OBSTETRICS AND GYNAECOLOGY ASSESSMENT

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OBSTETRICS AND GYNAECOLOGY ASSESSMENT - PART 1

THIS ASSESSMENT IS POWERED BY ACHIEVERS NCLEX-RN CONSULT. visit us at www.achieversnclexrn.com

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Q1. A primigravid client in early labor is admitted and reports intense back pain with contractions. The fetal position is determined to be right occiput posterior. Which action by the nurse would be most helpful for alleviating the client's back pain during early labor?
*

1 point

1. Applying counterpressure to the client's sacrum during contractions

2. Encouraging the client to remain in bed during early labor

3. Positioning the client on the left side with pillows for support

4. Requesting that the nurse anesthetist administer epidural anesthesia

Q2. A nurse is preparing to administer an oxytocin IV infusion to a client for labor induction. The nurse recognizes that an oxytocin infusion may increase the client's risk for which of the following? Select all that apply.
*

1 point

1. Abnormal or indeterminate fetal heart rate patterns

2. Delayed breast milk production

3. Placenta previa

4. Postpartum hemorrhage

5. Uterine tachysystole

Required

Q3. Which client in a prenatal clinic should the nurse assess first?
*

1 point

1. Client at 11 weeks gestation with backache and pelvic pressure

2. Client at 16 weeks gestation with earache and sinus congestion

3. Client at 27 weeks gestation with headache and facial edema

4. Client at 37 weeks gestation with white vaginal discharge and urinary frequency

Q4. A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply.
*

1 point

1. Influenza injection

2. Influenza nasal spray

3. Measles, mumps, and rubella

4. Tetanus, diphtheria, and pertussis

5. Varicella

Required

Q5. A nurse is caring for a client following a forceps-assisted vaginal birth. The client reports severe vaginal pain and fullness. On assessment, the nurse notices a firm, midline uterine fundus. Lochia rubra is light. Which diagnosis should the nurse anticipate?
*

1 point

1. Cervical lacerations

2. Inversion of the uterus

3. Uterine atony

4. Vaginal hematoma

Q6. A client in active labor who received an epidural 20 minutes ago reports feeling nauseated and lightheaded. Which action should the nurse perform first?
*

1 point

1. Administer IV ondansetron

2. Apply oxygen via face mask

3. Obtain blood pressure

4. Perform vaginal examination

Q7. The precepting nurse is supervising a new obstetric nurse performing a labor admission assessment on a client with suspected spontaneous rupture of membranes. Which action by the new nurse would cause the precepting nurse to intervene?

*

1 point

1. Documenting a positive nitrazine test result when the test strip turns blue

2. Donning nonsterile gloves and using soluble gel for vaginal examination

3. Palpating the client's abdomen before applying external fetal monitors

4. Providing the client with a variety of clear liquids to drink

Q8. The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After reviewing the client's chart and performing an initial assessment, the nurse notes several abnormal findings. Which finding should the nurse discuss with the health care provider immediately?
*

1 point

1. Dark red vaginal bleeding

2. Edema of the hands and face

3. Elevated liver enzymes

4. Urine output of 150 mL in 4 hours

Q9. The nurse is teaching a class of expectant parents about infant safety. Which statement by a class participant indicates a need for further instruction?
*

1 point

1. "I will allow my baby to sleep with a pacifier."

2. "I will dress my baby in a sleep sack to prevent my baby from getting cold."

3. "I will make sure there is a firm mattress in the crib."

4. "I will tie bumper pads to the sides of the crib to protect my baby's head."

Q10. The obstetric nurse is reviewing phone messages. Which client should the nurse call first?
*

1 point

1. Client at 18 weeks gestation taking ceftriaxone and reporting mild diarrhea

2. Client at 22 weeks gestation with twins who is taking acetaminophen twice a day

3. Client at 28 weeks gestation taking metronidazole and reporting dark-colored urine

4. Client at 32 weeks gestation taking ibuprofen for moderate back pain

Q11. The nurse is admitting a pregnant client who is experiencing intense "back labor." The nurse suspects the fetus is in which position? *

1 point

Option 1

Option 2

Option 3

Option 4

Q12. The nurse is caring for a postpartum couplet and notices that the newborn is cyanotic and apneic, with a heart rate of 70/min. The nurse calls for help and begins resuscitation. Which position is appropriate for ventilating the newborn? *

1 point

Option 1

Option 2

Option 3

Option 4

Q13. The graduate nurse (GN) receives report on a postpartum client with an Rh-negative blood type. Which statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide further teaching?
*

1 point

1. "Additional doses of Rh immune globulin may be required if excessive fetomaternal hemorrhage is suspected."

2. "I should administer Rh immune globulin to the client within 72 hours after birth."

3. "If the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health care provider."

4. "Rh immune globulin is not required if the newborn's blood type is Rh negative."

Q14. The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion. The nurse notes persistent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply.
*

1 point

1. Administer oxygen via a nonrebreather face mask

2. Change maternal position to the left side

3. Discontinue the oxytocin infusion

4. Notify the health care provider

5. Perform a nitrazine test

Required

Q15. The nurse is preparing to teach the perinatal unit staff about caring for newborns with either omphalocele or gastroschisis. Which of the following statements are appropriate for the nurse to include? Select all that apply.
*

1 point

1. "An omphalocele with an intact peritoneal sac should be covered with a sterile, nonadherent dressing immediately after birth."

2. "If immediate surgical repair of the defect is planned, the newborn should be fed via a nasogastric tube instead of breastfed."

3. "Newborns with omphalocele or gastroschisis require IV access for fluid and electrolyte replacement."

4. "Newborns with omphalocele or gastroschisis should be monitored closely for temperature instability and infection."

5. "Petroleum jelly should be applied to the exposed bowel of newborns with gastroschisis before it is covered with plastic."

Required

Q16. The nurse is performing the initial assessment of a newborn. Which of the following findings should the nurse report to the health care provider?

Select all that apply.
*

1 point

1. Cyanosis of the hands and feet

2. Decreased muscle tone

3. Heart rate of 150/min

4. Sacral dimple with a 0.4 in (1 cm) skin tag

5. Single artery in the umbilical cord

Required

Q17. The nurse is caring for a group of 1-day-old clients in the newborn nursery. Which finding requires immediate attention?
*

1 point

1. Abdominal breathing with 15-second pauses in a sleeping newborn

2. Apical pulse of 190/min in a newborn who is crying

3. Heart murmur in a newborn who is feeding appropriately

4. Respirations of 68/min with grunting in a newborn post cesarean birth

Q18. A laboring client at 35 weeks gestation comes to the labor and delivery unit with preterm rupture of membranes "about 18 hours ago." The client's group B Streptococcus status is unknown. What intervention is a priority for this client?.
*

1 point

1. Administration of prophylactic antibiotics

2. Assessment of uterine contraction frequency

3. Collection of a clean-catch urine specimen

4. Vaginal examination to assess cervical dilation

Q19. A nurse is caring for a pregnant client at 27 weeks gestation after a motor vehicle collision with side airbag deployment. The client's blood type is O negative. Which laboratory test should the nurse anticipate?
*

1 point

1. Group B streptococcal culture

2. Indirect Coombs test

3. Rubella immunity titer

4. Serum alpha-fetoprotein

Q20. Within thirty seconds after birth, an unresponsive and limp newborn is placed on the warmer in the "sniffing" position. The nurse clears the airway, dries, and stimulates the newborn. At 1 minute of life, the newborn has shallow, gasping respirations with a heart rate of 62/min. What action should the nurse take?
*

1 point

1. Administer epinephrine

2. Begin positive pressure ventilation

3. Continue stimulating the newborn

4. Start chest compressions

Q21. The nurse is performing the initial assessment of a newborn. Which finding should the nurse report to the health care provider?
*

1 point

1. A sudden jarring of the client's crib does not produce a Moro reflex.

2. The client has swollen labia and a thin, white vaginal discharge.

3. The posterior fontanel is triangular and smaller than the anterior fontanel.

4. There are pearly, white pinpoint papules on the client's face and nose.

Q22. The nurse reviews the external fetal monitoring tracing of a client receiving an oxytocin infusion for labor augmentation. The health care provider (HCP) asks the nurse to increase the oxytocin infusion rate. Which action by the nurse is appropriate at this time? Click the exhibit button for additional information. *

1 point

1. Ask the charge nurse to speak with the HCP

2. Increase the oxytocin infusion rate as requested by the HCP

3. Recommend to the HCP that the infusion rate be decreased at this time

4. Request that the current infusion rate be maintained due to the client's contraction pattern

Q23. The nurse cares for a client who gave birth an hour ago to a 9-lb (4.1-kg) newborn. The client's lochia is heavy with large clots, and the fundus remains boggy after fundal massage and an oxytocin bolus. Which prescription from the health care provider should the nurse question? Click on the exhibit button for additional information.
*

1 point

1. Administer 0.2-mg methylergonovine IM

2. Administer 800-mcg misoprostol rectally

3. Collect a hemoglobin and hematocrit STAT

4. Initiate second IV line with 18-gauge needle

Q24. When assessing a preterm newborn for cold stress, a graduate nurse in the newborn nursery needs further teaching when stating the need to assess for which finding?
*

1 point

1. Irritability

2. Poor feeding

3. Shivering

4. Weak cry

Q25. The nurse is caring for a client who reports severe abdominal pain and vaginal spotting. The client had a positive urine pregnancy test at home, and her last menstrual period was 8 weeks ago. Which client report to the nurse is most concerning?
*

1 point

1. Abdominal pain rated as 8 out of 10

2. History of pelvic inflammatory disease

3. Intermittent nausea and vomiting for the past 7 days

4. Right shoulder pain and dizziness

Q26. A nurse is teaching the parent how to care for a newly circumcised newborn. Which statement by the parent indicates that further teaching is needed?
*

1 point

1. "Discharge and odor indicate infection of the circumcision site."

2. "I will clean the area with alcohol-based wipes or soap water."

3. "Infant crying during petrolatum gauze changes is expected."

4. "The diaper should be changed at least every 4 hours."

Q27. A newborn diagnosed with trisomy 18 (Edwards syndrome) is on ventilator support. The client's parents have repeatedly asked when their child will be able to breathe without the ventilator. Which action by the nurse is appropriate?
*

1 point

1. Facilitate a meeting between the health care providers, palliative care team, and parents to discuss care plan

2. Notify the parents of the newborn's genetic test results and provide information to read about trisomy 18

3. Provide the parents with information about various options for curative medical treatment for their child

4. Share with the parents that many newborns with trisomy 18 live long enough to go home with their families

Q28. The nursery nurse is performing assessments of several newborns. Which of the following findings are abnormal and need to be reported to the health care provider? Select all that apply.
*

1 point

1. Chest wall retractions

2. Desquamation of the feet

3. Head circumference of 13.5 in (34 cm)

4. Jaundiced appearance

5. No voiding in 24 hours

Required

Q29. A client suspects she is pregnant and comes for prenatal evaluation. Which assessment findings indicate definitive evidence (positive signs) of pregnancy? Select all that apply.
*

1 point

1. Cervical softening on examination

2. Fetal heart tones detected by Doppler device

3. Positive serum human chorionic gonadotropin test

4. Report of fetal movement felt by client

5. Visualization of fetus by ultrasound

Required

Q30. The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What is the nurse's best action based on these results? Click on the exhibit button for additional information.
*

1 point

1. Complete the client assessment and documentation

2. Draw another sample for repeat complete blood count

3. Prepare for transfusion of packed red blood cells

4. Request a prescription for iron supplementation

31. Which assessment findings would the nurse most likely expect to find in a male infant born at 28 weeks gestation? Select all that apply.
*

1 point

1. Abundant lanugo on shoulders and back

2. Deep creases and peeling skin on soles of feet

3. Flat areolae without palpable breast buds

4. Smooth, pink skin with visible veins

5. Testes completely descended into the scrotum

Required

Q32. The nurse has received report for a term newborn after a vaginal birth. Maternal history includes diagnosis of gestational diabetes at 25 weeks gestation and poorly controlled blood glucose during pregnancy. When assessing the newborn, which finding should the nurse most likely expect?
*

1 point

1. Delayed meconium passage

2. Elevated hematocrit level

3. Shrill cry and frequent yawning

4. Smooth philtrum and thin upper lip

Q33. A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction?
*

1 point

1. Bishop score of 10

2. Firm and posterior cervix

3. History of precipitous labor

4. Reactive nonstress test

Q34. A client without prenatal care gives birth to a newborn at term gestation. The client denies opioid or other illicit drug use during pregnancy. When monitoring the newborn, which of the following signs would indicate neonatal abstinence syndrome to the nurse? Select all that apply. *

1 point

1. Irritability and restlessness

2. Meconium ileus and floppy muscle tone

3. Microcephaly and cleft palate

4. Nasal congestion and frequent sneezing

5. Poor feeding and loose stools

Required

Q35. A nurse is caring for a client at 30 weeks gestation who is admitted for preterm labor. Which of the following interventions should the nurse anticipate? Select all that apply.
*

1 point

1. Administering IM betamethasone

2. Administering penicillin via IV piggyback

3. Assisting with artificial rupture of membranes

4. Initiating IV magnesium sulfate

5. Obtaining fetal heart tones once per shift

Required

Q36. The nurse is caring for a client with gestational diabetes mellitus during the second stage of labor. After birth of the head, the nurse notes retraction of the fetal head against the maternal perineum. Which action should the nurse anticipate?
*

1 point

1. Administering a tocolytic

2. Initiating fundal pressure during a contraction

3. Obtaining the vacuum extractor

4. Pressing downward on the symphysis pubis

Q37. A pregnant client arrives in the labor and delivery unit with mild contractions and brisk, painless vaginal bleeding. The client received no prenatal care and reports being "about 7-8 months." Which actions should the nurse anticipate? Select all that apply.
*

1 point

1.Blood draw for type and screen

2.Electronic fetal monitoring

3.Initiation of 2 large-bore IV catheters

4.Pad counts to assess bleeding

5.Vaginal examination for cervical dilation

Required

Q38. The graduate nurse (GN) is caring for a client at 20 weeks gestation with secondary syphilis. The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When discussing the client's potential treatment plan with the precepting nurse, which statement by the GN indicates an appropriate understanding?.
*

1 point

1."Doxycycline is an acceptable alternative to penicillin for treatment of syphilis during pregnancy."

2."The client will require penicillin desensitization to receive appropriate treatment."

3."The newborn can be treated after birth if antepartum treatment is contraindicated."

4."Treatment is only effective if provided during the primary stage of syphilis."

Q39. The nurse is caring for a client in the first trimester during an initial prenatal clinic visit. Based on the information provided by the client, which factor places the client at an increased risk for preterm labor? *

1 point

1. Age 25

2. Periodontal disease

3. Vegetarian diet

4. White ethnicity

Q40. A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)?
*

1 point

1. Hemoglobin and hematocrit levels

2. Human chorionic gonadotropin level

3. Serum folate level

4. White blood cell count

Q41. A nulliparous client asks about being in "real" labor. The nurse should teach that which signs are most indicative of true labor? Select all that apply.
*

1 point

1. Contractions that increase in frequency

2. Contractions that lessen after resting

3. Increased blood-tinged, mucoid vaginal discharge

4. Pain in lower back that moves to lower abdomen

5. Progressive cervical effacement and dilation

Required

Q42. The graduate nurse (GN) is assisting the nurse preceptor to provide education to a client diagnosed with a molar pregnancy. Which statement by the GN requires the precepting nurse to intervene?

*

1 point

1. "A uterine evacuation procedure is the typical treatment for removing the abnormal tissue."

2. "We can provide you with resources for coping with perinatal loss if needed."

3. "You may start trying to conceive again as soon as you and your partner feel ready."

4. "You will need Rh immune globulin following a molar pregnancy because you have a Rh-negative blood type."

Q43. A laboring client with epidural anesthesia experiences spontaneous rupture of membranes, immediately followed by an abrupt change in the fetal heart rate. The nurse knows that considering the probable cause of the change in fetal heart rate, which action should be taken first? Click on the exhibit button for additional information.
*

1 point

1. Administer IV fluid bolus

2. Assess for umbilical cord prolapse

3. Notify the health care provider

4. Reposition client to alternate side

Q44. The nurse is caring for a 1-day-old client at term gestation who is irritable, feeding poorly, and only sleeping for very short intervals. The newborn's mother informs the nurse that she has been taking hydrocodone on a regular basis for several years. Which intervention is appropriate to include in the newborn's plan of care?
*

1 point

1. Avoid giving the newborn a pacifier

2. Position the newborn supine after feeding

3. Stimulate the newborn with light regularly

4. Swaddle and gently rock the newborn

Q45. A pregnant client in the first trimester tells the clinic nurse she will be traveling to an area with a known Zika virus outbreak and expresses concern regarding disease transmission. Which statement by the nurse is most appropriate?
*

1 point

1. "If you experience Zika symptoms, notify your health care provider."

2. "Take precautions against mosquito bites throughout the trip."

3. "You are not far enough along for the Zika virus to affect your baby."

4. "You should consider postponing your trip until after you have the baby."

Q46. The nurse reviews the laboratory results of a laboring client who is requesting epidural anesthesia. Which value is the priority to report to the anesthesia provider prior to epidural placement? Click on the exhibit button for additional information.
*

1 point

1. Blood type and Rh

2. Hemoglobin

3. Platelet count

4. White blood cell count

Q47. The nurse is monitoring a client who is 6 cm dilated with recurrent variable decelerations on the fetal heart rate monitor. The health care provider (HCP) places an intrauterine pressure catheter and prescribes an amnioinfusion. After the amnioinfusion bolus is complete, which assessment finding should the nurse report to the HCP immediately? Click the exhibit button for additional information.
*

0 points

1. Cervix is 8 cm dilated and 100% effaced, with fetal presenting part at +1 station

2. Contractions are every 3 minutes and 60-80 seconds each

3. Fetal heart rate baseline is 155/min with early decelerations and moderate variability

4. Uterine resting tone baseline has increased to 45 mm Hg and perineal pads are dry

Q47. A client at 38 weeks gestation is brought to the emergency department after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions and mild, dark vaginal bleeding. What actions should the nurse take? Select all that apply.
*

1 point

1. Anticipate emergent cesarean birth

2. Apply continuous external fetal monitoring

3. Assess routine vital signs every 4 hours

4. Draw blood for type and crossmatch

5. Initiate IV access with a 22-gauge catheter

Required

Q48. A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse?
*

1 point

1. Advise the client to consume hot, versus cold, foods

2. Instruct the client to drink 2 glasses of water with each meal

3. Suggest the client consume high-protein snacks before bedtime

4. Tell the client that morning sickness should pass in a few weeks

Q49. A pregnant client is brought to the emergency department by ambulance after her water broke. She is screaming and bearing down with every contraction. Which of the following assessment questions are essential to ask in preparation for the birth and possible newborn resuscitation? Select all that apply.
*

1 point

1. "Did you receive the influenza vaccine during pregnancy?"

2. "Do you take any medications or illicit drugs?"

3. "How many babies are you expecting?"

4. "What color was the fluid when your water broke?"

5. "When is your due date?"

Required

Q50. The nurse is documenting assessments of pregnant clients in the antepartum unit. Which client's assessment findings are most important to report to the health care provider?
*

1 point

1. Client at 28 weeks gestation with an asymptomatic systolic murmur

2. Client at 34 weeks gestation with 1+ edema of bilateral lower extremities

3. Client at 35 weeks gestation with painful genital lesions

4. Client at 39 weeks gestation with brownish, mucoid vaginal discharge

Q51. The nurse is monitoring a client who is in active labor with a cervical dilation of 6 cm. Which uterine assessment finding requires an intervention by the nurse?
*

1 point

1. Contraction duration of 95 seconds

2. Contraction frequency of every 3 minutes

3. Contraction intensity of 45 mm Hg

4. Uterine resting tone of 10 mm Hg

Q52. The nurse is caring for a postpartum client 36 hours after a cesarean birth who was just diagnosed with postpartum endometritis. Which prescription is priority for the nurse to administer? Click the exhibit button for additional information.
*

1 point

1. Acetaminophen PO PRN for fever

2. Clindamycin IV every 8 hours

3. Lactated Ringer IV bolus once

4. Methylergonovine PO every 4 hours

Q53. The nurse is obtaining a client's history during an initial prenatal visit. The client's last menstrual period was from March 1 to March 5. Unprotected intercourse occurred on March 15. Slight vaginal spotting was noted on March 23. The client's menstrual cycles are regular and 28 days long. Using the Nägele rule, what is the estimated date of birth?
*

1 point

1. December 8

2. December 12

3. December 22

4. December 30

Q54. A pregnant client comes to the labor and delivery unit stating, "My water just broke at home." On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina. Which nursing intervention would be appropriate?
*

1 point

1. Apply suprapubic pressure

2. Assist the client to the knee-chest position

3. Perform Leopold maneuvers

4. Perform the McRoberts maneuver

Q55. The nurse assesses a newborn with skin discoloration in the lumbar area, as shown in the exhibit. What would be an appropriate action for the nurse to complete? Click the exhibit button for additional information.
*

1 point

1. Assess the infant's hemoglobin, hematocrit, and platelet levels

2. Measure and document the size and location of the markings

3. Notify the health care provider of the markings immediately

4. Review the delivery record for evidence of a traumatic birth

Q56. The pediatric nurse is performing an assessment on a 4-week-old client in the clinic. During the assessment, the newborn's mother starts to cry and states, "I am the worst mother in the world." What should the nurse ask next?
*

1 point

1. "Do you have a support system to help process your feelings?"

2. "Do you have any questions about how to care for your newborn?"

3. "Have you experienced difficulty falling asleep or getting rest?"

4. "Have you felt depressed or hopeless over the last 2 weeks?"

Q57. A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. Which action should the nurse take first?
*

1 point

1. Administer normal saline fluid bolus

2. Ask about any prenatal complications

3. Initiate fetal heart rate monitoring

4. Tilt the backboard to one side

Q58. A client gives birth within an hour of arriving at the labor and delivery unit and delivers the placenta 5 minutes later. During assessment, the nurse notes that the uterus is midline and boggy. Which action should the nurse take first?

*

1 point

1. Check for pooled blood under buttocks

2. Increase IV oxytocin infusion rate

3. Monitor blood pressure and pulse

4. Perform firm fundal massage

Q59. A client, gravida 4 para 3, at 38 weeks gestation arrives in the emergency department with strong contractions that began 1 hour ago. The client is diaphoretic, grunting, and yelling loudly that she wants an epidural because she feels the need to push. What priority action should the nurse take?
*

1 point

1. Apply gloves and assess perineal area

2. Initiate large-bore IV access

3. Notify anesthesia provider of client's request for epidural

4. Obtain fetal heart tones via Doppler

Q60. A client in labor has reached 8 cm dilation, is fully effaced, and feels an urge to push. The nurse observes thick, blood-tinged mucus during the vaginal examination. What is the nurse's best action?
*

1 point

1. Administer prescribed IV meperidine for pain relief

2. Encourage client to bear down with spontaneous urges to push

3. Place client in the lithotomy position in preparation for birth

4. Provide encouragement and coaching in breathing techniques

Q61. A client at 41 weeks gestation is admitted to the labor and delivery unit for labor induction. The nurse is assisting the health care provider with an amniotomy. What actions should the nurse anticipate? Select all that apply.
*

1 point

1. Assessing the fetal heart rate before and after the procedure

2. Checking the client's temperature every 2 hours

3. Informing the client she will feel a sharp pain during the procedure

4. Keeping the client in a supine position after the procedure

5. Noting the characteristics of the amniotic fluid

Required

Q62. The nurse is preparing to discharge a client following a first trimester miscarriage. Which of the following statements should the nurse include in discharge teaching for the client and partner? Select all that apply.

*

1 point

1. "Attending a support group with other people who had a pregnancy loss can be helpful."

2. "Genetic counseling is recommended for couples after their first miscarriage."

3. "One of the most important things you can do right now is communicate with your partner."

4. "The grieving period only lasts about 6 months following a miscarriage."

5. "Trying to conceive again can help you cope by giving you something to look forward to."

Required

Q63. The nurse is reinforcing education to a group of clients that are pregnant or planning pregnancy. Which of the following client statements about alcohol use in pregnancy should concern the nurse? Select all that apply.
*

1 point

1. "As long as I don't binge drink, an occasional glass of wine is fine."

2. "I drank alcohol heavily before realizing I was pregnant, so there is no benefit to quitting now."

3. "If I drink alcohol, my baby may have withdrawal after birth but no permanent damage."

4. "It is important to stop drinking while I am trying to conceive."

5. "Third-trimester alcohol use is less harmful because the baby is fully developed."

Required

Q64. A newborn client is seen in the emergency department for vomiting. Which assessment finding indicates a possible emergency?
*

1 point

1. Frequent vomiting since birth

2. Tiny blood streaks in the vomit

3. Vomit that is green

4. Vomiting through the nose

Q65. The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G5T1P2A1L2. Which interpretation of this notation is correct?
*

1 point

1. The client had 1 birth at 37 wk 0 d gestation or beyond

2. The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation

3. The client has 3 currently living children

4. The client is currently not pregnant

Q66. A client postpartum 3 days scheduled for discharge today was given education about diaper changes yesterday. The client says to the nurse, "I'm so glad you are here. I think my baby has a dirty diaper. I can't change it as well as you can. Will you change my baby's diaper for me?" What is the nurse's best response?
*

1 point

1. Reassure the mother that it takes time to learn how to care for a baby while quickly changing the diaper

2. Suggest that the mother change the diaper as the nurse watches

3. Tell the mother that it is time to take over changing the baby's diaper as she will have to do it once discharged

4. Tell the mother that the nurse will change the baby's diaper while she watches

Q67. The labor and delivery nurse is caring for a Japanese client who has declined epidural anesthesia. The client has been very stoic and quiet throughout labor. Which nursing action represents the most appropriate care for this client?
*

1 point

1. Complete hourly pain assessments using a numeric pain scale

2. Document that the client appears to be experiencing minimal pain

3. Monitor for nonverbal signs of ineffective coping with labor

4. Recognize that the client's stoicism is ineffective coping with labor

Q68. The nurse is monitoring a neonate 1 hour after spontaneous vaginal delivery. Which of the following are expected findings? Select all that apply.
*

1 point

1. Capillary glucose of 60 mg/dL (3.3 mmol/L)

2. Holosystolic murmur auscultated at fourth intercostal space

3. Respirations of 56 breaths per minute

4. Single transverse crease across palm of the hand

5. White papules on bridge of the nose

Required

Q69. The nurse is caring for a baby born at 30 weeks gestation and diagnosed with necrotizing enterocolitis. Which nursing action should be implemented?
*

1 point

1. Encourage parents to increase skin-to-skin care

2. Measure abdominal girth daily

3. Measure rectal temperature every 3-4 hours

4. Position client on side and check diaper for stool

Q70. The nurse performing an initial newborn assessment observes a bluish discoloration of the hands and feet. The trunk has a pink color. Which action by the nurse is appropriate?
*

1 point

1. Apply blow-by oxygen and count respirations

2. Auscultate heart sounds for a murmur

3. Observe the newborn for expiratory grunting

4. Place the newborn skin-to-skin with the mother

Q71. The nurse is caring for a client at 21 weeks gestation with reports of occasional, bothersome heartburn (pyrosis). Which of the following lifestyle changes should the nurse recommend? Select all that apply.
*

1 point

1.Avoid intake of dairy products

2.Drink large amounts of fluid with meals

3.Eat several small meals each day

4.Eliminate fried, fatty foods

5.Lie down on the left side after meals

Required

Q72. A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not had prenatal care. Which topics are most important and priorities for the nurse to discuss with the client in anticipation of referral for prenatal care? Select all that apply.
*

1 point

1.Adoption planning

2.Family and social support

3.Future education plans

4.Nutrition and prenatal vitamins

5.Sexual abuse

Required

Q73. The labor and delivery charge nurse receives report on several clients. Which task is appropriate for the nurse to delegate to the unlicensed assistive personnel?
*

1 point

1.Assist a client to the restroom 1 hour after a vaginal birth with regional anesthesia

2.Check the perineal pad of a client who is in triage with possible rupture of membranes

3.Obtain vital signs on a newborn who is skin-to-skin with the mother 1 hour after birth

4.Reposition an unmedicated client who is in active labor onto a birthing ball

Q74. The labor and delivery nurse is performing a vaginal examination to assess for cervical dilation and effacement. While palpating the presenting fetal part, the nurse feels a diamond-shaped structure that feels soft in the middle. What is the nurse's best action?
*

1 point

1.Document fetal presentation as breech

2.Document fetal presentation as cephalic

3.Elevate the fetal presenting part away from the prolapsed cord

4.Request that the health care provider confirm fetal presentation

Q75. The nurse is performing telephone triage with a client at 38 weeks gestation who thinks she may be in labor. Which questions would help the nurse determine whether the client is in labor? Select all that apply.
*

1 point

1."Do you feel like the contractions are getting stronger?"

2."Does anything you do make the pain better?"

3."Have you lost your mucous plug?"

4."How frequent are the contractions?"

5."Where do you feel the contraction pain most?"

Required

Q75. A nurse is caring for a postpartum client who is breastfeeding and has been diagnosed with mastitis of the right breast. Which of the following instructions should the nurse include in client teaching? Select all that apply.
*

1 point

1.Apply warm compresses to breast

2.Discontinue breastfeeding until symptoms resolve

3.Increase oral fluid intake

4.Take ibuprofen as needed for pain

5.Wear a tight-fitting bra as much as possible

Required

Q77. A client who gave birth vaginally with epidural anesthesia still has limited movement and strength of the right leg, and reports no urge to urinate at 2 hours postpartum. The nurse palpates the client's fundus 2 cm above the umbilicus and to the right. What should the nurse do next?
*

1 point

1.Assist the client to the bathroom in a wheelchair

2.Encourage the client to drink plenty of fluids

3.Perform in-and-out catheterization

4.Reassess for bladder distension hourly

Q78. When assessing fetal heart rate status during labor, the monitor displays late decelerations with tachycardia and decreasing variability. What action should the nurse take?
*

1 point

A. Continue monitoring because this is a normal occurrence.

B. Turn client on right side.

C. Decrease IV fluids.

D. Report to physician or midwife.

Q79. A female client comes for her second prenatal visit. The nurse-midwife tells her, "Your blood tests reveal that you do not show immunity to the German measles." Which notation will the nurse include in her plan of care for the client? "Will need . . .
*

1 point

A. Rh-immune globulin at the next visit"

B. Rh-immune globulin within 3 days of delivery"

C. Rubella vaccine at the next visit"

D. Rubella vaccine after delivery on the day of discharge"

Q80. A client's membranes have just ruptured spontaneously. Which of the following nursing actions should take priority?
*

1 point

A. Assess quantity of fluid.

B. Assess color and odor of fluid.

C. Document on fetal monitor strip and chart.

D. Assess fetal heart rate (FHR).

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