LABOR AND DELIVERY NCLEX STYLE QUESTIONS|UPDATED&VERIFIED|GUARANTEED SUCCESS

2. Uterine tenderness The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present? 1. Soft abdomen 2. Uterine tenderness 3. absence of abdominal pain 4. painless, bright red vaginal bleeding 2. Obtain equipment for a manual pelvic examination. The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the health care provider's prescriptions and should question which prescription? 1.Prepare the client for an ultrasound. 2.Obtain equipment for a manual pelvic examination. 3.Prepare to draw a hemoglobin and hematocrit blood sample 4. Obtain equipment for external electronic fetal heart rate monitoring 1. Delivery of the fetus An ultrasound is preformed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruption placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription? 1.Delivery of the fetus. 2. Strict monitoring of intake and output 3.Complete bed rest for the remainder of the pregnancy 4. The need for weekly monitoring of coagulation studies until the time of delivery 2. The client has a history of cardiac disease The nurse is preforming an initial assessment on a client who has just been told that a pregnancy test is positive. Which assessment finding indicates that the client is at risk for preterm labor? 1.The client is a 35 year old primigravida 2. The client has a history of cardiac disease 3. The client's hemoglobin level is 13.5 g/dL 4. The client is a 20 year old primigravida of average weight and height 1.Hypotonic The nurse is monitoring a client in active stage of labor. The client has been experiencing contractions that are short, irregular, and weak. The nurse documents that the client is experiencing which type of labor dystocia? 1. Hypotonic 2. Precipitous 3. Hypertonic 4. Preterm labor 2. Support the mother in her reaction to the newborn infant After a precipitous delivery, the nurse notes that the new mother is passive and only touches her newborn infant briefly with her fingertips. What should the nurse do to help the woman process the delivery? 1.Encourage the mother to breastfed soon after birth 2. Support the mother in her reaction to the newborn infant 3.Tell the mother that it is important to hold the newborn infant. 4. document a complete account of the mother's reaction on the birth record. 4. Persistent nonreassuring fetal heart rate The nurse in a labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which assessment finding would alert the nurse to a compromise? 1. Maternal fatigue 2. coordinated uterine contractions 3. Progressive changes in the cervix 4. Persistent nonreassuring fetal heart rate 3. The cervix is completely dilated The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor? 1. The contractions are regular. 2. The membranes have ruptured 3. The cervix is completely dilated 4. The client starts to expel clear vaginal fluid 2. Fetal heart rate of 180 beats/minute The nurse is preforming an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate the need to contact the health care provider? 1. Hemoglobin of 11g/dL 2. Fetal heart rate of 180 beats/minute 3. Maternal pulse rate of 85 beats/minute 4. White blood cell count of 12,000 cells/mm3 3. 1 cm above the ischial spine The nurse is reviewing the record of a client in the labor room and notes that the health care provider had documented the fetal presenting part is at the -1 station. This documented finding indicates that the fetal presenting part is located at which area? 1. 1 inch below the coccyx 2. 1 inch below the iliac crest 3. 1 cm above the ischial spine 4. 1 fingerbreadth below the symphysis pubis 3. Increased efficiency of contractions A client arrives at birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcome of the amniotomy? 1. less pressure on her cervix 2. decreased number of contractions 3. increased efficiency of contractions 4. the need for increased maternal blood pressure monitoring 4. Increase hydration by encouraging oral fluids. A postpartum nurse is taking the vital signs of a client who delivered a healthy infant 4 hours ago. The nurse notes that the client's temperature is 100.2 degrees Farenheit. Which of the following actions would be appropriate? 1. Notify the physician. 2. Document the findings. 3. Retake the temperature in 15 minutes. 4. Increase hydration by encouraging oral fluids. 3. Instruct the client to request help when getting out of bed. A nurse is assessing a client who is 6 hours post-partum after delivering a full-term healthy infant. The client complains to the nurse of feelings of faintness and dizziness. Which nursing action would be most appropriate? 1. Elevate the client's legs. 2. Determine the hemoglobin and hematocrit levels. 3. Instruct the client to request help when getting out of bed. 4. Inform the nursery room nurse to avoid bringing the newborn infant to the client until the feelings of faintness and dizziness have subsided. 1. 3 days postpartum A postpartum nurse is providing instructions to a client after delivery of a healthy infant. The nurse instructs the client that she should expect normal bowel elimination to return: 1. 3 days postpartum 2. 7 days postpartum 3. On the day of delivery 4. Within 2 weeks postpartum 1. Acute pain A nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client had a midline episiotomy and has several hemorrhoids. What is the priority nursing diagnosis for this client? 1. Acute pain 2. Disturbed body image 3. Impaired urinary elimination 4. Risk for imbalanced fluid volume 3. Heavy A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that the client has saturated a perineal pad in 1 hour. The nurse reports the amount of lochial flow as: 1. Scant 2. Light 3. Heavy 4. Excessive 1. The diet should include additional fluids. A nurse is teaching a postpartum client about breast-feeding. Which of the following instructions should the nurse include? 1. The diet should include additional fluids. 2. Prenatal vitamins should be discontinued. 3. Soap should be used to cleanse the breasts. 4. Birth control measures are unnecessary while breast-feeding. 2. Ask the client to urinate and empty her bladder. A nurse is prepared to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following? 1. Ask the client to turn on her side. 2. Ask the client to urinate and empty her bladder. 3. Massage the fundus gently before determining the level of the fundus. 4. Ask the client to lie flat on her back with the knees and legs flat and straight. 4. The client with lochia that is read and has a foul-smelling odor. A nurse is caring for four 1-day postpartum clients. Which client has an abnormal finding that would require further intervention? 1. The client with mild afterpains. 2. The client with a pulse rate of 60 beats per minutes 3. The client with colostrum discharge from both breasts. 4. The client with lochia that is read and has a foul-smelling odor.