NACE Care Of Childbearing Family Actual
Exam
NACE Care Of Childbearing Family Exam
/NACE Care Of Childbearing Family Predictor
Exam With Complete Questions And Correct
Answers with Deatailed Rationales Graded A+
A newly admitted client becomes restless and confused at night. Which of these nursing
measures would be most important to promote the client's safety?
a. Putting the client on a bedpan at regular intervals.
b. Attaching the call bell to the bed near the client's dominant hand.
c. Moving the client to a room with ambulatory patients.
d. Keeping a small light on in the client's room.
d. Keeping a small light on in the client's room.
Keeping a small light on in the patient's room is the most important nursing measure to promote
the patient's safety. This will help the patient see the room (safety measure) and orient
themselves as to where they are during the night. Moving the patient to a room with ambulatory
patients, attaching the call bell to the bed near the patient's dominant hand, or putting the
patient on a bedpan at regular intervals would not be the most important nursing measures to
promote safety.
A nurse identifies all of these nursing diagnoses for a client. Which diagnosis should the nurse
give the highest priority?
a. Impaired skin integrity.
b. Altered nutrition: less than body requirements.
c. Impaired tissue perfusion.
d. Altered comfort: pain.
c. Impaired tissue perfusion.
A nurse gives priority to life-threatening conditions which need immediate professional attention
A+ TEST BANK 1
, NACE Care Of Childbearing Family Actual
Exam
(those related to oxygenation, circulation, and breathing). These include respiratory obstruction,
severe hemorrhage, or arrest. Nursing action is to remove or prevent the cause of the most
immediate life-threatening problem.
A nurse is instructing a client on how to limit saturated fat intake and increase intake of foods
high in polyunsaturated fat. Which of these fats is highest in polyunsaturated fatty acids?
a. Vegetable shortening.
b. Corn oil.
c. Butter.
d. Olive oil.
b. Corn oil.
Among these choices, corn oil has the highest amount of polyunsaturated fatty acid. Other oils
high in polyunsaturated fats are flax seed oil, hemp oil, pumpkin seed oil, safflower oil, sesame
oil, soybean oil, and sunflower oil. Olive oil, butter, and vegetable oil are not high in
polyunsaturated fatty acids.
A client who has a possible fractured wrist goes to the Emergency Department. For which of
these rationales should a nurse apply a cold pack to the area?
a. Reduce blood flow to the wrist.
b. Increase tissue metabolism in the wrist.
c. Promote delivery of nutrients to the wrist.
d. Reduce blood viscosity in the wrist.
a. Reduce blood flow to the wrist.
Ice will assist vasoconstriction, and therefore decrease blood flow. Increased blood flow will
increase swelling and pain in the affected area.
A client who has weakness of the left arm and leg can walk short distances with a cane and
assistance. Which of these techniques should a nurse select to provide the client with
appropriate assistance?
a. The nurse stands by the client's right side, supporting the right arm, with the cane on the left
side.
b. The client places the cane on the left side, with the nurse supporting the left side.
c. The nurse stands by the client's left side, supporting the right arm, with the cane on the left
A+ TEST BANK 2
, NACE Care Of Childbearing Family Actual
Exam
side.
d. The client places the cane on the right side, with the nurse supporting the left side.
d. The client places the cane on the right side, with the nurse supporting the left side.
The patient should place the cane on the right side, with the nurse supporting the left side.
Holding the cane on the unaffected side provides support to the affected lower limb. The other
choices (the nurse stands by the patient's right side, supporting the right arm, with the cane on
the left side; the nurse stands by the patient's left side, supporting the right arm, with the cane
on the left side; or the patient places the cane on the left side, with the nurse supporting the left
side) are not techniques a nurse should select in this situation.
An 83-year-old client who was recently admitted to a nursing care facility frequently looks
vacantly at family members and says, "I don't know where I am." A nurse notes that the client
also has a history of getting up several times at night and falling. Based on the information the
nurse should give priority to which of these measures?
a. Placing a call light within the client's reach.
b. Having the client void before they go to bed.
c. Reminding the client that this is their new home now.
d. Maintaining the bed in a low position.
d. Maintaining the bed in a low position.
Maintaining the bed in the lowest position and even placing the mattress on the floor will reduce
the risk of injury if the patient does fall, and should be a priority measure in the patient's evening
care. The other options are applicable but are not the priority.
A client has an abdominal wound drainage tube attached to wall suction. Which of these nursing
diagnoses should be included in the client's care plan?
a. Imbalanced body temperature.
b. Altered gastrointestinal tissue perfusion.
c. Fluid volume deficit.
d. Chronic pain.
c. Fluid volume deficit.
The suction will affect the amount of fluid removed from the patient's body. It will not alter the
A+ TEST BANK 3
, NACE Care Of Childbearing Family Actual
Exam
patient's temperature or tissue perfusion. The drain is temporary, and therefore the patient may
be experiencing acute, not chronic, pain.
A client has an intravenous infusion in the left forearm. A nurse finds that the solution is infusing
at a much slower rate than was established earlier. After verifying that the infusion
has NOT infiltrated, the nurse should take which of these actions next?
a. Agitate the infusion container.
b. Reposition the client's left arm.
c. Check the intravenous fluid for sedimentation.
d. Have the client open and close the left fist.
b. Reposition the client's left arm.
Repositioning the patient's arm can often change the position of the catheter enough to regain
proper flow. The other measures can be assessed for, and/or tried, but are not the first actions
that the nurse should consider.
A client has an order for a transdermal nitroglycerin (Nitro-Dur) patch q 6h. Which of these
actions should a nurse include when applying a new patch?
a. Rotate the application site.
b. Locate the point of maximal impulse.
c. Count the pulse for a full minute.
d. Leave the previous patches in place.
a. Rotate the application site.
The patch should be placed in a different position after the old one is removed. The medication
can be absorbed through the skin at any location. A one minute pulse would be obtained prior to
administering digoxin (Lanoxin).
A client has received instructions from a nurse about physical preparation for surgery. The
teaching has been effective if the client can identify that the purpose of having nothing by mouth
for six to eight hours prior to surgery is to
a. enhance the administration of anesthesia preoperatively.
b. regulate intraoperative fluid status.
A+ TEST BANK 4
Exam
NACE Care Of Childbearing Family Exam
/NACE Care Of Childbearing Family Predictor
Exam With Complete Questions And Correct
Answers with Deatailed Rationales Graded A+
A newly admitted client becomes restless and confused at night. Which of these nursing
measures would be most important to promote the client's safety?
a. Putting the client on a bedpan at regular intervals.
b. Attaching the call bell to the bed near the client's dominant hand.
c. Moving the client to a room with ambulatory patients.
d. Keeping a small light on in the client's room.
d. Keeping a small light on in the client's room.
Keeping a small light on in the patient's room is the most important nursing measure to promote
the patient's safety. This will help the patient see the room (safety measure) and orient
themselves as to where they are during the night. Moving the patient to a room with ambulatory
patients, attaching the call bell to the bed near the patient's dominant hand, or putting the
patient on a bedpan at regular intervals would not be the most important nursing measures to
promote safety.
A nurse identifies all of these nursing diagnoses for a client. Which diagnosis should the nurse
give the highest priority?
a. Impaired skin integrity.
b. Altered nutrition: less than body requirements.
c. Impaired tissue perfusion.
d. Altered comfort: pain.
c. Impaired tissue perfusion.
A nurse gives priority to life-threatening conditions which need immediate professional attention
A+ TEST BANK 1
, NACE Care Of Childbearing Family Actual
Exam
(those related to oxygenation, circulation, and breathing). These include respiratory obstruction,
severe hemorrhage, or arrest. Nursing action is to remove or prevent the cause of the most
immediate life-threatening problem.
A nurse is instructing a client on how to limit saturated fat intake and increase intake of foods
high in polyunsaturated fat. Which of these fats is highest in polyunsaturated fatty acids?
a. Vegetable shortening.
b. Corn oil.
c. Butter.
d. Olive oil.
b. Corn oil.
Among these choices, corn oil has the highest amount of polyunsaturated fatty acid. Other oils
high in polyunsaturated fats are flax seed oil, hemp oil, pumpkin seed oil, safflower oil, sesame
oil, soybean oil, and sunflower oil. Olive oil, butter, and vegetable oil are not high in
polyunsaturated fatty acids.
A client who has a possible fractured wrist goes to the Emergency Department. For which of
these rationales should a nurse apply a cold pack to the area?
a. Reduce blood flow to the wrist.
b. Increase tissue metabolism in the wrist.
c. Promote delivery of nutrients to the wrist.
d. Reduce blood viscosity in the wrist.
a. Reduce blood flow to the wrist.
Ice will assist vasoconstriction, and therefore decrease blood flow. Increased blood flow will
increase swelling and pain in the affected area.
A client who has weakness of the left arm and leg can walk short distances with a cane and
assistance. Which of these techniques should a nurse select to provide the client with
appropriate assistance?
a. The nurse stands by the client's right side, supporting the right arm, with the cane on the left
side.
b. The client places the cane on the left side, with the nurse supporting the left side.
c. The nurse stands by the client's left side, supporting the right arm, with the cane on the left
A+ TEST BANK 2
, NACE Care Of Childbearing Family Actual
Exam
side.
d. The client places the cane on the right side, with the nurse supporting the left side.
d. The client places the cane on the right side, with the nurse supporting the left side.
The patient should place the cane on the right side, with the nurse supporting the left side.
Holding the cane on the unaffected side provides support to the affected lower limb. The other
choices (the nurse stands by the patient's right side, supporting the right arm, with the cane on
the left side; the nurse stands by the patient's left side, supporting the right arm, with the cane
on the left side; or the patient places the cane on the left side, with the nurse supporting the left
side) are not techniques a nurse should select in this situation.
An 83-year-old client who was recently admitted to a nursing care facility frequently looks
vacantly at family members and says, "I don't know where I am." A nurse notes that the client
also has a history of getting up several times at night and falling. Based on the information the
nurse should give priority to which of these measures?
a. Placing a call light within the client's reach.
b. Having the client void before they go to bed.
c. Reminding the client that this is their new home now.
d. Maintaining the bed in a low position.
d. Maintaining the bed in a low position.
Maintaining the bed in the lowest position and even placing the mattress on the floor will reduce
the risk of injury if the patient does fall, and should be a priority measure in the patient's evening
care. The other options are applicable but are not the priority.
A client has an abdominal wound drainage tube attached to wall suction. Which of these nursing
diagnoses should be included in the client's care plan?
a. Imbalanced body temperature.
b. Altered gastrointestinal tissue perfusion.
c. Fluid volume deficit.
d. Chronic pain.
c. Fluid volume deficit.
The suction will affect the amount of fluid removed from the patient's body. It will not alter the
A+ TEST BANK 3
, NACE Care Of Childbearing Family Actual
Exam
patient's temperature or tissue perfusion. The drain is temporary, and therefore the patient may
be experiencing acute, not chronic, pain.
A client has an intravenous infusion in the left forearm. A nurse finds that the solution is infusing
at a much slower rate than was established earlier. After verifying that the infusion
has NOT infiltrated, the nurse should take which of these actions next?
a. Agitate the infusion container.
b. Reposition the client's left arm.
c. Check the intravenous fluid for sedimentation.
d. Have the client open and close the left fist.
b. Reposition the client's left arm.
Repositioning the patient's arm can often change the position of the catheter enough to regain
proper flow. The other measures can be assessed for, and/or tried, but are not the first actions
that the nurse should consider.
A client has an order for a transdermal nitroglycerin (Nitro-Dur) patch q 6h. Which of these
actions should a nurse include when applying a new patch?
a. Rotate the application site.
b. Locate the point of maximal impulse.
c. Count the pulse for a full minute.
d. Leave the previous patches in place.
a. Rotate the application site.
The patch should be placed in a different position after the old one is removed. The medication
can be absorbed through the skin at any location. A one minute pulse would be obtained prior to
administering digoxin (Lanoxin).
A client has received instructions from a nurse about physical preparation for surgery. The
teaching has been effective if the client can identify that the purpose of having nothing by mouth
for six to eight hours prior to surgery is to
a. enhance the administration of anesthesia preoperatively.
b. regulate intraoperative fluid status.
A+ TEST BANK 4
