Latest Version | 2025/2026 | Correct &
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A postpartum client experiences a sudden gush of vaginal blood when standing. What is the
nurse’s best action?
A. Call for immediate surgery
✔✔B. Assess fundal tone and massage if boggy
C. Restrict all ambulation
D. Provide IV antibiotics
A laboring woman reports intense back pain with each contraction. What nursing intervention is
most helpful?
A. Place client in Trendelenburg position
✔✔B. Apply counterpressure to the sacral area
C. Administer cold IV fluids
D. Encourage hyperventilation
A client at 10 weeks gestation reports nausea each morning. Which suggestion should the nurse
provide?
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,A. Drink coffee before rising
✔✔B. Eat dry crackers before getting out of bed
C. Skip breakfast to reduce nausea
D. Take prenatal vitamins on an empty stomach
A client at 39 weeks gestation presents with painless bright red vaginal bleeding. What should
the nurse suspect?
A. Placental abruption
✔✔B. Placenta previa
C. Preterm labor
D. Uterine rupture
A client in labor is receiving oxytocin. Which finding requires immediate intervention?
A. Contractions every 4 minutes
B. Fetal heart rate at 150 bpm
✔✔C. Contractions lasting 120 seconds each
D. Maternal complaint of mild fatigue
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, A woman in active labor reports feeling the urge to push, but she is only 8 cm dilated. What
should the nurse do?
A. Encourage her to push with contractions
✔✔B. Instruct her to pant and breathe through contractions
C. Place her in Trendelenburg
D. Call for immediate C-section
A postpartum woman has a firm fundus at the umbilicus but heavy lochia rubra with clots. What
should the nurse suspect?
A. Uterine atony
✔✔B. Vaginal laceration
C. Retained placenta
D. Normal finding
A client at 34 weeks gestation presents with severe hypertension and proteinuria. What is the
priority nursing action?
A. Encourage ambulation
✔✔B. Place client on bed rest in side-lying position
C. Start oxytocin infusion
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