Mcn 105

MCN 005
1. Myrna, who’s 4 months pregnant asks the nurse how much and what type of exercise she should get during pregnancy. How should nurse Maricel counsel her?
a. “Try high-intensity aerobics, but limit sessions to 15 minutes daily.”
b. “Perform gentle back-lying exercises for 30 minutes daily.”
c. “Walk briskly for 10 to 15 minutes daily, and gradually increase this time.”( Taking brisk walks is one of the easiest ways to exercise during pregnancy. The client should begin by walking slowly for 10 to 15 minutes per day and increase gradually to a comfortable speed and a duration of 30 to 45 minutes per day. The pregnant client should avoid high-intensity aerobics because these greatly increase oxygen consumption; pregnancy itself not only increases oxygen consumption but reduces oxygen reserve. Starting from the 4th month of pregnancy, the client should avoid back-lying exercises because in this position the enlarged uterus may reduce blood flow through the vena cava. The client should avoid exercises that raise the heart rate over 140 beats/minute because the cardiovascular system already is stressed by increased blood volume during pregnancy.)
d. “Exercise to raise the heart rate above 140 beats/minute for 20 minutes daily.”
2. Linda, who’s 37 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client’s preparation for parenting, nurse Kim might ask which question?
a. “Are you planning to have epidural anesthesia?”
b. “Have you begun prenatal classes?”
c. “What changes have you made at home to get ready for the baby?” (During the third trimester, the pregnant client typically perceives the fetus as a separate being. To verify that this has occurred, the nurse should ask whether she has made appropriate changes at home such as obtaining infant supplies and equipment.)
d. “Can you tell me about the meals you typically eat each day?”
3. Nurse Tanya is aware that the best place to detect fetal heart sounds for a client in the first trimester of pregnancy?
a. Above the symphysis pubis (In the first trimester, fetal heart sounds are loudest in the area of maximum intensity, just above the client’s symphysis pubis at the midline. Fetal heart sounds aren’t heard as well in the other locations.)
b. Below the symphysis pubis
c. Above the umbilicus
d. At the umbilicus
4. Lovelyn, asks the nurse whether she can take castor oil for her constipation. How should the nurse respond?
a. “Yes, it produces no adverse effects.” (Castor oil can initiate premature uterine contractions in pregnant women. It also can produce other adverse effects, but it doesn’t promote sodium retention. Castor oil isn’t known to increase absorption of fat-soluble vitamins, although laxatives can decrease absorption if intestinal motility is increased.)
c. “No, it can promote sodium retention.”
d. “No, it can lead to increased absorption of fat-soluble vitamins.”
5. A client at 35 weeks’ gestation complains of severe abdominal pain and passing clots. The client’s vital signs are blood pressure 150/100 mm Hg, heart rate 95 beats/minute, respiratory rate 25 breaths/minute, and fetal heart tones 160 beats/minute. Nurse Nikki must determine the cause of the bleeding and respond appropriately to this emergency. Which of the following should the nurse do first?
a. Examine the vagina to determine whether her client is in labor
b. Assess the location and consistency of the uterus (The nurse must determine the level of the uterus and mark that level on the client’s abdomen. She must also check the consistency of the uterus; a uterus that is filling with blood because the placenta has detached early is rigid. Bleeding from a placental previa is usually painless. A vaginal examination is contraindicated in the presence of bleeding. Most nurses haven’t been taught how to perform an ultrasound. If the client has a placental abruption, birth will most likely be by cesarean section.)
c. Perform an ultrasound to determine placental placement
d. Prepare for immediate delivery
6. When assessing a client during her first prenatal visit, nurse Lucy discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breast-feeding success?
a. “It’s contraindicated for you to breast-feed following this type of surgery.”
b. “I support your commitment; however, you may have to supplement each feeding with formula.” (Recent breast reduction surgeries are done in a way to protect the milk sacs and ducts, so breast-feeding after surgery is possible. Still, it’s good to check with the surgeon to determine what breast reduction procedure was done.)
c. “You should check with your surgeon to determine whether breast-feeding would be possible.”
d. “You should be able to breast-feed without difficulty.”
7. When questioned, Alma admits she sometimes has several glasses of wine with dinner. Her alcohol consumption puts her fetus at risk for which condition?
a. Alcohol addiction
b. Anencephaly
c. Down syndrome
d. Learning disability (Maternal alcohol use during pregnancy may cause fetal and neonatalcentral nervous system deficits such as learning disabilities.)
8. Nurse Helen has a client at 30 weeks’ gestation who has tested positive for the human immunodeficiency virus (HIV). What should the nurse tell the client when she says that she wants to breast-feed her baby?
a. Encourage breast-feeding so that she can get her rest and get healthier
b. Encourage breast-feeding because it’s healthier for the baby
c. Encourage breast-feeding to facilitate bonding
d. Discourage breast-feeding because HIV can be transmitted through breast milk (. Transmission of HIV can occur through breast milk, so breast-feeding should be discouraged in this case.)
9. During each prenatal checkup, nurse Paul obtains the client’s weight and blood pressure and measures fundal height. What is another essential part of each prenatal checkup?
a. Evaluating the client for edema (During each prenatal checkup, the nurse should evaluate the client for edema, a possible sign of pregnancy-induced hypertension (PIH). If edema exists, the nurse should assess for high blood pressure and proteinuria — other signs of PIH. Hb is measured during the first prenatal visit and again at 24 to 28 weeks’ gestation and at 36.)
b. Measuring the client’s hemoglobin (Hb) level
c. Obtaining pelvic measurements
d. Determining the client’s Rh factor
10. Which of the following instructions should nurse Dan give to a client who’s 26 weeks pregnant and complains of constipation?
a. Encourage her to increase her intake of roughage and to drink at least six glasses of water per day. (The best instruction is to encourage the client to increase her intake of high-fiber foods and to drink at least six glasses of water per day. Mild laxatives and stool softeners may be needed, but dietary changes should be tried first. Straining during defecation and diarrhea can stimulate uterine contractions, but telling the client to go to the evaluation unit doesn’t address her concern.)
b. Tell her to ask her caregiver for a mild laxative.
c. Suggest the use of an over-the-counter stool softener.
d. Tell her to go to the evaluation unit because constipation may cause contractions.
11. During the 6th month of pregnancy, Gail reports intermittent earaches and a constant feeling of fullness in the ears. What is the most likely cause of these symptoms?
a. A serious neurologic disorder
b. Eustachian tube vascularization (During pregnancy, increasing levels of estrogen, not progesterone cause vascularization of the eustachian tubes, leading to such problems as earaches, impaired hearing, and a constant feeling of fullness in the ears. Nothing in the question implies that the client has a serious neurologic disorder or an ear infection.
c. Increasing progesterone levels
d. An ear infection
12. Malou, 2 months pregnant, has hyperemesis gravidarum. Which expected outcome is most appropriate for her?
a. “Client will accept the pregnancy and stop vomiting.”
b. “Client will gain weight according to the expected pattern for pregnancy.”
c. “Client will remain hospitalized for the duration of pregnancy to relieve stress.”
d. “Client will exhibit uterine growth within the expected norms for gestational age.” (For a client with hyperemesis gravidarum, the goal of nursing care is to achieve optimal fetal growth, which can be evaluated by monitoring uterine growth through fundal height assessment. The nurse shouldn’t assume that excessive vomiting signifies the client doesn’t accept the pregnancy. Clients with hyperemesis gravidarum rarely gain weight according to the expected pattern. They may be hospitalized briefly to regulate fluid and electrolyte status, but they don’t require hospitalization for the duration of pregnancy. In fact, hospitalization may add to the stress of pregnancy by causing family separation and financial concerns.)
13. When assessing a pregnant client with diabetes mellitus, nurse Gio stays alert for signs and symptoms of a vaginal or urinary tract infection (UTI). Which condition makes this client more susceptible to such infections?
a. Electrolyte imbalances
b. Decreased insulin needs
c. Hypoglycemia
d. Glycosuria (Glycosuria predisposes the pregnant diabetic client to vaginal infections (especially Candida vaginitis) and UTIs, because the hormonal changes of pregnancy affect vaginal pH and the bladder. Electrolyte imbalances and hypoglycemia aren’t associated with vaginal infections or UTIs. Insulin requirements may decrease in early pregnancy; however, as the client’s food intake improves and maternal and fetal glycogen stores increase, insulin requirements also rise.)
14. Josephine, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. She tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:
a. a neurologic disorder.
b. inadequate nutrition.
c. an unknown cause. (. The cause of hyperemesis gravidarum isn’t known.)
d. hemolysis of fetal red blood cells (RBCs).
15. A client has come to the clinic for her first prenatal visit. Nurse Alex should include which of the following statements about using drugs safely during pregnancy in her teaching?
a. “During the first 3 months, avoid all medications except ones prescribed by your caregiver.”
b. “Medications that are available over the counter are safe for you to use, even early on.”
c. “All medications are safe after you’ve reached the 5th month of pregnancy.”
d. “Consult with your health care provider before taking any medications.” (Because all medications can be potentially harmful to the growing fetus, telling the client to consult with her health care provider before taking any medications is the best teaching.) 16. A pregnant client asks how she can best prepare her 3-year-old son for the upcoming birth of a sibling. Nurse Lou should make which suggestion?
a. “Tell your son about the childbirth about 1 month before your due date.”
b. “Reassure your son that nothing is going to change.”
c. “Reprimand your son if he displays immature behavior.”
d. “Involve your son in planning and preparing for a sibling.” (Being involved in the pregnancy helps reinforce a child’s position in the family and minimizes feelings of neglect and abandonment. Telling the child about the childbirth only 1 month before the due date wouldn’t allow enough time to prepare him for the sibling and would prevent him from conceptualizing the passage of time. Reassuring him that nothing will change would be misleading; instead, the parents should discuss which aspects of family life will be changed by the upcoming birth and which will remain the same. Parents should reward mature behavior and ignore immature behavior.)
17. Nurse Cathy is caring for a 16-year-old pregnant client. The client is taking an iron supplement. What should this client drink to increase the absorption of iron?
a. A glass of milk
b. A cup of hot tea
c. A liquid antacid
d. A glass of orange juice (. Increasing vitamin C enhances the absorption of iron supplements. Taking an iron supplement with milk, tea, or an antacid reduces the absorption of iron.)
18. Nurse Rey is using Doppler ultrasound to assess a pregnant woman. When should the nurse expect to hear fetal heart tones?
a. 7 weeks
b. 11 weeks (Using Doppler ultrasound, fetal heart tones may be heard as early as the 11th week of pregnancy.)
c. 17 weeks
d. 21 weeks
19. Nurse Edith is caring for a client who’s on ritodrine therapy to halt premature labor. What condition indicates an adverse reaction to ritodrine therapy?
a. Hypoglycemia
b. Crackles ( Use of ritodrine can lead to pulmonary edema. Therefore, the nurse should assess for crackles and dyspnea. Blood glucose levels may temporarily rise, not fall, with ritodrine. Ritodrine may cause tachycardia, not bradycardia. Ritodrine may also cause hypokalemia, not hyperkalemia.)
c. Bradycardia
d. Hyperkalemia
20. Noemi, a newly pregnant woman tells the nurse that she hasn’t been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to:
a. switch brands.
b. take the vitamin on a full stomach. (Prenatal vitamins commonly cause nausea and taking them on a full stomach may curb this. Switching brands may not be helpful and may be more costly. Orange juice tends to make pregnant women nauseated. The vitamins may be taken at night, rather than in the morning, to reduce nausea.)
c. take the vitamin with orange juice for better absorption.
d. take the vitamin first thing in the morning.
21. A client is scheduled for amniocentesis. When preparing her for the procedure, nurse Vince should do which of the following?
a. Ask her to void. (The nurse should ask her to empty her bladder to reduce the risk of bladder perforation.)
b. Instruct her to drink 1 L of fluid.
c. Prepare her for I.V. anesthesia.
d. Place her on her left side.
22. After determining that a pregnant client is Rh-negative, Dr. Smith orders an indirect Coombs’ test. What is the purpose of performing this test in a pregnant client?
a. To determine the fetal blood Rh factor
b. To determine the maternal blood Rh factor
c. To detect maternal antibodies against fetal Rh-negative factor
d. To detect maternal antibodies against fetal Rh-positive factor (The indirect Coombs’ test measures the number of antibodies against fetal Rh-positive factor in maternal blood.)
23. During a routine prenatal visit, a pregnant client reports heartburn. To minimize her discomfort, nurse Faith should include which suggestion in the plan of care?
a. Eat small, frequent meals. (The nurse should advise a pregnant client to eat smaller meals at shorter intervals; drink six to eight 8-oz glasses of fluid daily to minimize regurgitation and reflux of stomach contents; and avoid citrus juice, which may act as a gastric irritant and worsen heartburn, and sodium bicarbonate, which may disrupt the body’s sodium-potassium balance.)
b. Limit fluid intake sharply.
c. Drink more citrus juice.
d. Take sodium bicarbonate.
24. A pregnant client asks nurse Mary about the percentage of congenital anomalies caused by drug exposure. How should the nurse respond?
a. 1% (Drug exposure causes 1% of congenital anomalies.)
b. 10%
c. 20%
d. 60%
25. Sandy, age 39, visits the nurse practitioner for a regular prenatal check-up. She’s 32 weeks pregnant. When assessing her, the nurse should stay especially alert for signs and symptoms of:
a. pregnancy-induced hypertension (PIH). (Mature pregnant clients are at increased risk for PIH and are more likely to require cesarean delivery.)
b. iron deficiency anemia.
c. cephalopelvic disproportion.
d. sexually transmitted diseases (STDs).