Lisette’s NCLEX OB Study #1

A plan of care is created for a term small-for-gestational-age (SGA) neonate who was admitted to the neonatal intensive care unit (NICU). The goal was for the newborn to reach 5 pounds by a specified date. On the specified date the infant weighs 4 pounds, 2 ounces. What should the nurse do next?

1. Increase the daily number of calories

2. Change the goal to a more realistic number

3. Reassess the problem before altering the plan

4. Postpone the evaluation date for another month

3 Before further intervention, the reason for the inadequate weight gain should be evaluated. Evaluation should take place before changing the plan or altering the goal.

1 This intervention is premature.

2 This intervention is premature.

4 This is unsafe; the reason for the lack of goal attainment must be identified.

A 17-year-old client, who is at 38 weeks’ gestation, is being prepared for an emergency cesarean birth because there is an abruptio placentae and severe fetal compromise. The client received nalbuphine (Nubain) 10 mg IV 30 minutes ago. Because the client is too sedated to sign the consent form, the nurse should:

1. Call the client’s mother and request a verbal consent

2. Proceed with the preparation and forgo written consent

3. Have the surgeon and attending practitioner sign the consent form

4. Sign the consent form and have the nurse manager countersign the form

3 The data indicate a life-threatening emergency, and if the client is unable to sign an informed consent it is the legal responsibility of the surgeon and the health care provider to sign the consent form so that further injury to the client and her fetus may be prevented.

1 There is not enough time to obtain a verbal consent.

2 It is illegal to perform the surgery without a signed consent.

4 Legally, a nurse is not allowed to countersign an informed consent unless the client has signed it first.

A female client is scheduled for a hysterectomy. When discussing the preoperative preparation, the nurse identifies that the client has inadequate understanding of the surgery. What is the next nursing intervention?

1. Describe the proposed surgery to the client

2. Proceed with implementing the preoperative plan

3. Notify the surgeon that the client needs more information

4. Explain gently that she should have asked more questions

3 Legally, the person performing the surgery is responsible to inform the client adequately; the nurse may clarify information, witness the client’s signature and cosign the consent form.

1 This is beyond the scope of nursing practice.

2 The nurse may face criminal charges of assault and battery if proceeding when there is a lack of informed consent.

4 This places blame on the client; it is the responsibility of the surgeon to impart the vital information required for consent

A client in labor is being prepared for a cesarean birth. What is the most important nursing intervention before anesthesia is administered?

1. Prepare the abdomen

2. Obtain informed consent

3. Initiate an intravenous infusion

4. Insert an indwelling urinary catheter

2 This is the priority before anesthesia is administered. Anesthesia depresses the central nervous system and the client cannot participate in decision making.

1 This can be done later; it is not the priority.

3 This can be done later; it is not the priority.

4 This can be done later; it is not the priority.

New parents are asked to sign the consent for their son to be circumcised. They ask for the nurse’s opinion of the procedure. How should the nurse respond?

1. “You should talk to the physician about this if you have any questions.”

2. “Let’s talk about it because there are advantages and disadvantages.”

3. “It is a safe procedure and it is best for male infants to be circumcised.”

4. “Although it may be a somewhat painful experience for the baby, I would allow it if I were you.”

2 This response permits exploration of the parents’ wishes and leads to assisting them in making their own decision.

1 This response blocks further discussion; the nurse can answer some of the questions and refer those that cannot be answered to the practitioner.

3 This is a value judgment; it denies the parents’ right to decide.

4 This response might frighten the parents; it denies the parents their power of decision.

A new mother tells the nurse that her baby “spits up” after each formula feeding. The nurse teaches her how to position her newborn after feedings. Following the next feeding the nurse observes that the mother positions the baby correctly. The nurse observed this activity to:

1. Prepare a basic teaching plan

2. Validate that learning has occurred

3. Ascertain the mother’s knowledge base

4. Determine the mother’s readiness to learn

A return demonstration can validate that desired learning has taken place from earlier teaching.

1 Teaching was already done and now must be evaluated.

3 This is not necessary; a return demonstration provides feedback for evaluation.

4 This is not necessary; a return demonstration provides feedback for evaluation.

When obtaining informed consent for sterilization from a developmentally challenged adult client, the nurse must be sure that the:

1. Parent or guardian signs the consent

2. Client is able to explain what the procedure entails

3. Client is able to comprehend the outcome of the procedure

4. Parent or guardian has encouraged the client to make the decision

3 The client must be intellectually competent;that is, able to comprehend the outcome of the procedure to give informed consent.

1 This avenue may be pursued after the client is deemed unable to provide informed consent. The parent or guardian must be designated by the court to perform this function.

2 This may be unrealistic for this client; it is more important for the client to demonstrate that the outcome of the procedure is understood.

4 The client should be free from the influence of others who might press to have the procedure performed. This is an individual decision by a client who is capable of making this decision.

A client at 16 weeks’ gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse observes bruises on the client’s face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm:

1. Domestic abuse

2. Hydatidiform mole

3. Excessive exercising

4. Thrombocytopenic purpura

1 Domestic abuse is more likely to intensify during pregnancy and the attacks usually are directed toward the pregnant woman’s abdomen.

2 A hydatidiform mole may be manifested by an unusually enlarged uterus for gestational age, hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen.

3 Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising.

4 Thrombocytopenic purpura and other bleeding disorders are manifested by bruises and petechiae on many areas of the body surface, not just the face and abdomen.

A nurse is teaching a prenatal class about infant safety. After the class several of the students are heard discussing what they had learned. The nurse identifies that the teaching is effective when one of the future parents states:

1. “My mother has already made the cutest pillowcases for the baby’s pillows.”

2. “I have just bought a new baby seat that can be strapped into the front seat of the car.”

3. “My mother can’t believe that babies are supposed to sleep on their backs, not their stomachs.”

4. “I was given a baby tub at my shower that has a special safety strap that lets me leave the baby alone in it.

3 Research demonstrates that placing an infant on the back reduces the incidence of sudden infant death syndrome (SIDS).

1 Pillows in an infant’s crib can cause suffocation.

2 It is unsafe to strap an infant seat into the front seat of a car.

4 Infants can drown in a very small amount of water in a tub; it is unsafe to leave an infant alone in a tub.

The parents of a newborn tell the nurse that they do not want their infant’s eyes treated with a prophylactic agent. How should the nurse respond?

1. “This is really for the baby’s good.”

2. “This is a legal requirement that must be done.”

3. “It is best that you discuss this with your pediatrician.”

4. “You’ll have to sign an informed consent to refuse the treatment.”

4 This is the required intervention when legally mandated eye treatment is refused.

1 This denies the parents’ desires and implies wrongdoing on their part.

2 The parents have the right to refuse but must indicate their refusal on an informed consent form.

3 This is shifting the responsibility to the pediatrician.

A 16-year-old girl at 28 weeks’ gestation arrives at the prenatal clinic with her mother for a routine sonogram. Before the procedure, the girl requests that the nurse not reveal the fetus’s gender if it should become apparent. Afterward the mother asks the nurse the sex of the fetus. Considering the mother-daughter relationship, the nurse’s best response is:

1. “That information is not available at this time.”

2. “I’m not allowed to divulge confidential information.”

3. “Your daughter asked me not to give that information to anyone.”

4. “The sex of the baby isn’t the most important information to know at this time.”

1 This response supports the client’s right to confidentiality without antagonizing the client’s mother.

2 Although this response protects the client’s right to confidentiality, it may disrupt the relationship between the client and her mother.

3 Although this response protects the client’s right to confidentiality, it may disrupt the relationship between the client and her mother.

4 This is a judgmental, nontherapeutic statement.

Because of the high discomfort level during the transition phase of labor, nursing care should be directed toward:

1. Helping the client maintain control

2. Decreasing the rate of intravenous fluid

3. Administering the prescribed medication

4. Having the client breathe in a uniform pattern

1 This is the most difficult phase of labor, and the client needs encouragement and support to cope.

2 Fluids should be increased at this time because of the increase in metabolism.

3 Medication at this time is contraindicated because it can depress the newborn at birth.

4 Breathing patterns should be complex, not uniform, at this time because they require a high level of concentration that helps to distract the client.

The nurse is caring for a client who is in the taking-in phase of the postpartum period. The area of health teaching that the client will be most responsive to is:

1. Perineal care

2. Infant feeding

3. Infant hygiene

4. Family planning

1 During the taking-in phase a woman is primarily concerned with being cared for and being cared about.

2 This is best taught during the taking-hold phase of postpartum adjustment.

3 This is best taught during the taking-hold phase of postpartum adjustment.

4 This is not a primary concern during the immediate postpartum period.

A postpartum adolescent mother confides to the nurse that she hopes her baby will be good and sleep through the night. What should the nurse plan to teach the client to do?

1. Talk softly and cuddle her baby when crying occurs

2. Keep her baby awake for longer periods during the day

3. Ensure sleep by adding cereal to her baby’s bedtime bottle

4. Put a soft and brightly colored toy next to her baby at bedtime

1 The mother needs to learn the realities of infant behaviors and how to cope with them; holding and talking to her infant are consoling measures.

2 It is unhealthy to disrupt a neonate’s sleep pattern.

3 The infant is too young to be given cereal.

4 At this age a toy is not meaningful and is an inadequate substitute for parental attention.

The husband of a woman who had her fourth child 3 weeks ago states she has been irritable and crying since bringing her newborn home. The nurse tries to assist him in understanding the situation by stating that:

1. Having four children is tiring and assistance may be needed

2. His wife probably has postpartum blues and it will soon pass

3. This behavior is common after birth and he should not be too concerned

4. Women often express themselves by crying and he should allow her to continue

1 This statement acknowledges the situation and suggests a possible solution to the problem.

2 Postpartum blues occurs earlier; this may be postpartum depression and should not be dismissed lightly.

3 This response is not only false reassurance, but it does not address the problem that is evident in the situation.

4 This is stereotyping and nontherapeutic.

A client with mild preeclampsia is told that she must remain on bed rest at home. The client starts to cry and tells the nurse that she has two small children at home who need her. How should the nurse respond?

1. “How do you plan to manage with getting child care help?”

2. “Are you worried about how you will be able to handle this problem?”

3. “You can get a neighbor to help out and your husband can do the housework in the evening.”

4. “You can prepare light meals and the children can go to nursery school a few hours each day.”

1 This response addresses the problem directly while providing an opportunity for the client to examine her options. The therapeutic regimen includes bed rest and peace of mind; these can best be achieved if the children are cared for adequately.

2 This explores feelings without including a therapeutic regimen.

3 This is giving solutions rather than exploring the situation with the client.

4 Complete bed rest has been prescribed, and the suggested plan assumes that the client is able to afford nursery school for her children.

What is the best nursing intervention to achieve the cooperation of an extremely anxious pregnant client during her first pelvic examination?

1. Distract the client by asking her preference as to the sex of her infant

2. Assist the practitioner so the client’s examination can be completed quickly

3. Explain the procedure and maintain eye contact while touching the client gently

4. Encourage the client to squeeze the nurse’s hand, close her eyes, and hold her breath

3 Doing this will help the client relax and will lessen discomfort.

1 This may distract the client but will not produce relaxation.

2 The client may become more anxious if the procedure is hurried.

4 This may make the client more anxious; holding the breath causes tightening of the perineum.

A pregnant client whose first child has Down syndrome is about to undergo an amniocentesis. The client tells the nurse that she does not know what she will do if this fetus has the same diagnosis. The client asks the nurse, “Do you think abortion is the same as killing?” How should the nurse respond?

1. “Some people think this is what an abortion is.”

2. “No, I do not think so, but it is your decision to make.”

3. “I really can’t answer that question. Are you ambivalent about abortion?”

4. “I don’t want to answer that question at this time. How do you feel about it?”

3 This response is nonjudgmental; it permits the client to identify her own feelings.

1 This is judgmental; it does not give the client the opportunity to express her feelings.

2 This is judgmental; it gives the nurse’s opinion on a moral question for the client.

4 This response leaves the burden of the decision to the client without offering assistance.

A client who has just given birth to an infant with Down syndrome tells the nurse that she could not possibly take a retarded child home and asks whether she should plan to place the child in an institution. Which response is the most appropriate at this time?

1. “It must be difficult not to realize your vision of a perfect child.”

2. “I understand how you feel. I will notify the nursery personnel of your decision.”

3. “Give yourself time to get acquainted, and you will see that your baby may not be retarded.”

4. “You should not make such a hasty decision because your baby is like any other baby right now.”

1 This is a nonjudgmental response that encourages exploration of feelings.

2 This response identifies the client’s feelings but cuts off communication because it ends the discussion.

3 This is a judgmental response that questions the mother’s decision making and deals only with the present.

4 This is a judgmental response that questions the mother’s decision making and deals only with the present.

A neonate is born with exstrophy of the bladder and the parents are upset. They are told that corrective surgery will be done as soon as possible. How can the nurse best help the parents at this time?

1. Teaching the parents about preoperative and postoperative care

2. Caring for the newborn in the same manner as any other newborn

3. Keeping the newborn as clean as possible to decrease the odor of urine

4. Reassuring the parents that after surgery their newborn will grow and develop without any after effects

2 The nurse’s role modeling of the acceptance of the infant, even with the newborn’s altered physical appearance, can help the parents to adjust.

1 This teaching is appropriate later; the parent’s first need to deal with their feelings regarding the newborn’s appearance.

3 The parents’ current major adjustment concern is the appearance of the infant; odor is secondary.

4 This is false reassurance; there are no guarantees related to the outcome of the surgery. (Nugent 344)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 4-day-old male with exstrophy of the bladder and ambiguous genitalia is in the neonatal intensive care unit (NICU). The everted bladder is inflamed and there is continual leaking of urine onto the surrounding skin. What is the nurse’s initial concern when trying to support his mother?

1. Promote her acceptance of her baby as he is

2. Prepare her for the surgery her baby will require

3. Teach her how to care for her baby’s urinary needs

4. Instruct her on ways she can meet her baby’s emotional needs

1 Before learning to care for her newborn emotionally and physically, the mother needs to begin to accept him as he is.

2 It is too soon to prepare the mother for the impending surgery. The priority at this time is to accept her baby.

3 This concern is important but if the mother first accepts the infant with the defect, teaching will be more effective

4 The mother will be better able to meet her baby’s emotional needs after she has accepted him.

A client with severe preeclampsia who was admitted to the high-risk unit anxiously asks the nurse, “Will my baby be all right?” How should the nurse respond?

1. “There is no way of telling at this time what the outcome will be.”

2. “If you do what the physician tells you to do, everything will progress normally.”

3. “The baby will probably be all right. Do you know that the amniotic fluid provides protection?”

4. “We will be monitoring your baby’s condition continuously. Would you like to listen to the baby’s heartbeat?”

4 This reassures the client of the fetus’s well-being and the fact that the nurse will be monitoring the fetus’s status.

1 This response does not provide the mother with reassurance of the fetus’s status or that anything is being done to monitor the fetus.

2 This provides false reassurance; following instructions does not guarantee a healthy newborn.

3 This provides false reassurance; amniotic fluid makes the umbilical cord less vulnerable but does not protect against other causes of fetal compromise.

A client in active labor is rushed from the emergency department to the labor and birth suite screaming, “Knock me out.” Examination reveals that her cervix is 9 cm dilated. What should the nurse say while trying to calm her?

1. “I’ll rub your back, which will help ease your pain.”

2. “You will get a shot when you reach the birthing room.”

3. “I’m sure you’re in pain, but try to bear with it for the baby’s sake.”

4. “Medication may interfere with the baby’s first breaths; try to bear the pain.”

4 Analgesia crosses the placental barrier; because birth is imminent, it can cause respiratory depression in the newborn.

1 The client is exhibiting fear and panic; a back rub at this time will not be effective and probably will be rejected.

2 This is incorrect information and provides false reassurance.

3 Although this is an empathic response, an explanation as to why medication cannot be given is more appropriate.

A preterm male newborn will be in the neonatal intensive care unit (NICU) for several weeks. The parents live about 100 miles away and say they can visit only every 2 weeks or so. What is most important for the nurse to do when planning care for this newborn and the family?

1. Plan for contact with the parents by sending e-mails with pictures of the infant

2. Focus on the infant’s biophysical needs in view of his present critical condition

3. Refer the infant’s parents to the social worker to arrange housing close to the hospital

4. Prepare a teaching plan to be given to the parents on the day of their infant’s discharge

1 This intervention promotes bonding.

2 Although the infant’s physical condition is a priority, the nurse must not overlook the psychosocial aspects of care.

3 Such planning may be unrealistic because the parents may have work and family responsibilities.

4 Postponing teaching until discharge limits its effectiveness; this action does not give the parents time to demonstrate an understanding of and competence with skills that will be needed.

A nurse understands the stages of parental adjustment that follow birth of an at-risk infant who is in the neonatal intensive care unit (NICU). To better plan nursing care, nursing observations and assessments are based on the recognition that the:

1. Parents should be encouraged to visit their newborn within the first day of birth

2. Mother should not see the infant until she has completed the necessary grief work

3. Mother should be reunited with her infant as soon as possible to enhance adjustment

4. Nurse should wait until the parents request to see their newborn before suggesting a visit

3 When the mother is emotionally prepared she should be reunited with her newborn at the first opportunity.

1 There is no magic about the first 24 hours; some mothers are too ill or both parents may be too frightened to see their baby that soon.

2 Grief work will go on for an extended period and has no relationship to when the infant is seen.

4 Some parents may be too frightened to ask to see their baby; the nurse can prepare the parents and then suggest a visit.

A nurse in the neonatal intensive care unit (NICU) is showing a mother her preterm infant for the first time. The mother immediately starts to cry and refuses to touch her baby. What does this behavior represent?

1. A typical detachment behavior

2. An incomplete bonding behavior

3. An expected reaction to the situation

4. A negative reaction to the NICU environment

3 To cry in this situation is a typical response. It is not unusual to be frightened about touching a small preterm infant and the nurse should provide support while encouraging the mother to do so.

1 Bonding does not have a detachment behavior phase; the behavior indicates apprehension in a difficult situation.

2 This is not incomplete bonding but fear in a difficult situation.

4 This reaction to her newborn is more complex than merely fear of the NICU.

The parents of a preterm newborn visit the neonatal intensive care unit (NICU) for the first time. They are obviously overwhelmed by the amount of equipment and the tiny size of their baby. What is the nurse’s most appropriate response to their reaction?

1. Placing the baby in the mother’s lap

2. Showing the parents how to touch the baby

3. Explaining the purpose of the equipment being used

4. Discouraging the parents from staying too long on this first visit

2 Parent-infant bonding follows a natural progression involving touch; touching helps the parent overcome fear and initiates the bonding process.

1 The mother may not be ready for this step on her first contact and the newborn may not be well enough to be moved.

3 The parents are not ready for explanations about the equipment in their present state of anxiety.

4 This may make the parents feel unwelcome and set a negative tone for future visits

When seeing her preterm infant son in the neonatal intensive care unit (NICU) for the first time, a mother exclaims, “My baby is so little. How will I ever care for him?” The nurse explains to the mother that she:

1. Will be encouraged to participate in his care as much as possible

2. Can watch his care to assist her in becoming familiar with the specific routines

3. Should find someone with preterm care training to help at home for the first week

4. Will be able to care for him in a special nursery for a few days before his discharge

1 By participating in her infant’s care, the mother will gain confidence in her own ability to meet her infant’s needs.

2 Watching the provision of care by others may only increase the client’s sense of inadequacy.

3 There is no need for a specialist to care for the infant after discharge.

4 The mother should be involved with infant care as early as possible, not just a few days before discharge.

On the third postpartum day, a client who had an unexpected cesarean birth is found crying when the nurse enters her room. She says, “I know my baby is fine, but I can’t help crying. I wanted natural childbirth so much. Why did this have to happen to me?” The nurse responds knowing that:

1. The client’s feelings will pass after she has bonded with her infant

2. The client is probably suffering from a postpartum depression and needs special care

3. A cesarean birth may be a traumatic experience but most women know it is a possible outcome

4. A woman’s self-concept may be negatively affected by a cesarean birth, and the client’s statement may reflect this

4 The client’s response is appropriate to the situation reflecting disappointment in not achieving her goal; in addition, this is the time “postpartum blues” occur.

1 This may or may not occur; there is no indication that the feeling will pass or that bonding is involved.

2 The client’s statement is not indicative of depression.

3 With rising cesarean rates across the United States, most women know that a cesarean birth is a real possibility. However, knowing this does not negate the disappointment the client feels for not reaching her goal.

Before an amniocentesis both parents express anxiety about the fetus’s safety during the test. Which nursing intervention will best promote the parents’ ability to cope?

1. Initiating a parent-practitioner conference

2. Reassuring them that the procedure is safe

3. Informing them about the procedure step by step

4. Arranging for the father to be present during the test

3 Giving the parents information about what to expect during the procedure will help to allay their fears and encourage their cooperation.

1 The nurse should be able to provide information and interpretation of procedures for clients; delay in answering their questions may increase clients’ concerns.

2 An amniocentesis is a low-risk procedure, but some complications may occur.

4 If the father is uninformed, viewing the procedure may increase his anxiety, even though his presence may be comforting to the mother.

A nurse determines that the husband of a client is reacting positively to his wife’s pregnancy when, during the second trimester, he says:

1. “I’m planning to take a part-time job because we’ll need a larger apartment.”

2. “I’m so proud of my wife. I’m already digging a baseball diamond in our backyard.”

3. “I get so excited when I feel the baby kicking. I didn’t realize how strong those little legs are.”

4. “I hope I’ll be able watch my baby’s birth. A childbirth movie was shown in class last night that sort of turned me off.”

3 During the second trimester the big event is palpation of movement. The husband’s reaction indicates enthusiasm for the progress of the pregnancy.

1 This is true of the first trimester when the father becomes concerned about the future needs of his expanded family.

2 This is true of the first trimester when the father expresses excitement over confirmation of pregnancy and his virility.

4 It is too early to predict the father’s response to childbirth. (Nugent 345)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During labor a client tells the nurse that she and her husband are very concerned because the baby will be born 2 months early. How should the nurse respond?

1. “You should be concerned; I feel for you.”

2. “If you are concerned; let’s talk about it.”

3. “Try not to worry about it; just concentrate on your labor.”

4. “Don’t worry; the care of preterm babies has greatly improved.”

2 This response encourages the client to verbalize concerns; verbalization is an outlet for discharging tension.

1 This response reinforces the client’s fears; it conveys sympathy, not empathy.

3 This response denies the client’s feelings and cuts off communication.

4 This response denies the client’s feelings and gives false reassurance. (Nugent 345)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is at 28 weeks’ gestation and in active labor is crying. She says, “I just know this baby will die. What’s the use of doing all this to save it?” The nurse concludes that the client is:

1. Depressed and needs firm, positive support during labor

2. Experiencing anticipatory grief and withdrawing from bonding

3. In need of sedation to aid her in coping with the impending birth

4. Demonstrating difficulty dealing with the birth by using the word “it”

2 Anticipatory grief is expected with a potential loss; ventilation of feelings should be encouraged.

1 Gentle, not firm, support is required to help the client cope with potential grieving; maintaining a positive attitude may provide false reassurance.

3 This delays the client’s adaptation to the possible loss; it is more desirable to allow the client to ventilate feelings and work through the anticipatory grieving process.

4 The use of the word “it” is not relevant; this refers to the fetus and is an expression of the grieving process. (Nugent 345-346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What must the nurse assess first when planning to promote mother-infant attachment?

1. Mother-infant interaction

2. Mother-father interaction

3. The infant’s physical status

4. The mother’s ability to care for her infant

1 The extent and quality of the mother-infant interaction is believed to be a predictor of positive or negative attachment behaviors.

2 Although this is assessed, it is not as significant as mother-infant interaction.

3 Although this is assessed, it is not as significant as mother-infant interaction.

4 Although this is assessed, it is not as significant as mother-infant interaction. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What common concern of the mother after an unexpected cesarean birth should the nurse anticipate?

1. Postoperative pain

2. Prolonged period of hospitalization

3. Inability to assume the mothering role

4. Sense of failure in the birthing process

…4 An unplanned cesarean birth can result in guilt, disappointment, anger, and a sense of failure as a woman.

1 This is not usually a common concern.

2 The hospital stay is not exceptionally prolonged; the client usually is discharged within 2 to 4 days.

3 Mothers who have had a cesarean birth can assume the mothering role to the same degree as women who have had a vaginal birth. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is instructing a client to cough and deep breathe after an emergency cesarean birth. The client says, “Get out of here. Don’t you know that I am in pain?” Which response is most effective?

1. “I’m sure you are in pain. I’ll come back later.”

2. “If you are unable to cough, try to take six very deep breaths.”

3. “Your pain is to be expected, but you must exercise your lungs.”

4. “I’ll give you something for your pain. We can start the coughing tomorrow.”

2 This is important because deep breathing aids in fully expanding the alveoli and prevents stasis of pulmonary secretions.

1 This postpones needed pulmonary exercises, which may result in atelectasis and retained respiratory secretions.

3 This response avoids the problem; it states a fact and does not allow the client a sense of control.

4 Although this response is empathic, it postpones needed pulmonary exercises, which may compromise the client’s respiratory status. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who had a cesarean birth seems upset. She has been having difficulty breastfeeding for 2 days and now asks the nurse to bring her a bottle of formula. What is the nurse’s initial action?

1. Obtaining the requested formula

2. Administering the prescribed pain medication

3. Assessing the client’s breastfeeding technique

4. Notifying the practitioner of the client’s request to switch feeding methods

3 The nurse should assess the client to determine why she is having difficulty with breastfeeding. She may be uncomfortable or in need of assistance with her breastfeeding technique.

1 Immediately providing the formula without assessing the situation does not meet the client’s needs at this time.

2 Pain may be a factor in the client’s frustration with breastfeeding, but this should be determined as a result of the assessment process.

4 This is premature. It is the nurse’s responsibility to assess the situation and arrive at a solution in collaboration with the client. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On the first postpartum day, a client whose infant is rooming-in asks the nurse to return her baby to the nursery and bring the baby to her only at feeding time. How should the nurse respond?

1. “It seems you changed your mind about rooming-in.”

2. “I think you are having difficulty caring for the baby.”

3. “All right, I will inform the other nurses of your decision.”

4. “You must be tired. I’ll bring the baby back at feeding time.”

1 This opens communication and allows the client to verbalize thoughts and feelings.

2 This is judgmental; there are not enough data to make this assumption.

3 This does not give the client the opportunity to verbalize feelings and needs.

4 This ignores the client’s needs and cuts off communication. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 37 weeks’ gestation gives birth to a healthy boy. When inspecting her newborn in the birthing room the client becomes concerned and asks, “What’s this sticky white stuff all over him?” How should the nurse respond?

1. “It’s a secretion from the baby’s fat cells and is called milia.”

2. “This is vernix. It helps protect the baby while he’s in the uterus.”

3. “Your baby was born several weeks early and we expect to see this.”

4. “It’s nothing to be concerned about. Most newborns are covered with it.”

. 2 A factual response will allay the mother’s concern. Vernix caseosa is a cheesy white substance that covers the fetus. Vernix caseosa protects the fetus from the amniotic fluid while in utero; most of it disappears by 40 weeks’ gestation.

1 Milia are white pinpoint dots (sebaceous glands) on the newborn’s nose, chin, and forehead that disappear within a few weeks.

3 The nurse should explain only what vernix is; referring to the infant as preterm may unnecessarily alarm the mother.

4 This is not answering the mother’s question nor is it abundant on neonates born at term. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The mother of a pregnant teenager asks the nurse how her daughter could have been so foolish because birth control had been discussed with her many times. How should the nurse respond?

1. “Apparently your daughter was not listening to you.”

2. “You should have made sure her boyfriend understood birth control, too.”

3. “Teenagers often fail to use birth control because they forget to discuss this with their sexual partner.”

4. “Although teenagers can intellectually discuss birth control, they don’t believe that they will become pregnant.”

4 Teenagers are capable of cognitively understanding the risk of unprotected sex but often believe themselves invulnerable, which leads to risk-taking behaviors.

1 This response does not help the mother to understand her daughter’s behavior and may precipitate increased hostility toward the daughter.

2 This may precipitate feelings of guilt and does not help the mother to understand her daughter’s behavior.

3 Sexual activity may be impulsive, which is not conducive to a discussion; also, adolescents who are developing their sense of sexuality may feel too insecure to raise this discussion. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The mother of a newborn son tells the nurse that she is concerned about a circumcision because of the pain involved. What is the nurse’s best response?

1. “A newborn’s nerves are not mature enough to feel pain.”

2. “It is such a short procedure that the pain will not last long.”

3. “Your baby should have no memory of it even if there is pain.”

4. “The practitioner will tell you how your baby’s pain will be controlled.”

4 Each health care provider has a protocol for relieving the pain caused by the circumcision; the parent has the right to be informed before signing the consent form.

1 Newborns do feel pain, although their nervous systems are not yet mature enough to localize it.

2 The mother is concerned about her newborn’s pain irrespective of the duration of the procedure.

3 Although the infant may have no memory of the pain, this does not address the mother’s concern adequately. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Since her infant’s birth, a woman has breastfed her now 6-month-old infant. The woman becomes hysterical after learning her husband has been seriously injured in an automobile accident. Culturally, this woman believes that emotional stress while breastfeeding can “sour the milk,” and she indicates she must wean her infant immediately. What should the nurse do?

1. Instruct the mother about formula feeding

2. Explain to the mother that these beliefs are wrong

3. Provide the mother with books which indicate that the milk does not sour

4. Encourage the mother to take an antianxiety drug while continuing breastfeeding

1 The nurse should teach the mother how to formula feed because cultural beliefs are deeply ingrained and it is unlikely at this time that the nurse can change the client’s mind.

2 This is a judgmental response that does not recognize the client’s beliefs or feelings. It is not therapeutic to contradict the client, especially when the alternative to breastfeeding will not harm the mother or infant.

3 This is a judgmental response that does not recognize the client’s beliefs or feelings. This is not therapeutic.

4 Antianxiety medications are contraindicated when breastfeeding. (Nugent 346)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in preterm labor does not respond to therapy, and birth seems imminent. The client begins to cry and says, “I’m so worried about my baby.” Which is the nurse’s best response?

1. “All of this must leave you very confused and frightened.”

2. “Think positively; your anxiety will increase your contractions.”

3. “You are receiving the best medical and nursing care available.”

4. “This hospital has a neonatal unit; it can handle emergencies such as yours.”

1 Focusing on the mother’s feelings permits her to express fears and concerns.

2 This answer will frighten the client and cut off further communication.

3 This is subjective and cuts off further communication.

4 This answer will frighten the client and cut off further communication. (Nugent 346-347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. What is the most therapeutic nursing intervention for this client?

1. Focus on the client’s physical needs

2. Encourage the client to verbalize her feelings about the loss

3. Remind the client that she will be able to become pregnant again

4. Encourage the client to think of herself, her husband, and their future

2 This intervention demonstrates understanding of grief work; the nurse should first help the client resolve the current problem.

1 Although this is important, it focuses only on a part of the necessary interventions; the client needs help to cope with her loss.

3 This does not demonstrate understanding of the grieving process; the present loss must be dealt with before moving on to future plans.

4 This does not demonstrate understanding of the grieving process; the present loss must be dealt with before moving on to future plans. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After a difficult labor a client gives birth to a 9-pound boy who dies shortly afterward. That evening the client tearfully describes to the nurse her projected image of her son and what his future may have been. What is the nurse’s most therapeutic response?

1. “I guess you wanted a son very much.”

2. “It must be difficult to think of him now.”

3. “I am sure he would have been a wonderful child.”

4. “If you dwell on this now your grief will be harder to bear.”

2 This response uses empathy; the nurse is attempting to show understanding of the client’s feelings.

1 This is nontherapeutic reassurance; the nurse has no way of knowing this.

3 This switches the focus away from the client, whose needs should be met at this time.

4 This denies the client’s feelings; it implies that the client should curb painful emotions. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a client who has a newborn with a neurological impairment. What is the most important nursing action?

1. Assisting the client with the grieving process

2. Performing frequent neurologic assessments of the newborn

3. Arranging for social services to discuss possible placement of the newborn

4. Obtaining a prescription for an antidepressant to help the client cope with the depressing news

1 Grieving is expected and necessary whenever a newborn is born less than healthy.

2 More data are needed to come to this conclusion; frequency of assessments depends on the severity and type of the neurological problem.

3 This may be done later, but it is not the priority at this time.

4 This may delay the client’s ability to actively participate in dealing with feelings. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is obtaining the history of a client in the third trimester who is visiting the prenatal clinic for the first time. She tells the nurse she has two toddlers at home, and their father abandoned the family last month. She adds that she doesn’t know what to do. The nurse concludes that the client is:

1. Angry that the father has left

2. Overwhelmed by the situation

3. Ambivalent about her pregnancy

4. Denying the reality of her pregnancy

2 Because of the critical home situation, this client is experiencing multiple stressors that may cause difficulty with coping.

1 There are no data to support this conclusion.

3 There are no data to support this conclusion.

4 The client is attending the prenatal clinic, which indicates that she is aware of reality and is not in denial. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While a client in the prenatal clinic is dressing at the completion of her pelvic examination, she states, “Why must I be pregnant now? It’s the wrong time.” What is the nurse’s most therapeutic response?

1. “This is a typical response to pregnancy.”

2. “No time is ever the right time to be pregnant.”

3. “You don’t seem to be happy about this pregnancy.”

4. “There are alternatives if you don’t want to be pregnant.”

3 This is a reflective statement that opens the door for the client to express her feelings.

1 This is not a common reaction of most pregnant women.

2 This response dismisses the client’s concern; it may close the door for further discussion.

4 Exploring abortion is premature. There are insufficient data for this response. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client had a mastectomy because of breast cancer. She is now receiving chemotherapy, which caused hair loss. The client states, “I feel like I have lost my sense of power.” What is the nurse’s best response?

1. “Hair does not empower a person.”

2. “Losing power seems important to you.”

3. “Knowledge is power; I will give you some pamphlets to read.”

4. “Losing hair is common; it will grow back, so you should not worry.”

2 This response provides an opportunity for the client to discuss feelings.

1 This statement is confrontational, which may cut off further communication.

3 This response dismisses the client’s concern and does not promote the client’s further verbalization of feelings.

4 This response dismisses the client’s concerns and cuts off further communication. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 49-year-old client is admitted with a diagnosis of cervical cancer. While obtaining her health history she tells the nurse, “I have not had a Pap smear for more than 5 years. I probably wouldn’t be in the hospital today if I’d had those tests more often.” How should the nurse respond?

1. “Please tell me why you waited so long.”

2. “You feel like you’ve neglected your health.”

3. “It’s never too late to start taking care of yourself.”

4. “Most women hate to have Pap smears done although it’s really important.”

2 This indicates recognition of expressed feelings; a nondirective response encourages verbalization.

1 This ignores the client’s present emotional needs; direct statements frequently do not elicit feelings and may cut off communication.

3 This is a judgmental response because it implies that the client has been negligent.

4 Although this is a true statement, this response ignores the client’s present emotional needs. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A husband is sitting in the waiting room while his wife is getting her infertility prescription refilled by the clinic pharmacist. As the nurse sits down beside him he blurts out, “It’s like there are three of us in bed—my wife, me, and the doctor.” What feeling is reflected by this statement?

1. Guilt

2. Anger

3. Depression

4. Unworthiness

. 2 Anger is a coping strategy that allows a person to gain a sense of control over life; the husband feels a loss of control over the spontaneity of his intimate relationship with his wife because intercourse is based on administration of the medications.

1 There is no evidence that the client is feeling guilty.

3 The client is not withdrawing or expressing sadness, dejection, or lethargy.

4 There is no evidence of the client feeling undeserving of an intimate relationship. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is taking an oral contraceptive calls the nurse with concerns about side effects of the medication. Which adverse effect to this medication should alert the nurse to inform the client to immediately stop the contraceptive and contact the practitioner? Select all that apply.

1. _____ Nausea

2. _____ Weight loss

3. _____ Visual disturbances

4. _____ Persistent headaches

5. _____ Decreased blood pressure

Answer: 3, 4

1 Nausea is an expected side effect and does not require notification of the practitioner.

2 Weight gain, not weight loss, may occur because of edema.

3 Visual disturbances, such as a partial or complete loss of vision or double vision, may indicate neuro-ocular lesions, which are associated with the use of oral contraceptives.

4 Persistent headaches may indicate hypertension, which can occur with the use of contraceptives.

5 The client may develop hypertension, not hypotension. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is instructing a client who is taking oral contraceptives to increase her intake of dietary supplements. Which supplement should be increased?

1. Calcium

2. Vitamin C

3. Vitamin E

4. Potassium

2 Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C; supplementation may be required.

1 It is unnecessary to increase the intake of calcium when taking oral contraceptives.

3 There is no clinical evidence that links oral contraceptives and a deficiency of vitamin E.

4 There is no interrelationship between oral contraceptives and dietary intake of potassium. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is visiting the family planning clinic has an oral contraceptive prescribed. As part of teaching the nurse plans to inform the client of the possibility of developing:

1. Cervicitis

2. Ovarian cysts

3. Fibrocystic disease

4. Breakthrough bleeding

4 This commonly occurs when women start using oral contraceptives; it is midcycle bleeding and if it persists, the dosage should be changed.

1 There is no evidence that this is related to the use of oral contraceptives.

2 There is no evidence that this is related to the use of oral contraceptives.

3 There is no evidence that this is related to the use of oral contraceptives. (Nugent 347)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should a nurse include in the teaching plan for a couple who seek information about family planning?

1. Condoms must be held in place by the rim when withdrawing the penis from the vagina

2. Diaphragms are effective even when the partners choose not to utilize a spermicidal cream

3. When coitus interruptus is used, sperm cannot reach the ovum if the man withdraws before ejaculation

4. When periodic abstinence is used, the woman should have intercourse on days that she has an increase in temperature

1 Unless the condom is held, it can be displaced, allowing the sperm to enter the vagina.

2 Spermicidal cream is needed because the diaphragm may be displaced during intercourse.

3 Sperm can be deposited at the beginning of intercourse without the man being aware of it.

4 When the woman has an increase in her basal temperature, she is most fertile and should avoid intercourse. (Nugent 347-348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 28-year-old woman seeks advice about oral contraceptives from the nurse in her company health office. What should the nurse tell her if she is a smoker?

1. Oral contraceptives can cause thrombophlebitis

2. Oral contraceptives can be used with other methods

3. Some oral contraceptives can be used without concern

4. Some oral contraceptives are safe while others are not safe

1 Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis.

2 This is not necessary if there are no contraindications; oral contraceptives are effective if used alone.

3 There are no “safe” oral contraceptives for all women; women at risk should be informed of the potential consequences.

4 There are no “safe” oral contraceptives for all women; women at risk should be informed of the potential consequences. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse at a women’s health clinic identifies that client teaching regarding use of an oral contraceptive is understood when the client states, “I:

1. can stop the pill and try to get pregnant right away.”

2. may miss two periods and not worry about being pregnant.”

3. will put a baby’s picture on my bathroom mirror, so I’ll see it every morning.”

4. am so glad we won’t have to use condoms even if I miss just one pill during the month.”

3 This acts as a reminder that the oral contraceptive must be taken every day.

1 A woman should wait 2 to 3 months after stopping the oral contraceptive pill before attempting pregnancy.

2 If two consecutive menstrual cycles are missed the client should stop the contraceptive pill and perform a pregnancy test.

4 The client should use a barrier method of contraception for the first month of pill use and if a pill is missed to help prevent conception. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is counseling a client with type 1 diabetes who has requested contraceptive information. On which method of contraception should the nurse place the most emphasis?

1. Rhythm

2. Diaphragm

3. Oral contraceptive

4. Intrauterine device

2 This is the preferred method for clients with diabetes because there are no physiological side effects.

1 This requires dedication, self-control, and a strong desire to avoid pregnancy; it is not as effective as a diaphragm.

3 Oral contraceptives have a diabetogenic effect; they alter carbohydrate metabolism, and insulin dosage must be adjusted.

4 Because of the possibility of perforation, this method increases the risk of infection for women who have diabetes. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse in a family planning clinic determines that a client understands the discussion about using a cervical cap with a spermicide when the client states that after intercourse, a cervical cap must be left in place for at least:

1. 6 hours

2. 5 hours

3. 3 hours

4. 2 hours

1 The cervical cap used in conjunction with a spermicide that remains active for 6 hours provides the most effective contraceptive result.

2 The chemical barrier will not be capable of destroying all the sperm in such a short period of time.

3 The chemical barrier will not be capable of destroying all the sperm in such a short period of time.

4 The chemical barrier will not be capable of destroying all the sperm in such a short period of time. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A couple tells the nurse that they wish to use the rhythm method of birth control. The woman states that she menstruates every 32 days. What should the nurse teach the couple about when her ovulation probably occurs?

1. On the 14th day of the cycle

2. 10 days after the first day of bleeding

3. 14 days before the start of the next menses

4. 2 to 3 days after the last day of menstrual bleeding

. 3 In a regular cycle, ovulation occurs 14 days before the onset of the next menses.

1 This occurs in a woman who menstruates every 28 days.

2 This is too early in the cycle.

4 This is too early in the cycle. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The school nurse is teaching a group of 16-year-old girls about the female reproductive system. One student asks how long after ovulation it is possible for conception to occur. The nurse’s most accurate response is based on the knowledge that an ovum is no longer viable after:

1. 12 hours

2. 24 hours

3. 48 hours

4. 72 hours

2 The ovum is viable for about 24 hours after ovulation, and if not fertilized before this time it degenerates.

1 The ovum is viable longer than 12 hours.

3 The ovum is viable for a shorter length of time than this.

4 The ovum is viable for a shorter length of time than this. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client states that she wishes to use the calendar method of birth control. The nurse concludes that the client understands how to calculate the beginning of the fertile period when she states, “I will:

1. Subtract 11 days from the length of my longest cycle.”

2. Subtract 18 days from the length of my shortest cycle.”

3. Abstain from sexual intercourse after the 10th day of my cycle.”

4. Abstain from intercourse from the 10th day prior to the middle of my average cycle.”

2 The fertile period is determined by subtracting 18 days from the length of the shortest cycle to determine the first unsafe day and subtracting 11 days from the length of the longest cycle to determine the last unsafe day.

1 This is how the last day, not the first day, of the unsafe period is determined.

3 This is true only if the shortest cycle is 28 days; the date depends on a calculation based on the length of the woman’s shortest and longest cycles.

4 The longest and shortest cycles are used, not the average length of a cycle. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When teaching a client about using a diaphragm as a form of contraception, the nurse should tell her that the diaphragm:

1. May or may not be used with a spermicidal lubricant

2. Should remain in place for at least six hours after intercourse

3. Must be inserted with the dome facing down to be maximally effective

4. Often appears puckered, but this will not interfere with its being effective

2 The diaphragm should remain in place for at least 6 hours after intercourse because the spermicidal jelly or cream requires this amount of time to be effective.

1 The diaphragm must always be used with a spermicide to be effective.

3 The diaphragm may be inserted with the dome facing either up or down and still be effective.

4 Puckering, especially near the rim, may indicate thin spots that can rupture during intercourse; the diaphragm should be replaced if puckering is identified. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While a nurse is discussing methods of contraception with a client during her first visit to the woman’s health clinic, the client expresses a desire to postpone her first pregnancy for at least 5 years. Her health history reveals that she currently smokes 1½ packs of cigarettes a day, has never been pregnant, and does not want to use a barrier method of contraception. Which method should the nurse anticipate the practitioner will recommend?

1. A vaginal ring (NuvaRing)

2. An intrauterine device (IUD)

3. MedroxyPROGESTERone (Depo-Provera)

4. Combined oral contraceptive pills (COCPs)

3 MedroxyPROGESTERone (Depo-Provera) is a long acting, progestin-only contraceptive that is less likely to cause cardiovascular problems in women who smoke than contraceptives containing estrogen.

1 This contraceptive contains estrogen and is not recommended for women who smoke.

2 An intrauterine device (IUD) usually is not recommended for nulliparous women.

4 This contraceptives contains estrogen and is not recommended for women who smoke. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse in a women’s health clinic is counseling a 34-year-old client who has requested a prescription for oral contraceptives. The nurse determines that more discussion is necessary if the client’s health history reveals:

1. Anemia

2. Depression

3. Hypertension

4. Dysmenorrhea

3 One of the side effects of oral contraceptives is hypertension; therefore, they are contraindicated for a woman who already has hypertension.

1 This is not a contraindication for women who want to take oral contraceptives.

2 This is not a contraindication for women who want to take oral contraceptives.

4 Oral contraceptives may be prescribed for women with menstrual difficulties such as dysmenorrhea. (Nugent 348)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse assesses a married 35-year-old client who is to undergo a tubal ligation to determine the client’s possible emotional response to the procedure. A factor in the history that contributes most to the healthy resolution of any emotional problem associated with sterilization is that the client:

1. Has a son and daughter and feels her family is complete

2. Believes that the surgery will relieve her monthly dysmenorrhea

3. Knows that her husband does not want her to have any more children

4. Has just had a complicated birth and never wants to undergo another birth again

1 Many couples in their 30s who are happy with their family and feel their family is complete choose sterilization as their method of contraception.

2 Sterilization via tubal ligation should have no effect on dysmenorrhea because hormonal influence does not change.

3 The decision for sterilization should not be made by others, only by the woman herself.

4 Decisions regarding sterilization should not be made during pregnancy or in the immediate postpartum period and especially if the client is stressed. (Nugent 348-349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A couple at the prenatal clinic for a first visit tells the nurse that their 2-year-old child has just been diagnosed with cystic fibrosis. They state there is no family history of this disorder. They ask the nurse what the chances are for their having another child with cystic fibrosis. Based on the knowledge that this disorder has an autosomal recessive mode of inheritance, how should the nurse respond?

1. There is a 50% chance that this baby will also be affected

2. If this baby is male, there is a 50% chance of his being affected

3. If this baby is female, there is no chance of her being affected, but she will be a carrier

4. There is a 25% chance the baby will be affected, but a 50% chance that the baby will be a carrier

4 According to Mendelian law, because both parents are carriers, this baby has a 50% chance of being a carrier, a 25% chance of having the disease, and a 25% chance of being unaffected.

1 This may occur with an X-linked inheritance, or in autosomal dominant inheritance patterns, but not in autosomal recessive inheritance when both parents are carriers.

2 This occurs in an X-linked inheritance pattern.

3 This occurs in an X-linked inheritance pattern. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A woman in the family planning clinic has decided to use the diaphragm for contraception. What should the nurse teach her about using a diaphragm?

1. Completely cover the outside of the diaphragm with spermicidal jelly or cream

2. Douche within 1 hour after intercourse to enhance the effectiveness of the diaphragm

3. Correct placement of the diaphragm allows an inch between the diaphragm and the vaginal wall

4. Insert the diaphragm before intercourse and leave it in at least 6 hours after intercourse to kill all the sperm

4 This is important information; removing the diaphragm too early may allow for some still motile sperm to ascend into the uterus.

1 Spermicidal jelly should be applied inside the dome so that it is directly over the cervical os.

2 Douching should not be done at all, especially while the diaphragm is in place because it will wash away some of the spermicidal jelly; also it interferes with the normal flora of the vagina.

3 Correct placement of the diaphragm affords a close fit from vaginal wall to vaginal wall while covering the cervix. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A couple, married for 5 years, want to start a family. When talking with them the husband says, “Well, I guess we are going to have to jump into bed three or four times a day, every day until it works.” What is the nurse’s best response?

1. Tell them to continue intercourse as usual until conception occurs

2. Instruct them on the frequency and timing of intercourse to promote conception

3. Discourage this because sperm production decreases with frequent sexual intercourse

4. Agree that the frequency of intercourse must increase but twice daily is sufficient to promote conception

2 Instructing the couple to have intercourse four times a week with at least 12 to 24 hours between ejaculations will increase the chance of conception and will correct the client’s misconceptions in a nonthreatening manner.

1 This is too vague; specific instructions should be given in a nonthreatening manner.

3 To openly discourage the partner without providing instruction may be harmful to the relationship between the couple themselves or the couple and the nurse.

4 Twice daily intercourse is too frequent because it does not allow enough time between ejaculates for adequate spermatogenesis. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A female client with Hodgkin’s disease is to start chemotherapy. She and her husband have been trying to have a child and are quite concerned when they learn that sterility may result. On what information should the nurse base the reply?

1. Ova can be harvested and frozen for future use

2. Chemotherapy is not radical enough to destroy ovarian function

3. Ovarian function will be temporarily destroyed but will return in time

4. Radiation can be substituted for chemotherapy to preserve ovarian function

1 Women in the childbearing years should be informed of all options available to preserve the ability to reproduce.

2 Chemotherapy can depress or destroy ovarian functioning.

3 Destroyed ovarian function cannot be reversed; it is permanent.

4 Both radiation and chemotherapy can destroy ovarian function. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 16-year-old girl who has become sexually active asks the nurse, “What is the most effective way to prevent a pregnancy?” Which method of preventing pregnancy should the nurse tell her is most effective?

1. Using birth control pills

2. Using spermicidal foam

3. Abstinence from sexual intercourse

4. Having an intrauterine device inserted

3 Absence of sexual intercourse is the most effective form of birth control (100% effective) because the egg and sperm do not come into contact with one another.

1 The oral contraception pill has a high, but not perfect (97% to 99%), effective rate when used correctly.

2 This is a fairly effective (82% to 98%) means of preventing pregnancy; effectiveness depends on correct, consistent use.

4 This is a fairly effective (94% to 99%) means of preventing pregnancy but it is contraindicated for nulliparas. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client asks the nurse what she should do if she forgets to take the pill one day. How should the nurse respond?

1. “Take your pills as instructed.”

2. “Call your practitioner immediately.”

3. “Continue as usual and there should not be a problem.”

4. “On the next day take one pill in the morning and one before bedtime.”

4 The client should make up for the missed pill by taking two the next day; taking one in the morning and one in the evening lessens the chance of the client becoming nauseated.

1 This response does not tell the client what to do if a pill is missed; missing one pill can alter hormone levels and predispose the client to becoming pregnant.

2 It is unnecessary to call the practitioner unless other problems are identified.

3 This is wrong advice; missing one pill may alter hormone levels and predispose the client to pregnancy. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

At a client’s first visit to the prenatal clinic, the nurse asks the client when she had her last menstrual period so the estimated date of birth (EDB) can be determined. The client responds, “January 21.” Using Nägele’s rule, what is the month and day of the client’s EDB?

1. October 21

2. October 28

3. November 21

4. November 28

2 October 28. Nägele’s rule for determining the estimated date of birth (EDB) is to subtract 3 months from the first day of the last menstrual period and add 7 days and 1 year.

1 According to Nägele’s rule this is an incorrect calculation; this EDB is too early.

3 According to Nägele’s rule this is an incorrect calculation; this EDB is too late.

4 According to Nägele’s rule this is an incorrect calculation; this EDB is too late. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client visiting the prenatal clinic for the first time tells the nurse that she has heard conflicting stories about sex during pregnancy and asks about continuing sexual activity. How should the nurse respond?

1. “Intercourse should be discontinued after the second trimester.”

2. “This information can be given only by your obstetrician or nurse-midwife.”

3. “With an uncomplicated pregnancy, there are no limitations on sexual activity.”

4. “Sexual activity should be avoided during the first and last six weeks of pregnancy.”

3 Although there are no limitations on sexual activity, as the pregnancy progresses the client and her partner may need some guidance in altering positions to make sexual activity more comfortable.

1 Intercourse may be continued throughout the entire pregnancy if there are no complications.

2 Sex information can be given by a professional nurse; it is not necessary to refer this client to another care provider.

4 This is unnecessary if the cervical plug is still in place and the membranes are intact. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An active 19-year-old primigravida attends the prenatal clinic for the first time. She asks the nurse if she can continue playing tennis and go horseback riding while she is pregnant. How should the nurse reply?

1. “Continue your usual activities as long as you are comfortable.”

2. “Horseback riding is acceptable, but only up to the last trimester”

3. “Tennis is good exercise for you, but horseback riding is too strenuous.”

4. “Both of these sports have been found to be too strenuous for a pregnant woman.”

1 Any regular activity that was typical before pregnancy can be continued in pregnancy if there are no complications such as bleeding, cramps, or pain.

2 It is not necessary to stop riding after the second trimester unless the woman is uncomfortable or it is otherwise contraindicated.

3 A woman used to riding horses can continue; no exercise is too strenuous if it was done consistently before pregnancy.

4 Both activities are acceptable as long as the woman is accustomed to doing them. (Nugent 349)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

At a client’s first prenatal visit, the nurse-midwife performs a pelvic examination. The nurse states that the client’s cervix is bluish purple, which is known as Chadwick’s sign. The client becomes concerned and asks if something is wrong. The nurse replies, “This is expected and it:

1. helps confirm your pregnancy.”

2. is not unusual even in women who are not pregnant.”

3. occurs because the blood is trapped by the pregnant uterus.”

4. is caused by increased blood flow to the uterus during pregnancy.”

4 This response identifies the normalcy of Chadwick’s sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected.

1 This answers part of the question but fails to explain why it occurs.

2 Chadwick’s sign is a probable sign of pregnancy; it is not seen in nonpregnant women.

3 There is no free blood circulating in the uterus during pregnancy. (Nugent 349-350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 7 weeks’ gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? Select all that apply.

1. _____ Focus on and repeat a rhythmic chant

2. _____ Sit upright for 30 minutes after meals

3. _____ Take low-sodium antacids after meals

4. _____ Drink carbonated beverages with meals

5. _____ Eat small but frequent meals with dry crackers in between

Answer: 1, 5

1 Focusing helps mitigate odors, tastes, and thoughts that may cause nausea.

2 Sitting upright after meals will help decrease heartburn but not nausea.

3 Prescribed low-sodium antacids may be taken between meals later in pregnancy to promote relief from heartburn.

4 Carbonated beverages may or may not help, but women should be advised to take fluids between, not with meals.

5 Avoiding an empty stomach decreases the occurrence of nausea associated with pregnancy. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client is experiencing nausea and vomiting. The nurse determines that this discomfort:

1. Is present during early pregnancy

2. Will disappear when lightening occurs

3. Is a common response to an unwanted pregnancy

4. May be related to an increased human chorionic gonadotropin level

4 Increased levels of human chorionic gonadotropin (hCG) may cause nausea and vomiting, but the exact reason for this is unknown.

1 Some pregnant women do not experience nausea and vomiting.

2 Lightening occurs at the end of the third trimester; nausea and vomiting usually cease at the end of the first trimester.

3 Nausea and vomiting are unrelated to whether the pregnancy is desired or unwanted. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse explains to a pregnant woman that absorption of medications taken orally during pregnancy may be altered as a result of:

1. Delayed gastrointestinal emptying

2. A reduced glomerular filtration rate

3. Developing fetal-placental circulation

4. Increasing secretion of hydrochloric acid

1 There is reduced GI motility during pregnancy because of the high level of placental progesterone and displacement of the stomach superiorly and of the intestines laterally and posteriorly; absorption of some medications, vitamins, and minerals may be increased.

2 The glomerular filtration rate increases during pregnancy and is unrelated to the absorption of medications.

3 Developing fetal-placental circulation is unrelated to the absorption of medications.

4 The amount of gastric secretion is somewhat lower in the first and second trimesters but increases dramatically in the third trimester; neither decreased nor increased gastric secretions affect medication absorption. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse reply?

1. Rubella (measles)

2. Rubeola (German measles)

3. Inactivated poliovirus (IPV)

4. Diphtheria, tetanus, pertussis (dTAP)

3 The inactivated poliovirus (IPV) may be given because it is a killed virus vaccine and will not have a teratogenic effect on the fetus.

1 This vaccine consists of an attenuated live virus that may be teratogenic to the fetus and is contraindicated during pregnancy.

2 This vaccine consists of an attenuated live virus that may be teratogenic to the fetus and is contraindicated during pregnancy.

3 This vaccine consists of an attenuated live virus that may be teratogenic to the fetus and is contraindicated during pregnancy. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse instructs a pregnant client about the sources of protein that assist in meeting the increased daily requirements during pregnancy. How many grams of protein should she eat each day?

1. 65 grams

2. 60 grams

3. 55 grams

4. 50 grams

2 The Food and Nutrition Board of the National Academy of Sciences recommends that a pregnant woman consume 60 grams of protein daily to meet the needs of pregnancy.

1 65 grams of protein is the recommended daily intake of protein for a breastfeeding (lactating) woman.

3 55 grams of protein is less than the recommended daily intake of protein for a pregnant woman.

4 50 grams of protein is the recommended daily intake of protein for a healthy nonpregnant woman. This does not meet the protein needs of a pregnant woman. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 8 weeks’ gestation tells the nurse that she does not feel like making love to her husband since becoming pregnant and is concerned that her husband may not understand. What is the nurse’s most appropriate response?

1. “Was this a problem before your pregnancy?”

2. “Why don’t you feel like having intercourse?”

3. “A decrease in libido is expected during the first trimester of pregnancy.”

4. “I’m sure your husband will understand that this feeling is related to your pregnancy.”

3 Often there is a decrease in sexual desire in the first trimester, probably related to nausea and vomiting; if couples are informed about this, they are less likely to become distressed.

1 Calling the situation a problem can cause more anxiety. The client has already stated this began with pregnancy.

2 The client is asking the nurse for information; the client may be unable to answer this question.

4 This does not tell the client why this feeling is occurring; furthermore it offers false reassurance. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 10 weeks’ gestation tells the nurse in the maternity clinic that she is worried because she is voiding frequently. How should the nurse respond?

1. Recommend that she inform her practitioner

2. Explain why this is expected in early pregnancy

3. Tell the client not to worry because this is expected

4. Collect the client’s urine for a culture and sensitivity test

2 The client should be given accurate information. Urinary frequency is caused by the pressure of the enlarging uterus on the bladder. Until 12 to 14 weeks the uterus is in the pelvic cavity. It then rises into the abdominal cavity and urinary frequency diminishes.

1 It is unnecessary to refer the client to the practitioner. Urinary frequency is an expected adaptation during the first and last trimesters of pregnancy.

3 Telling the client not to worry is demeaning because it implies that the client is not capable of understanding an explanation.

4 It is not necessary to plan for a culture and sensitivity test because the routine urinalysis done at each visit will indicate if an infection is present. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse-midwife palpates the uterus of a client who is at 12 weeks’ gestation and determines that it is enlarged and:

1. Just above the symphysis pubis

2. Buried deep in the pelvic cavity

3. Three fingerbreadths above the symphysis pubis

4. Causing noticeable bulging of the abdominal wall

1 At 12 weeks’ gestation the enlarging uterus begins to rise out of the pelvis and is palpable just above the symphysis pubis.

2 During the early weeks of gestation the uterus remains in the pelvic cavity.

3 Usually this occurs at about 16 weeks’ gestation.

4 This occurs later than 12 weeks’ gestation when the fundus has risen completely out of the pelvis and enters the abdominal cavity. (Nugent 350)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida complains of morning sickness. What should the nurse plan to teach her?

1. Increase her fluid intake

2. Eat three small meals a day

3. Increase the calcium in her diet

4. Avoid long periods without food

4 Fasting results in hypoglycemia, which can cause nausea; in addition, the developing fetus should not be deprived of nutrients for any length of time.

1 Fluids need not be increased but should be consumed between meals.

2 This intake is insufficient to meet the nutritional needs of both mother and fetus.

3 Increasing calcium intake will not relieve nausea. (Nugent 350-351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse discusses the recommended weight gain during pregnancy with a newly pregnant client, who is 5 feet, 3 inches tall and weighs 125 pounds, The nurse explains that to achieve the recommended weight gain at term, the client should weigh about:

1. 150 pounds

2. 140 pounds

3. 135 pounds

4. 130 pounds

1 This is within the recommended weight gain of at least 25 pounds for a woman who was of average weight for her height before pregnancy.

2 This is less than the recommended weight gain for a woman who is average weight for her height before pregnancy.

3 This is less than the recommended weight gain for a woman who is average weight for her height before pregnancy.

4 This is less than the recommended weight gain for a woman who was of average weight for her height before pregnancy. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida who is in her 7th week of gestation asks the nurse when she can expect to feel her baby move. The nurse replies that quickening usually occurs in the:

1. 24th week

2. 20th week

3. 16th week

4. 12th week

2 Most primigravidas feel movement by the 20th week of gestation.

1 This is very late to feel initial movement; lack of movement by the 24th week should be investigated.

3 Multiparas may feel movement this early, but for most primigravidas movement is felt between 18 and 20 weeks.

4 Twelve weeks is too early to feel movement. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client asks the nurse for information about toxoplasmosis during pregnancy. What should the nurse teach the client?

1. Pork and beef should be thoroughly cooked before eating

2. Toxoplasmosis is a disease that is most prevalent in foreign countries

3. Raw shellfish are intermediary hosts and should be avoided during pregnancy

4. Salad dressings made with mayonnaise should be avoided during the summer months

1 This avoids the possibility of ingesting the cyst stage of the toxoplasma protozoa in inadequately cooked meat.

2 Even though this disease is more prevalent in foreign countries, it occurs in the United States and its prevention should be addressed.

3 This is not related to toxoplasmosis.

4 This is not related to toxoplasmosis. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client tells the nurse that she thinks she has developed an allergy because her nose is often very congested and she has difficulty breathing. How should the nurse reply?

1. “It will help if you use a nasal decongestant at least twice a day.”

2. “It is common for women to develop allergies during pregnancy.”

3. “This is not normal; perhaps you have a chronic respiratory infection.”

4. “This is an expected occurrence; the increased hormones are responsible for the congestion.”

4 Increased estrogen and progesterone levels during pregnancy cause increased vascularization and resultant congestion of mucous membranes.

1 Nasal decongestants are not advised during pregnancy; clients should consult their practitioner before using any medication.

2 It is not common for women to develop allergies during pregnancy.

3 This is expected because of the higher estrogen and progesterone levels during pregnancy. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse should explain to the newly pregnant primigravida that the fetal heartbeat will first be heard with:

1. A fetoscope around 8 weeks

2. A fetoscope at 12 to 14 weeks

3. An electronic Doppler after 17 weeks

4. An electronic Doppler at 10 to 12 weeks

4 The fetal heartbeat can be heard with an electronic Doppler between 10 and 12 weeks’ gestation.

1 This is too early for the heartbeat to be heard with a fetoscope; a fetoscope cannot pick up the fetal heartbeat before the 17th week.

2 This is too early for the heartbeat to be heard with a fetoscope; a fetoscope cannot pick up the fetal heartbeat before the 17th week.

3 The fetal heartbeat can be heard at least 5 weeks earlier with an electronic Doppler. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client, who is at 10 weeks’ gestation, returns for her second prenatal visit. She asks why she has to urinate so often. The nurse tells her that urinary frequency in the first trimester is:

1. Caused by the baby’s head descending into the uterus

2. Influenced by the enlarging uterus, which is still within the pelvis

3. Because the mother’s kidneys filter more waste products excreted by the growing fetus

4. Mostly a psychological phenomenon that results from knowing that the pregnancy has occurred

2 The uterus remains in the pelvis until the second trimester, placing pressure on the bladder.

1 The fetus is in the uterus; this is too early for the uterus to descend, which occurs in the latter stages of pregnancy and can cause urinary frequency at that time.

3 Fetal waste products are very slight at this time and do not influence urinary frequency.

4 Frequency is a physiological, not a psychological, sign of early and late pregnancy. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 10 weeks’ gestation tells the nurse that she urinates more often now, without discomfort, and would like to know what to do. What does the nurse tell the client to do?

1. Collect a clean catch specimen for testing

2. Contact her practitioner as soon as possible

3. Maintain increased fluid intake during the day

4. Try to resist the urge to void as long as possible

3 During pregnancy the need for water is increased; it is related to the elevated metabolic rate and expanded blood volume.

1 This is unnecessary because there is no indication of a urinary tract infection.

2 Urinary frequency is expected during the first and third trimesters of pregnancy and it is unnecessary to inform the practitioner.

4 The bladder needs to be emptied often to prevent urinary stasis and cystitis, which can result in an ascending infection into the kidneys (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What prenatal teaching is applicable for a client who is between 12 and 24 weeks’ gestation?

1. Infant care, travel to the hospital, and signs of labor

2. Growth of the fetus, personal hygiene, and nutritional guidance

3. Interventions for nausea and vomiting, urinary frequency, and anticipated care

4. Danger signs of preeclampsia, relaxation breathing techniques, and signs of labor

2 The issue of pregnancy is resolved by the time the client is in the second trimester. Awareness of the fetus as an individual and the body changes of pregnancy lead the client to desire to learn about fetal growth, body changes, and nutrition.

1 This information is appropriate for the last trimester.

3 This information is appropriate for the first trimester.

4 This information is appropriate for the last trimester. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in her second trimester is at the prenatal clinic for a routine visit. While listening to the fetal heart, the nurse hears a heartbeat at the rate of 136 in the right upper quadrant and also at the midline below the umbilicus. What are the sources of these 2 sounds?

1. Heart rates of two fetuses

2. Maternal and fetal heart tones

3. Funic souffle and fetal heart rate

4. Maternal heart rate with a uterine souffle

3 The funic souffle is blood rushing through the fetal umbilical cord and is therefore the same rate as the fetal heart rate.

1 Twins will have different heart rates.

2 The maternal heart rate should be much slower than the fetal heart rate.

4 The uterine souffle is blood moving through the maternal side of the placenta and is the same as the mother’s heart rate, which should be less than 100. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

At a routine prenatal visit the sign or symptom that a healthy primigravida at 20 weeks’ gestation will most likely report for the first time is:

1. Quickening

2. Palpitations

3. Pedal edema

4. Vaginal spotting

1 The recognition of fetal movement commonly occurs in primigravidas at 16 to 18 weeks’ gestation; it is felt about 2 weeks earlier in multigravidas.

2 Palpitations should not occur in the healthy primigravida.

3 Pedal edema may occur at the end of the pregnancy as the gravid uterus presses on the femoral arteries, impeding circulation. Immediate follow-up care is required when it occurs this early in the pregnancy.

4 Vaginal spotting at this time requires immediate follow-up care. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 28 weeks’ gestation has gained 13 pounds and tells the nurse in the prenatal clinic that she is glad she has not gained as much weight as her sister did during her pregnancy. How should the nurse respond?

1. “Do you think you are getting fat?”

2. “Are you trying to watch your figure?”

3. “You have to eat right during pregnancy.”

4. “Tell me what you have been eating lately.”

4 Before the nurse can determine the adequacy of weight gain it is necessary to determine the client’s current dietary intake.

1 This may prevent further exploration of the diet because the client may answer yes or no.

2 This may prevent further exploration of the diet because the client may answer yes or no.

3 This assumes the client is not eating properly. (Nugent 351)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a routine 32-week prenatal visit, a client tells the nurse that she has had difficulty sleeping on her back at night. What should the nurse advise the client about her position when she sleeps?

1. Turn from side to side

2. Try to sleep on her stomach

3. Elevate the head of the bed on blocks

4. Place two pillows under her knees while sleeping

1 The side-lying position will relieve back pressure; also it promotes uterine perfusion and fetal oxygenation.

2 At 32 weeks’ gestation the abdomen is too distended to lie in the prone position.

3 Elevating the head of the bed will not relieve back pressure; it is used to limit GERD. Lying on the back is contraindicated because it puts pressure on the vena cava, resulting in hypotension and uteroplacental insufficiency.

4 Pillows are contraindicated because they place pressure on the popliteal area, which compresses the venous circulation, increasing the risk of thrombophlebitis. (Nugent 351-352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida at 34 weeks’ gestation tells the nurse that she is beginning to experience some lower back pain. What should the nurse recommend that the client do? Select all that apply.

1. _____ Wear low-heeled shoes

2. _____ Wear a maternity girdle while awake

3. _____ Sleep flat on her back with her feet elevated

4. _____ Perform pelvic tilt exercises several times a day

5. _____ Take an acetaminophen (Tylenol) tablet at the start of back pain

Answer: 1, 4

1 Low heeled shoes help maintain her center of gravity to counterbalance the gravid uterus.

2 A maternity girdle is not recommended routinely.

3 Sleeping in this position decreases venous return, impedes respirations, and puts pressure on the vena cava which can cause uteroplacental insufficiency.

4 Pelvic tilt exercises help relieve lower backaches, are easily learned, and can be done without any equipment.

5 Medication should be avoided during pregnancy; prescribing medications is beyond the scope of nursing practice. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 35 weeks’ gestation calls the prenatal clinic concerned that she has “not felt the fetus move as much as usual.” The most appropriate recommendation by the nurse is to have the client call the clinic with the results after she has:

1. Drunk a glass of orange juice and timed 10 fetal movements

2. Sat in a tub filled with warm water and then timed 30 fetal movements

3. Walked for 15 minutes and checked if the fetus moved more frequently

4. Taken a nap and counted the number of fetal movements for 20 minutes

1 Drinking orange juice can increase fetal movement. Fetal kick counts, either the number counted in 30 minutes or the length of time it takes for 10 kicks to occur, are the accepted methods of assessing for the appropriate amount of fetal movement.

2 Sitting in a tub of warm water may help the client be more sensitive to fetal movements, but it is unnecessary to time 30 kicks.

3 Walking may increase fetal movements but accuracy regarding the timing of the movements is needed to make an adequate assessment.

4 Lying quietly may increase the sensitivity to fetal movements, but they must be counted for 30 minutes for an accurate assessment. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse discusses fetal weight gain with a pregnant client. When does it usually show a marked increase?

1. During the third trimester

2. During the second trimester

3. At the end of the first trimester

4. At the beginning of the first trimester

1 During the third trimester the fetus is laying down fat deposits and gaining the most weight.

2 There is fetal weight gain throughout pregnancy, but it is most marked in the third trimester.

3 There is fetal weight gain throughout pregnancy, but it is most marked in the third trimester.

4 There is little fetal weight gain during this period of organ development. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse emphasize in a class about childbirth?

1. Birth as a family experience

2. Labor without using analgesics

3. Education, exercise, and breathing techniques

4. Hydration, relaxation, and pain control during labor

3 The objective of childbirth classes is to adequately prepare parents for childbearing.

1 This is only part of the class content.

2 This is not an absolute; most childbirth methods inform parents that analgesics are available if necessary.

4 This is only part of the class content. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client, interested in childbirth education, asks how the Lamaze method differs from the Read method. What should the nurse explain about the Lamaze method?

1. It is an easier method to teach and learn

2. It requires extensive prenatal preparation

3. This is a natural approach based on childbirth without pain

4. This avoids the use of pain-relieving medications during labor

2 There is much to be learned and practiced so that the client can vary the breathing and relaxation techniques through the stages of labor.

1 The Read method can be quickly taught to an “unprepared” woman in labor.

3 The Read method focuses on naturalness and denial of pain.

4 Medication use is acceptable if required. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During a childbirth class the nurse evaluates that the women understand how to use effleurage correctly when they are observed:

1. Rocking gently on their knees

2. Practicing panting to avoid pushing during labor

3. Taking deep breaths before imagined contractions

4. Massaging their abdomens gently with their fingertips

4 Effleurage is a gentle massage of the abdomen that is effective during the first stage of labor because it distracts the client from the discomfort of the contractions.

1 This is the pelvic rock; it is used during pregnancy to relieve backache.

2 This is a technique of breathing.

3 This is a technique of breathing. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Methods of relieving back pain are explained during a childbirth class. What activities identified by the client permit the nurse to conclude that the teaching is understood? Select all that apply.

1. _____ Tailor sitting

2. _____ Pelvic rocking

3. _____ Forward tilting

4. _____ Sacral pressure

5. _____ Kegel exercises

Answer: 2, 3, 4

1 Tailor sitting aids in relaxing the muscles of the pelvic floor.

2 Pelvic rocking eases the tension in the muscles of the lumbar region. Lumbar pain during pregnancy results from the changes in posture as the uterus grows.

3 Forward tilting eases the tension in the muscles of the lumbar region. Lumbar pain during pregnancy results from the changes in posture as the uterus grows.

4 Applying the heel of the hand to the laboring client’s sacral area (counterpressure) helps to relieve the back discomfort associated with a fetus in the occiput posterior position.

5 Kegel exercises strengthen the muscles of the pelvic floor. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a pregnant client about fetal growth and development. Which statement indicates that the client needs further teaching?

1. “Pregnant women need to drink more milk.”

2. “Pregnant women need to eat more protein.”

3. “The fetus gets nutrients from the amniotic fluid.”

4. “The fetus gets oxygen from blood in the placenta.”

3 The amniotic fluid is a protective environment; it does not provide nutrition; the fetus depends on the placenta, along with the umbilical blood vessels, for obtaining nutrients and oxygen.

1 This indicates that the client understands the teaching.

2 This indicates that the client understands the teaching.

4 This indicates that the client understands the teaching. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for four clients on the postpartum unit. Which client will most likely state that she is having difficulty sleeping because of afterbirth pains?

1. Multipara who has 3 children

2. Primipara whose newborn weighed 7 pounds

3. Primipara with effectively controlled diabetes

4. Multipara whose second child was small for gestational age

1 A multipara’s uterus tends to contract and relax spasmodically, even if the uterine tone is effective, resulting in pain that may require an analgesic for relief.

2 A primipara’s uterus usually remains in the contracted state unless the newborn is large for gestational age (LGA). However, she is less likely to have afterbirth pains requiring an analgesic than a multipara.

3 If a client’s diabetes is controlled during pregnancy she is not likely to give birth to a large infant.

4 Although a multipara might have afterbirth pains even with a small newborn, the pain probably will be mild because the uterus was not fully stretched. (Nugent 352)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is teaching a prenatal breathing and relaxation class. What does the nurse suggest to best ease back discomfort during labor?

1. Clients should alternate lying on the back and side

2. Support persons should use back massage techniques

3. Support persons should use distraction techniques such as abdominal effleurage

4. Clients should assume the knee-chest position before and after assessments of the fetal heart rate

2 The fetus exerts pressure against the spine during labor; back massage provides counterpressure, which eases the discomfort.

1 The back-lying position is contraindicated because the weight of the fetus compresses the vena cava, decreasing the flow of blood to the placenta.

3 Although abdominal effleurage can be a distractor during labor, it will not relieve back discomfort.

4 The knee-chest position will not relieve back pain during labor. (Nugent 352-353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client attending a prenatal class about nutrition tells the nurse that she is a strict vegetarian (vegan). What should the nurse encourage the client to eat that includes all the essential amino acids?

1. Macaroni and cheese

2. Whole grain cereals and nuts

3. Scrambled eggs and buttermilk

4. Brown rice and whole-wheat bread

. 2 This combination provides a complete protein for vegans because they do not eat foods from animal sources, which contain all the essential amino acids.

1 This combination provides a complete protein and is acceptable to ovo-lacto-vegetarians, who eat milk, eggs, and cheese, but is not acceptable to vegans.

3 Eggs are a complete protein but are not acceptable to vegans, only to ovo-lacto-vegetarians, who eat milk, eggs, and cheese.

4 These are both unrefined grains but together they do not provide a complete protein. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client who is a strict vegetarian (vegan) asks the nurse if there is anything special she should do in relation to her diet. What should the nurse recommend?

1. Taking a vitamin supplement daily

2. Eating at least 40 grams of protein a day

3. Drinking at least 1 quart of milk per day

4. Including specific nonanimal proteins in her daily diet

4 A conglomerate of incomplete proteins (vegetable proteins) can result in a combination that contains all the essential amino acids; the client must be taught which vegetables, nuts, and fruits to include in her daily diet that will supply all the essential amino acids.

1 Although important, the intake of optimum dietary nutrients is the priority.

2 The pregnant client should be consuming at least 60 grams of protein daily.

3 Strict vegetarians do not drink milk. Calcium is found in some vegetables and calcium supplements are available. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a pregnant client why she needs a folic acid supplement. Which neonatal disorder does this prevent?

1. Phenylketonuria

2. Down syndrome

3. Neural tube defects

4. Erythroblastosis fetalis

3 A folic acid supplement (0.4 mg/day) greatly reduces the incidence of fetal neural tube defects.

1 This is a genetic disorder that cannot be prevented by the action of folic acid.

2 This is a genetic disorder that cannot be prevented by the action of folic acid.

4 This is related to the Rh factor and is not prevented by folic acid. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When discussing dietary needs during pregnancy, a client tells the nurse that milk constipates her at times. What should the nurse teach the client?

1. Substitute a variety of cheeses for the milk

2. Replace fat-free or low-fat milk for whole milk

3. Increase intake of prenatal supplements and omit the milk

4. Treat constipation when it occurs and continue drinking milk

4 Unless a lactose intolerance is present, the client should drink milk; eating dried fruits and high-fiber foods and increasing fluids and activity will aid in lessening constipation.

1 These can cause constipation.

2 These can cause constipation.

3 Megadoses of vitamins can be harmful; prenatal vitamins are not a substitute for milk. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a client about the increased need for vitamin A to meet rapid fetal tissue growth during pregnancy. Which nutrients should the nurse encourage the client to ingest to meet this increased need? Select all that apply.

1. _____ Carrots

2. _____ Citrus fruits

3. _____ Fat-free milk

4. _____ Sweet potatoes

5. _____ Extra egg whites

Answer: 1, 4

1 Carrots provide the precursor pigment carotene, which the body converts to vitamin A.

2 These contain a very small amount of vitamin A precursor.

3 This contains only about half the needed vitamin A precursor.

4 Sweet potatoes baked in the skin contain large amounts of carotene, which the body converts to vitamin A.

5 These do not contain any vitamin A precursor. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a client in early pregnancy about the need to increase her intake of complete proteins. The nurse asks the client to identify foods that contain these proteins. Which response indicates that she understands the teaching? Select all that apply.

1. _____ Spinach and broccoli

2. _____ Milk, eggs, and cheese

3. _____ Beans, peas, and lentils

4. _____ Fish, hamburger, and chicken

5. _____ Whole grain cereals and breads

Answer: 2, 4

1 Plant proteins are incomplete proteins.

2 These animal proteins are complete proteins containing all nine indispensable (essential) amino acids.

3 Plant proteins are incomplete proteins.

4 These animal proteins are complete proteins containing all nine indispensable (essential) amino acids.

5 These are incomplete proteins; also, comparatively small amounts of protein are contained in these foods. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A newly married client visits the women’s health clinic because she has not been feeling well. What indicates that the client may be pregnant?

1. Her menses is a week late

2. Her urine immunoassay test is positive

3. She relates that she has urinary frequency

4. She complains that she has nausea every morning

2 A probable sign of pregnancy is a positive urine pregnancy test because it is 95% accurate in detecting pregnancy; the basis for this test is the presence of human chorionic gonadotropin (hCG) in the urine.

1 This is a presumptive sign of pregnancy; there are many other causes of amenorrhea.

3 This is a presumptive sign of pregnancy; there are other causes of frequency, such as urinary tract infection.

4 This is a presumptive sign of pregnancy. Nausea can occur during the first trimester because of the secretion of hCG; there are many causes of nausea other than the hormones secreted in early pregnancy. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

At a routine monthly visit, while assessing a client who is in her 26th week of gestation, the nurse identifies the presence of striae gravidarum. How is this condition described?

1. Brownish blotches on the face

2. Purplish discoloration of the cervix

3. Reddish streaks on the abdomen and breasts

4. Black line that is seen between the umbilicus and the mons veneris

3 This is a description of striae gravidarum; they occur from the stretching of the breast and abdominal skin.

1 This is chloasma.

2 This is Chadwick’s sign.

4 This is linea nigra. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a pregnant client who is having an ultrasound examination during the first trimester. Why is a sonogram done during the first trimester?

1. Estimates fetal age

2. Detects hydrocephalus

3. Rules out congenital defects

4. Approximates fetal linear growth

1 Measurement of the crown-rump length (CRL) is useful in approximating fetal age in the first trimester.

2 This cannot be detected during the first trimester.

3 Ultrasonography is used to detect structural defects in the second trimester.

4 It is too early to determine this. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client’s blood test reveals an elevated alpha-fetoprotein (AFP) level. What condition does the nurse suspect this result indicates?

1. Cystic fibrosis

2. Phenylketonuria

3. Down syndrome

4. Neural tube defect

4 Elevated levels of alpha-fetoprotein in pregnant women have been found to reflect open neural tube defects such as spina bifida and anencephaly.

1 This is a genetic defect; it is not associated with alpha-fetoprotein levels.

2 A Guthrie test soon after ingestion of formula can determine if the infant has PKU.

3 This is a chromosomal defect that is associated with low alpha-fetoprotein levels. (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 40-year-old primigravida is scheduled to have her first ultrasound scan. What should the nurse’s instructions include?

1. Postponing breakfast until after the test

2. Drinking eight glasses of water before the test

3. Emptying the bladder immediately before the test

4. Inserting a suppository after arising on the day of the test

. 2 A full bladder raises the uterus above the pelvis, providing a better visual field of its contents.

1 It is not necessary to arrive for the test with an empty stomach.

3 The bladder should not be emptied until after the test.

4 It is not necessary to evacuate the bowel before the test (Nugent 353)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

How does the nurse know that a client, at 40 weeks’ gestation, is experiencing true labor?

1. Cervical dilation

2. Membranes rupture

3. Fetal heart rate decreases

4. Contractions become more intense

1 The markers for true labor are cervical dilation and/or effacement.

2 It is not uncommon for membranes to rupture before true labor begins.

3 A change in the fetal heart rate does not indicate true labor; the rate may be slowing because the fetus is resting or fetal compromise is occurring.

4 The client’s perception of the intensity of contractions is not an indication of true labor. Because of admission to the hospital and loss of diversionary activities, the client may perceive the contractions as becoming more intense. (Nugent 353-354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is interpreting the results of a nonstress test (NST) on a client at 41 weeks’ gestation. After 20 minutes, which result is suggestive of fetal reactivity?

1. Absent long-term variability

2. Above average fetal baseline heart rate of 160

3. No late decelerations associated with contractions

4. Two accelerations of 15 beats per minute lasting 15 seconds

4 The criteria for fetal reactivity in a healthy fetus are as follows: 2 or more accelerations of 15 beats per minute lasting 15 seconds in a 20-minute period; normal baseline rate; and long-term variability amplitude of 10 or more beats per minute.

1 Absent long-term variability is an ominous sign that must be addressed.

2 An above-average baseline heart rate is acceptable up to 160 beats per minute. An increasing baseline heart rate is a sign of maternal infection.

3 Contractions are not expected with a nonstress test; early, late, or variable fetal heart rate decelerations are associated with uterine contractions. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client whose membranes have ruptured is admitted to the birthing unit. Her cervix is 3 cm dilated and 50% effaced. The amniotic fluid is clear and the fetal heart rate is stable. What does the nurse anticipate?

1. Second stage of labor will be prolonged

2. Delayed effacement will result in a difficult birth

3. Birth of the fetus will probably occur within a day

4. Stimulation of labor with an oxytocin infusion will be required

3 In an uneventful full term pregnancy, birth usually occurs within 24 hours after membranes have ruptured. If the birth does not occur within this timeframe, both the mother and fetus will be exposed to sepsis and labor probably will be stimulated by the practitioner.

1 There is no relationship between ruptured membranes and the second stage of labor.

2 There are no data that indicate that effacement is delayed.

4 Although this may be done eventually, it is too early to anticipate that labor will be stimulated. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida at 36 weeks’ gestation is admitted to the birthing room with ruptured membranes and a cervix that is 2 cm dilated and 75% effaced. What is the priority question the nurse should ask?

1. “When is your expected date of birth?”

2. “How have you planned to manage your labor?”

3. “When was your last meal and what did you eat?”

4. “How frequent are your contractions and how long do they last?”

4 The priority is to assess the progress of labor so that the nurse can plan care.

1 This question should be asked, but it is not the priority.

2 This question should be asked, but it is not the priority.

3 This question should be asked, but it is not the priority. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When a client at 39 weeks’ gestation arrives at the birthing suite she says, “I have been having contractions for 3 hours and I think my membranes have ruptured.” What will the nurse do to confirm if the membranes have ruptured?

1. Take the client’s temperature

2. Test the leaking fluid with nitrazine paper

3. Obtain a clean-catch urine specimen and send it to the laboratory

4. Place the client in the reverse Trendelenburg position and observe the vagina for leaking fluid

2 The nitrazine paper will turn dark blue if amniotic fluid is present; it remains the same color if urine is present.

1 Temperature assessment is not specific to ruptured membranes at this time; vital signs are part of the initial assessment.

3 Although this may be done as part of the initial assessment, a urine test is unrelated to leaking amniotic fluid.

4 This will not confirm rupture of the membranes. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During labor the nurse encourages the client to void. The nurse considers that an overdistended urinary bladder during labor can:

1. Predispose to uterine hemorrhage after birth

2. Interfere with the assessment of cervical dilation

3. Prevent the diagnosis of cephalopelvic disproportion

4. Delay expulsion of the placenta after the birth of the neonate

1 An overdistended urinary bladder prevents the uterus from contracting after birth; contraction of the uterus constricts blood vessels, preventing hemorrhage.

2 A digital examination to assess vaginal dilation does not require an empty urinary bladder to be accurate.

3 An overdistended urinary bladder may impede descent but does not interfere with this diagnosis.

4 This does not interfere with the third stage of labor. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When is the most appropriate time for the nurse to administer an opioid analgesic to a client in active labor?

1. Between contractions

2. When a contraction starts

3. At the peak of a contraction

4. Just before the end of a contraction

2 When an analgesic is administered at the beginning of a contraction, the uterine muscle tension increases resistance to the absorption of the medication, thereby slowing its passage through the placenta to the fetus.

1 This is the most relaxed state of the uterine muscle, thereby increasing the rate of the opioid’s passage through the placenta to the fetus.

3 Although this will decrease the rate of the opioid’s passage through the placenta, it is not the time of maximum resistance.

4 There will be minimum resistance to the opioid’s passage through the placenta at this time. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted to the birthing room in active labor. The nurse determines that the fetus is in the left occiput posterior (LOP) position. At what point can the fetal heart be heard?

1. right side above the umbilicus

2. left side above the umbilicus

3. right side below the umbilicus

4. left side below the umbilicus

4 Fetal heart sounds are heard through the fetus’s back. When the position of the fetus is in the left occiput posterior (LOP) or left occiput anterior (LOA), the fetal heart sounds are located in the left lower quadrant of the mother.

1 The fetus will be in the right sacrum anterior (RSA) position if the fetal heart tones are heard in this area.

2 The fetus will be in the left sacrum anterior (LSA) position if the fetal heart tones are head in this area.

3 The fetus will be in the right occiput posterior (ROP) position if the fetal heart tones are head in this area. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse performs Leopold’s maneuvers on a newly admitted client in labor. Palpation reveals a soft, firm mass in the fundus; a firm, smooth mass on the mother’s left side; several knobs and protrusions on the mother’s right side; and a hard, round movable mass in the pubic area with the brow on the right. Based on these findings, the nurse identifies that the fetal position is:

1. LOA

2. ROA

3. LMP

4. RMP

1 The fetus is in a left occiput anterior position because the buttock (firm mass) is in the fundus, the back is on the left, the small parts are on the right, and the head is flexed, indicating an anterior occiput.

2 The right occiput anterior will reveal the back on the right side and the cephalic prominence on the left side; the occiput will be anterior.

3 The left mentum posterior will reveal cephalic prominence and the back on the same side, indicating an extended head and chin presentation.

4 The right mentum posterior will reveal the back and cephalic prominence on the same side (right), indicating an extended head and chin presentation. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The fetus of a client in labor is in the left occiput posterior (LOP) position. What should the nurse advise the client’s partner to do to alleviate some of the discomfort caused by this type of labor?

1. Encourage the client to sleep whenever possible

2. Instruct the client to take deeper breaths during contractions

3. Apply pressure to the client’s sacral area during a contraction

4. Elevate the head of the client’s bed to a semi-Fowler position

3 Pressure on the sacral area during a contraction provides counterpressure to the gravitational force of the fetal head in the occiput posterior position.

1 This may promote relaxation but will not relieve the back pain caused by the force of the head during a contraction.

2 This will not help to alleviate the back pain caused by the force of the fetal head during a contraction.

4 This may aggravate the back pain because it increases the pressure of the fetal head on the sacral area. (Nugent 354)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

An expectant couple asks the nurse about the cause of low back pain during labor. The nurse replies that this pain occurs most often when the position of the fetus is:

1. Breech

2. Transverse

3. Occiput anterior

4. Occiput posterior

4 A persistent occiput posterior position causes intense back pain because of fetal compression of the sacral nerves.

1 This position is not associated with back pain.

2 This position is not associated with back pain.

3 This is the most common fetal position and generally it does not cause back pain. (Nugent 354-355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Which position does the nurse teach the client to avoid when experiencing back pain during labor?

1. Sims position

2. Supine position

3. Right lateral position

4. Left side-lying position

2 Low back pain is aggravated when the mother is in the supine position because of increased fetal pressure on the sacral nerves.

1 The Sims’ position relieves back pain during labor, but it may not be as comfortable as the other lateral positions.

3 This position relieves back pain during labor.

4 This position relieves back pain during labor. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A woman at 40 weeks’ gestation is having contractions. She is concerned whether she is in true labor. She states, “How will you know if I am really in labor?” What knowledge must the nurse have before responding?

1. The cervix dilates and effaces in true labor

2. The bloody show is the first sign of true labor

3. Membranes rupture at the beginning of true labor

4. Fetal movements lessen and become weaker in true labor

1 The major difference between true and false labor is that true labor can be confirmed by verifying dilation and effacement of the cervix.

2 Bloody show can occur before or after true labor begins.

3 The membranes may rupture before or after labor begins.

4 Fetal movements continue unchanged throughout labor. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The teaching plan for a father who is acting as a coach during labor should include the information that it is best for him to:

1. Leave the room periodically so that his wife can rest between contractions

2. Let his wife know the progress she is making and that she is doing a good job

3. Keep the conversation in the birthing room to a minimum so that his wife can concentrate

4. Maintain his wife in the supine position so that fetal and uterine monitoring equipment will not be disturbed

2 Identifying progress and providing encouragement motivate the client and promote a positive self-concept.

1 A client in active labor should have continuous partner support unless it is specifically contraindicated.

3 There are no data to indicate which phase of labor the client is in; diversion is preferred during early labor.

4 Lying flat on her back may induce supine hypotension; side-lying should be encouraged to promote venous return. The electronic monitoring equipment will not be disturbed when in the side-lying position. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The partner of a woman in labor is having difficulty timing the frequency of contractions and asks the nurse to review the procedure. How should the timing of contractions be performed?

1. End of one contraction to the end of the next contraction

2. End of one contraction to the beginning of the next contraction

3. Beginning of one contraction to the end of the next contraction

4. Beginning of one contraction to the beginning of the next contraction

4 The frequency of contractions is noted from the beginning of one contraction to the beginning of the next; this is the point of reference for one contraction cycle.

1 The beginning, not the end, of a contraction is the starting point to time the frequency of contractions.

2 This is the interval between contractions.

3 This is too long a time frame and will result in inaccurate information. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A husband who is coaching his wife during labor demonstrates an understanding of the transition phase of labor when, as his wife starts to push with each contraction, he instructs her to:

1. Take cleansing breaths before pushing

2. Take quick, shallow breaths, and then blow

3. Use slow rhythmic, diaphragmatic breathing

4. Switch between accelerated and decelerated breathing

. 2 This is done to prevent pushing because full dilation has not yet occurred.

1 This is not done until full dilation; it can cause cervical edema and may tire the mother.

3 This is done early in the first stage of labor; it is ineffective in the transition phase.

4 This is done in the middle of the first stage of labor. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After a client has been in labor for 6 hours at home, she is admitted to the birthing room. The client is 5 cm dilated and at −1 station. In the next hour her contractions gradually become irregular but are more uncomfortable. What does the nurse conclude?

1. The client is in false labor

2. The client has a full bladder

3. There is uterine dysfunction

4. There is a breech presentation

2 A full bladder can impede the forces of labor and it must be emptied before any other assessment can be made.

1 The client’s cervix is dilating, and therefore she is in true, not false, labor.

3 Before this conclusion is considered, the client’s bladder should be emptied to relieve the pressure of the bladder on the uterus; the client should then be observed to determine whether regular contractions have resumed.

4 This should have been established during the admission examination. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in active labor is admitted to the birthing room. A vaginal examination reveals the cervix is 6 to 7 cm dilated. Based on this finding, the nurse expects the:

1. Client may experience nausea and vomiting

2. Client’s bloody show to become more profuse

3. Client will have uncontrollable shaking of her legs

4. Client’s contractions to become more frequent and longer in duration

4 This is a description of the contractions as labor progresses through the active portion of the first stage of labor.

1 This adaptation occurs in the transition phase of the first stage of labor.

2 This adaptation occurs in the transition phase of the first stage of labor.

3 This adaptation occurs in the transition phase of the first stage of labor. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

As the nurse inspects the perineum of a client who is in active labor, the client suddenly turns pale and says she feels as if she is going to faint even though she is lying flat on her back. What should the nurse do?

1. Turn her onto her left side

2. Elevate the head of the bed

3. Place her feet on several pillows

4. Give her oxygen via a face mask

1 The client is experiencing supine hypotension, which is caused by the gravid uterus compressing the large vessels; side-lying will relieve the pressure, increase venous return, improve cardiac output, and raise blood pressure.

2 Raising the head of the bed will not relieve uterine compression of large vessels.

3 Elevating her feet will not relieve uterine compression of large vessels.

4 Oxygen administration will not relieve uterine compression of large vessels. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor is admitted to the birthing room. The nurse’s assessment reveals that the fetus is at −1 station. Where is the presenting part?

1. 1 cm above the ischial spines

2. 1 cm below the ischial spines

3. Visible at the vaginal opening

4. At the level of the ischial spines

1 Station-1 signifies that the fetal head is 1 cm above the ischial spines and has not reached the vaginal canal.

2 When the fetal head is 1 cm below the ischial spines it is at station +1.

3 When the fetal head is visible at the vaginal opening it is at station +4.

4 When the fetal head is level with the ischial spines it is at station 0. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the assessment of a client in labor, the cervix is determined to be 4 cm dilated. What stage of labor does the nurse record?

1. First

2. Second

3. Prodromal

4. Transitional

1 The first stage of labor is from 0 cervical dilation to full cervical dilation (10 cm).

2 This is the stage from full cervical dilation to delivery.

3 This is the stage before cervical dilation begins.

4 This is the last phase of the first stage of labor from 8 cm dilation to 10 cm dilation. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A vaginal examination reveals that a client’s cervix is 90% effaced and 6 cm dilated. The fetus’s head is at station 0, and is in an ROA position. The contractions are occurring every 3 to 4 minutes, are lasting 60 seconds, and are of moderate intensity. What should the nurse record about the client’s stage of labor?

1. Early first stage of labor

2. Transition stage of labor

3. Beginning second stage labor

4. Midway through first stage of labor

4 The cervix is 90% effaced and 6 cm dilated during the active phase of the first stage of labor.

1 When the cervix is 6 cm dilated, the individual is beyond the early stage of labor.

2 The transition is not a stage of labor; it is the last phase of the first stage of labor which begins when the cervix is 8 cm dilated.

3 The second stage of labor begins when the cervix is fully dilated and 100% effaced. (Nugent 355)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse helps a client to the bathroom to void several times during the first stage of labor. This is done because a full bladder:

1. Is often injured during labor

2. May inhibit the progress of labor

3. Jeopardizes the status of the fetus

4. Predisposes the client to urinary infection

2 A full bladder encroaches on the uterine space and impedes the descent of the fetal head.

1 The bladder can become atonic but is not physically damaged during the course of labor.

3 A full bladder may lead to prolonged labor but generally it does not jeopardize fetal status as long as adequate placental perfusion continues.

4 A full bladder during labor does not predispose the client to an infection. (Nugent 355-356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During labor a client begins to experience dizziness and tingling of her hands. What should the nurse instruct the client to do?

1. Breathe into her cupped hands

2. Pant during the next three contractions

3. Hold her breath with the next contraction

4. Use a fast, deep or shallow breathing pattern

1 These symptoms indicate respiratory alkalosis because the client probably is hyperventilating; breathing into cupped hands promotes rebreathing of carbon dioxide.

2 This may cause the client to hyperventilate further.

3 This will not improve the client’s respiratory alkalosis.

4 This may cause the client to hyperventilate further. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A multigravida in active phase of labor states, “I feel all wet. I think I urinated.” What should the nurse do first?

1. Give her the bedpan

2. Change the bed linens

3. Inspect her perineal area

4. Auscultate the fetal heart rate

3 Inspection of the perineum is done to determine if rupture of the membranes has occurred and if the umbilical cord has prolapsed.

1 This is not a priority.

2 This is not the priority; it is done eventually if the membranes have ruptured.

4 The fetal heart rate should be assessed after it is established that the membranes have ruptured and the cord has not prolapsed. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse assesses a primigravida who has been in labor for 5 hours. The fetal heart rate tracing is reassuring. Contractions are of mild intensity lasting 30 seconds and are 3 to 5 minutes apart. An oxytocin (Pitocin) infusion is prescribed. What is the priority nursing intervention at this time?

1. Checking cervical dilation every hour

2. Keeping the labor environment dark and quiet

3. Infusing oxytocin by piggybacking into the primary line

4. Positioning the client on the left side throughout the infusion

3 Piggybacking the oxytocin (Pitocin) infusion permits its discontinuation of the medication, if necessary, while permitting the vein to remain open via the primary IV.

1 Cervical dilation is checked when there is believed to be a change, not on a regular basis.

2 Unless specifically requested by the client, there is no reason to maintain this environment.

4 Although this intervention is recommended, it is not the primary concern at this time; there are no data to indicate maternal hypotension. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse considers the pros and cons of external fetal monitoring versus internal fetal monitoring. What is one advantage of the external fetal monitor?

1. Simpler to read

2. Allows freedom of movement

3. Assesses the fetal heart rate more accurately

4. Prevents foreign material from entering the uterus

4 External fetal monitoring does not require the insertion of a probe into the head of the fetus. Internal monitoring requires the insertion of a probe into the fetal head inside the uterus, thus placing the mother and fetus at greater risk for infection.

1 The monitoring strips are the same.

2 Each time the client with external monitoring moves, the baseline may need to be adjusted.

3 Internal monitoring tends to be more accurate because the recording is not affected by the mother’s movements. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a client who is in the first stage of labor. The fetal heart rate monitor displays an irregular baseline with variability. What is the priority nursing intervention?

1. Administering oxygen

2. Notifying the practitioner

3. Changing the client’s position

4. Continuing to monitor the client

4 This is an expected occurrence caused by the interplay between the sympathetic and parasympathetic nervous systems.

1 There is no need for this intervention because this is an expected response.

2 There is no need for this intervention because this is an expected response.

3 There is no need for this intervention because this is an expected response. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During labor a client has an internal fetal monitor applied. The nurse should take action in response to a fetal heart rate that:

1. Remains at 140 beats per minute during contractions

2. Uniformly drops to 120 beats per minute with each contraction

3. Fluctuates from 130 to 140 beats per minute unrelated to contractions

4. Repeatedly drops abruptly to 90 beats per minute unrelated to contractions

4 This fetal heart rate change is known as variable-type decelerations. This is indicative of umbilical cord compression that if left uncorrected may lead to fetal compromise; interventions are directed at improving umbilical circulation.

1 This is not an unusual finding and therefore does not require nursing intervention.

2 These are recurrent early decelerations, a result of fetal head compression during a contraction. They are a benign reflex response requiring no immediate intervention.

3 This is an expected variation of the fetal heart rate reflecting a well-oxygenated fetal nervous system. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor is receiving an oxytocin (Pitocin) infusion. What should the nurse do first when repetitive late decelerations of the fetal heart rate are observed?

1. Administer oxygen

2. Place the client on the left side

3. Discontinue the oxytocin infusion

4. Check the client’s blood pressure

3 The infusion should be stopped because it is the likely source of fetal compromise.

1 This may not be necessary if late decelerations stop with other interventions.

2 This should be done after the oxytocin infusion is discontinued.

4 This can be done, but it is not the priority. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Although a client in labor is prepared and plans to participate in the labor and birth process, she states that she is in severe discomfort. The nurse administers the prescribed butorphanol (Stadol). During which phase of labor is the safest time for the nurse to administer this medication?

1. Early phase

2. Active phase

3. Transition phase

4. Expulsion phase

2 Respiratory depression of the newborn will not occur if the medication is given at this time; it should not be given when birth is expected to occur within 2 hours.

1 The level of pain during this phase can usually be managed by other strategies such as breathing techniques or diversion; giving an opioid early in labor may slow the progress of labor.

3 An opioid should be avoided within 2 hours of birth; giving it to a client in the transition phase can cause respiratory depression in the newborn.

4 Giving the medication when birth is imminent is contraindicated because it may cause respiratory depression in the newborn; the mother’s level of consciousness will be altered as well, making it difficult to cooperate with pushing efforts. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client’s membranes rupture and the nurse identifies the presence of a prolapsed umbilical cord. The nurse alerts another nurse, who calls the practitioner. Place the following nursing interventions in the order in which they should be performed.

1. Check the fetal heart rate

2. Administer oxygen by face mask

3. Move the presenting part off the cord

4. Place client in the Trendelenburg position

Answer: 3, 4, 2, 1

If cord compression is allowed to continue, fetal hypoxia results in central nervous system damage or death; therefore, manual elevation of the presenting part is the priority. Then the client should be placed in the Trendelenburg position, which allows gravity to reduce pressure on the cord. The nurse should then administer oxygen because this will increase the amount of oxygen being perfused to the fetus. Finally, assessing the fetal heart rate obtains information to evaluate the fetus’s response to the nursing interventions. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A vaginal examination reveals that a client in labor is 7 cm dilated. Soon afterward she becomes nauseated, has the hiccups, and has an increase in bloody show. What phase of labor does the nurse determine the client is entering?

1. Latent phase of labor

2. Active phase of labor

3. Transition phase of labor

4. Early active phase of labor

3 This is the most difficult phase of labor. It is characterized by restlessness, irritability, nausea, and increased bloody show; this phase continues from 8 to 10 cm dilation.

1 The latent phase is early labor (1 to 4 cm dilation). It is relatively easy to tolerate and the client generally is in control and not too uncomfortable.

2 The active phase lasts from about 6 to 8 cm dilation. It is difficult but is not accompanied by nausea, irritability, and increasing bloody show.

4 The early active phase lasts from about 4 to 6 cm dilation. It is difficult but is not accompanied by nausea, irritability, and increasing bloody show. (Nugent 356)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Nursing assessment of a client in labor reveals that she is entering the transition phase of the first stage of labor. Which clinical manifestations support this conclusion?

1. Facial redness and an urge to push

2. Bulging perineum, crowning, and caput

3. Less intense and less frequent contractions

4. Increased bloody show, irritability, and shaking

4 These are some of the classic signs of the transition phase of the first stage of labor. The increase in bloody show is related to the complete dilation of the cervix, the irritability is related to the intensity of contractions, and the shaking is believed to be a vasomotor response.

1 These are associated with the start of the second stage of labor.

2 This signals that birth is imminent.

3 This may signal uterine hypotonicity, which can occur throughout the first stage of labor. (Nugent 356-357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

How can the nurse best manage a client’s care during the transition phase of labor?

1. Decrease the fluid intake

2. Help the client maintain control

3. Administer the prescribed opioid medication

4. Encourage the client to breathe in simple patterns

2 This phase is the most difficult part of labor, and the client needs encouragement and support to cope.

1 Fluid management does not depend on the stage of labor.

3 An opioid at this time will depress the newborn’s respirations and is contraindicated.

4 Breathing patterns should be complex and should require a high level of concentration to distract the client. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is a priority nursing intervention for a laboring client with a sudden prolapse of the umbilical cord protruding from the vagina?

1. Preparing the client for surgery

2. Gently replacing the cord in the vaginal vault

3. Checking the fetal heart rate every 15 minutes

4. Starting oxygen at 10 L per minute via a tight facemask

1 The fetus’s life is in jeopardy and a cesarean birth must take place immediately.

2 The cord is never handled because it can go into spasm and block the fetal blood supply.

3 This is not the priority; the client must be prepared for an emergency cesarean birth.

4 This is not the priority; the client must be prepared for an emergency cesarean birth. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While having contractions every 2 to 3 minutes lasting from 60 to 90 seconds, a client complains of severe rectal pressure. What should the nurse do?

1. Assess for change in the fetal heart rate

2. Inspect the client’s perineum for bulging

3. Determine when the client’s labor began

4. Verify whether the membranes have ruptured

2 All signs indicate impending birth; the perineum should be inspected for the appearance of caput.

1 Assessment of fetal status is important; however, the nurse must first determine if birth is imminent.

3 This is important to know, but it does not address the client’s complaint.

4 This is important to know, but it does not address the client’s complaint. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor states that she feels an urge to push. After a vaginal examination, the nurse determines that the cervix is 7 cm dilated. Which breathing pattern does the nurse encourage the client to use?

1. Expulsion breathing

2. Rhythmic chest breathing

3. Continuous blowing-breathing

4. Accelerated-decelerated breathing

3 A continuous blowing-breathing pattern overcomes the urge to push; pushing before 10 cm may traumatize the cervix.

1 Expulsion breathing (pushing) should not be encouraged until the cervix is fully dilated; doing it too early may cause cervical trauma and fatigue.

2 This type of breathing is used in the early active phase of labor for relief of discomfort; it is not used to overcome the desire to push.

4 This breathing pattern is not effective in overcoming the urge to push. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida at term is admitted to the birthing room in active labor. Later, when the client is 8 cm dilated, she tells the nurse that she has the urge to push. The nurse instructs her to pant-blow at this time because pushing can:

1. Prolapse the cord

2. Rupture the uterus

3. Cause cervical edema

4. Lead to a precipitous birth

3 The head cannot emerge when the cervix is not fully dilated. Pushing in this situation can cause cervical edema, predisposing the client to cervical lacerations.

1 A prolapsed cord usually is associated with rupture of the membranes before the head is fully engaged; it occurs more frequently in multiparas.

2 A ruptured uterus may be caused by hypertonic uterine dysfunction or excessive oxytocic stimulation.

4 A precipitous birth results from sudden, rapid labor and an uncontrolled birth. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client’s membranes rupture during the transition phase of labor and the amniotic fluid appears pale green. What nursing care should the nurse give the newborn immediately after birth?

1. Stimulate crying

2. Administer oxygen

3. Put a moist saline dressing on the cord stump

4. Provide for suctioning the oropharynx as the head emerges

4 The color of the amniotic fluid is indicative of meconium staining; the practitioner must therefore prepare for the potential fetal aspiration of meconium.

1 The newborn should not be stimulated to cry until the airway is cleared of meconium.

2 Oxygen is administered only after a patent airway is established and if needed.

3 This is unnecessary because there is no indication that umbilical cord blood or a transfusion is needed. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When doing her shallow, rapid breathing during transition, a client in labor experiences tingling and numbness of her fingertips. The nurse encourages her to breathe into:

1. A paper bag

2. An oxygen mask

3. A compressed air mask

4. An incentive spirometer

1 The client is hyperventilating. Using a paper bag helps the client to rebreathe carbon dioxide, which corrects respiratory alkalosis.

2 The client needs to elevate the carbon dioxide, not the oxygen, level.

3 Compressed air does not enhance the rebreathing of carbon dioxide.

4 An incentive spirometer is used to improve lung expansion, not to rebreathe carbon dioxide. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a client in the first stage of labor and an external fetal heart monitor is in place. What do the tracings indicate?

1. Fetal tachycardia

2. Early accelerations

3. Variable decelerations

4. Inadequate long-term variability

3 Variable decelerations are illustrated by a sudden decrease in the FHR below the baseline, lasting about 15 seconds and then returning to baseline within 2 minutes; they are caused by compression of the umbilical cord. If they occur during the first stage of labor, resolution usually occurs when the mother is repositioned from one side to the other.

1 Fetal tachycardia is not reflected in this illustration.

2 Early accelerations are transitory and are not evident in this illustration.

4 Inadequate long-term variability is not reflected in this illustration. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. What does this usually indicate?

1. Maternal diabetes

2. Fetal cord prolapse

3. Maternal hypotension

4. Fetal head compression

4 Early decelerations are expected occurrences as the fetal head passes through the birth canal; the fetal heart rate returns to baseline quickly, indicating fetal well-being.

1 The data do not indicate that the mother has diabetes.

2 Variable decelerations occur with umbilical cord compression, not prolapse.

3 This will cause late decelerations because of fetal hypoxia. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A local anesthetic is administered to a client as second stage labor begins. What response does the nurse anticipate?

1. Fewer contractions

2. Depressed respirations

3. Decreased blood pressure

4. Accumulated respiratory secretions

3 Mild reactions occur because of vasodilation from direct action of these medications on maternal pelvic blood vessels; vertigo, dizziness, and hypotension may occur.

1 The progress of labor is not affected by a local anesthetic administered during the second stage of labor.

2 A local anesthetic does not affect the respiratory center in the central nervous system.

4 This is not caused by a local anesthetic administered during the second stage of labor. (Nugent 357)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The cervix of a client in labor is fully dilated and 100% effaced. The fetal head is at +3 station, the fetal heart rate ranges from 140 to 150 beats per minute, and the contractions are 2 minutes apart lasting 60 seconds. What does the nurse expect to observe when inspecting the perineum?

1. Small tears in the perineum

2. Greenish-yellow amniotic fluid

3. Enlarging areas of caput with each contraction

4. Increasing amounts of amniotic fluid with each contraction

3 The client should be pushing with each contraction; with the head at +3 station each push will bring more of the caput into view at the vaginal opening.

1 It is too early for the perineum to be stretched to the point of tearing; if this should occur later, an episiotomy may be performed.

2 Meconium is discoloring the amniotic fluid; it is an unexpected finding that may indicate that the fetus is at risk.

4 There are decreased, not increased, amounts of amniotic fluid at the end of labor. (Nugent 357-358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant woman arrives in the emergency department crying, “My baby is coming!” The nurse identifies that the fetus’s head is crowning and birth is imminent. What should the nurse do to support the baby’s head?

1. Apply suprapubic pressure

2. Distribute fingers evenly around the head

3. Place a hand firmly against the mother’s perineum

4. Maintain firm pressure against the anterior fontanel

2 This will prevent rapid change in intracranial pressure after the birth of the head.

1 This maneuver will not assist in the birth of the head; it is used if shoulder dystocia occurs during the birth process.

3 This may interfere with the birth and injure the fetus.

4 This may injure the fetus; gentle pressure over the entire head is the safest action. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client gives birth to an 8-pound baby. Ten minutes after the birth, the placenta has not yet separated. What is the next nursing intervention?

1. Applying fundal pressure

2. Administering a second dose of oxytocin

3. Continuing to assess the client for signs of separation

4. Preparing a consent form for manual removal of the placenta

3 The third stage of labor (from birth to expulsion of the placenta) may last as long as 30 minutes and still be within acceptable limits.

1 This is an outmoded procedure; it may cause eversion of the uterus.

2 Oxytocin is not administered before the expulsion of the placenta.

4 At the time of admission the client signed a consent form that covers all the stages of labor. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Five minutes after a birth the nurse-midwife assesses that the client’s placenta is separating. What indicates that this is occurring?

1. Uterine fundus relaxes

2. Umbilical cord lengthens

3. Abdominal pain becomes severe

4. Vaginal seepage of blood is continuous

2 As the placenta separates and descends down the uterus, the cord descends down the vaginal canal, thus appearing to lengthen.

1 The fundus contracts and becomes rounded and firmer.

3 The client may feel a contraction, but it is not as uncomfortable as the painful contractions at the end of the first stage of labor.

4 Continual seepage occurs when there is hemorrhaging; a large sudden gush of blood heralds placental separation. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

One hour after a birth a nurse palpates a client’s fundus to determine if involution is taking place. The fundus is firm, in the midline, and two fingerbreadths below the umbilicus. What should the nurse do next?

1. Encourage the client to void

2. Notify the practitioner immediately

3. Massage the uterus and attempt to express clots

4. Continue periodic assessments and record the findings

4 Immediately after birth the uterus is 2 cm below the umbilicus; during the first several postpartum hours the uterus will rise slowly to slightly above the level of the umbilicus. These findings are expected and they should be recorded.

1 This is unnecessary; if the bladder is full, the uterus will be higher and pushed to one side.

2 This is unnecessary; involution is occurring as expected.

3 Massage is used when the uterus is soft and “boggy”; when the uterus is firm and the expected size, it is not necessary to attempt to express clots. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is the primary outcome for client care in the third stage of labor?

1. Absence of discomfort

2. Firmly contracted uterine fundus

3. Efficient fetal heart beat-to-beat variability

4. Maternal respiratory rate within the expected range

2 The third stage of labor is from the birth of the baby to the birth of the placenta; a firmly contracted uterus is desired to minimize blood loss.

1 Providing comfort is a desirable goal but is secondary to the life-threatening possibility of hemorrhage associated with a boggy uterus.

3 This is a concern in the first and second stages of labor; it is no longer applicable after the fetus is born.

4 The maternal respiratory rate may vary above or below this range. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse caring for a client who gave birth to a healthy neonate evaluates the client’s uterine tone 8 hours later. How does the nurse determine that the uterus is involuting appropriately?

1. Amount of lochia rubra is moderate

2. Numerous clots are passed vaginally

3. Bleeding from the episiotomy has stopped

4. Uterine cramps are absent during breastfeeding

1 Red, distinctly blood-tinged vaginal flow (lochia rubra) is expected during the first few postpartum days; involution is progressing as it should.

2 Clots indicate uterine atony, which prevents involution of the uterus.

3 The status of the episiotomy is unrelated to the status of the uterus.

4 Uterine cramps during breastfeeding are evidence that the uterus is involuting appropriately. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After a cesarean birth a nurse performs fundal checks every 15 minutes. During one check the nurse determines that the fundus is soft and boggy. What is the priority nursing action at this time?

1. Elevate the client’s legs

2. Massage the client’s fundus

3. Increase the client’s oxytocin drip rate

4. Examine the client’s perineum for bleeding

2 Gentle massage stimulates muscle fibers and results in firming the tone of the fundus; it also helps expel any clots that may be interfering with contraction of the fundus.

1 Elevating the client’s legs will increase return of blood from the extremities, but it will not improve the tone of the client’s fundus.

3 This will be done if massaging the uterus is ineffective.

4 This should not be the first action at this time; gentle massage to contract the fundus is the priority. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

After giving birth, the mother’s vital signs are T, 99.3° F (37.4° C); P, 80 regular and strong; R, 16 slow and even; and BP, 148/92 mm Hg. Which vital sign should the nurse monitor more frequently?

1. Pulse

2. Respirations

3. Temperature

4. Blood pressure

4 This blood pressure is elevated; intervention may be necessary.

1 This is within expected limits.

2 This is within expected limits.

3 This is a slight elevation, which is consistent with the physiology of the birthing process. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

In the second hour after giving birth a client’s uterus is firm, above the level of the umbilicus, and to the right of midline. What is the most appropriate nursing action?

1. Have the client empty her bladder

2. Observe for signs of retained secundines

3. Massage the uterus vigorously to prevent hemorrhage

4. Explain to the client that this is a sign of uterine stabilization

1 A full bladder elevates the uterus and displaces it to the right. Even though the uterus feels firm, it may relax enough to foster bleeding. Therefore, the bladder should be emptied to improve uterine tone.

2 This may be done if emptying the bladder does not rectify the situation. If parts of the placenta, umbilical cord, or fetal membranes are not fully expelled during the third stage of labor, their retention limits uterine contraction and involution; a boggy uterus and bleeding may be evident.

3 Vigorous massage tires the uterus, and even with massage the uterus is unable to contract over a full bladder.

4 (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a group of postpartum clients. What places a client at increased risk for postpartum hemorrhage?

1. Breastfeeding in the birthing room

2. Receiving a pudendal block for the birth

3. Having a third stage of labor that lasts 10 minutes

4. Giving birth to a baby weighing 9 pounds, 8 ounces

4 Chances of postpartum hemorrhage are five times greater with large infants because uterine contractions may be impaired after the birth.

1 Early breastfeeding will stimulate uterine contractions and lessen the chance of hemorrhage.

2 This does not contribute to postpartum hemorrhage because the anesthetic for a pudendal block does not affect uterine contractions.

3 This is a short third stage; a prolonged third stage of labor, 30 minutes or more, may lead to postpartum hemorrhage. (Nugent 358)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During the fourth stage of labor, about 1 hour after giving birth, a client begins to shiver uncontrollably. What should the nurse do?

1. Cover the client with blankets to alleviate this typical postpartum sensation

2. Check vital signs because the client may be experiencing hypovolemic shock

3. Monitor the client’s blood pressure because shivering may cause it to elevate

4. Obtain an order for increasing the IV fluid infusion to restore the client’s fluid reserves

1 There are several theories as to why chilling occurs; one theory is that it is caused by vasomotor instability resulting from fetus to mother transfusion during placental separation; comfort measures such as warm blankets or fluids are indicated.

2 Although the vital signs should be monitored during the fourth stage of labor, they are not being monitored because of the shivering, which is an expected response to the birth.

3 Changes in blood pressure are unexpected.

4 Shivering is not a sign of dehydration. (Nugent 358-359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primipara gave birth 12 hours ago. Although an ice bag has been applied to her perineal area, the client continues to complain of rectal pressure causing excruciating pain in the area of the episiotomy. What does the nurse conclude is the cause of the client’s pain?

1. Multiple hemorrhoids

2. Low tolerance to pain

3. Hematoma in the perineal area

4. Infection at the episiotomy site

3 Pain becomes excruciating with hematoma development at the episiotomy site because of pressure on surrounding nerve endings. This pain is not relieved by the application of ice because ice only reduces edema formation around the incision.

1 There are no data to indicate the presence of hemorrhoids.

2 There are no data to indicate that the client has a low pain tolerance.

4 It is too early to assume that an infection has developed; pyrexia and local signs of infection support this conclusion. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What does the nurse anticipate that a primipara with a second-degree laceration and repair is most likely to develop during the postpartum period?

1. Posterior vaginal varicosities

2. Difficulty voiding spontaneously

3. Delayed onset of milk production

4. Maladaptive bonding with the newborn

2 Voiding will be difficult because of periurethral edema and discomfort.

1 This rarely occurs with primiparas, even when pushing during a prolonged second stage of labor.

3 A second-degree laceration is unrelated to lactation.

4 A second-degree tear is unrelated to bonding and attachment. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse teaches a postpartum client how to care for her episiotomy at home. What statement indicates to the nurse that the client understands the priority instruction?

1. “I should discontinue the sitz baths once I am in my own home.”

2. “I must not climb up or down stairs for at least 3 days after discharge.”

3. “I should continue the sitz baths 3 times a day if it makes me feel better.”

4. “I must continue perineal care after I go to the bathroom until everything is healed.”

4 Prevention of infection is the priority.

1 It is not necessary to stop sitz baths as long as they provide comfort.

2 Stair climbing may cause some discomfort but is not detrimental to healing.

3 This provides comfort, but is not the priority. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Twelve hours after a spontaneous birth a client’s temperature is 100.4° F. What does the nurse suspect caused this temperature elevation?

1. Mastitis

2. Dehydration

3. Puerperal infection

4. Urinary tract infection

2 A client’s temperature may be elevated to 100.4° F (38° C) within the first 24 postpartum hours as a result of dehydration and expenditure of energy during labor.

1 Mastitis may develop after breastfeeding is established and mature milk is present.

3 An infection usually begins with a fever of 100.4° F or more on 2 successive days, excluding the first 24 postpartum hours.

4 Urinary tract infections usually become evident later in the postpartum period. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Twenty-four hours after an uncomplicated labor and birth a client’s CBC reveals a WBC count of 17,000/mm3. How should the nurse interpret this WBC count?

1. Usual decrease in white blood cells

2. Expected response to the process of labor

3. Acute sexually transmitted viral infection

4. Bacterial infection of the reproductive system

2 During the postpartum period, leukocytosis (WBC count of 15,000 to 20,000/mm3) is expected and related to the physical exertion experienced during labor and birth.

1 This is not a drop in the WBC count because the usual postpartum white blood cell count is between 15,000 and 20,000/mm3.

3 This is an expected response to the physical exertion of labor and birth, not an infection.

4 This is an expected response to the physical exertion of labor and birth, not an infection. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primipara about to be discharged with her newborn asks the nurse many questions regarding infant care. What phase of maternal adjustment does this behavior illustrate?

1. Let-down

2. Taking-in

3. Taking-hold

4. Early parenting

3 This phase begins about the second or third postpartum day and involves concern about being a “good” mother; the new mother is most receptive to teaching at this time.

1 This is not related to bonding. The let-down reflex refers to the flow of milk in response to suckling and is caused by the release of oxytocin from the posterior pituitary.

2 This is the first period of adjustment to parenthood. It includes the first 2 postpartum days; the mother is passive and dependent and preoccupied with her own needs.

4 The behavior described refers to the “taking-hold” phase of bonding. Early parenting involves many behaviors, of which “taking-hold” is only one. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is giving discharge instructions to a new mother. What is the most important instruction to help prevent postpartum infection?

1. “Don’t take tub baths for at least six weeks.”

2. “Wash your hands before and after changing your sanitary napkins.”

3. “Douche with a dilute antiseptic solution twice a day and continue for a week.”

4. “Tampons are better than sanitary napkins for inhibiting bacteria in the postpartum period.”

2 Infection is most commonly transmitted through contaminated hands.

1 Tub baths are permitted.

3 Douching is contraindicated.

4 Tampons are contraindicated in the postpartum period until the cervix is completely closed. Tampons promote infection when used too early. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Before discharge, a breastfeeding postpartum client and the nurse discuss methods of birth control. The client asks the nurse, “When will I begin to ovulate again?” How should the nurse respond?

1. “You should discuss this at your first clinic visit.”

2. “Ovulation will occur after you stop breastfeeding.”

3. “Ovulation may occur before you begin to menstruate.”

4. “I really can’t tell you because everyone is so different.

3 If the client is breastfeeding, ovulation and fertility can occur before menstruation resumes.

1 It is the nurse’s responsibility to answer the client’s questions.

2 Ovulation can occur while breastfeeding because the process of follicular maturation begins when prolactin levels decrease.

4 This response evades the question. There are general guidelines that the nurse can share with the client. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On the third postpartum day a nurse is preparing a breastfeeding mother of twins for discharge. Which statement by the client indicates there is a potential problem?

1. “I’ve been urinating large amounts ever since I gave birth.”

2. “My lochia is bright red with small brown clots the size of my thumb.”

3. “My breasts feel full, heavy, and tingly before I breastfeed the babies.”

4. “I hope I will stop being so hungry because I don’t want to gain weight.”

2 This indicates subinvolution and needs further assessment.

1 This is the expected postpartum diuresis.

3 This is the influence of the posterior pituitary hormone, oxytocin, that causes the let-down reflex, which is expected before each feeding.

4 An increased appetite is expected when breastfeeding, especially twins. (Nugent 359)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them the lochial discharge will be on the fourth postpartum day?

1. Dark red

2. Deep brown

3. Pinkish brown

4. Yellowish white

3 Lochia serosa is the expected vaginal discharge around the third to tenth postpartum day; it is pinkish to brownish and consists of serous exudate, shreds of degenerating decidua, erythrocytes, leukocytes, cervical mucus, and numerous microorganisms.

1 Lochia rubra is the expected vaginal discharge on the first 2 to 3 postpartum days; it is dark red and consists of epithelial cells, erythrocytes, leukocytes, shreds of decidua, and occasionally fetal meconium, lanugo, and vernix caseosa.

2 Lochia is never a dark brown.

4 Lochia alba is the expected vaginal discharge that begins about 10 days postpartum and persists for 1 to 2 weeks; it is a creamy or yellowish color and consists of leukocytes, decidual cells, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria. (Nugent 359-360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client gives birth to a 7-pound, 2-ounce baby and has decided to breastfeed. What should the nurse tell the client to expect regarding breastfeeding?

1. Lochial flow will increase

2. Weight loss will occur rapidly

3. Involution of her uterus will be delayed

4. Application of heat to her breasts is contraindicated

. 1 Breastfeeding stimulates oxytocin release and uterine contractions, resulting in increased lochial flow.

2 Weight loss may occur slowly for the breastfeeding mother because of her increased nutritional and caloric needs.

3 The increased levels of oxytocin and subsequent uterine contractions will enhance involution.

4 Heat is not contraindicated, and the client may take warm showers. Heat is used if the mother experiences problems such as engorgement or sore nipples. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A new mother who has begun breastfeeding asks for assistance with removing the baby from her breast. What should the nurse teach her?

1. “Pinch the baby’s nostrils gently to help release the nipple.”

2. “Let the baby nurse as long as desired without interruption.”

3. “Pull your nipple out of the baby’s mouth when the baby falls asleep.”

4. “Insert your finger in the corner of the baby’s mouth to break the suction.”

4 This measure is painless and will avert damage to the mother’s nipple.

1 This is somewhat cruel; breaking suction with a finger is less traumatic.

2 The mother may need to remove the baby from the breast before the baby is ready to let go, and the mother should be taught how to do this.

3 Pulling without first breaking the suction may traumatize the nipple. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A statement by a breastfeeding mother that indicates that the nurse’s teaching about stimulating the let-down reflex has been successful is, “I will:

1. take a cool shower before each feeding.”

2. drink a couple of quarts of fat-free milk a day.”

3. wear a snug-fitting breast binder day and night.”

4. apply warm packs and massage my breasts before each feeding.”

4 This dilates milk ducts, promotes emptying of the breasts, and stimulates further lactation.

1 This will contract the milk ducts and interfere with the let-down reflex.

2 A large consumption of milk products is not required to stimulate the production of milk.

3 Breast binders may inhibit lactation; they fool the body into thinking that milk secretion is no longer needed. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client’s nipples become sore and tender as a result of her newborn’s vigorous sucking. What should the nurse recommend that the mother do to alleviate the soreness? Select all that apply.

1. _____ Apply ice packs before each feeding

2. _____ Formula feed the baby for a few days

3. _____ Take the prescribed analgesic medication

4. _____ Expose the nipples to air several times a day

5. _____ Apply hydrogel pads to the nipples after each feeding

Answer: 4, 5

1 Ice packs are used to relieve the discomfort caused by engorged breasts, not sore nipples; if applied before a feeding, the let-down reflex is inhibited.

2 If kept from the breast for a prolonged period, the infant may become accustomed to the bottle and not wish to breastfeed again; in addition, absence of suckling will inhibit lactation.

3 Analgesic medication may relieve discomfort but will not help toughen the nipples.

4 Exposure of the nipples to air dries the nipples by evaporation; exposure also tends to harden the nipples, making them less tender.

5 Hydrogel pads create a moist, healing environment. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who has been breastfeeding her newborn every 3 hours develops sore nipples. What should the nurse teach her about decreasing nipple soreness?

1. Using breast shields at each feeding

2. Washing with mild soap when cleansing the nipples

3. Changing the baby’s breastfeeding position for each feeding

4. Allowing just the edge of the nipple to be placed in the baby’s mouth

3 If the infant’s position is changed for each feeding, the infant will exert pressure on different areas of the nipples while sucking, thus decreasing the possibility of soreness from constant pressure on one site.

1 Persistent use of nipple shields does not foster effective breastfeeding; the rubber nipple of the shield may cause infant “nipple confusion.”

2 The nipples should not be washed with soap because soap can cause further irritation.

4 The entire nipple and surrounding areolar tissue should be in the infant’s mouth. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A new mother wishes to breastfeed her infant and asks the nurse whether she needs to alter her diet. How should the nurse respond?

1. “Eat as you have been doing during your pregnancy.”

2. “Drink a lot of milk and the added calcium will help you make milk.”

3. “Your body produces the milk your baby needs as a result of the vigorous sucking.”

4. “You’ll need greater amounts of the same foods you’ve been eating and more fluids.”

4 Compared with the prenatal diet, the diet for lactation requires an increased intake of all food groups, vitamins, and minerals, plus increased fluid to replace that lost with milk secretion.

1 Breastfeeding mothers need an additional 200 to 500 calories and 5 grams of protein per day more than during pregnancy to maintain adequate milk production.

2 The client needs additional calories, not just additional milk.

3 This response does not address the mother’s concern; optimum nutrition is necessary to produce an adequate milk supply. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client arrives at the clinic with swollen, tender breasts and flulike symptoms. A diagnosis of mastitis is made. What does the nurse plan to do?

1. Assist her to wean the infant gradually

2. Teach her to empty her breasts frequently

3. Review breastfeeding techniques with her

4. Send a sample of her milk to the laboratory for testing

2 Emptying the breasts limits engorgement because engorgement causes pressure and tenderness in an already tender site.

1 Breastfeeding should be continued; it is not only unnecessary but also unwise to remove the infant from breastfeeding. Sucking keeps the breasts empty, limits engorgement, and reduces pain.

3 Learning is difficult when the client is in pain; this may be done eventually after the client has some relief from pain.

4 The milk culture may be negative because the infection may be limited to the connective tissue of the breast. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should the nurse teach a formula-feeding mother about breast engorgement when it occurs?

1. Wear a tightly-fitted brassiere

2. Take two aspirin every 4 hours

3. Cease drinking milk for 2 weeks

4. Apply warm compresses to her breasts

1 This is like binding the breasts; it reduces pain and prevents further engorgement.

2 Medication will reduce pain but will not prevent further engorgement.

3 Milk and fluids should not be restricted.

4 Cold compresses will prevent further engorgement in the non-breastfeeding mother. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is teaching a client, who is formula feeding her infant, how to care for her engorged breasts. The statement that indicates that the client understands the teaching is, “I am:

1. wearing a well-fitting, tight brassiere.”

2. drinking 10 glasses of liquid every day.”

3. expressing milk from my breasts every 4 hours.”

4. letting warm water run over my breasts when I am showering.”

1 Wearing a well-fitting tight brassiere gives the body the message that milk production is not needed.

2 Non-breastfeeding mothers do not need extra fluids; 8 glasses of fluid per day is recommended for healthy adults.

3 If the client expresses milk from her breasts, she is stimulating milk production and this will not relieve engorgement.

4 Warm water running over the breasts will promote vasodilation, leading to emptying of the breasts, which promotes further milk production. (Nugent 360)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A primigravida with pregestational type 1 diabetes is at her first prenatal visit. When discussing changes in insulin needs during pregnancy and after birth, the nurse explains that based on the client’s blood glucose levels, she should expect to increase her insulin dosage. Between which weeks of gestation is this expected to occur?

1. 10th and 12th weeks of gestation

2. 18th and 22nd weeks of gestation

3. 24th and 28th weeks of gestation

4. 36th and 40th weeks of gestation

3 At the end of the second trimester and the beginning of the third trimester, insulin needs increase because there is increased maternal resistance to insulin.

1 During the earlier part of pregnancy, fetal demands for maternal glucose may lead to a tendency toward hypoglycemia.

2 During the earlier part of pregnancy, fetal demands for maternal glucose may lead to a tendency toward hypoglycemia.

4 During the last weeks of pregnancy, maternal resistance to insulin decreases and insulin needs decrease accordingly. (Nugent 360-361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During her first visit to the prenatal clinic a client tells the nurse that she has a cat and is responsible for changing the cat’s litter box. The client asks if doing this will be harmful to her or the fetus. How should the nurse reply?

1. “Cat litter is not harmful during pregnancy.”

2. “Exposure to cat litter for short periods of time is not harmful.”

3. “There are several factors that determine a person’s response to the toxins in cat litter.”

4. “Fetal abnormalities are associated with exposure to cat litter, even after minimal contact.”

3 Among the factors that can precipitate a teratogenic fetal response are exposure to the teratogen, intensity of the exposure, and maternal/fetal genetic predisposition.

1 Exposure to cat feces containing oocysts of Toxoplasma gondii can cause maternal toxoplasmosis, which may be transmitted to the fetus.

2 The length of maternal exposure is but one variable in determining if the fetus will be affected.

4 The length of maternal exposure is but one variable in determining if the fetus will be affected. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

During their first visit to the prenatal clinic, a couple asks the nurse whether the woman should have an amniocentesis for genetic studies. Which factor indicates that an amniocentesis should be performed?

1. Recent history of drug abuse

2. Family history of genetic problems

3. More than 3 prior spontaneous abortions

4. Older than 30 years of age at time of first pregnancy

2 One of the specific reasons to perform an amniocentesis is to diagnose genetic problems.

1 This is not a reason for performing this invasive procedure.

3 This is not a reason for performing this invasive procedure.

4 An amniocentesis is no longer done routinely if the client is an older primigravida; a sonogram is done first. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at her first visit to the prenatal clinic states that she has missed three menstrual periods and thinks she is carrying twins because her abdomen is so large. She now has a brownish vaginal discharge. Her blood pressure is elevated, indicating that she may have gestational hypertension. What condition does the nurse suspect the client may have?

1. Renal failure

2. Placenta previa

3. Hydatidiform mole

4. Abruptio placentae

3 Fifteen percent of the women with gestational hypertension during the first trimester develop hydatidiform mole.

1 Renal failure is an unlikely complication unless the hypertension becomes severe or there was preexisting hypertension.

2 The client’s adaptations are not associated with placenta previa. Placenta previa is a hemorrhagic condition that creates problems in the third trimester.

4 Premature separation of the placenta is associated with uterine bleeding, uterine hypertonicity, abdominal pain, and a boardlike abdomen; usually it occurs in the last trimester. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with pregestational type 1 diabetes is being counseled on what to expect during her recently confirmed pregnancy. Which statement indicates that the client needs further education?

1. “I can expect that my baby will be larger than average.”

2. “My blood glucose levels may be lower during my first trimester.”

3. “Additional insulin may be needed in the second half of my pregnancy.”

4. “Drinking more water will decrease my risk of getting a urinary tract infection.”

1 The infant of a diabetic mother (IDM) should not be larger than average if the client maintains glycemic control during the pregnancy.

2 This is a true statement, and the client does not require further education.

3 This is a true statement, and the client does not require further education.

4 This is a true statement, and the client does not require further education. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client who has type 2 diabetes and a history of three miscarriages is scheduled for a contraction stress test. Before the test she begins to cry when answering the nurse’s questions about her previous pregnancies. She states, “I know it’s my diabetes. This baby will never live. It’s all my fault.” What is the nurse’s best response?

1. “I understand that this must be very stressful for you.”

2. “Diabetes is a difficult disease to manage during pregnancy.”

3. “This baby will live because it is being very closely monitored.”

4. “I know you’re worried, although getting upset can alter test findings.”

1 The nurse empathizes with the client and keeps the lines of communication open without being judgmental.

2 This response does not address the client’s feelings and may increase anxiety.

3 This is false reassurance; close monitoring does not guarantee a live baby.

4 This response denies the client’s right to emotions and may evoke more feelings of guilt about her obstetric history. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse in the prenatal clinic determines the fundal height of a healthy multipara, at 16 weeks’ gestation, to be one fingerbreadth above the umbilicus. What should the nurse do next?

1. Assess for two distinct fetal heart rates

2. Ascertain birth weights of her other children

3. Inform the client that she may be mistaken about her due date

4. Instruct the client about appropriate weight gain during pregnancy

1 Twins should be suspected with a more rapid increase in fundal height than expected; the nurse should assess for two distinct heartbeats.

2 Fundal height, not the size of the fetus, should alert the nurse to suspect a multiple pregnancy.

3 This cannot be determined until ultrasonography is done.

4 Weight gain does not influence the height of the fundus. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a prenatal class about smoking during pregnancy. What neonatal consequence of maternal smoking should the nurse include in the teaching?

1. Low birthweight

2. Facial abnormalities

3. Chronic lung problems

4. Hyperglycemic reactions (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Smoking during pregnancy causes a decrease in placental perfusion, resulting in newborns who are small for gestational age (SGA).

2 Facial abnormalities and developmental restriction may occur if the woman ingests alcoholic drinks during pregnancy and the infant has fetal alcohol syndrome (FAS).

3 Smoking during pregnancy and chronic lung problems in newborns are not related.

4 Maternal smoking may result in a small for gestational age neonate; these neonates may experience hypoglycemia, not hyperglycemia. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client has a diagnosis of an unruptured tubal pregnancy. Which assessments correlate with this diagnosis? Select all that apply.

1. _____ Firm, rigid abdomen

2. _____ Referred shoulder pain

3. _____ Unilateral abdominal pain

4. _____ History of a sexually transmitted infection

5. _____ Ecchymotic blueness around the umbilicus (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 3, 4

1 This is not expected if the tube has not ruptured; it occurs after the rupture of a tubal pregnancy.

2 This occurs as a result of diaphragmatic irritation caused by blood in the peritoneal cavity after a tubal pregnancy ruptures, not before.

3 Pain usually occurs at the location of the affected tube before it has ruptured.

4 An STI is related to pelvic inflammatory disease; this increases the likelihood that the tubes will be affected, resulting in a tubal pregnancy.

5 Ecchymotic blueness around the umbilicus (Cullen sign) indicates hematoperitoneum in a ruptured intra-abdominal ectopic pregnancy. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse teaches a client who is to have an amniocentesis that ultrasonography will be performed just before the procedure to determine the:

1. Gestational age of the fetus

2. Amount of fluid in the amniotic sac

3. Position of the fetus and the placenta

4. Location of the umbilical cord and the placenta (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The position of the fetus and placenta is located by ultrasonography to avoid trauma from the needle during the amniocentesis.

1 Although ultrasonography can be used to determine gestational age, this is not its purpose just before an amniocentesis.

2 This is not the purpose of ultrasonography just before an amniocentesis.

4 The position of the placenta and fetus, not just the cord and the placenta, is needed for safe introduction of the needle. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is to have an amniocentesis at 38 weeks’ gestation to determine fetal lung maturity. What lecithin/sphingomyelin ratio (L/S ratio) is adequate for the nurse to conclude that the fetus’s lungs are mature enough to sustain extrauterine life?

1. 2:1

2. 1:1

3. 1:4

4. 3:4 (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The lecithin concentration increases abruptly at 35 weeks, reaching a level that is twice the amount of sphingomyelin, which decreases concurrently.

2 At about 30 to 32 weeks’ gestation, the amounts of lecithin and sphingomyelin are equal, indicating lung immaturity.

3 This ratio does not reflect fetal lung maturity.

4 This ratio does not reflect fetal lung maturity. (Nugent 361)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is the priority nursing care after an amniocentesis?

1. Giving perineal care

2. Encouraging fluids every hour

3. Changing the abdominal dressing

4. Monitoring for signs of uterine contractions (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 It is possible that stimulation of the uterus resulting from the amniocentesis may cause uterine contractions.

1 This is not necessary because an amniocentesis is not done via the vagina.

2 This is irrelevant because the amount of amniotic fluid is not influenced by fluid ingestion.

3 This is not necessary because the needlestick site seals immediately. (Nugent 361-362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse explains to a pregnant client undergoing a nonstress test that the test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with:

1. Fetal lie

2. Fetal movement

3. Maternal blood pressure

4. Maternal uterine contractions (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 In a healthy well-oxygenated fetus the heart rate increases with fetal movement; there should be accelerations of 15 beats with fetal movement.

1 This is not a part of the evaluation of the fetus in the nonstress test.

3 This is not a part of the evaluation of the fetus in the nonstress test.

4 This is used in the contraction stress test (CST). (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What should be included in the nursing care for a client at 41 weeks’ gestation who is to have a contraction stress test (CST)?

1. Having the client empty her bladder

2. Placing the client in a supine position

3. Informing the client about the need for cesarean birth

4. Preparing the client for insertion of an internal monitor (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Once the test is initiated the client will require continuous electronic monitoring and will be confined to bed; contractions are more uncomfortable with a full bladder.

2 The client should be in the semi-Fowler position to avoid supine hypotension.

3 This discussion is premature, causing unnecessary anxiety; however, a cesarean birth may be necessary if the results of the test are positive.

4 Only external monitoring is done because there is no indication that the membranes have ruptured. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a client at 42 weeks’ gestation, who is having a contraction stress test (CST). What does a positive test indicate?

1. Placenta has stopped growing

2. Fetal lungs have not yet matured

3. Amniotic fluid is meconium stained

4. Function of the placenta has diminished (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 During a CST uterine blood flow to the placenta decreases. When there is too great a decrease, fetal hypoxia and late decelerations occur, reflecting diminished placental function.

1 Although this may cause fetal problems, a CST cannot determine this.

2 The CST cannot determine fetal lung maturity; this is determined by an amniocentesis.

3 The CST cannot determine this because amniotic fluid is not obtained. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Laboratory studies reveal that a pregnant client’s blood type is O and she is Rh positive. Problems related to incompatibility may develop in her infant if the infant is:

1. Rh negative

2. Type A or B

3. Born preterm

4. Type O and Rh positive (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2. An ABO incompatibility may develop even in first-born infants because the mother has antibodies against the antigens of the A and B blood cells; these antibodies are transferred across the placenta and produce hemolysis of the fetal RBCs; if the infant were AB, an incompatibility may also occur.

1 Problems will not occur if the mother is Rh positive and the infant is Rh negative.

3 A preterm birth will not produce an incompatibility; it may intensify problems if an incompatibility exists.

4 If the infant is the same type and has the same Rh factor as the mother, there is no incompatibility. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 16-year-old primigravida who appears to be at or close to term arrives at the emergency department stating that she is in labor and complaining of pain continuing between contractions. The nurse palpates the abdomen, which is firm with no signs of relaxation. What problem does the nurse conclude the client is experiencing?

1. Placenta previa

2. Precipitous birth

3. Abruptio placentae

4. Breech presentation (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This indicates premature placental separation; the classic signs are abdominal rigidity, a tetanic uterus, and dark red bleeding.

1 This occurs with a low-lying placenta and is manifested by painless bright red bleeding.

2 Information on cervical effacement, dilation, and station is required before coming to this conclusion.

4 Fetal presentation is not related to the client’s signs and symptoms. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is pregnant for the first time and is carrying twins is scheduled for a cesarean birth. What should preoperative teaching include?

1. Frequent ambulation is begun within 24 hours

2. Discharge from the hospital occurs in 5 to 7 days

3. Enemas are required for effective bowel movements

4. Sponge baths are taken until incisional healing is complete (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Early postoperative ambulation helps prevent postpartum complications such as thrombophlebitis and constipation.

2 Clients usually are discharged by the third or fourth postpartum day.

3 A bowel movement can occur spontaneously if early ambulation and adequate fluids are ingested.

4 Clients are permitted to shower within 48 hours. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A 40-year-old multigravida’s pregnancy is confirmed at 8 weeks’ gestation. She states, “I can’t wait another 2 months for an amniocentesis to find out whether my baby has a chromosomal anomaly like my first child.” The nurse responds that she can have a chorionic villi sampling between the 10th and 12th weeks because if it is performed before this time:

1. It can cause fetal anomalies

2. The results are not as accurate

3. The information it provides is inadequate

4. It must be done using laparoscopic surgery (Nugent 319)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The American College of Obstetricians and Gynecologists recommends that a chorionic villi sampling (CVS) should not be performed before 9 weeks’ gestation and should be performed between 10 to 12 weeks. If performed before 9 weeks’ gestation it has the potential of interfering with organogenesis.

2 The test, if successfully performed, is 100% accurate.

3 The test, if successfully performed, is 100% accurate and it provides enough information for a diagnosis.

4 A laparoscopic procedure is not necessary because CVS is performed either by transcervical catheter aspiration or transabdominal needle aspiration. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Which clients are at the highest risk for developing a postpartum infection?

1. Women who require catheterization after voidings that are less than 75 mL

2. Women who have lost at least 350 mL of blood during the birthing process

3. Primiparas who have given birth to an infant weighing more than 8.5 pounds

4. Multiparas who have hemoglobin levels of 11 grams at the time of admission (Nugent 319-320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Repeated catheterizations for residual urine increase the chance of introducing bacteria and promoting its growth.

2 A loss of 250 to 500 mL of blood is considered acceptable.

3 The size of the newborn does not predispose the mother to postpartum infection.

4 This does not reflect the highest risk for infection; a hemoglobin of 11 grams is at the low end of the acceptable range. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is having a difficult labor is diagnosed with cephalopelvic disproportion. Which medical order should the nurse question?

1. Maintain NPO status

2. Start peripheral IV of ¼ NS

3. Record fetal heart tones every 15 minutes

4. Piggyback another 10-unit bag of oxytocin (Pitocin) (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 When there is cephalopelvic disproportion, a cesarean birth is indicated; infusing oxytocin (Pitocin) at this time may result in fetal compromise and uterine rupture.

1 The NPO status is appropriate in anticipation of a cesarean birth.

2 A peripheral IV is needed not only for hydration but as a venous access if IV medications become necessary.

3 The client probably has an electronic monitor recording the FHR and uterine contractions; these assessments should be documented regularly according to hospital protocol. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is the priority nursing intervention for a client who has just given birth to her fifth child?

1. Palpating her fundus frequently because she is at risk for uterine atony

2. Offering her fluids because multiparas generally lose more fluid during labor

3. Assessing her bladder tone because she is at increased risk for urinary tract infection

4. Performing passive range-of-motion exercises on her extremities because she is at risk for thrombophlebitis (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Because of the client’s multiple parity, postpartum uterine involution may be ineffective.

2 Primiparas, not multiparas, become more dehydrated because their labors are usually longer.

3 There is no evidence of an increased risk for a urinary tract infection; routine assessment of bladder tone should be performed.

4 Clients are encouraged to ambulate soon after birth; it is too soon to be concerned about the effects of immobility. (Nugent 362)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a group of postpartum clients. Which one should the nurse monitor most closely?

1. Primipara who had an 8-pound newborn

2. Grand multipara who just had her sixth child

3. Primipara who received 50 mcg of IV fentanyl during her labor

4. Multipara whose placenta was expelled 5 minutes after the birth (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 A grand multipara is a woman who had at least 6 births. Multiple parity contributes to an increased incidence of uterine atony because the uterine muscle may not contract effectively, thus leading to postpartum hemorrhage.

1 A primipara should maintain a well-contracted uterus because with only one pregnancy the uterus usually maintains its tone.

3 50 mcg of fentanyl is not considered excessive for a primipara and will not contribute to uterine atony.

4 A multipara is a woman who has given birth to at least 2 children. The birth of the placenta 5 minutes after birth of the neonate is expected and does not affect uterine tone. (Nugent 362-363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client had a cesarean birth 4 hours ago. What is the major nursing intervention at this time?

1. Promoting dietary intake

2. Promoting bowel function

3. Relieving gaseous distention

4. Relieving postoperative pain (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 As with any abdominal surgery, pain is a major postoperative problem during the first 24 hours after cesarean birth.

1 Oral intake is not a priority concern.

2 Promoting bowel function is not a priority concern.

3 Gaseous distention is more likely to occur later. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who had a cesarean birth is unable to void 3 hours after the removal of an indwelling catheter. How can the nurse evaluate whether the client’s bladder is distended?

1. Catheterizing the client for residual urine

2. Palpating the client’s suprapubic area gently

3. Determining if the client is experiencing suprapubic pain

4. Asking the client whether she still feels the urge to urinate (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Palpation will indicate if bladder distention is present. The increased intra-abdominal space available after birth can result in bladder distention without discomfort.

1 Assessment should be done first.

3 The increased intra-abdominal space available after birth can result in bladder distention without discomfort.

4 Trauma to the area makes surrounding organs atonic; the client may have a full bladder and not feel the urge to void. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

On her first visit to the prenatal clinic a client with rheumatic heart disease asks the nurse if she will have special nutritional needs. What supplements in addition to the regular pregnancy diet and prenatal vitamin and minerals will she need? Select all that apply.

1. ____ Iron

2. ____ Calcium

3. ____ Folic acid

4. ____ Vitamin C

5. ____ Vitamin B12 (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 3

1 Because pregnant women with heart disease are more prone to anemia, there may be an additional need for iron.

2 If the pregnant client with heart disease is eating the recommended pregnancy diet and taking prenatal vitamin and mineral supplements, there is no additional need for calcium.

3 Because pregnant women with heart disease are more prone to anemia, there may be an additional need for folic acid.

4 If the pregnant client with heart disease is eating the recommended pregnancy diet and taking prenatal vitamin and mineral supplements, there is no additional need for vitamin C.

5 If the pregnant client with heart disease is eating the recommended pregnancy diet and taking prenatal vitamin and mineral supplements, there is no additional need for vitamin B12. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What is the nursing action, during the postpartum period, that has the highest priority for a client with class I heart disease?

1. Promoting early ambulation

2. Observing for signs of cardiac decompensation

3. Assessing the mother’s emotional reaction to the birth

4. Instructing the mother about activity levels during the postpartum period (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Cardiac decompensation may occur because of the increased circulating blood volume during the early postpartum period, which requires increased cardiac functioning.

1 Although important, observation for cardiac decompensation is the priority.

3 Although important, observation for cardiac decompensation is the priority.

4 Although instructions are an essential component of care, at this time they are not the priority. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 28 weeks’ gestation with previously diagnosed mitral valve stenosis is being evaluated in the clinic. Which sign or symptom indicates that the client is experiencing cardiac difficulties?

1. Systolic murmur

2. Heart palpitations

3. Syncope on exertion

4. Displaced apical pulse (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Syncope on exertion is a definitive sign of cardiac decompensation; cardiac output is not meeting cellular oxygen needs.

1 This may occur in a healthy pregnant woman because of the displacement of the heart, caused by the enlarging uterus that shifts the contents of the thoracic cavity and the increased blood volume and cardiac output.

2 This may occur in a healthy pregnant woman because of the displacement of the heart, caused by the enlarging uterus that shifts the contents of the thoracic cavity and the increased blood volume and cardiac output.

4 This may occur in a healthy pregnant woman because of the displacement of the heart, caused by the enlarging uterus that shifts the contents of the thoracic cavity and the increased blood volume and cardiac output. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

While a client at 30 weeks’ gestation is being examined in the prenatal clinic, the nurse identifies a respiratory rate of 26, blood pressure of 100/60, diaphragmatic tenderness, and a reported increased urinary output. Which finding indicates that the client may be experiencing a complication?

1. Urinary output

2. Blood pressure

3. Respiratory rate

4. Diaphragmatic tenderness (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 The increased respiratory rate is one sign of cardiac decompensation; cardiac output and increased blood volume peak during the second trimester, and signs and symptoms of cardiac disease become prominent at this time.

1 Oliguria, not increased urine output, accompanied by edema of the face, legs, and fingers is a sign of cardiac complications.

2 The client’s blood pressure is within the expected range for a pregnant woman.

4 Diaphragmatic tenderness is a vague symptom that is not related to heart disease. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is diagnosed with placenta previa and asks the nurse what this means. What is the nurse’s best response?

1. “It is premature separation of a normally implanted placenta.”

2. “The placenta is not implanted securely in place on the uterine wall.”

3. “It is premature aging of a placenta that is implanted in the uterine fundus.”

4. “The placenta is implanted in the lower uterine segment, covering part or all of the cervical opening.” (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 This is the accepted definition of placenta previa.

1 This occurs in abruptio placentae.

2 This occurs in abruptio placentae.

3 This may not lead to placenta previa but will place the fetus in jeopardy. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with frank vaginal bleeding is admitted to the birthing unit at 30 weeks’ gestation. The admission data include BP, 110/70; P, 90; R, 22; FHR, 132; uterus, nontender; contractions, none; membranes, intact. Based on this information, what problem does the nurse suspect this client has?

1. Preterm labor

2. Uterine inertia

3. Placenta previa

4. Abruptio placentae (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A nontender uterus and bright red bleeding are classic signs of placenta previa; as the cervix dilates the overlying placenta separates from the uterus and begins to bleed.

1 There is no information to indicate that the client is in labor.

2 There is no indication that the client had contractions that have now ceased.

4 The classic adaptations to abruptio placentae are pain and a rigid boardlike abdomen; dark red blood may or may not be present. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse in the high-risk prenatal unit admits a client at 35 weeks’ gestation with a diagnosis of complete placenta previa. What is the most appropriate nursing intervention at this time?

1. Apply a pad to the perineal area

2. Have oxygen available at the bedside

3. Allow bathroom privileges with assistance

4. Educate the client regarding the intensive care nursery (Nugent 320)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 If hemorrhage should occur, oxygen is needed to prevent maternal and fetal compromise.

1 A perineal pad is not necessary; close monitoring is required.

3 The client admitted with a complete placenta previa usually is on complete bed rest.

4 It is too soon to discuss the neonatal intensive care unit (NICU); this may be unnecessary. (Nugent 363)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse gently performs Leopold’s maneuvers on a client with a suspected placenta previa. What does the nurse expect from this assessment?

1. Fetal head is firmly engaged

2. Small fetal parts are difficult to palpate

3. Fetal presenting part is high and floating

4. Uterus is hard and tetanically contracted (Nugent 320-321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 With a low-implanted placenta (placenta previa) the presenting part may have difficulty entering the pelvis.

1 Engagement is difficult with a low-lying placenta.

2 Placenta previa does not make it difficult to palpate small fetal parts.

4 This occurs with abruptio placentae. (Nugent 363-364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted with a marginal placenta previa. What should the nurse have available?

1. One unit of freeze-dried plasma

2. Vitamin K for intramuscular injection

3. Two units of typed and screened blood

4. Heparin sodium for intravenous injection (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A sudden, severe hemorrhage may occur because of the location of the placenta near the cervical os; blood should be ready for administration to prevent shock.

1 Freeze-dried plasma is not used in this situation.

2 Adults manufacture their own vitamin K, and an injection will not help to prevent bleeding from the placenta.

4 Giving heparin sodium is contraindicated in the presence of hemorrhage. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client arrives in the birthing unit from the emergency department with blood running down both legs. What is the primary intervention?

1. Assessing fetal heart tones

2. Observing for a prolapsed cord

3. Starting an intravenous infusion

4. Inserting a uterine pressure catheter (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The priority is to determine fetal viability; this will determine the next intervention.

2 Observing for a prolapsed cord is not the priority.

3 An intravenous line will be inserted, but it is not the priority.

4 Inserting a pressure catheter might increase the bleeding; it will not yield useful information. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who at 24 weeks’ gestation is admitted to the high-risk unit with a diagnosis of preeclampsia. She has a seizure. What is the nurse’s immediate action?

1. Turn the client’s head to the side

2. Check the client for an imminent birth

3. Place an airway into the client’s mouth

4. Observe for bleeding from the client’s vagina (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 This will allow saliva to drain out of the mouth by gravity, which will help to maintain a patent airway.

2 Although birth may be imminent, the priority is to maintain a patent airway.

3 This is contraindicated because it may cause an injury.

4 Observing the client’s vagina is not the priority, nor is bleeding an expected response to a seizure. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client is admitted with abdominal pain and heavy vaginal bleeding. What is the priority nursing action?

1. Administering oxygen

2. Elevating the head of the bed

3. Drawing blood for a hematocrit

4. Giving an intramuscular analgesic (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 These adaptations indicate blood loss; to compensate for decreased cardiac output, oxygen is given to maintain the well-being of both mother and fetus.

2 This will decrease blood flow to the vital centers in the brain.

3 This is not the priority.

4 This may mask abdominal pain and sedate an already compromised fetus. Also it requires a practitioner’s prescription. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for pregnant clients in the high-risk unit. In what disorder is stimulation of labor contraindicated?

1. Diabetes mellitus

2. Mild preeclampsia

3. Total placenta previa

4. Premature rupture of the membranes (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A total placenta previa requires a cesarean birth; early intervention helps ensure a healthy neonate and mother.

1 This is a complication that may necessitate an early birth to ensure a healthy neonate and mother.

2 This is a complication that may necessitate an early birth to ensure a healthy neonate and mother.

4 Induction of labor is indicated if the fetus is at term because prolonged rupture of membranes can lead to maternal and/or fetal sepsis. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is teaching a pregnant client with sickle cell anemia about the importance of taking supplemental folic acid. Folic acid is important for this client because it:

1. Lessens sickling of RBCs

2. Prevents vaso-occlusive crises

3. Decreases oxygen needs of cells

4. Compensates for a rapid turnover of RBCs (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Folic acid is needed to produce heme for hemoglobin.

1 Folic acid supplementation does not reduce sickling.

2 Folic acid supplementation will not prevent vaso-occlusive crisis. Adequate oxygenation and hydration help prevent vaso-occlusive crisis (painful episode).

3 There is no change in needs; sickling decreases the oxygen-carrying capacity of hemoglobin. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The laboratory blood tests of a client at 10 weeks’ gestation reveal that she has anemia. The client refuses iron supplements. The nurse teaches her that the best source of iron is liver. What other foods does the nurse encourage her to eat? Select all that apply.

1. ____ Tofu

2. ____ Chicken

3. ____ Canned ham

4. ____ Broiled halibut

5. ____ Ground beef patty (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

Answer: 1, 5

1 Tofu contains 3 mg of iron per 3 ounces.

2 White meat chicken contains 0.9 mg of iron per 3 ounces; dark meat chicken contains 1.2 mg of iron per 3 ounces.

3 Canned ham contains 0.8 mg of iron per 3 ounces.

4 Broiled halibut contains 0.91 mg of iron per 3 ounces.

5 A ground beef patty contains 2.2 mg of iron per 3 ounces. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional assessment should be made at each visit?

1. Signs of hypothyroidism

2. Evidence of pyelonephritis

3. Symptoms of hypoglycemia

4. Presence of hyperemesis gravidarum (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Pregnant clients with sickle cell anemia are particularly vulnerable to infections, especially of the genitourinary tract; the examination of urine specimens should be performed frequently.

1 Hypothyroidism affects 1 in 1500 women during pregnancy; women with sickle cell anemia are not at any higher risk for hypothyroidism than the general population.

3 Women with sickle cell anemia are not at an increased risk for this problem during pregnancy.

4 Women with sickle cell anemia are not at an increased risk for this problem during pregnancy. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor is admitted with a suspected breech presentation. For what occurrence should the nurse be prepared?

1. Uterine inertia

2. Prolapsed cord

3. Imminent birth

4. Precipitate labor (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 The feet or buttocks are not effective in blocking the cervical opening, and the cord may slip through and be compressed.

1 Uterine inertia may result from fatigue or cephalopelvic disproportion; it is not related to fetal position.

3 When a fetus is in the breech presentation the labor usually is long and difficult.

4 Rapid dilation and precipitate labor can occur with infants in cephalic positions as well. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

The nurse is caring for a client whose fetus is in a breech presentation. Suddenly the membranes rupture and meconium appears in the vaginal introitus. The nurse realizes that this:

1. Indicates that the cord will prolapse

2. Is evidence of fetal heart abnormalities

3. Is a common occurrence in breech presentations

4. Requires immediate notification of the practitioner (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 This occurs because pressure on the fetal abdomen from the contractions forces meconium from the bowel.

1 Cord prolapse is not an absolute, but it may occur if the presenting part does not fill the pelvic cavity.

2 Fetal heart abnormalities are identified by auscultation or continuous electronic fetal monitoring, not by the presence of meconium.

4 This is unnecessary; it is caused by pressure on the fetal abdomen during contractions when the fetus is in the breech presentation. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client in labor is admitted to the birthing unit. Assessment reveals that the fetus is in a footling breech presentation. What should the nurse consider about breech presentations when caring for this client?

1. Severe back discomfort will occur

2. Length of labor usually is shortened

3. Cesarean birth probably will be necessary

4. Meconium in the amniotic fluid is a sign of fetal hypoxia (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A cesarean birth may be performed when the fetus is in the breech presentation because there is an increased risk of morbidity and mortality.

1 Vertex presentations in the occiput posterior position usually cause back pain.

2 Labors usually are longer with a fetus in the breech presentation because the buttocks are not as effective as the head as a dilating wedge.

4 Meconium is a common finding in the amniotic fluid of a client whose fetus is in a breech presentation because contractions compress the fetal intestinal tract causing release of meconium. (Nugent 364)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client’s membranes ruptured 20 hours before admission. She was in labor for 24 hours before giving birth. The nurse plans to monitor her closely. For which postpartum complication is she at highest risk?

1. Infection

2. Hemorrhage

3. Uterine atony

4. Amniotic fluid embolism (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 When the membranes rupture, microorganisms from the vagina may travel into the embryonic sac, causing chorioamnionitis. The longer the time between the rupture of the membranes and the birth, the greater the risk for infection. The temperature should be assessed every 1 to 2 hours and an elevation to 100.4° F (38° C) should be reported.

2 If there are no other complications, this is not expected.

3 If there are no other complications, this is not expected.

4 This is not likely to occur when the membranes rupture before birth because the fluid exits via the vagina rather than being forced upward. (Nugent 364-365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client has a history of multiple preterm births followed by neonatal deaths. What is the danger sign that the nurse must teach the client to report?

1. Leg cramps

2. Pelvic pressure

3. Nausea after 11 AM

4. No fetal movement at 12 weeks (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Pelvic pressure or a feeling that the fetus is pushing down is one symptom of preterm labor and should be taught to the client so that she can seek care immediately.

1 Leg cramps are not a danger sign of preterm labor.

3 Nausea is not a danger sign of preterm labor.

4 Fetal movement is not felt until approximately 16 weeks. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A multipara whose membranes have ruptured is admitted in early labor. Assessment reveals a breech presentation, cervical dilation at 3 cm, and fetal station at −2. For what complication should the nurse assess when caring for this client?

1. Vaginal bleeding

2. Urinary tract infection

3. Prolapse of the umbilical cord

4. Meconium in the amniotic fluid (Nugent 321)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 A breech presentation provides for a greater space between the cervix and the fetal sacrum than a vertex presentation. When the client is a multipara, the muscle tone of the cervix may be relaxed; thus the umbilical cord may prolapse and become compressed, leading to fetal hypoxia and potential fetal demise.

1 Unless there were other complications, vaginal bleeding is not expected.

2 A urinary tract infection is not related to a breech presentation.

4 As the fetal sacrum is compressed during labor, meconium might be expelled; this is not a fetal life-threatening concern with a breech presentation. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client is admitted to the emergency department at 34 weeks’ gestation with trauma and significant bleeding from the leg. What is the priority intervention after determining fetal well-being?

1. Obtaining the client’s vital signs

2. Offering the client emotional support

3. Placing the client in a left lateral position

4. Drawing the client’s blood for laboratory screening (Nugent 321-322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

. 3 The left lateral position will increase placental perfusion, which may be compromised because of the significant bleeding.

1 Obtaining the client’s vital signs is not the priority.

2 Although emotional support is important, preventing fetal and maternal compromise is the priority.

4 Although important, it is not the priority. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

When entering the room of a client in active labor to answer the call light, the nurse identifies that the client is ashen gray, is clutching her chest, and is dyspneic. What should the nurse do after pressing the emergency light in the client’s room?

1. Administer oxygen by face mask

2. Check for rupture of the membranes

3. Begin cardiopulmonary resuscitation

4. Increase the rate of intravenous fluids (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 The client is exhibiting signs and symptoms of an amniotic fluid embolism; increasing oxygen intake is essential.

2 The client is experiencing an emergency situation; checking for rupture of membranes is irrelevant at this time.

3 The client is breathing and conscious; CPR is not indicated, but it may be necessary if her condition worsens.

4 It is not necessary to increase the IV fluid rate, although the present rate should be maintained. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A pregnant client with a history of preterm labor is at home on bed rest. What instructions should a teaching plan for this client include?

1. Place blocks under the foot of the bed

2. Sit upright with several pillows behind the back

3. Lie on the side with the head raised on a small pillow

4. Assume the knee-chest position at regular intervals throughout the day (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Bed rest keeps the pressure of the fetal head off the cervix. The side-lying position keeps the gravid uterus from impeding blood flow through major vessels, thus maintaining uterine perfusion.

1 The Trendelenburg position is used when the cord is prolapsed or the client is in shock.

2 Sitting up in bed increases pressure on the cervix; this may lead to further dilation.

4 This may aid in relieving pressure of the fetus on the cervix, but it will not enhance uterine perfusion. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a client with a history of treatment for preterm labor during this pregnancy. The client now is at 33 weeks’ gestation. With regard to sexual intercourse, the nurse should explain that it is:

1. Allowed if penile penetration is not deep

2. Permitted unless there is vaginal discomfort

3. Limited to once a week to decrease contractions

4. Eliminated to prevent stimulation of uterine activity (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

4 Prostaglandins in semen may stimulate labor, and penile contact with the cervix may increase myometrial contractility.

1 Sexual intercourse may cause labor to progress.

2 Sexual intercourse may cause labor to progress.

3 Sexual intercourse may cause labor to progress. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who is in the first trimester is being discharged after a week of hospitalization for hyperemesis gravidarum. She is to be maintained at home with rehydration infusion therapy. What is the priority nursing activity for the home health nurse?

1. Determining fetal well-being

2. Monitoring for signs of infection

3. Assessing for signs of electrolyte imbalances

4. Teaching about changes in nutritional needs during pregnancy (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

. 3 Rehydration fluids contain only saline and dextrose; if the client continues to vomit, she will lose electrolytes.

1 Monitoring the fetus is not the priority. Early in the pregnancy the mother’s well-being will be reflected by the fetus.

2 Although there is danger of infection when an IV is in place, monitoring for it is not the priority.

4 Teaching about nutritional needs is a nontherapeutic nursing action while the client is still vomiting. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client with type 1 diabetes is scheduled for an amniocentesis at 36 weeks’ gestation. She asks the nurse why this is done so late in her pregnancy. What should the nurse consider before responding?

1. Fetus’s age can be calculated

2. Fetal lung maturity can be evaluated

3. Vaginal birth will be performed if fetal size permits

4. Cesarean birth can be performed before labor begins (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 A test of the amniotic fluid can determine the fetus’s lung maturity; this determination can assist with the timing of a scheduled birth.

1 This is done with ultrasonography.

3 The size of the fetus cannot be determined by amniocentesis; it may be approximated by palpation or sonographic measurements.

4 Cesarean births are not done routinely on women with diabetes unless a vaginal birth is ruled out. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A nurse is caring for a client with type 1 diabetes on her first postpartum day. What changes in the client’s insulin requirements does the nurse expect?

1. Slowly decrease

2. Quickly increase

3. Suddenly decrease

4. Usually remain unchanged (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

3 Insulin requirements may decrease suddenly during the first 24 to 48 postpartum hours because the endocrine changes of pregnancy are reversed.

1 Insulin requirements suddenly, not slowly, decrease because of the rapid physiologic changes occurring when the postpartum period starts.

2 Insulin requirements decrease, not increase, during the postpartum period.

4 Insulin requirements of women with diabetes fluctuate throughout pregnancy and decrease suddenly during the postpartum period. (Nugent 365)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

What assessment finding should the nurse consider a concern in a client at 35 weeks’ gestation?

1. Frequent painless urination

2. Painful intermittent contractions

3. Increased fetal movement after eating

4. Lower back pain that results in insomnia (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

2 Painful contractions at this time may indicate preterm labor or the presence of preparatory contractions (formerly called Braxton-Hicks contractions), although preparatory contractions may be painless or painful. The client’s painful intermittent contractions must be assessed further to distinguish between the two.

1 Frequent urination is common during the last trimester because of the pressure of the enlarging fetus; painful urination may indicate a urinary tract infection.

3 Fetal movements usually increase after the mother eats.

4 Difficulty sleeping and lower back pain are both common adaptations during the third trimester. (Nugent 365-366)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client who had tocolytic therapy for preterm labor is being discharged. What instructions should the nurse include in the teaching plan?

1. Restrict fluid intake

2. Limit daily activities

3. Monitor urine for protein

4. Avoid deep-breathing exercises (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

. 2 Although it has not been proven that bed rest limits preterm labor, it is often recommended; activities are restricted to bathroom privileges and movement to a daytime resting area.

1 Fluid intake should not be restricted; hydration should be maintained.

3 Monitoring the urinary protein level is included in the care of a client with preeclampsia, not preterm labor.

4 Deep-breathing exercises do not influence preterm labor. (Nugent 366)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

A client at 34 weeks’ gestation is receiving terbutaline (Brethine) subcutaneously. Her contractions increase to every 5 minutes, and her cervix dilates further to 4 cm. The tocolytic is discontinued. What is the priority nursing care during this time?

1. Promoting maternal-fetal well-being during labor

2. Reducing the anxiety associated with preterm labor

3. Supporting communication between the client and her partner

4. Assisting the client and her partner with the breathing techniques needed as labor progresses (Nugent 322)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

1 Labor is continuing, and the promotion of the well-being of the client and fetus is the priority nursing care during this period.

2 This addresses one aspect of this client’s needs; the priority is maternal/fetal well-being.

3 This addresses one aspect of this client’s needs; the priority is maternal/fetal well-being.

4 This addresses one aspect of this client’s needs; the priority is maternal/fetal well-being (Nugent 366)
Nugent, Patricia M. Mosby’s Review Questions for the NCLEX-RN® Examination, 7th Edition. Mosby, 2011. VitalBook file.

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A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? Glucose level After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion …

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