Answers 2023
26. 30 year old primigravida delivers 9 pound vaginally after 30 hour labor. Priority nursing action?
-
✔observe for signs of hemorrhage
27. Magnesium Sulfate in D5W 500 mL. 20 g Mag Sulfate at 1 g/hr. How many mL/hr? -
✔25
28. 32 weeks gestations with possible UTI. Action to implement? -
✔collect urine for culture
29. 38 weeks gestation, tachycardia, tremulous, hypertensive. Assessment action most important? -
✔obtain a drug screen
30. Patient requests an epidural for pain control. Action to implement first? -
✔check cervical dilation
31. Patient presents with bright red blood, rigid abdomen and in pain. Nurse suspects possibility? -
✔abruptio placentae
, 32. Large for gestational age infant. Action to implement first? - -
✔obtain blood glucose
After delivery patient presents with profuse hemorrhage. Action to implement? -
✔check maternal blood pressure
39. Discussing involution. Patient understands effect of breastfeeding when states? -
✔period may be delayed
40. Baby born with congenital heart defect. Which assessment finding warrants immediate
intervention? - -
✔bluish tinge to tongue
41. Mom is Rh- suffers abdominal trauma in a motor vehicle accident. Which assessment
finding is most important to report to the healthcare provider? -
✔positive fetal hemoglobin
42. Which hormone is responsible for positive pregnancy test? - -
✔HcG
43. Doctor hands baby to nurse immediately after delivery. Which action is most important to
implement? -
✔place under warmer
44. Education most important for nurse to implement to teenage pregnant patient? -
✔iron deficiency anemia
45. Nurse identifies localized swelling that does not cross the suture line of parietal bone. Action
to implement? -
✔notify pediatrician of cephalhematoma
46. Action to implement before administering Hep B vaccine? -
✔get consent signed