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N ——W e —
43 % GALEN [z ot e jii
Faculy S
Y Name: Jsanette Jones CoLLEGE OF NURSING
Program Associate of Science Degree in Nursing
Course
Number: NUR 254
Exam
Cover Sheet
Sectlon: 03003
Course Name: Concepts of Nursing: The Childbearing/Child Caring Family
Exam Name: Exam 1 a
Test Form: A
ik B
b
Exam Intormation
e
Term Exam Administered: 21 Fall
Time Allowed for Completion (minutes): 75
Number of Exam Items: 50
Points per Exam item: 2
Materials Supplied: none
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Page 1/
NUR
NUR
NUR
Exam
1 a\Versiona
I
—
EXMOUSSIONS I
The nurse
ispreparing
to
teach a client
about
thr
pregnancy.
Which
ofthe
following
decreases
or
o cardiovascular
changes
that
occur during
emains
unchanged?
a.
Heartrate.
5/]
Blood
pressure.
c. Cardiac
output.
d. Blood volume.
who
has
iron
deficiency
anemia.
Whicl
ided di
i
lient
e
- The nurse
has provided dietary
teaching forapregpaqt
cl
| o feciye
of
the f0||0WingpmeaI
options
selected
bythe
client indicates
that
teaching ha
Grilled steak, creamed spinach, and an apple.
b. Baked chicken breast and macaroni salad.
c. Oatmeal, whole-wheat toast, and jelly.
d. Grilled cheese sandwich and tomato soup.
i S
- The nurse
is caring for
a client who is pregnant.
The first
day of the last menstrual
pengcé)
g.l:l:)b;va
October 11. Using
Naegele's rule,
the nurse calculates
the estimated
date of delivery
June 4.
a.
)
b. July4.
; d
@ July 18.
d. June 18.
The nurse is
caring fora
pregnant client
who is recently
diagnosed
with pica.
Which of the
following
hemoglobin (Hgb) levels should the nurse expect to find inthe client’s chart?
37
g/dL.
S
9 g/dL. ,}
12 gldL. ((&
16 g/dL.
2IGE
- The nurse is caring for aclient who is at 38 weeks gestation and inasupine position fora pelvic examination. The client reports feeling dizzy and nauseated, and upon assessment
her skin damp feels and cool. Which ofthe following actions should the nurse take first?
Turn the client on her side.
Elevate the client’s legs 20 degrees above her hips.
Take the client's blood pressure (BP).
Assess the client's respiratory rate (RR).
aoomw
Page 2/
NUR 230,
NUR 231,
NUR 254
Exam 1 a Version a
- A nurse is teaching a client about symptoms to report during her pregnangy. Which of the following
statements by the client indicates a correct understanding of the teaching?
“If Ihave any vaginal bleeding before 20 weeks, |should report it.”
“I'l report increased frequency of urination during the third trimester.”
“If |feel tired after resting, |should report it.”
d. “I'llreport if|experience lower back pain during the third trimester.”
2
The nurse is caring for a client who isat 15 weeks gestation and has an immune rubella titer, Which
of the following actions isappropriate
forthe nurse to take?
a. Convey
to the client
that she needs
to wait until
after delivery
to have
an MMR vaccine.
,b./ Suggest that the client receive a rubella vaccine at this visit.
@ Tell the client that she has immunity
at this time.
Plan to immunize the client when she reaches the third trimester.
12 The
nurse is
teaching a
client who
is inthe 10th
week
of pregnancy
about
mormning sickness.
Which
of the following should the nurse include in the teaching?
a. The degree of nausea is linked to the mother’s acceptance
ofthe pregnancy.
b. Drink
a protein
supplement
first
thing upon
arising.
@ Alternate dry carbohydrate foods with fluids every hour. W? ’ \ 3
Increase the intake ofprotein inthe evening meal to help decrease nausea in the morning.
Thenurseis teaching a pregnant client about possible complications
of pregnancy. Which of the
following client statements requires follow-up by the nurse?
“I will change my cat's litterbox daily because it could contain harmful bacteria.”
b. “Iwill check my urine daily for any protein while at home.”
c. “I'should callthe clinic immediately
if|notice increased edema in my ankles orfeet."
d. “I'should notify my primary health care provider (PHCP) if |experience blurred vision.”
The nurse iscollecting data from a client who isconfirmed pregnant. The client tells the nurse that
twins; 1 pregnancy she delivered at 31 weeks;
and 1 pregnancy
she delivered at 18 weeks. Which the of following isthe correct way to document the client's gravidity, term births, pretérm births,
abortions, and living children (GTPAL)?
G=5, T=1, P=2, A=1, L=4.
;
b. G= T=1, P=2, A=1, L=3.
P /
& G=4,T=1, P=3, A=1, L=3.
G)§T/ / /L/
d
~d- G=4, Te=1, P=2, A=1, L=4.
Page 4 /
i
(5.
R 230
NUR 231, NUR 254 Exam 1 a Version a
T T
.
rhe nurse iscaring for assigned clients. Which ofthe following assessment findings should the nurse
€cognize as consistent with aclient inthe second stage of labor?
a.
The fetus is at -1 station.
b.
The membranes
ruptured
during
a contraction.
The client has the urge to push. 5
S The placenta isbeing delivered.
The
nurse is caring for
a client who received
an epidural 10
minutes ago. The
client now reports
dizziness,
lightheadedness,
and nausea. After
checking the client's
blood pressure, which
of the
following
actions
should
the nurse
take?
a. Elevate the client's feet.
b. Give
the client an antiemetic.
Ambulate
the clientin
the room.
d. Administer oxygen.
The nurse
iscaring for a
clientwho is in
labor and has spontaneous
rupture
of membranes
with a
large
amount ofclear
fluid noted.
Which of the
following, ifobserved
by the
nurse, indicates
cord
compression?
a. Late decelerations.
(o) Variable
decelerations.
c. Early decelerations.
d. Fetal bradycardia.
The nurse is
preparing toteach
agroup ofprimipara
clients about
active relaxation
techniques for
pain
control. Which
ofthe following statements
by a client
requires follow-up
by the nurse?
a.
“lwill listen to
an audio recording
of acrying baby
to help relax me
for labor.”
b.
“Relaxing uninvolved
muscles during
uterine contractions
can help control the
pain.”
@
“Breathing slowly and
deeply during contractions
will help to control the
pain.” -
“Iwill plan to focus on
an object inthe room during
contractions.”
The
nurse iscaring for a clientwhose
membranes ruptured 8 hours
ago. Which ofthe following
actions should the nurse take?
Check the client's temperature
every 2 hours to
assess for infection.
b. Assess the vagina
frequently for a prolapsed
cord.
c. Monitor the client's blood pressure every hour.
d. Assess the client's pain level. ’[
w
Page 5/
;.UR 230, NUR 231, NUR 254 Exam 1 a Version a
Th nurse is assessing the contractions of a client on a fetal monitor. The client had the following
activity according to the monitor.
Contraction
at 0905 lasting 30
seconds.
Contraction at 0915 lasting 40
seconds.
Contraction at 0935 lasting 30
seconds.
Contraction at 0939 lasting 40
ieconds.
Which of the following is the correct assessment to document regarding the frequency of the
contractions?
a
o®
5-20 minutes.
4-20 minutes.
4-5 minutes.
5-34 minutes.
The nurse working in the labor unit has become aware of the following client situations. Which of the
following clients should the nurse assess first?
o
gon
&
The client who had IV butorphanol 5 minutes ago and reports no relief.
The client who has just vomited in an emesis basin.
The client who is yelling that she wants a cesarean birth.
The client who is asking for a bed pan to move her bowels.
The nurse working in the labor and delivery unit is caring for a client whose membranes have just
ruptured. After assessing the fetal heart rate (FHR), which of the following actions is the priority?
s
d.
Ask the client when labor began.
Offer the client ice chips.
Report the color and consistency of the client's amniotic fluid.
Change the client's bed pad and give perineal care.
=N
The nurse isteaching a newly hired nurse about signs to expect inthe first phase of the first stage of
labor. Which of the following signs referenced
by the newly hired nurse indicates a
need for further
teaching?
a.
b.
@
d.
The cervix is dilated 3-4 centimeters.
The fetus is -2 station.
The client is relaxed and excited.
The cervix has 80% effacement.
Page 7/
NUR 230, NUR 231, NUR 254 Exam 1 a Version a
The nurse iscaring forclients who have oxytocin prescribed to induce labor. Which of the following
clients requires
follow-up with the
primary health care provider
(PHCP)?
@ Primigravida who has placenta previa.
%
g. Primigravida who has oligohydramnios.
L
. Multigravida
who has diabetes mellitus (type 1). _(V‘()
Multigravida
who
has
gestational
hypertension.
The nurse has performed a vaginal exam on a client and notes that the fetal head is at the level
indicated
inthe image
below.
Which
ofthe following
should
the nurse
document?
+1 station.
+2 station.
Crowning.
a
b.
c.
0 station.
The nurse is planning a staff development
conference
about indications
for labor induction.
Which of
the following statements,
ifmade by a participant,
indicates a correct understanding
of the
conference?
@ “Induction
would be contraindicated
fora client with complete
placenta previa.”
b. “Induction
iscontraindicated
with premature
rupture of membranes.”
€. “Induction of labor wo_uld not be indicated for a client with severe preeclampsia.”
d. “Induction
isindicated
forsevere fetal distress.”
A
client who has had a cesarean
birth asks the nurse about the possibility
of a vaginal birth after
cesarean (VBAC).
Which of the following
isa contraindication
to VBAG?
a. History of low-transverse
cesarean
birth,
History
ofclassical
uterine
incision.
. History of diabetes mellitus
(type 1).
d. History
ofmacrosomia
infant.
Page 8/
NUR 230, NUR 231, NUR 254 Exam 1 aVersion a
.
J
The
nurse is explaining the
3-hour oral glucose tolerance
test (QGTU toa
cligni:u:ing fiiprinata|
visit. Which of the following statements
by the nurse is appropriate to include in the teaching?
a. "You will need to follow a restricted diet prior to the test.”
b. “You will need to complete this test if you have gestational diabetes.”
€. “You will need to eat a small meal before testing.”
@ “You will have your blood drawn after ingesting the glucose load.”
The nurse is assessing a client who is 32 weeks pregnant. Which of the following client reports is a
priority for the nurse to follow up?
Urinary frequency.
Blurring vision.
+1 pitting edema.
Cramps in her calf at night.
aol@e
The nurse is developing a teaching plan for a primigravida client at 30 weeks gestatioq who has
preeclampsia and is being cared forat home. Which of the following should the nurse instruct the
client to report to the primary health care provider (PHCP)irErB_e’dia[ely?
7 fetal movements in a 2-hour period.
X
b. Decreased
gastroesophageal
reflux.
€ ‘@
. 9 3
c. Blood pressure of 130/ mm Hg.
d. Increased urine output within 6 hours.
The nurse is caring for multiple clients in labor. Which ofthe following clients should the nurse
assess first?
a. The client with a blood pressure of 145/96 mm Hg and is on an antihypertensive.
b. The client receiving an oxytocin drip with contractions every 5 to 6 minutes.
The client who is 3 cm dilated, 30% effaced, and presenting at -2station.
The clientwho has new onset of headache
with nausea and right ribpain. 7
S
The nurse is caring for a primigravida
client who is inearly labor and has ruptured membranes. The client has a blood pressure (BP) of 168/ mmHg, her face and hands are swollen, and she has 3+ protein in her urine. Which of the following
medications should the nurse expect to be initially
prescribed for this client?
a. Oxytocin.
Magnesium sulfate.
Hydralazine.
d. Nifedipine.
Page 10/ 13
WUR 2
30, NUR 231, NUR 254 Exam 1 a Version a
- Th :.
thee nurse
is caring for a group of clients
at 39 weeks gestation. Which
of the following clients should
nurse recognize is experiencing a possible abruptio placenta?
The client who has persistent
variables in the fetal heart tracing with
moderate variability.
The
client who is experiencing moderate to strong
contractions every 5 to 6 minutes.
The client who iscrying
out with intermittent fundal
pain.
The
client who reports having
dark-red bleeding
and abdominal pain today. a
ow
41, The.nurse
is caring for an 8-month
pregnant client. The
nurse assesses the fetal
position shown in
the image below. Which of
the following Isthe correct description
for the image?
a. Left
occipital transverse.
b. Left
occipital anterior.
c. Right
occipital transverse.
@ Right
occipital anterior.
The nurse
is caring for a client
who is at 38
weeks gestation
and arrives at
the emergency
department
(ED) in active labor.
Which of the
following should
the nurse expect
to assess upon
examination?
a.
lIrregular contractions
with cervical
effacement.
,g)%
b. Irregular contractions
with
no cervical dilation.
c. Regular
contractions
with no
cervical dilation.
d) Regular
contractions
with cervical
dilation.
- The nurse
is teaching a pregnant
client who has
diabetes mellitus about
insulin needs during
pregnancy.
Which
of the following statements
by the nurse
is correct?
_a—
“Insulin dosages
will remain stable
throughout the entire
pregnancy.”
b. “Episodes
of hypoglycemia are
more likely to occur
during the first
3 months of pregnancy.”
“Insulin dosage will
need to increase
during the first 3 months
of pregnancy.”
d. “Insulin
dosage will likely decrease
in the 3rd trimester.”
Page 11/
Eg
L
PAUR 230, NUR 231, NUR 254 Exam 1 a Version a
- The nurse is caring for a client admitted with preeclampsia. Upon entering the client's "I’I°"‘_' ihe
nurse notes the client is in bed and disoriented with muscular twitching. Which of the following
actions
should
the nurse
expect to initially
implement?
a. Go
get assistance.
O\q
@ Administer oxygen.
9 fl
Notify the rapid response team (RRT). i
Protect client from Injury.
i i. Which of the
The nurse is teaching a client who is being discharged following a cerfcl:g?eF:gfifi]’gfm e
following statements by the client indicates a correct understanding of the '
a.
“The goal of placing
this cerclage
is to carry
my baby to 34
weeks" gestation.
b. “ltis normal
to experience perineal
pressure after
this procedure.
o “Once
the cerclage
is placed, |will
be on bedrest
forthe
remainder of
my pregnancy.
@?\3 “The
cerclage is placed
becasue my cervix
isweak."
N\
Page 13/
The
nurse
is
assessing
a newborn
who
has
just
been
delivered.
Which
of
the
following
is
the
priority
physiological
change?
a.
Successful
feeding.
e
Thermoregulation.
Extra-uterine
circulatory
shift.
:
ntaneous
respirations.
oc~=
)
.
d.
Spo
Pt
apnes
7
15
C
or
e,
WY
2
The
nurse
is
caring
for a
newborn
who
was
delivered
24
hours
ago
and
is
due
to have
an
initial
bath.
Which
of the
following
interventions
should
the
nurse
include
when
bathing
the
newbomn?
Place
a
hat
on
the
newborn
during
bathing.
Utilize
a
cleanser
with
a neutral
pH
during
bathing.
i~
o
oxX
Make
sure
the
newborn
is
placed
in
hot
water.
Use
warm
0.9%
sodium
chloride
(normal
saline)
during
bathing.
ao@e
The
nurse
is caring
for
a
newbom
who
was
bom
30
minutes
ago.
The
nurse
recognizes
which
of
the
following
as
a probable
sign
of
respiratory
distress?
é)
Chest
reftractions.
b.
Respirations
(R)
of
c.
Short
pefiodi
of
apnea
lasting
8
to
10
seconds.
d.
Blue
hands
and
feet.
The
nurse
is caring
for
a newbom
immediately
following
bisth.
After
ensuring
a patent
airway,
which
of
the
following
is
the
priority
nursing
action?
Dry
the
skin.
b.
Administer
eye
prophylaxis
c.
Administer
vitamin
K.
d.
Place
an
identification
bracelet
The
nurse
is
assessing
a newborn
who
has
just
been
admitted
to
the
nursery.
Which
of
the
following
findings
requires
further
assessment
by
the
nurse?
)
o
}
.-
AT
o
(a)
An
edematous
area
on
the
occiput
of
the
scalp.
X
g
Yi
il
b.
Headis
1/
the
total
body
length.
/v/
o~
<
|
p
c.
Transient
rash
with
macules
and
papules.
X
d.
Imegular
shape
of
biue-grey
pigmentation
over
the
sacral
area.
X
Newboms
weighing
less than
8 Ib.
Significant
jaundice
in sibling
of newbom.
Poor
feeding
ability
of a newbom.
Exclusive
bottle-feeding
of a newbomn.
Petechia
present
on newbom's
chest
upon
delivery.
.
1,
%
D 9:3:4!
@
1,3,4.
. 3,56,
~
/fl
Thenmseisdevelopingap!anclweloranim
i
vi
2
-old
who
is receivin,
totherapy.
Which
of the
following
interventions
should
the
nurse
include
in flb:zan?
i
S
a)
Place
the baby
under
the lights
with eyes
covered.
Lb.
Tightly
swaddle
to maintain
normal
lemperature.
¢.
Administer
prescribed
intravenous
(IV)
fluids.
d.
Give
the
baby
rehydration
therapy
after
all feedings.
A2,
The nurseiswfingtoranif\iamehasdiedinfl\eheamwarefacimy.Theparems
request
some
time
alone
with their
infant.
Which
of the following
actions
should
the nurse
take?
a.
Discourage
the
parents
from
seeing
the infant
because
it will be too painful.
b.
Deny the parent's
request
because
they are emotionally
distraught.
c.
Auowmeparemsmflewmeimmbtmeframmmtaflmgmwm
@
Ask the parents
if they
wouid fike 10 bathe and dress
the infant.
Thenumehwadfingamsmmncflemabmnmemnbnedmewbanreflexmemwemims
/
teaching
has been effective
when the client reports
that the newborn
will
a. extendandabdudmeannsamlegswimmemesfamingwt.
b. extend both arms out and abduct them in an embracing motion.
c. move legs up and down when held on a firm surface.
@ tum the head to the left, extend left extremity,
and flex right extremity.
Themrsepreparesba&finisteravnamhKhjeabnmanmmemomaasksmemsewhy
her infant needs the injection. Which of the following is the best response by the nurse?
a. “Your newborn needs vitamin K (o begin digesting millk."
b) “Newboms are deficient in vitamin K, and this injection prevents your newborn from excessive
bleeding.”
c. “The vitamin K will protect your newbom from being infected with a virus.”
d. “Newboms have sterile bowels, and vitamin K promotes the growth of bacteria in the bowel.”
- The nurseiswing!o«apfelenn
hflmmisat
risk for kemnicterus.The parents
of the infant ask
the nurse what kerniclerus means. Which of the following responses by the nurse is appropriate?
a. “Reversible condition caused by poor fiver function.”
b.) “Long-term consequences of bilirubin toxicity.”
“~¢. “Condition
thal causes
delayed growth.”
d. “Consequence ol substance abuse during pregnancy.”
/
18/
The nurse is
working in the
nursery caring
for assigned
newboms.
Which of the
following newbom
assessments
should the
nurse consider
to be abnormal?
a. Newbom
who is 12 hours
post-delivery
and has a Mongolian
spol. ¥
b. Newbom who
is 16 hours post-delivery and
has not passed meconium.
@ Newborn who is 2 hours posti-defivery and has webbing of digits.
d. Newbom
who is 18 hours post-delivery
and has acrocyanosis.
-17.
The nurse is
caring for a Rh-positive
infant
who was born
to a Rh-negative
mother.
The pediatrician
orders
a direct Coombs
test on the
cord blood
sample to determine
damaging
antibodies.
The nurse
should suspect
maternal isoimmunization
if the infant
appears
@
jaundiced.
.
imitable.
c.
lethargic.
d.
cyanolic.
)8.
The nurse
is teaching
a new
mother about
newbomn
security
precautions.
Which
of the following
information
should
the nurse
include
in the
teaching?
a.
The newbom
can
be left in
the nursery
by themselves
but close
the door
so it locks.
Check
the identity
of anyone
who
requests
to take
the newbomn
out
of the room.
.
It the security
bracelet
falls
off, keep
it in the
bassinet
near
the newbomn.
d.
Family
members
may
take
the newbomn
outside
if they ask.
The nurse
manager
is assigning
a newly hired
nurse
to complete
an
Apgar score
on a
newbomn.
The
newly
hired
nurse
understands
that
this
task should
be
completed
at
a.
1 minute
and
10
minutes
after
birth.
b.
birth
and 10
minutes
after
birth.
(©)
1
minute
and
5
minutes
after
birth.
d.
birth
and
5 minutes
after
birth.
/The
nurse
is caring
for a 2-day-old
male
newbomn
of Jewish
parents.
When
reviewing
the primary
health care provider's (PHCP) orders, which | -
prescription
for
d
of
the
following
requires
follow
up
by
the
nurse?
A
/) scheduled circumcision.
formula
if not enough
breast
milk
intake.
C. vaccinations.
d. hearing
screening.
_26.
The nurse
is observing
a new mother
suctioning
her newbom
with a bulb syringe.
Which
of the
following
observations
requires
the nurse 1o intervene?
a. Refraining from inserting the tip in the center of the newborn's mouth.
b,) Compressing
the bulb after inserting the tip into the newborn’s mouth.
c. Suclioning
nasal passages,
one nostril al a time.
d. Suctioning
the mouth before
the nose.
The
nurse is
preparing
a newborn
who is
24 hours
old
for discharge.
The
nurse
should
notify
the
primary
health
care
provider
(PHCP)
if the
newborn
has
@ apneic episodes lasting 30 seconds.
b. ablood glucose level of 50 mg/dL.
C. caput succedaneum.
d. abilirubin of 4 mg/dL.
Z/ The
nurse is caring
for a client
and notes the
following laboratory
results on
the first day after
delivery:
white
blood cell
(WBC) count
8 mm®,
hemoglobin
(Hgb)
13 g/dL,
and platelets
90 mnP.
Which of
the following is a
comrec! interpretation
of the client’s
laboratory values?
a. Hgb is
low but normal for the postpartum
client.
b.
Blood bank
needs
to be notified
to send
immune
globulin
human
for the
client.
c. Client
is developing
a postpartum
infection.
d. |
Platelets
are abnormal
and
would place
the
client at
risk for postpartum
hemorrhage.
\’
The nurse
is caring
for a
formula-feeding
postpartum
client who
reports painful
swollen
breasts
on
her third
postpartum
day. The
nurse should
encourage
the mother
1o
apply
cabbage
leaves
lo
the area.
c.
gently
massage
the
breasts.
d.
expel
a
small
amount
of
milk.
;
stimulate
the
nipples
manually.
T EEER——.
this
client?
Arrange
for
the
client
(
meet
with
a
psychiatrisL
Assist
the
client
with
washing
the
newborm.
Ask
the
client
if
she
wants
to
keep
the
newborn.
e
d.
Notify
child
protective
services
(CPS)
of
potential
child
neglect.
The
nurse
is
preparing
assess
a
postpartum
client's
boggy
fundus.
Which
of
the
following
should
the
nurse
ask
the
client
prior
to
palpation?
@
Ask
the
client
if
they
have
used
the
restroom
recently.
b.
Ask
the
client
to
raise
the
bed
to
degrees.
c.
Ask
the
client
to
attempt
a
bowel
movement.
d.
Ask
the
client
to
place
the
hands
under
the
head
of
the
3{
The
nurse
is
providing
instructions
fo
a
client
who
is
breastfeeding
her
fxe'.\mom.
Which
following
statements
by
the
client
indicates
the
need
for
further
instructions?
a.
“Ishould
make
sure
the
baby
latches
on
well
in
the
beginning.”
b,
“I
should
refrain
from
giving
my
baby
a
pacifier
until
breastfeeding
“
should
see
the
baby's
cheeks
dimpled
when
sucking.”
/)
d.
“Ishould
breastieed
my
baby
when
they
are
hungry.”
o
is
established.”
oY
3:_3/
The
nurse
is
caring
for
assigned
postpartum
clients.
The
nurse
recognizes
the
client
at
highest
risk
for
a
postpartum
infection
is
the
client
who
had
an
external
bladder
scan.
had
a
preterm
infant.
a.
b.
c..
a
clean-catch
urine
sample.
( :d/fi‘:i
a
cesarean
birth.
J.
The
nurse
is
caring
for
a
postparium
Asian
client.
the
client's
room,
but
the
client
immediately
insists
responses
is
most
appropriate
by
the
nurse?
The
nurse
brings
a
large
container
of
ice
water
that
the
water
be
removed.
Which
of
the
following
“Let
me
get
your
doctor.”
“Do
you
want
something
to
eat
instead?”
c.
“This
is
to
keep
you
hydrated.”
y
d.
“Is
there
a
reason
this
upset
you?”
