Pearson Prenatal NCLEX questions

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50 terms nip A primigravida is hospitalized at 32 weeks' gestation after a second hemorrhage from a complete placenta previa.The client appears subdued and sad after learning she will remain hospitalized until delivery. She says she is worried about her husband, who will be at home alone much of the time. The nurse interprets the client's response as indicating which psychological state?

• Anxiety
• Denial
• Immaturity
• Ineffective coping

A Rationale: The client has stated that she is worried, which creates anxiety. The information presented does not represent denial or immaturity. There is not enough data to to determine whether the client's coping is effective at this time The nurse is caring for a client with a concealed abruption placentae prepares to assess the client for which complications a priority after delivery?

• Retained placental fragments
• Urinary tract infection
• Uterine atony
• Vaginal hematoma

C

Rationale: A concealed abruption could result in a Couvelaire uterus, which

doesn't contract effectively after delivery, leading to uterine atony. Retained placental fragments, vaginal hematoma, or urinary tract infection could occur in any client.A pregnant client with class II heart disease progressed through pregnancy without complications and is admitted to the hospital in active labor. Soon after admission, the client reports shortness of breath and the nurse auscultates lung crackles. The nurse anticipates administering which medication based on client's history?

SATA

• Penicililn (generic)
• Metoprolol (Lopressor)
• Furosemide (Lasix)
• Digoxin (Lanosin)
• Procainamide (Proestyl)

A, C, D

Rationale: Prophylatctic antibiotics such as peicillin are given during labor to prevent bacterial endocarditis. A cardiac glycoside such as digoxin and diuretic such as furosemide may help counteract the new signs of decreased cardiac output (crackles and shortness of breath). An antihypertensive such as metoprolol or antidysrhythmic such as procainamide would be used only as needed.

The nurse conducts client teaching with a pregnant client who has placenta previa and who states she has religious beliefs that prohibit receiving blood or blood products.The nurse evaluates that the teaching has been effective if the client makes which statement?

• "A judge will force meto accept a transfusion if I really

need it"

• "I might have to sign out of the hospital against medical

advice (AMA)."

• "I will meet with the dietician to increase the amount of

iron in my diet."

• "There is little chance that I will bleed heavily during

this pregnancy." C Rationale: The client is likely to lose some blood with a placenta previa. Increasing ironin her diet is a positive response that does not interfere with her religious beliefs. A judge will not force a transfusion. The client wil not need to sign out AMA to avoid receiving a transfusion, even if one is indicated. It isn ot possible to predict that amount of bleeding that could be expeirenced by a specific client with placenta previa.A client experiencing profuse hemorrhage from placenta previa is being prepared for an emergency cesarean birth. The client exhibits signs of hypovolemia. The nurse makes it a priority to place the client in which position?

• Knee-chest
• Left lateral
• Semi-Fowler's
• Trendelenburg

B Rationale: The left lateral position facilitates uteroplacental perfusion. Knee-chest position will not aid circulation and is unlikely to be maintained by a client in shock. Semi-Fowler's position would decrease maternal cerebral perfusion.Trendelenburg puts the weight of the gravid uterus against maternal lungs.Which nursing diagnosis has the highest priority for a client with a missed abortion who has developed disseminated intravascular coagulopathy (DIC)?

• Anticipatory grieving
• High Risk for Deficient Fluid Volume
• High Risk for injury
• Spiritual distress

B Rationale: The client with DIC is at risk for hemorrhage leading to Deficient Fluid Volume, which takes priority over the psychosocial concerns of Anticipatory Grieving and Spiritual Distress. The client could experience bruising or other areas of local bleeding from the disorder (risk for injury), but hypovolemia from hemorrhage takes priority.A client with premature rupture of membranes (PROM) at 33 weeks' gestation is to be given betamethasone (Celestone) to increase fetal lung maturity. The nurse checks the client's record to ensure that the client does not have what disorder that could be affected by this drug?

• Diabetes mellitus
• History of alcohol abuse
• Incompetent cervix
• Intrauterine growth restriction (IUGR)

A Rationale: Glucocorticoids raise the blood glucose and this has implications for diabetic control in a client with diabetes. A history of alcohol abuse, incompetent cervix and IUGR are not complications for giving betamethasone.The nurse concludes that the client is at risk for preeclampsia when the vital signs taken today show that the blood pressure has shown which pattern of elevation since the previous prenatal visit?

• 90/56 to 110/70
• 100/60 to 130/76
• 122/80 to 138/86
• 134/80 to 140/88

B

Rationale: An increase of 30 mmHg systolic and 15 mmHg diastolic is diagnostic

for preeclampsia. The blood pressures in each of the other options do not meet the criteria for the increase in either the systolic or the diastolic blood pressure reading.

A client who has experienced a spontaneous abortion at

• weeks asks the nurse why this happened. What would

the nurse include in a response to address the most common cause of "miscarriage"?

• Chromosome abnormalities
• Environmental teratogens
• Excessive activity
• Substance abuse

A

Rationale: The majority of early abortions are related to abnormal chromosomes.

The client may fear that she casued the loss, and should be provided with accurate information. The majority of early abortions are not related to environmental teratogens, excessive activity, or substance abuse.