EXAMS WITH ACTUAL CORRECT
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The nurse notes that a two-day old infant shows a tendency to bleed. The nurse understands this is
MOST likely caused by which of the following?
1. Hemophilia.
2. Absence of intestinal bacteria needed for the production of vitamin K.
3. Immature liver that is unable to synthesize clotting factors.
4. Excessive breakdown of red blood cells coupled with a delayed production of new ones.
Absence of intestinal bacteria needed for the production of vitamin K.
The nurse cares for a patient after a breast biopsy. After the procedure, it is MOST important for the
nurse to take which of the following actions?
1. Apply ice to the area.
2. Reposition the patient for comfort
3. Carefully transport the specimen to the lab
4. Observe for bleeding.
Observe for bleeding.
The nurse admits a patient to the postpartum unit two hours after a vaginal delivery. Three hours after
admission the nurse ambulates the patient to the bathroom, and the patient states there is a sudden
gush of bleeding from her vagina. The nurse understands that the increase in amount of bleeding is due
to which of the following?
1. The lochia pooled in the patient's vagina when she was lying in bed.
2. The patient has a tear in her cervix that needs to be repaired.
,3. The patient's fundus is relaxed and requires massaging.
4. The patient's bladder is distended because she needs to void.
The lochia pooled in the patient's vagina when she was lying in bed.
A woman comes to the clinic pregnant with her second child. She questions the nurse about the amount
of exercise that is acceptable for her to perform during her pregnancy. Which of the following is the
MOST important response by the nurse?
1. "You can continue your activities but rest when you get tired."
2. "You should take a brisk walk daily."
3. "You can exercise as much as you want but limit household activities."
4. "What is your usual type of exercise?"
"What is your usual type of exercise?"
The health care provider orders a colposcopy for the client. The nurse explains to the client that which is
the purpose of this procedure?
1. Magnify the tissue for examination
2. Directly examine ovaries, fallopian tubes, uterus, and small intestine.
3. View structures in the pelvic cavity,
4. Visualize the bladder.
Magnify the tissue for examination
The nurse monitors a client at 30 weeks gestation, and the client states that she has periodic heartburn.
It is MOST important for the nurse to make which of the following recommendations?
1. Lie down after eating a meal.
2. Eat frequent small meals.
3. Take Alka-Seltzer as needed.
4. Sip iced tap water.
Eat frequent small meals.
The nurse instructs the woman about how to prevent conception using the basal body temperature
(BBT) method. The nurse explains that during ovulation the woman's basal body temperature will
change in which direction?
1. Lowers significantly
2. Rises significantly
3. Is unchanged
4. Rises slightly
Rises slightly
A nurse accidentally bumps into a newborn's bassinet. The newborn jumps and pulls the extremities into
the trunk. The nurse identifies the newborn is demonstrating which of the following reflexes?
1. Tonic neck
2. Moro's
,3. Babinski's
4. Rooting
Moro's
When administering phototherapy to a newborn with jaundice, it is MOST important for the nurse to
take which of the following actions?
1. Expose only the infant's back to the light.
2. Remove the infant from the light for 15 minutes each hour.
3. Cover the infant's eyes with protective pads during therapy.
4. Check the infant's temp every hour.
Cover the infant's eyes with protective pads during therapy.
The nurse cares for a patient in labor. The patient suddenly shouts, "I have to push! I have to push!" The
nurse determines that the patient is 8 cm dilated. Which of the following actions should the nurse take
FIRST?
1. Instruct the patient to take a deep breath and bear down.
2. Apply pressure to the patient's fundus.
3. Coach the patient in relaxation techniques.
4. Encourage the patient to pant with pursed lips.
Encourage the patient to pant with pursed lips.
A 25-year-0ld primigravida diagnosed with type 1 diabetes mellitus reviews insulin regimen with the
nurse. The nurse reinforces the importance of regular prenatal care and explains changes in insulin
requirements will include which of the following?
1. Insulin requirements will increase during pregnancy and decrease after delivery.
2. Insulin requirements will decrease during pregnancy and increase after delivery.
3. Insulin requirements will increase during pregnancy and remain increased after delivery.
4. Insulin requirements decrease during pregnancy and remain decreased after delivery.
Insulin requirements will increase during pregnancy and decrease after delivery.
By the fifth month of pregnancy, a 32 year old multipara of average prenatal height and weight has
gained 14 pounds. Which of the following actions by the nurse is MOST important?
1. Advise the client she has gained too much weight and her diet should be reevaluated.
2. Advise the client she has not gained enough weight and her diet should be reevaluated.
3. Inform the client her weight gain is appropriate and she should continue on her present diet.
4. Inform the client she may have difficulties later in pregnancy and more frequent visits to the physician
are indicated.
Inform the client her weight gain is appropriate and she should continue on her present diet.
, The nurse instructs a patient who recently had a modified radical mastectomy. The nurse states that it is
important that the patient exercise her arm postoperatively to
1. increase muscle strength and diameter.
2. maintain body balance.
3. limit full range of motion.
4. prevent lymphedema.
prevent lymphedema.
The nurse instructs a client in the prenatal clinic about nutrition during pregnancy. The nurse
determines teaching is successful if the client selects which of the following foods from a menu?
1. Two eggs and 8 oz of milk
2. A 2 oz steak and 10 oz of beer.
3. A lettuce and tomato salad and 12 oz of orange juice.
4. One bag of potato chips and 16 oz of cola.
Two eggs and 8 oz of milk
The nurse prepares the client for a total abdominal hysterectomy with bilateral salpingo-oophorectomy
due to uterine cancer. The nurse observes that the client is talking continuously and has difficulty
maintaining eye contact. Which response by the nurse is BEST?
1. "What are your concerns about the surgery?"
2. "Why isn't your husband here with you?"
3. "Are you afraid that you are going to die?"
4. "You seem to be coping with the surgery very well."
"What are your concerns about the surgery?"
A woman is in active labor when her membranes rupture. She expresses a concern to the nurse she is
afraid of having a "dry labor." Which of the following responses by the nurse is MOST appropriate?
1. "Amniotic fluid does not function as lubrication for the labor process."
2. "The sac actually impedes the progress of labor and if it had not ruptured, the doctor would have to
do it artificially."
3. "Labor is only slightly more difficult with early rupture of the amniotic sac."
4. "Now that there is limited amniotic fluid, you may have to have a cesarean section."
"Amniotic fluid does not function as lubrication for the labor process."
The woman tells the nurse that she has always had a heavy menstrual flow and needs extra iron. The
nurse should recommend the client eat which food?
1. Chicken livers
2. Pork
3. Hamburger
4. Tofu
Chicken livers