NursGuru

    Exam Review

    1. A nurse is reviewing the diagnostic tests for a pregnant client. Which of the following tests should the nurse expect to monitor or perform as part of the client care plan?
      (SATA)
      A)
      Glucose tolerance test.
      B)
      Deep tendon reflexes.
      C)
      Non-stress test (NST).
      D)
      Complete blood count (CBC).
      E)
      Vaginal Exam.
      F)
      Urine dipstick.
    2. The nurse is caring for a 2-day postpartum client who reports having to go to the bathroom to urinate numerous times last night and was sweating much more than usual. What is the best response by the nurse to explain the symptoms the client is experiencing?
      A)
      Some clients experience this type of complication after birth.I will notify your provider to obtain a prescription.
      B)
      We will need to measure your intake and output.You may need to stay an additional day in the hospital.
      C)
      After delivery, extra fluid will be released from the body by urinating and sweating.These are normal symptoms.
      D)
      Decreased venous pressure in the lower extremities after delivery will cause these symptoms.
    3. The nurse is caring for a postpartum client who gave birth yesterday. The client reports that their new pad was saturated with lochia rubra within 15 minutes of changing it. The client's fundus is firm at the umbilicus. What is the priority nursing action?
      A)
      Continue fundal massage.
      B)
      Notify the Health Care Provider.
      C)
      Administer oxytocin.
      D)
      Assist the client to the restroom.
    4. The nurse is caring for a gravida 7 para 5 client admitted 3 hours ago who is now 9 cm dilated, 90
      A)
      Instruct client to reposition every 3 hours.
      B)
      Instruct the client to push with the next contraction.
      C)
      Provide initial labor education to the family.
      D)
      Prepare supplies for the anticipated delivery.

    Exam Review

    1. The nurse administers a RhoGAM injection to a client with a negative blood type at 28 weeks gestation. The client asks the nurse if future injections of this medication are needed. What is the best response by the nurse?
      A)
      Yes, RhoGAM only works for 12 weeks so you will need another injection after you deliver.
      B)
      No, this one injection will prevent your body from creating antibodies against the Rh factor.
      C)
      It depends.Your healthcare provider will do an amniocentesis to determine your baby's blood type before you give birth.
      D)
      It depends.You will need another injection within 72 hours after you deliver if your baby's blood type is Rh positive.
    2. The labor and delivery nurse is preparing for the delivery of their client's newborn infant. The nurse brings a stack of warm blankets into the room and places them at the bedside. Which statement by the nurse best educates the parents on why warm blankets are needed?
      A)
      We will use the warm blankets to dry the baby which will help to prevent cold stress.
      B)
      We will wrap the baby in warm blankets after delivery so that they will not shiver.
      C)
      We will use the blankets to warm the baby's hands and feet to prevent acrocyanosis.
      D)
      We will use the warm blankets only if the baby has a low temperature.
    3. The nurse is providing discharge instructions to new parents about the care of their newborn. Which statement by the nurse provides appropriate education regarding the newborn's umbilical cord?
      A)
      Report any redness or foul odor to your pediatrician.
      B)
      It usually takes about a month for the cord to fall off.
      C)
      Keep the diaper over the cord to protect it from clothing.
      D)
      Make sure to keep the cord moist at all times.
    4. The nurse is educating a sexually active female teenager about the importance of sexual health. The client is resistant to undergoing sexually transmitted infection (STI) testing and states that they do not need testing because they do not have any symptoms. What is the best response by the nurse?
      A)
      It is important to be tested because you may not have symptoms with a sexually transmitted infection.
      B)
      As long as you have only one partner, you do not really need testing.
      C)
      If you were practicing abstinence, you would not be dealing with this issue.
      D)
      You should get tested because STIs are more prevalent among people of your race and background.

    Exam Review

    1. The nurse continues to care for the client in the antepartum unit and has received several provider orders. Review the electronic health record (EHR) and for each provider's order, click to specify whether the order is essential, nonessential, or contraindicated for this client.
      (SATA)
      A)
      Administer Magnesium Sulfate 4g bolus over 15-30 minutes.
      B)
      Monitor blood pressure every 15 minutes.
      C)
      Have client lie in supine position.
      D)
      Administer Betamethasone 12.5 mg intramuscularly now, repeat in 24 hours.
      E)
      Collect urine sample for culture and sensitivity.
    2. The nurse is measuring the fundal height on a 28-week client who presents to the office with a history of no prenatal care. Which statement made by the client indicates that the nurse has accurately educated them about the task being performed?
      A)
      Measuring fundal height can be a highly invasive procedure.
      B)
      Fundal height evaluates fetal growth in the second and third trimesters.
      C)
      The fundal height is measured from the umbilicus to the fundus.
      D)
      Fundal height is only done once during the initial antepartum assessment.
    3. The nurse is caring for a client during a prolonged second stage of labor. The nurse observes that the fetal head retracts against the client's perineum immediately following the delivery of the head, known as the turtle sign. Which of the following actions will the nurse anticipate in this situation?
      A)
      Administer fundal pressure.
      B)
      Apply suprapubic pressure.
      C)
      Assist client in flexing thighs out and towards ears.
      D)
      Call for additional assistance.
      E)
      Prepare the client for immediate cesarean birth.
    4. The nurse is educating a client who has been menopausal for 2 years and reports physical changes and vasomotor symptoms. What information should the nurse include when educating the client?
      A)
      You should consider hormone replacement because it has no risks.
      B)
      You can use light pads for any bleeding you may experience.
      C)
      You can use an acidic lotion for the oily skin you may experience.
      D)
      You may want to take calcium supplements to decrease bone loss.

    Exam Review

    1. The nurse is caring for several clients in a clinic who are at risk for or have been diagnosed with a sexually transmitted infection. Which client would the nurse anticipate that the provider will see first?
      A)
      The pregnant client at 6 weeks gestation who is positive for syphilis.
      B)
      The client who reports a painful lesion on their penis.
      C)
      The client who tested positive for herpes simplex virus.
      D)
      The client who would like education regarding the HPV vaccine.
    2. The nurse is caring for a client who has been prescribed an IV infusion of oxytocin to induce labor. The client is gravida 1 para 0. The fetus is in a vertex cephalic presentation and the patient's cervix is dilated 1cm. Which is the priority action for the nurse before starting the oxytocin induction?
      A)
      Administer a 1000cc bolus of IV fluid to prevent hypotension.
      B)
      Educate the family about risks and benefits of the medication.
      C)
      Notify the provider of malposition of the fetus and hold the medication.
      D)
      Place monitors to evaluate fetal heart rate and contraction pattern.
    3. The newborn intensive care unit (NICU) nurse receives a call to prepare for an urgent admission of a 41-week gestation newborn with appearance, pulse, grimace, activity, and respiration (APGAR) scores of 1 and 4. In preparing for the admission, what should be the nurse's highest priority?
      A)
      Place the identification ankle bands at the bedside.
      B)
      Set up an intravenous line with 10
      C)
      Connect the resuscitation bag and mask to the oxygen outlet.
      D)
      Prepare the Vitamin K injection and erythromycin ointment.
    4. A client at 38 weeks gestation presents to OB triage complaining of contractions for 2 hours. How can the nurse best assess for true labor?
      A)
      Assess for fetal lightening.
      B)
      Ask the client about relief with ambulation.
      C)
      Assess contraction frequency.
      D)
      Check for cervical change.

    Exam Review

    1. The nurse is caring for a client of 22 weeks gestation who presents to the clinic for a follow-up prenatal visit. Which of the following assessments should the nurse perform?
      A)
      Fundal height.
      B)
      Vaginal exam.
      C)
      Leopold's maneuver.
      D)
      Pregnancy history.
    2. The nurse is caring for a newborn with suspected patent ductus arteriosus (PDA). Which assessment finding would further indicate that this infant could have a PDA?
      A)
      Narrow pulse pressure.
      B)
      Tachypnea.
      C)
      Weak peripheral pulses.
      D)
      Bradycardia.
    3. Review the documentation in the EHR and evaluate the most recent assessment findings for the 38-year-old client. Match the finding of urine output and deep tendon reflexes (DTRs) with the appropriate status.
      A)
      Urine output is within normal limits and DTRs are 2 plus.
      B)
      Urine output is decreased and DTRs are brisk at 4 plus.
      C)
      Urine output is increased and DTRs are absent at 0.
      D)
      Urine output is stable and DTRs are diminished at 1 plus.
    4. The nurse is caring for a postpartum client who delivered vaginally 4 hours ago. The client has a fundal height of 2 fingerbreadths above the umbilicus and is deviated to the right. What is the priority nursing action?
      A)
      Immediately notify the healthcare provider.
      B)
      Assist the client to empty their bladder.
      C)
      Administer intravenous pain medications.
      D)
      Insert a sterile foley catheter.

    Exam Review

    1. The nurse is evaluating the external fetal monitoring strip of a laboring client. Based on the information from the strip, what is the nurse's next plan of action?
      A)
      Decrease the oxytocin.
      B)
      Continue to monitor.
      C)
      Prepare for urgent C-section.
      D)
      Administer tocolytics.
    2. The nurse in the obstetrics/gynecology (OB/GYN) clinic is providing prenatal education to a group of clients who desire to have a natural labor at home. Which recommendation of non-pharmacological methods by the nurse would require correction by the nurse educator?
      A)
      It is good to utilize a support person, such as a doula, during labor.
      B)
      You can reach out to a certified acupuncturist to see if they can provide services.
      C)
      I can provide a list of hypno-birthing classes in the local area.
      D)
      You can research a company that rents large ice baths for home use.
    3. The nurse is caring for a client in the active phase of the first stage of labor. The client reports a new onset of severe abdominal pain. What is the priority nursing action?
      A)
      Offer client pain medications.
      B)
      Assess for vaginal bleeding.
      C)
      Apply a pulse oximeter.
      D)
      Prepare for a cesarean section.
    4. The nurse in the OB/GYN clinic is caring for several couples who are planning to get pregnant. For which couple(s) would the nurse recommend genetic counseling? (Select all that apply).
      A)
      The female who is 37 and male partner who is 52 years old.
      B)
      The client who had a macrosomic baby due to gestational diabetes.
      C)
      The couple who has a child with a congenital anomaly.
      D)
      The couple with a history of 3 miscarriages.
      E)
      The client with a family history of an X-linked disorder.