ACTUAL EXAM WITH QUESTIONS AND
100% VERIFIED ANSWERS RATED A+|2024
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One hour after giving birth to an 8-pound infant, a client's
lochia rubra has increased from small to large and her fundus is
boggy despite massage. The client's pulse is 84 beats/minute
and blood pressure is 156/96. The healthcare provider
prescribes Methergine 0.2 mg IM X 1. What action should the
nurse take immediately?
Give the medication as prescribed and monitor for efficacy.
Encourage the client to breastfeed rather than bottle feed.
Have the client empty her bladder and massage the fundus.
Call the healthcare provider to question the prescription. -
correct answer > D
,A primigravida at 40-weeks gestation is receiving oxytocin
(Pitocin) to augment labor. Which adverse effect should the
nurse monitor for during the infusion of Pitocin?
Dehydration.
Hyperstimulation.
Galactorrhea.
Fetal tachycardia. - correct answer > B
A client at 28-weeks gestation calls the antepartal clinic and
states that she is experiencing a small amount of vaginal
bleeding which she describes as bright red. She further states
that she is not experiencing any uterine contractions or
abdominal pain. What instruction should the nurse provide?
Come to the clinic today for an ultrasound.
Go immediately to the emergency room.
Lie on your left side for about one hour and see if the bleeding
stops.
Bring a urine specimen to the lab tomorrow to determine if you
have a urinary tract infection. - correct answer > A
,A 30-year-old gravida 2, para 1 client is admitted to the hospital
at 26-weeks gestation in preterm labor. She is given a dose of
terbutaline sulfate (Brethine) 0.25 mg subcutaneous . Which
assessment is the highest priority for the nurse to monitor
during the administration of this drug?
Maternal blood pressure and respirations.
Maternal and fetal heart rates.
Hourly urinary output.
Deep tendon reflexes. - correct answer > B
Monitoring maternal and fetal heart rates is most important
when terbutaline is being administered becauseTerbutaline
acts as a sympathomimetic agent that stimulates both beta 1
receptors (causing tachycardia, a side effect of the drug) and
beta 2 receptors (causing uterine relaxation, a desired effect of
the drug).
A client is admitted with the diagnosis of total placenta previa.
Which finding is most important for the nurse to report to the
healthcare provider immediately?
, Heart rate of 100 beats/minute.
Variable fetal heart rate.
Onset of uterine contractions.
Burning on urination. - correct answer > C
Total (complete) placenta previa involves the placenta covering
the entire cervical os (opening). The onset of uterine
contractions places the client at risk for dilation and placental
separation, which causes painless hemorrhaging. The risk of
hemorrhage is the priority.
A client at 32-weeks gestation is diagnosed with preeclampsia.
Which assessment finding is most indicative of an impending
convulsion?
3+ deep tendon reflexes and hyperclonus.
Periorbital edema, flashing lights, and aura.
Epigastric pain in the third trimester.
Recent decreased urinary output. - correct answer > A