2020 Assessment A with a few review questions
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A nurse is reinforcing teaching with a new parent about the prevention of newborn abduction.
... [Show More] Which of the following statements by the parent indicates an understanding of the teaching?
A. "Some assistive personnel might not have name badges."
B. "A nurse will carry my baby back to the nursery in their arms for routine care when it is needed."
C. "I will ask the nurse to take my baby back to the nursery if I need to leave my room."
D. "I can remove my baby's security band before giving her a bath."
"I will ask the nurse to take my baby back to the nursery if I need to leave my room."
A nurse is caring for a client who is planning to become pregnant. The client asks the nurse why folic acid supplements are necessary. The nurse should inform the client that the purpose of the folic acid supplement is to do which of the following?
A. Facilitate the storage of iron in the fetus' liver
B. Prevent certain kinds of birth defects
C. Inhibit premature labor
D. Aid in the absorption of other important nutrients
Prevent certain kinds of birth defects
A nurse is assisting with monitoring a newborn who is 3 days old and has received phototherapy. Which of the following laboratory values should the nurse recognize as an indication that the therapy has been effective?
A. Glucose 45 mg/dL
B. WBC count 10,000/mm3
C. Total bilirubin 5 mg/dL
D. Hgb 16 g/Dl
Total bilirubin 5 mg/dL
A nurse is assisting with collecting data from a newborn who was born 2 hr ago and has respiratory distress. Which of the following findings should the nurse report to the provider? (select all that apply)
A. Acrocyanosis
B. Tachypnea
C. Nasal flaring
D. Retractions
E. Expiratory grunting
1. Tachypnea
2. Nasal flaring
3. Retractions
4. Expiratory Grunting
A nurse is reinforcing teaching about formula feeding a newborn with a group of new parents. Which of the following instructions should the nurse include?
A. Begin giving approximately 240 mL (8 oz) per feeding after the first week
B. Position the bottle at a 45 angle during feedings
C. Ensure that the newborn empties the bottle
D. Wait to burp the newborn until the end of the feeding
Position the bottle at a 45 angle during feedings
A nurse is collecting data from a client who is in the second trimester of pregnancy. Which of the following findings should the nurse report to the provider?
A. Increased leukorrhea
B. Hyperpigmentation of the face
C. Varicose veins
D. Frequent uterine contractions
Frequent uterine contractions
A nurse is collecting data from a newborn who is 8 hr old. Which of the following findings should the nurse report to the provider?
A. Vernix in the skin folds
B. Positive Moro reflex
C. Apneic episode of 10 seconds
D. Apical heart rate of 90/min while crying
Apical heart rate of 90/min while crying
A nurse is reinforcing teaching about food sources that are high in folate with a group of clients who are pregnant. Which of the following foods should the nurse recommend to this group as the best source of folate?
A. 1 cup dried prunes
B. 1/2 cup boiled potatoes
C. 1/2 cup dried peas
D. 1 cup grapes
1/2 cup dried peas
A nurse is assisting with the care of a client who is postpartum and is receiving magnesium sulfate IV by continuous infusion to treat preeclampsia. Which of the following findings should the nurse identify as manifestations of magnesium toxicity? (select all that apply)
A. Hyperreflexia
B. Decreased respiratory rate
C. Polyuria
D. Decreased level of consciousness
E. Double vision
1. Decreased respiratory rate
2. Decreased level of consciousness
3. Double vision
A nurse is collecting data from a client who is at 33 weeks of gestation. Which of the following findings should the nurse identify as an indication of a potential complication of pregnancy?
A. Leg cramps
B. Tingling of fingers
C. Varicose veins
D. Epigastric pain
epigastric pain
*manifestation of preeclampsia
A nurse is reinforcing family planning options with a client who is requesting information about contraceptives. Which of the following client statements indicates an understanding of the teaching?
A. "The diaphragm should be removed 2 hours after having intercourse."
B. "I can use water-soluble lubricant when my partner wears a latex condom."
C. "It is ok for me to remove the birth control sponge within 2 hours after having intercourse."
D. "When I use the birth control patch, it must be changed once a month."
"I can use water-soluble lubricant when my partner wears a latex condom."
A nurse is planning to administer terbutaline to a client who is experiencing preterm labor. Which of the following routes of administration should the nurse plan to use?
A. Intramuscular
B. Intradermal
C. Subcutaneous
D. Topical
Subcutaneous
*every 4 hours. relaxes the smooth muscles and inhibits uterine activity
A nurse is observing a client bather her 1 day old newborn. Which of the following actions should the nurse identify as an indication that the client understands how to bathe the newborn?
A. The client shakes powder from the container onto the newborn's skin
B. The client uses a cotton-tipped swab to clean the newborn's ears
C. The clients washes the newborn's hair before unwrapping them
D. The client rinses the newborn under warm, running water
The clients washes the newborn's hair before unwrapping them
A nurse on a postpartum unit is assisting in the care of a client who is experiencing hypovolemic shock. Which of the following actions should the nurse take?
A. Place the client in high-Fowler's position
B. Administer terbutaline subcutaneously
C. Apply oxygen at 2 L/min via nasal cannula
D. Insert an indwelling catheter
insert an indwelling catheter
*to monitor output closely. Decreased kidney perfusion caused by shock can lead to oliguria
A nurse is caring for a newborn who has a high-pitched cry and does not respond to consoling efforts. Which of the following neonatal data collection tools should the nurse expect to complete?
A. Apgar score
B. Newborn Hearing Screen
C. Critical Congenital Heart Disease screen (CCHD)
D. Neonatal Abstinence Scoring System
Neonatal Abstinence Scoring System
A nurse is reviewing the prenatal record of a client who is at 34 weeks of gestation. Which of the following results should the nurse identify as a desirable outcome?
A. Negative rubella titer
B. Reactive stress test
C. 1 hour glucose tolerance screening test result of 150 mg/dL
D. Hemoglobin 9.5 g/dL
Reactive stress test
A nurse is assisting with the care of a client who is at 40 weeks of gestation and is in active labor. Which of the following findings should the nurse report to the charge nurse?
A. Maternal newborn temperature of 37.5 C (99.5 F)
B. Contractions every 3 min
C. Presence of bloody show
D. Prolonged deceleration of FHR
Prolonged deceleration of FHR
A nurse is a prenatal clinic is caring for a client who is at 16 weeks of gestation and has a positive hepatitis B test result. Which of the following actions should the nurse take?
A. Instruct the client to avoid crowds until a repeat hepatitis B test is negative
B. Tell the client that they will need to start the hepatitis B vaccine series after birth
C. Explain to the client that they will receive the hepatitis B immune globulin immediately
D. Inform the client that hepatitis B cannot be transmitted to the fetus
Explain to the client that they will receive the hepatitis B immune globulin immediately [Show Less]