NUR 263 Health Nursing-50QA|100% verified document|latest 2024|Rasmussen College, Quizzes of Nursing

Download NUR 263 Health Nursing-50QA|100% verified document|latest 2024|Rasmussen College and more Quizzes Nursing in PDF only on Docsity! NUR 263 Health Nursing-50QA|100% verified document|latest 2024|Rasmussen College 1. Three hours after a vaginal delivery, the client reports increase perineal pain. What should the nurse do first? a. Assess the perineum. b. Perform perineal care. c. Apply ice to the perineum. d. Administer analgesia as order. 2. A woman gave birth to a 7-pound 6-ounce infant girl one hour ago. The birth was vaginal, and the estimated blood loss (EBL) was 1500ml. When assessing the woman's vital sign what should be most concerning to the nurse? a. HR 116 b. Temp 99. *F c. HR 60 d. BP 138/86 3. The nurse is caring for a 15-year-old Primipara who was delivered yesterday. Which is the most appropriate intervention when planning the clients discharge education? a. Have the client watch a video on newborn care. b. Demonstrate how to care for the newborn and have the clients return the demonstration. c. Give her information about a support group for adolescent mothers. d. Give the client printed instructions on newborn care. 4. A woman presents to labor and delivery at 35 weeks gestation with the following obstetric history: She delivered one child at 28 pg. 1 weeks gestation: child still living. She had a miscarriage at 8 weeks gestation. Should deliver one child at 36 weeks gestation: Child still living. What is her GTPAL? G= 4 T= 0 P= 2 A= 1 L= 2 5. The nurse is caring for a client who has just delivered vaginally. After assuring there is a patent airway, which of the following action should the nurse’s next priority in the care of the neonate? pg. 2 d. Agree with the client. 11. A woman gave birth vaginally to a 9-pound 12-ounce girl yesterday. Her primary care provider has written order for perineal ice packs, use of a sitz bath TID and a stool softener. What information is most closely correlated with disorders? a. The woman is a gravida 2 para 2. b. The woman received epidural Ennis this year. c. The woman has an episiotomy. d. The woman experienced an atraumatic delivery 12. The prenatal nurse providing care to a laboring woman recognizes variable deceleration. What is the appropriate initial nursing action? a. Assist the woman to a left lateral position. b. Increase the IV rate. c. Document the fetal heart rate and variability. d. All the health care providers. 13. A nurse applies an external fetal monitor and toco- transducer to monitor the fetal heart rate and contractions of a client in labor. The FHR is in the one 40s contractions are every 2- 3 minutes and 60 seconds in duration. The nurse performs a vaginal exam and finds the cervix is 6 cm dilated, and the fetus is at a -1 station. Which of the following stages and phases of Labor is this client experiencing? a. first stage, transition phase b. second stage of Labor c. first stage, active phase. d. first stage, early (latent) phase. pg. 5 14. A client experiences a large gush of fluid from her vagina while walking in the Hallway of the birthing unit. the nurse established the fluid is amniotic fluid. what should be the nurses first action? a. Monitor the fetal heart rate for distress. b. Dry the client and make her comfortable. c. monitor the clients for contractions. d. Test the amniotic fluid for meconium. 15. A client who is pregnant present with chronic hypertension. Which of the following is the primary adverse effect of this disorder that result in risk to the fetus? a. enlargement of the liver. pg. 6 b. Increase urinary output, c. Large for gestation age. d. Uteroplacental insufficiency. 16. If a newborn does not pass meconium during the first 36 hours of life. what is the most appropriate priority action by the nurse? a. Notify the physician. b. Measure the abdominal girth. c. Increase the number of oral feedings. d. Observe the annual area for fissures. 17. A client at 39 weeks gestation in the latent phase of Labor is admitted to the labor and delivery unit. the client is attempting a vaginal birth after caesarean birth. in reviewing the client's medical record, the nurse should recognize which of the following has a contraindication to a VBAC? a. low transverse incision. b. A full-thickness incision. c. a classical vertical incision. 18. a horizontal incision. 18. A client is admitted in labor. her cervix is 100% effaced and 5 cm dilated. her fetus is in cephalic position and is at +1 station. What does the nurse know about the position of the fetus head? A. It is below the ischial of the spine. B. It Is ballotable. C. It is not yet engaged. D. it is visible at the vaginal opening. 19. A G2 T2 P0 a L2 client experienced a precipitous birth 90 minutes ago. her in front weight 4200 grams and a repair of a second-degree laceration was needed following the birth. as part of the nursing pg. 7 on. C. Radiation. D. Convection. 25. Which symptoms would require careful medical assessment during the postpartum period? A. Constipation. B. Urinary output of 2000mL/day C. Engorgement D. Headaches 26. A laboring woman received butorphanol in opioid, IVP 30 minutes before she gave birth. which medication should be available to reduce the effect of the butorphanol on the neonate? A. Naloxone B. Promethazine pg. 10 C. Surfactant D. Nalbuphine 27. The mothers of a term neonate ask the nurse what the thick, white, cheesy coating is on her baby’s skin. which correctly describes this finding? A. amniotic fluid B. vernix C. lanugo D. milia 28. A client continues to pass large number of clots and bright red lochia despite the nurses attempt to massage the fundus. Upon reexamination, the nurse finds that the clients uterine fundus remains boggy. The nursing action and oxytocin do not seem to be helping to keep the fundus firm. which of the following medications would the nurse anticipate the physicians may order to manage uterine atony? A. Methylergonovine B. Betamethasone C. Terbutaline Sulfate D. Magnesium Sulfate 29. A woman has requested an epidural for her pain. she is 5 cm dilated and 100% effaced. the nurse reviews her laboratory value and note that the woman's hemoglobin is 12g/dL hematocrit is 38%, platelets are 70,000 and WBC are 12,000/mm3. which factors would contraindicate an epidural for the woman? A.she has thrombocytopenia. B.She is septic. C. She is anemic. D.She is too far dilated. 30 The neonatal nurse providing care for a premature infant who begins to demonstrate signs of cyanosis in room air, tachypnea, retractions, and it is often accompanied by an expiratory grunt. what are these pg. 11 symptoms most likely signs of? A Transient tachypnea of the newborn. B Apnea of prematurity. C. Respiratory distress syndrome. D meconium aspiration syndrome. 31 Medications that are used to manage postpartum hemorrhage include which of the following? (select all apply) A. Terbutaline B. Methylergonovine C. Methotrexate D. Misoprostol pg. 12 newborn? A.Discontinuing breastfeeding for 24 hours the first 3 days of life. B.Encourage frequent feeding to breast milk. C. Conducting frequent visual assessments. D.Limiting breast feeding to 10 minutes per breast at each feeding. 38. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. what signs and symptoms should the nurse include in her discussion? (select all apply) A. Afebrile B. Warm to the touch. C. Redness D. Breast tenderness E. Increase in milk production. 39. A newborn is placed under a radiant warmer, and the nurse evaluates the infant body temperature every hour. maintaining the newborn body temperature is important for preventing what risk? A.Tachycardia B.Cold stress C. Respiratory depression D.Vasoconstriction 40. You are assigned to care for a newborn at delivery. part of this care includes assigning APGAR scores. at 1 minute of life, you observe the following. Body pink with blue extremities. (1) heart rate 90 (1) body slightly grimaces when stimulated. (1) the baby is moving all limbs vigorously. (2) pg. 15 the baby displays a weak respiratory effort. (1) What is the APGAR score? SCORE IS 6 41. A postpartum client who delivered 3 hours ago states I feel all wet underneath. “what should be the initial action of the nurse? A. Determine when she last avoided. B. Perform perineal care. C. Ask the client to rate her discomfort on a scale of 1-10. D. Assess her lochia flow. 42. Following delivery, the nurse would first assess which two newborn body system that must undergo the most rapid changes to support extrauterine life? A. Respiratory and cardiovascular pg. 16 B. Neurologic and temperature control. C. Gastrointestinal and hepatic. D. Urinary and hematologic 43. What is the most critical nursing action in caring for the newborn immediately after birth? A.Keeping the newborn airway clear. B.Crying the newborn and wrapping the infant in the blanket. C. Fostering parent- newborn attachment. D.Administering eye drops and vitamin K. 44 A newborn goes through many changes at the time of delivery when transitioning two extrauterine life. what is a normal change that the nurse will observe? A. Asymmetry B. Acrocyanosis C. Atonia D. Apnea 45. The nurse expects to administer oxytocin to a woman after expulsion of her placenta. what effect will this medication have on the client? A.Decrease uterine contraction. B.Relieve pain C. Stimulate uterine contraction. D.Prevent infection. 46. A new mother calls the clinic 4 days after deliver. She is breastfeeding her infant and is concerned that her baby is not getting enough milk. what is the most important question for the nurse to ask the mother? A.How many wet diapers has your baby had in the last 24 hours? B.Do your breasts tingle when you begin to nurse? C. Are your nipple sores or bleeding. D do you have any red or tender area on your breast. pg. 17