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    Exam Review

    1. A postpartum client who is Rh-negative refuses to receive Rho(D) immune globulin after delivery of an infant who is Rh-positive. Which information should the nurse provide this client?
      A)
      The Rh-positive factor from the fetus threatens her blood cells.
      B)
      The mother should receive Rho(D) immune globulin when the baby is Rh-negative.
      C)
      Rho(D) immune globulin prevents maternal antibody formation for future Rh-positive babies.
      D)
      Rho(D) immune globulin is not necessary unless all her pregnancies are Rh-positive.
    2. The nurse is providing preconception counseling. Which supplement should the nurse recommend to help prevent the occurrence of anencephaly?
      A)
      Iron.
      B)
      Vitamin D.
      C)
      Folic acid.
      D)
      Calcium.
    3. Exhibits The nurse is reviewing the clients' chart.
      (Highlight — findings requiring follow-up are marked)
      Exhibits

      The nurse is reviewing the clients' chart.

      Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage.

      36-year-old client who is gravida 5, para 5, transferred to the postpartum unit 1 hour after delivery of a 9 lb 1 oz (4.1 kg) female. She was in labor for 25 hours and forceps were used to assist with the delivery. She was given an epidural for anesthesia that was effective. The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale. Her vital signs were stable, and she was catheterized for 500 mL of light yellow urine just prior to delivery. Her spouse was at the bedside for delivery and appeared supportive. Blood type A+. Estimated blood loss was 600 mL after delivery.

    4. Exhibits Based on the client's history and physical, the nurse notes that this postpartum client is most at risk for developing ▾ postpartum hemorrhageand▾ venous thromboembolism.
      Dropdown 1:
      Option 1: preeclampsia
      Option 2: venous thromboembolism
      Option 3: seizures
      Option 4: wound dehiscence
      Option 5: postpartum hemorrhage
      Dropdown 2:
      Option 1: preeclampsia
      Option 2: venous thromboembolism
      Option 3: seizures
      Option 4: wound dehiscence
      Option 5: postpartum hemorrhage
    Page 1 of 15

    Exam Review

    1. Exhibits The nurse has reviewed the client's chart. Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. The nurse recognizes that this client is ▾ At risk of hemorrhagedue to▾ boggy fundus with a shift to the right.
      Dropdown 1:
      Option 1: At risk for infection
      Option 2: In pain
      Option 3: At risk of hemorrhage
      Dropdown 2:
      Option 1: genital tract trauma
      Option 2: boggy fundus with a shift to the right
      Option 3: moderate lochia rubra with small clots
      Option 4: I apologize for the misunderstanding. Here is the revised answer based on your instructions:
    2. Exhibits The nurse reviews the nurse's notes and flow chart to identify trends.
      (Highlight — findings requiring follow-up are marked)
      Exhibits

      The nurse reviews the nurse's notes and flow chart to identify trends. Click to specify the notations that require immediate follow up (more than one notation may be correct.)

      Body System

      Nurses Notes and Flow Sheet

      Respiratory

      Respirations 16 breaths/minute

      Oxygen saturation of 89%

      Several deep breaths

      Integumentary

      Episiotomy intact with no redness

      Pad is saturated with blood

      18 gauge IV to left forearm

      Circulatory

      Heart rate 96 beats/minute

      Blood pressure 90/62 mm Hg

      IV infusing at 125 mL/hr

      Genital/Urinary

      Boggy fundus 1 cm above umbilicus

      Fundus rotated to the right

      Voided 200 mL of clear yellow urine
    3. Exhibits Based on the assessment data, the nurse recognizes the need to intervene immediately. Select the 5 priority interventions that the nurse should initiate based on the most recent assessment.
      (SATA)
      A)
      Notify primary healthcare provider
      B)
      Weigh all bloody materials
      C)
      Administer 2 units of packed red blood cells (PRBC)
      D)
      Increase the IV fluid to maximum rate
      E)
      Count saturated pads per hour
      F)
      Insert straight catheter
      G)
      Alert the emergency response team
      H)
      Administer 0.2 mg methylergonovine IM
      I)
      Massage fundus until firm
    4. Exhibits The nurse is reviewing the client's chart. For each finding, click to indicate whether findings suggest that the client's condition has improved or put the client at risk for hypovolemia. Each column must have at least one selection.
      Condition has improvedAt risk for hypovolemia
      Fundus massaged until firm and at umbilicus✓
      Multiple large clots were expelled✓
      Blood pressure of 110/80 mm Hg, heart rate of 66 beats/minute, oxygen saturation at 98% on room air✓
      Fundus remains firm with slight lochia noted on pad✓
      Straight catheter produced 500 mL clear yellow urine✓
      Total blood loss of 800 mL✓
      200 mL blood loss✓
    Page 2 of 15

    Exam Review

    1. A young married couple asks the nurse at a community outreach clinic for guidance about having children because the wife was born with a cleft lip and palate, and the husband has an uncle with a cleft lip. Which action should the nurse take?
      A)
      Inform the couple that this is not an inherited disorder.
      B)
      Tell the couple to discuss this issue with the obstetrician.
      C)
      Encourage the couple to consider adopting a baby.
      D)
      Refer the couple to a genetic counselor or geneticist.
    2. Prior to performing a postpartum assessment, the client tells the nurse, "I have pain in my stitches." The nurse knows that the client had a midline episiotomy. Which action should the nurse take first?
      A)
      Place an ice glove on the episiotomy for 20 minutes.
      B)
      Visualize the perineum and check the episiotomy.
      C)
      Administer the prescribed PRN analgesic.
      D)
      Instruct the client on the use of a sitz bath.
    3. A premenopausal client with uterine leiomyomas (fibroids) reports to the clinic nurse that her menstrual bleeding has increased in volume and duration. Which assessment should the nurse perform first?
      A)
      Palpate the abdomen for uterine enlargement.
      B)
      Observe the appearance of the bleeding on the client's pad.
      C)
      Measure the client's vital signs.
      D)
      Obtain a history of the exact length of each cycle.
    4. A client who has cervical cancer is admitted to the hospital for placement of a cervical radiation implant. Which instructions should the nurse provide before insertion of the applicator?
      A)
      Enemas and stool softeners are used during treatment.
      B)
      Activity and ambulation as tolerated are encouraged.
      C)
      Bed rest with minimal turning should be maintained.
      D)
      A bedside commode will be provided for urination.
    Page 3 of 15

    Exam Review

    1. Exhibits The nurse reviews the client data. Drag the Word Choices to complete the sentence. Abnormal FHR patterns can result in dropdown, dropdownanddropdown.
    2. A 17-year-old client gave birth 12 hours ago. She informs that she doesn't know how to care for her baby. To promote parent- infant attachment behaviors, which intervention should the nurse implement?
      A)
      Explore the basis of fears with the client.
      B)
      Ask if she has help to care for the baby at home.
      C)
      Provide a video on newborn safety and care.
      D)
      Encourage rooming-in while in the hospital.
    3. The healthcare provider prescribed triazolam 500 mcg for a client with insomnia. The pharmacy supplies triazolam in 0.25 mg tablets. How many tablets should the nurse administer? (Enter numeric value only.)
    4. A 20-year-old female client tells the nurse that her menstrual periods occur about every 28 days, and her breasts are quite tender when her menstrual flow is heavy. She also informs that she performs her breast self-examination (BSE) on the first day of every month. Which action should the nurse implement in response to the clients statements?
      A)
      Remind the client that is also important to schedule an annual mammogram.
      B)
      Refer the client to a nurse practitioner for an in-depth review of the BSE procedure.
      C)
      Instruct the client to continue with her regular monthly exams as she is doing.
      D)
      Encourage the client to perform BSE 2 to 3 days after her menstrual period ends.
    Page 4 of 15

    Exam Review

    1. The nurse is preparing a 35 weeks gestation client with type 1 diabetes for an amniocentesis. After obtaining maternal vital signs and a baseline fetal heart rate, which nursing intervention has the highest priority?
      A)
      Obtain a baseline complete blood count.
      B)
      Review maternal Rh factor status.
      C)
      Provide family support.
      D)
      Initiate a saline lock.
    2. The nurse is reviewing the genetic test report for a pregnant client with a history of several spontaneous abortions. The results show the client has a heterozygous x-linked dominant inheritance disorder. How should the nurse explain the results to the client?
      A)
      This gene is passed down only to male children.
      B)
      This gene is passed down only to female children.
      C)
      There is a 100% chance of passing this gene on to all children.
      D)
      There is a 50% chance of passing this gene on to all children.
    3. At a prenatal visit, a primigravida client confides to the nurse that her partner is abusive. Which information should the nurse provide?
      A)
      Safety plan to keep in a purse at all times.
      B)
      Paperwork needed to file a restraining order.
      C)
      Visit summary documenting the report of abuse.
      D)
      Contact information for a women's shelter.
    4. The nurse is caring for a laboring client who is group B Streptococcus positive (GBS+). Which immediate treatment is indicated for this client?
      A)
      Artificial rupture of the membranes.
      B)
      Administration of antibiotics.
      C)
      Amnioinfusion for the baby.
      D)
      Administration of oxytocin.
    Page 5 of 15

    Exam Review

    1. A woman who delivered a normal newborn 24 hours ago reports, "I seem to be urinating every hour or so. Is that OK? Which action should the nurse implement?
      A)
      Measure the next voiding, then palpate the client's bladder.
      B)
      Catheterize the client for residual urine volume.
      C)
      Evaluate for normal involution, then massage the fundus.
      D)
      Obtain a specimen for urine culture and sensitivity.
    2. The nurse is initiating an interview with a client in the emergency department (ED) who presents with a fractured ulna and swollen, red lips and nose. The client's spouse is pacing outside the door of the examination room. Which action should the nurse take?
      A)
      Request hospital security to come to the department.
      B)
      Invite a colleague to document during the interview.
      C)
      Close the examination room door for privacy.
      D)
      Ask the client to describe the history of the injuries.
    3. Exhibits The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet. Select the findings that will help the nurse determine which is causing the client's symptoms.
      A)
      Rupture of membranes for 16 hours
      B)
      Normal spontaneous vaginal birth
      C)
      Breastfeeding 7 to 8 times a day for 10 minutes
      D)
      Discharge hemoglobin of 9.2 g/dL (92 g/L)
      E)
      Shopping yesterday for 5 hours
      F)
      Foul-smelling lochia rubra
      G)
      Current vital signs
    4. Exhibits The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet to determine the cause of the client's symptoms. For each assessment finding, click to indicate whether findings from this client's assessment are generally associated with mastitis, endometritis, or could be a sign of both conditions. Each row must have only one response option selected.
      A)
      Pain rating of 4 on a 0 to 10 scale
      B)
      Baby fed pumped breast milk
      C)
      Temperature of 101.2° F (38.4°C)
      D)
      Foul-smelling lochia rubra at 2 weeks postpartum
    Page 6 of 15