If the condition progresses to severe starvation where the body burns fat
stores for energy, it can concurrently trigger ketosis, but the primary, immediate
hazard from direct gastric loss is metabolic alkalosis accompanied by hypokalemia
and hypochloremia.
Question 2
When planning the discharge education for a pregnant client who has just been
stabilized following an episode of hyperemesis gravidarum, which dietary and
lifestyle strategies should the nurse reinforce to minimize the recurrence of nausea
and vomiting? A. Consuming three large, nutrient-dense meals daily with plenty of
water during the meals B. Eating small, frequent, dry meals high in protein and
complex carbohydrates, while consuming fluids mainly between meals C.
Maintaining an empty stomach between meals to prevent digestive overload D.
Incorporating high-fat, highly seasoned comfort foods to quickly replace lost
calories
,✔✔ B. Eating small, frequent, dry meals high in protein and complex
carbohydrates, while consuming fluids mainly between meals
Rationale: To manage hyperemesis and prevent gastric distension or irritation,
patients should eat small, frequent meals (every 2 to 3 hours) that are high in
protein and complex carbohydrates, as these are easier to tolerate and stabilize
blood sugar. Avoiding large meals keeps the stomach from becoming overly full.
Crucially, fluids should be consumed between meals rather than with food to
prevent an overfilled stomach, and an empty stomach should be avoided because
hunger can actively trigger or worsen nausea. High-fat, heavily seasoned foods
delay gastric emptying and should be completely avoided.
A client at 30 weeks' gestation is admitted to the maternity unit with vaginal
bleeding. What should be the nurse's initial nursing action?
a. Count and weigh peripads.
b. Start an intravenous infusion drip.
c. Assess blood pressure and pulse.
d. Observe for pallor, clammy skin, and perspiration. - ANSWER......c. Assess
blood pressure and pulse.
Rationale: The nurse's initial action for a client with vaginal bleeding at 30 weeks
would be to assess blood pressure and pulse. Counting and weighing peripads;
observing for pallor, clammy skin, and perspiration; and starting an intravenous
infusion drip are all important actions for this client; they are just not the initial
action.
A prenatal client at 16 weeks' gestation presents to the clinic with unexplained
bright red bleeding, cramping, and backache, which she has had for the past two
days. A pelvic exam reveals a closed cervix. What type of abortion does this
indicate?
a. Threatened.
b. Incomplete.
c. Missed.
,d. Imminent. - ANSWER......a. Threatened.
Rationale: A threatened abortion (miscarriage) has symptoms of vaginal bleeding
and backache without cervical dilation. In an imminent abortion, the internal
cervical os is dilated. Although the cervix is closed in a missed abortion, other
symptoms would include a regression in breast changes and a brownish vaginal
discharge. Diagnosis is made based on history, pelvic exam, and a negative
pregnancy test. With an incomplete abortion, the embryo has passed out of the
uterus, but the placenta remains, and the internal os is slightly dilated.
The client asks for information about ectopic pregnancy. The nurse correctly
responds by saying ectopic pregnancy is caused by: (Select all that apply.)
a. Pelvic inflammatory disease (PID).
b. Presence of an IUD.
c. In utero exposure to diethylstilbestrol (DES).
d. Endometriosis. - ANSWER......a. Pelvic inflammatory disease (PID).
d. Endometriosis.
b. Presence of an IUD.
c. In utero exposure to diethylstilbestrol (DES).
Rationale: Ectopic pregnancy can be caused by tubal damage from pelvic
inflammatory disease (PID), previous tubal surgery, congenital anomalies of the
tube, endometriosis, previous ectopic pregnancy, presence of an IUD, and in utero
exposure to diethylstilbestrol (DES).
A client presents to the physician's office with complaints of right-sided abdominal
pain, dizziness, and vaginal bleeding. A pelvic exam determines adnexal
tenderness. What diagnosis should the nurse suspect?
a. Cholelithiasis.
b. Appendicitis.
c. Threatened abortion.
, d. Ectopic pregnancy. - ANSWER......d. Ectopic pregnancy.
Rationale: A client with an ectopic pregnancy would present to the physician's
office with complaints of one-sided abdominal pain, dizziness, and vaginal
bleeding, and would have adnexal tenderness on exam. Clients with a threatened
abortion would have complaints of unexplained bleeding, cramping, or backache.
A pelvic exam would reveal a closed cervix. Clients with appendicitis would have
complaints of lower right-sided tenderness, low-grade fever, nausea, and often
vomiting. Clients with cholelithiasis would have complaints of epigastric distress,
such as fullness, distention, and vague pain in the right upper quadrant of the
abdomen.
A client at 15 weeks' gestation presents to the prenatal clinic with "prune juice"-
like vaginal bleeding. Other assessment data include a hematocrit of 10 and
complaints of severe nausea and vomiting. What diagnosis should the nurse
suspect?
a. Prolapsed cord.
b. Hydatidiform mole.
c. Placenta previa.
d. Abruptio placentae. - ANSWER......b. Hydatidiform mole.
Rationale: In hydatidiform mole, vaginal bleeding occurs almost universally. It is
often brownish due to liquefaction of the uterine clot. In addition, because serum
hCG levels are higher with molar pregnancy than with normal pregnancy, the
woman might experience hyperemesis gravidarum. Anemia occurs frequently due
to blood loss and poor nutrition secondary to hyperemesis. Placenta previa
symptoms include painless bright red vaginal bleeding, usually in the third
trimester of pregnancy. Prolapsed cord symptoms include a trickle of bright red
vaginal blood and possibly a visible cord at the vaginal opening. Abruptio
placentae symptoms include vaginal bleeding (bright red or dark red), abdominal
pain, and uterine tenderness.
A client is being maintained at home with a diagnosis of mild pre-eclampsia.
Which of the following complaints require further evaluation? Select all that apply.
