-During active labor, there is a gush of clear fluid and thefetal heart rate drops to 100 bpm. A

-During active labor, there is a gush of clear fluid and thefetal heart rate drops to 100 bpm. A vaginal examination reveals a loop of umbilical cord in the vagina. The nurse places the client in which position?                 A)            Trendelenburg  B)            Lithotomy            C)            Hands and knees              D)           Left-side lying    2.  A client at 8 weeks’ gestation comes to the clinic with vaginal bleeding and cramps. An ultrasound examination shows the cervix is dilated. What is the client experiencing?           A)  Inevitable abortion                    B) Threatened abortion                C) Missed abortion                         D) Complete abortion3.    The nurses assesses a neonate born at 36 weeks’ gestation. The neonate is grunting, has nasal flaring, and subcostal retractions. Respiratory rate is 82 breaths/min, and on auscultations there are crackles in the lungs. What is the nurse’s assessment of the neonate’s condition?           -A)            Transient tachypnea        -B)            Surfactant deficiency       -C)            Persistent pulmonary hypertension          -D)           Apnea   4.  A client at 38 weeks’ gestation is admitted to labor and delivery with vaginal bleeding after sustaining abdominal trauma. Which laboratory values are a priority in determining the plan of care for this client? Select all that apply.   -A)            Fibrinogen            -B)            Fibrin degradation products         -C)            Prothrombin time             -D)           Red blood cell count                E)           Bleeding time5.   Why are newborns born to diabetic mothers prone to hypoglycemia?                -A)            Excess subcutaneous fat reduces blood flow to the tissues              -B)            Increased metabolic stress due to the stress on mother’s body     -C)            Elevated insulin production metabolized glucose faster    -D)           Liver is immature and cannot convert glycogen to glucose 6.  A new mother is alarmed because her newborn has lost 10 ounces in weight since being born 2 days ago. She believes that she has been breastfeeding properly. Which information would the nurse include as a likely cause of this phenomenon? Select all that apply.          -A)            Absence of salt- and fluid-retaining maternal hormones   -B)            The infant’s voiding and passing stool       -C)            Low calorie content of colostrum               -D)           A congenital digestive disorder   -E)            An increase in fetal metabolism                F)             Failure of mother to bond with newborn     7.     A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?             -A)            6 months              -B)            3 months              -C)            9 months              -D)           12 months  8.     A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?       -A)            Schedule induction of labor today.             -B)            Allow her to continue without plans for delivery.                -C)            Schedule cesarean delivery at 39 weeks.                -D)           Prepare for assessment of fetal lung maturity.     9.   The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. The nurse interprets this result as suggesting which situation? Select all that apply.       -A)            The patient is sleeping.   -B)            The patient is hypoglycemic.        -C)            The patient is using an illicit drug.              -D)           The patient is exercising too much.            -E)            The patient is smoking while pregnant.   10.  A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?                 -A)            Twin-to-twin transfusion syndrome (TTTS)             -B)            HELLP syndrome               -C)            TORCH syndrome                     D)             ABO incompatibility11. A patient in labor and delivery has just been diagnosed with pre-eclampsia. Which signs and symptom should the nurse prioritize when assessing this client? Select all that apply.   -A)            BP 140/90 mm Hg             -B)            slow reflexes      -C)            glucose in urine                 -D)           edema of face            E)           headache12.  A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?  -A. Painless red vaginal bleeding  -B. Increasing abdominal pain with a nonrelaxed uterus  -C. Abdominal pain with scant red vaginal bleeding  -D. Intermittent abdominal pain following passage of bloody mucus 13.  A nurse is caring for a newborn immediately following birth. After assuring a patent airway, what is the priority nursing action? -A. Administer vitamin K. -B. Dry the skin. -C. Administer eye prophylaxis. -D. Place an identification bracelet.14. A nurse in a prenatal clinic is caring for a client who is at 7 weeks of gestation. The client reports urinary frequency and asks if this will continue until delivery. Which of the following responses should the nurse make? -A. “It’s a minor inconvenience, which you should ignore.” -B. “In most cases it only lasts until the 12th week, but it will continue if you have poor bladder tone.” -C. “There is no way to predict how long it will last in each individual client.” -D. “It occurs during the first trimester and near the end of the pregnancy.”15.     A nurse is caring for a client who just delivered a newborn. Following the delivery, which nursing action should be done first to care for the newborn? -A. Clear the respiratory tract. -B. Dry the infant off and cover the head. -C. Stimulate the infant to cry. -D. Cut the umbilical cord.16.  A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. Which of the following vessels should the nurse expect to observe in the umbilical cord? -A. Two veins and one artery -B. One artery and one vein -C. Two arteries and one vein -D. Two arteries and two veins17.    A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client? -A. Rapid decline in human chorionic gonadotropin (hCG) levels -B. Profuse, clear vaginal discharge -C. Irregular fetal heart rate -D. Excessive uterine enlargement 18.       A nurse is caring for a new mother who is concerned that her newborn’s eyes cross. Which of the following statements is a therapeutic response by the nurse? -A. “I will call your primary care provider to report your concerns.” -B. “I will take your baby to the nursery for further examination.” -C. “This occurs because newborns lack muscle control to regulate eye movement.” -D. “This is a concern, but strabismus is easily treated with patching.”19.   A nurse is caring for a client who is having a nonstress test performed. The fetal heart rate (FHR) is 130 to 150/min, but there has been no fetal movement for 15 min. Which of the following actions should the nurse perform? -A. Immediately report the situation to the client’s provider and prepare the client for induction of labor. -B. Encourage the client to walk around without the monitoring unit for 10 min, then resume monitoring. -C. Offer the client a snack of orange juice and crackers. -D. Turn the client onto her left side.20.   A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a duration of 1 min and a frequency of 3 min. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. Which of the following is the priority action for the nurse to take? -A. Notify the provider of the findings. -B. Position the client with one hip elevated. -C. Ask the client if she needs pain medication. -D. Have the client void.21. A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is “not -really sure if she is in labor or not.” Which of the following should the nurse recognize as a sign of true labor? -A. Rupture of the membranes -B. Changes in the cervix -C. Station of the presenting part -D. Pattern of contractions22.   A nurse is caring for a client who is at 40 weeks of gestation and is in labor. The client’s ultrasound examination indicates that the fetus is small for gestational age (SGA). Which of the following interventions should be included in the newborn’s plan of care? -A. Observe for meconium in respiratory secretions. -B. Monitor for hyperglycemia. -C. Identify manifestations of anemia. -D. Monitor for hyperthermia.23. A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect, which of the following information should the nurse include in the teaching? -A. Limit alcohol consumption. -B. Increase intake of iron-rich foods. -C. Consume foods fortified with folic acid.’ -D. Avoid foods containing aspartame.24.  A nurse in the ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage. Which of the following should be included in the teaching? -A. Vaginal intercourse can be resumed after 2 weeks. -B. Products of conception will be present in vaginal bleeding. -C. Increased intake of zinc-rich foods is recommended. -D. Aspirin may be taken for cramps.25.   A nurse is preparing to assess a newborn who is postmature. Which of the following findings should the nurse expect? (Select all that apply.) -A. Cracked, peeling skin -B. Positive Moro reflex -C. Short, soft fingernails -D. Abundant lanugo -E. Vernix in the folds and creases  26.  A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first? -A. Cover the cord with a sterile, moist saline dressing. -B. Prepare the client for an immediate birth. -C. Place the client in knee-chest position. -D. Insert a gloved hand into the vagina to relieve pressure on the cord.                                 Health Science Science Nursing NURS 221 Share QuestionEmailCopy link Comments (0)

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