with Revised Answers, (A+ Guarantee) LATEST UPDATE
A client at 8-months gestation tells the nurse that she knows her baby listens to
her, but her husband thinks she is imagining things. What information should
the nurse provide? - CORRECT ANSWER ✔✔✔✔✔ The fetus in utero is
capable of hearing and does respond to the mother's voice.
Rationale:
Fetal hearing and response to sound occurs by 24-weeks gestation, so the fetus
can be soothed by the familiar sound of the mother's voice.
A female client who wants to delivery at home asks the nurse to explain the role
of a nurse-midwife in providing obstetric care. What information should the
nurse provide? - CORRECT ANSWER ✔✔✔✔✔ The pregnancy should
progress normally and be considered low risk.
Rationale:
A nurse midwife is an advanced practice nurse who is prepared to provide
quality perinatal care for a low-risk obstetric client.
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,What nursing action should be included in the plan of care for a newborn
experiencing symptoms of drug withdrawal ? - CORRECT ANSWER ✔✔✔✔✔
Swaddle the infant snugly and hold tightly.
Rationale:
An infant experiencing drug withdrawal should be swaddled, wrapped snugly, or
placed in a "kangaroo pouch" to reduce self-stimulation behaviors and protect
skin from abrasions that may occur due to muscular irritability.
The nurse is teaching a new mother about diet and breastfeeding. Which
instruction is most important to include in the teaching plan? - CORRECT
ANSWER ✔✔✔✔✔ Avoid alcohol because it is excreted in breast milk.
Rationale:
Alcohol should be avoided while breastfeeding because, when consumed by the
mother, it is excreted in breast milk.
A primigravida at 12-weeks gestation who just moved to the United States
indicates she has not received any immunizations. Which immunization(s) should
the nurse administer at this time? (Select all that apply.)
Tetanus.
Rubella.
Diphtheria.
Chickenpox.
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,Hepatitis B. - CORRECT ANSWER ✔✔✔✔✔ Correct selections are (A, C, and
E).
Rationale:
Vaccines composed of killed viruses may be administered during pregnancy.
Rubella (B) and chickenpox (D) consist of live or attenuated live viruses which
would be contraindicated during pregnancy due to potential teratogenicity.
A client at 25-weeks gestation tells the nurse that she dropped a cooking utensil
last week and her baby jumped in response to the noise. What information
should the nurse provide? - CORRECT ANSWER ✔✔✔✔✔ The fetus can
respond to sound by 24-weeks gestation.
Rationale:
At 24-weeks gestation, the fetus's ability to hear loud environment sounds can
illicit a startle response.
A client at 28-weeks gestation experiences blunt abdominal trauma. Which
parameter should the nurse assess first for signs of internal hemorrhage? -
CORRECT ANSWER ✔✔✔✔✔ Changes in fetal heart rate patterns.
Rationale:
Hypoperfusion of the fetus may be present before the onset of clinical signs of
maternal compromise or shock in a pregnant woman, so the external fetal
monitor tracings should be assessed first to determine signs of fetal hypoxia due
to internal bleeding in the mother.
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, The nurse is discussing the stages of labor with a group of women in the last
month of pregnancy and provides examples of different positional techniques
used during the second stage of labor. Which position should the nurse address
that provides the best advantage of gravity during delivery? - CORRECT
ANSWER ✔✔✔✔✔ Squatting.
Rationale:
Squatting helps to align the fetus with the pelvic outlet and allows gravity to
assist in fetal descent and gives the client an adventitious position for birth.
A multiparous client is bearing down with contractions and crying out, "The
baby is coming!" Which immediate action should the nurse implement? -
CORRECT ANSWER ✔✔✔✔✔ Visualize the perineum for bulging.
Rationale:
The perineum should be visualized for bulging or the presentation of the baby so
assistance with the impending birth can be immediately rendered.
The nurse is assessing a full-term newborn's breathing pattern. Which findings
should the nurse assess further? (Select all that apply.)
Shallow with an irregular rhythm.
Chest breathing with nasal flaring.
Diaphragmatic with chest retraction.
Abdominal with synchronous chest movements.
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Rate of 58 breaths per minute.
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