Exam Review
- 1. A nurse is obtaining a capillary blood sample from a newborn for phenylketonuria testing. Identify the sequence of steps the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)A)Puncture the heel and collect the blood.3B)Apply pressure with a dry gauze pad.4C)Wrap a warm, moist cloth around the heel.1D)Cover the heel with an adhesive bandage.5E)Cleanse the heel with an antiseptic.2
- A nurse is caring for a client who had a vaginal delivery 1 day ago. The nurse determines that the client's fundus is firm, located 2 fingerbreadths above the umbilicus, and deviated to the left. Which of the following actions should the nurse take first?A)Notify the provider.B)Assist the client to empty her bladder.C)Monitor perineal pads for clots.D)Administer a prescribed analgesic.
- A nurse is caring for a client who is at 12 weeks of gestation and has hyperemesis gravidarum. Which of the following manifestations should the nurse expect?A)PruritusB)Decreased BPC)Hemoglobin 18 g/dL (11 to 16 g/dL)D)WBC count 15,000/mm³ (5,000 to 15,000/mm³)
- A nurse has just received change-of-shift report about four clients who are postpartum. Which of the following clients should the nurse plan to see first?A)A client whose newborn is having difficulty latching-onB)A client who received magnesium sulfate during laborC)A client who has a history of oligohydramniosD)A client whose labor lasted for 6 hr
Exam Review
- A nurse in a provider's office is reviewing the medical record of a client who is requesting a diaphragm. Which of the following findings in the client's history should the nurse identify as a contraindication for this type of contraception?A)Recurrent urinary tract infectionsB)Tobacco useC)History of positive group B streptococcus B-hemolyticD)Deep-vein thrombosis
- A nurse is reinforcing teaching about safety precautions to take when driving a car with a client who is in the first trimester of pregnancy. Which of the following instructions should the nurse include in the teaching?A)Wear the lap belt high across the abdomen.B)Place the shoulder harness across the gravid uterus.C)Disable the vehicle's driver-side airbags.D)Move the seat as far away as possible from the steering wheel.
- A nurse is administering a miconazole vaginal suppository to a client who has vaginal candidiasis. Which of the following actions should the nurse take?A)Insert the suppository 5 cm (2 in).B)Insert the suppository along the posterior vaginal wall.C)Apply petroleum jelly to the suppository.D)Assist the client into a prone position.
- A nurse in the newborn nursery is caring for an infant who has trisomy 21. When collecting data, which of the following findings should the nurse expect?A)A single crease in the palmB)A notch in the lipC)Extra digits on the handD)An inversion of the foot
Exam Review
- A nurse is reinforcing teaching about outpatient resources for a client who is recovering from a molar pregnancy. Which of the following statements by the client indicates an understanding of the teaching?A)"I will need to start chemotherapy immediately."B)"I will need home palliative services after I am discharged from the hospital."C)"I will need an amniocentesis within 1 month."D)"I will need to attend a support group when I get home."
- A nurse is collecting data from a newborn who was delivered at 40 weeks of gestation. Which of the following is an expected finding when eliciting reflexes from the newborn?A)The newborn's legs flex at the knees and hips when pressure is applied to the soles of the newborn's feet.B)The newborn turns their head away from the stimulus when their cheek is touched.C)The newborn's fingers curl around the nurse's finger when placed in the newborn's palm.D)The newborn closes their eyes and keeps them closed when tapped on the forehead.
- A nurse is reinforcing teaching about risk factors for preeclampsia with a group of clients who are pregnant. Which of the following risk factors should the nurse include in the teaching?A)Chronic hypertensionB)Maternal age of 30 yearsC)Third pregnancyD)Prepregnancy BMI of 19
- A nurse is caring for a client who is postpartum and has inverted nipples. Which of the following actions should the nurse take?A)Encourage the client to wear an underwire bra.B)Have the client apply breast cream on a regular basis.C)Provide plastic-lined breast pads.D)Place breast shells in the client's bra.
Exam Review
- A nurse is caring for a client who reports discomfort due to afterpains following breastfeeding. Which of the following actions should the nurse take?A)Encourage the client to perform Kegel exercises.B)Apply a cool compress to the client's abdomen.C)Place the client in a side-lying position.D)Administer ibuprofen to the client.
- A nurse in a prenatal clinic is reinforcing teaching with a client about expected physiological changes during pregnancy. Which of the following statements by the client indicates an understanding of the teaching?A)"I should expect to have burning when I urinate during the third trimester."B)"I may have an infection if I develop a dark line in the middle of my abdomen."C)"I may develop discoloration on my cheeks from hormonal changes."D)"I should expect my fingers and face to be swollen."
- A nurse in a prenatal clinic is collecting data from four clients. Which of the following findings is the nurse's priority to report to the provider?A)LeukorrheaB)GingivitisC)Varicose veinsD)Dysuria
- A nurse is assisting in the care of a client who is experiencing an unruptured ectopic pregnancy that is at 8 weeks of gestation. Which of the following medications should the nurse expect the provider to prescribe?A)Magnesium sulfateB)MethotrexateC)Calcium gluconateD)Terbutaline
Exam Review
- A nurse is caring for a client who is at 9 weeks of gestation and reports nausea in the morning that continues until midafternoon. Which of the following actions should the nurse encourage the client to take?A)Increase intake of fresh fruits.B)Restrict fluids to 1,000 mL/day.C)Eat dry, bland foods in the morning.D)Take an over-the-counter antacid.
- A nurse is preparing to administer phytonadione to a newborn. Which of the following actions should the nurse take?A)Administer the medication into the deltoid muscle.B)Administer the medication with a 25-gauge needle.C)Administer the medication 12 hr after birth.D)Check the mother's Rh factor prior to administration.E)NoneF)None
- A nurse is preparing to collect a specimen for newborn screening. Which of the following actions should the nurse take?A)Use a lancet to puncture the inner aspect of the newborn's heel.B)Warm the newborn's heel for 5 to 10 min before the puncture.C)Apply an antiseptic to the newborn's heel after collecting the specimen.D)Leave the newborn's heel open to the air after the puncture.
- A nurse is caring for a full-term newborn who is 1 day old. Which of the following laboratory findings should the nurse report to the provider?A)Glucose 60 mg/dLB)WBC 10,000/mm³C)Platelets 225,000/mm³D)Hgb 9.5 g/dL