QUESTIONS AND VERIFIED ANSWERS
1. A nurse is planning care for a client who is pregnant and is Rh-negative. In
which of the following situations should the nurse administer Immune Globulin?
A. At 28 weeks of gestation
B. Prior to a blood transfusion
C. Following an episode of influenza during pregnancy
D. While the client is in labor
- answers-A. At 28 weeks of gestation
A 40-year-old patient who is 36 weeks pregnant presents with complaints of
vaginal bleeding and lack of fetal movement over the last 3 days. What is the
priority action by the nurse?
A. X-ray the abdomen
B. Ultrasound examination
C. Check for fetal heart tones
D. Palpate for fetal movement
- answers-C. Check for fetal heart tones
A client is 37 weeks gestation and is admitted to the hospital with bright red
vaginal bleeding, complaining of abdominal discomfort, but is not having any
contractions. After you assess the client's vital signs and see that the FHR is 105
what is the most A. The amount of cervical dilation present
B. The exact location of her abdominal pain
C. The station of the presenting part of the fetus
D. At what time the client last ate
- answers-D. At what time the client last ate
,A client is receiving mag sulfate to help stop preterm labor. What signs of
magnesium toxicity should the nurse watch for?
A. Headache, blurred vision, tachycardia, oliguria
B. Loss of deep tendon reflexes, lethargy, paralysis, respiratory depression, blurred
vision
C. Palpitations, edematous lower extremities, pruritus
D. Dyspepsia, malaise, tachypnea, erythema on extremities, fever
- answers-B. Loss of deep tendon reflexes, lethargy, paralysis, respiratory
depression, blurred vision
A client reports that her last menstrual period was November 10. She asks the
nurse "When will my baby be due?" What is the best answer?
A. July 3rd
B. August 30th
C. Around the middle of September
D. August 17th
- answers-D. August 17th
A clinically labeled infertile woman is considered to be in which category?
A. A woman who practices sexual abstinence.
B. A woman who has had a hysterectomy.
C. A woman who refused to eat chicken eggs.
D. A woman who can't conceive despite having unprotected sex for a time of at
least 12 months.
- answers-D. A woman who can't conceive despite having unprotected sex for a
time of at least 12 months.
A female patient took a pregnancy test. These are interpreted as what kind of
chances of pregnancy.
A. Presumptive
B. Probable
C. Positive
D. Possible
- answers-A. Presumptive
, A Labor and Delivery nurse is caring for a client in labor and has applied an
external fetal monitor and tocotransducer. The FHR is around 140/min.
Contractions are occurring every 8 min and lasting 30-40 secs. The nurse performs
a vaginal exam and finds the cervix is dilated to 2 cm, 50% effaced, and the fetus is
at -2 station. Which stage and phase of labor is this client experiencing?
A. First stage, active phase
B. Fourth stage of labor
C. Second stage of labor
D. First stage, latent phase
- answers-D. First stage, latent phase
A newborn is newly admitted to the nursery. A nursing assessment finds all of the
following findings. Which of these are abnormal? (Select all that apply)
A. acrocyanosis
B. visible jaundice
C. respiratory Rate of 47 breaths per minute
D. heart rate of 93 bpm
E. anteroposterior lateral ratio of 1:1
- answers-B. visible jaundice
D. Heart rate of 93 bpm
A nurse is assessing a client who is at 38 weeks of gestation during a weekly
prenatal visit. Which of the following should the nurse report to the provider?
A. Report of insomnia: an expected finding
B. BP of 136/88: Within the reference range for a pt at 38 wks
C. Report of Braxton-Hicks contractions: an expected finding
D. Weight gain of 2.2 kg (4.8 lb)
- answers-D. Weight gain of 2.2 kg (4.8 lb)
A nurse is assessing new parents feeding their newborn. Which of the following
assessments requires more education?
A. Parents are holding the newborn in a semi-upright position
B. The bottle is tilted enough that no air is coming through the nipple
C. The father is allowing the bottle to prop on the blanket