A nurse is assisting with the care of a client who is in the first stage of labor.
The nurse observes the umbilical cord protruding from the vagina. Which of
the following actions should the nurse take first? ✔️Ans - Place the client
in a knee-chest or Trendelenburg position.
A nurse is assisting with monitoring a client who has preeclampsia and is
receiving magnesium sulfate. The client's respiratory rate is 8/min. Which of
the following should the nurse administer? ✔️Ans - Calcium gluconate
A nurse is collecting data from a client who gave birth 12 hr ago. The nurse
notes the fundus is deviated to the right, boggy, and 2 cm above the umbilicus.
Which of the following actions should the nurse take first? ✔️Ans - Assist
the client to void.
A nurse is assisting in the care of a client following an amniotomy who is now
in the active phase of the first stage of labor. Which of the following actions
should the nurse take? ✔️Ans - Encourage the client to empty the
bladder every 2 hr.
A nurse is caring for a client in the prenatal clinic who has a possible ectopic
pregnancy at 8 weeks of gestation. Which of the following findings should the
nurse expect? ✔️Ans - Pelvic pain
A nurse is caring for a client who is pregnant and reports constipation. Which
of the following recommendations should the nurse make? ✔️Ans -
Increased cellulose and fluid in the diet
A nurse is reinforcing teaching with a client who is pregnant and has a new
prescription for ferrous sulfate due to iron-deficiency anemia. The nurse
should instruct the client to take this medication with which of the following?
✔️Ans - Orange juice
A nurse is collecting data from a client who is at 35 weeks of gestation. Which
of the following findings should the nurse report to the provider? ✔️Ans -
Blurred vision
, A nurse is caring for a client who is pregnant and undergoing a nonstress test.
The nurse records the FHR as 130 to 150/min, with no fetal movement for 15
min. Which of the following actions should the nurse take? ✔️Ans -
Apply vibroacoustic stimulation to the woman's abdomen.
A nurse is assisting with the care of a client who presents to a labor and
delivery unit with rapidly progressing labor. Which of the following actions is
the priority for the nurse to take? ✔️Ans - Supporting the infant during
the birth
A nurse is assisting with the admission of a client who is at 38 weeks of
gestation and has severe preeclampsia. When collecting data from the client,
the nurse should expect which of the following findings? ✔️Ans -
Headache
A nurse is reinforcing teaching about appropriate exercises during pregnancy
with a client who is at 24 weeks of gestation. Which of the following
statements indicates a need for additional teaching? ✔️Ans - "I will
participate in a game of racquetball once a week."
A nurse is caring for a client who has unrelieved episiotomy pain 8 hr
following delivery. Which of the following actions should the nurse take?
✔️Ans - Apply an ice pack to the perineum.
A nurse is reinforcing teaching with a client who is pregnant and has a
prescription for Rho(D) immune globulin. Which of the following information
should the nurse include? ✔️Ans - This medication prevents the
formation of Rh antibodies by a woman who is Rh-negative.
A nurse in a provider's office is collecting data from a female client in her third
trimester of pregnancy. The client describes actions she took to obtain relief
from a headache which lasted all day. Which of the following client statements
should the nurse identify as the priority? ✔️Ans - "I took 400 mg of
ibuprofen with a diet soda."
A nurse is assisting with the care of a client who is at 37 weeks of gestation
and has placenta previa. Which of the following risks is the primary reason the
nurse should avoid performing a pelvic examination? ✔️Ans - Profound
bleeding