2026 QUESTIONS AND VERIFIED ANSWERS
ALREADY GRADED A+
Twenty-four hours after admission to the newborn nursery, a
full-term male infant develops localized edema on the right side
of his head. The nurse knows that in the newborn, an
accumulation of blood between the periosteum and skull which
does not cross the suture line is a newborn variation known as.
Answer;A cephalohematoma, caused by forceps trauma and
may last up to 8 weeks.
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The nurse attempts to help an unmarried teenager deal with
her feelings following a spontaneous abortion at 8-weeks
gestation. What type of emotional response should the nurse
anticipate?
Answer;Grief related to her perceptions about the loss of this
child.
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What action should the nurse implement when preparing to
measure the fundal height of a pregnant client? Answer; Have
the client empty her bladder.
The nurse identifies crepitus when examining the chest of a
newborn who was delivered vaginally. Which further
assessment should the nurse perform?
Answer;Observe for an asymmetrical Moro reflex.
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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?
Answer;Call the healthcare provider to question the
prescription.
,Methergine is contraindicated for clients with elevate blood
pressure, so the nurse should contact the healthcare provider
and question the prescription.
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The nurse is preparing to give an enema to a laboring client.
Which client requires the most caution when carrying out this
procedure?
A. A gravida 6, para 5 who is 38 years of age and in early labor.
B. A 37-week primigravida who presents at 100% effacement, 3
cm cervical dilatation, and a -1 station.
C. A gravida 2, para 1 who is at 1 cm cervical dilatation and a 0
station admitted for induction of labor due to post dates.
D. A 40-week primigravida who is at 6 cm cervical dilatation and
the presenting part is not engaged.
Answer;D.
When the presenting part is ballottable, it is floating out of the
pelvis. In such situation, the cord can descend before the fetus
causing a prolapsed cord, which is a emergency situation.
, In evaluating the respiratory effort of a one-hour-old infant
using the Silverman-anderson Index, the nurse determines the
infant has synchronized chest and abdominal movement, just
visible lower chest retractions, just visible xiphoid retractions,
minimal and transient nasal flaring, and an expiratory grunt
heard only on auscultation. What Silverman-Anderson score
should the nurse assign to this infant?
Answer;4
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A client at 32-weeks gestation comes to the prenatal clinic with
complaints of pedal edema, dyspnea, fatigue, and a moist
cough. Which question is most important for the nurse to ask
this client?
Answer;Do you have a history of rheumatic fever?
Clients with a history of rheumatic fever may develop mitral
valve prolapse, which increases the risk for cardiac
decompensation due to the increased blood volume that occurs
during pregnancy, so obtaining information about this client's
health history is a priority.
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