TOP, * NLE * NCLEX * HAAD* PROMETRICS * DHA* MIDWIFERY. Situation 1: Nurse Momo assists a primigravida who just gave birth 12 hours ago. Nurse Evelynn in the effort to help the patient transition motherhood. 1. As the patient takes hold of her newbotfy nurse would be corect to suggest which postion to ensure and clabondng? ‘he les in bed and places the infant on her 3. She sow racks With Berane whe siting in 2 rocking chair C. She gently burps the infant while holding the infant over her shoulder D. She speaks and looks directly at the infant face 2. Nurse Momo visits the patient 3 days after giving bith and notices that the patient is occupied with taking care of the baby as she is “getting to know" the baby 2s much as possble, Nurse Nome knows that according to Reva Rubin, the mother is in what phase of behavioral adjustment? ‘A. Taking-in phase C. Taking-hold phase D._Letting-go phase 3. Nurse Momo has been suspecting post-partum blues since the patient verbalzed a sense of disappointment, periods of sadness, and agitation. Nurse Momo would be correct if she gave which aavice? A. Refer the patient to a psychiatrist B. Comfort the patient and reassure her that this is ‘normal among post-partum mothers C. Allow these feelings to run its course as all of these vill pass Recommend consistent breastfeeding of the infant 4, The patient asks about ways to avoid post-parturt when she returns home. Nurse Momo would be correct to the following advice, except? A. Recommend that she take some time everyday to something for herself B. Advise the patient to strive for perfection’ that she wor't fee! bad about herself C. Help the client build!/ashealthy balance in sleep, exercise, and nutrition . Encourage the client to verbalize emotions to support 5. As nlzse Momo frther assesses the palent’s nurse Momo would be mest concemed about which of following statements as it would be indigative of post-partum, payenosie? “I've been extremely tired since giving birth” “wish my baby had a faler complexion” ~The baby was heavier than I thought when I her” D. "Motherhood is tiring; I'm glad I haven't had any children” 6. A clent at 4 weeks postpartum tells the nurse that she cannot cone any longer and is overwhelmed by her newbom. The baby has new formula on her clothes and under her neck. The mother does not remember when she last bath the bathed the baby. The nurse should encourage the client and her husband to call theie healthcare provider because the mother should be further evaluated for: ‘A. Postpartum blues 8. Poor bonding C. Postpartum depression D._ Infant abuse 7. A 22-year-old. woman is 6 weeks postpartum. In the dlric, TOP RANK REVIEW ACADEMY, INC. R Wo ACADEMY [CH * CRIMINOLOGY * DENTISTRY * PHARMACY * MED TECH NK TD aying every day, fecing overwhelmed, and that she may hurt the baby. What would e priority nursing action at this time? vse the Datient of community resources, parent and depression hotlines the ‘mother that the "baby bes" are at this time and assess her nutrition, rest, and avallabity of help at home . Contact the health care provider to evaluate patient before allowing her to leave the clinic D. Advise the woman that she cannot use the medication for depression because she is breastfeeding 8. When developing a teaching plan for @ prinigrevid client with insuli-dependent diabetes about monitoring blood ‘Glucose control and insuin dosage at home, what would the Turse expect to include as the desired target range for blood Pr B. 70-100 mg/dL © 110-140 maya. D._ 160 - 180 moat 9. A woman is diagnosed with complete molar (H.ole) Pregnancy. The nurse understands that the woman requires more teaching when she makes which statement? A. “Lneed to make folow-up appointments to have my hhormore levels checked.” 'B. ” know the placenta caused problems, and my bbaby died in my uterus.” CC "Toplanto get pregnant again after a year” D._"Tunderstand T may develop a serious ypé of cancer” 410. When caring for a muligravidavclient admitted to the hospital with vagina! bleeding at 38 weeks gestation, which therapeutic agent. would the nurse anticipate administering intravenousyf the lient develops dsseminated intrvascular rin Streptokinase! D. rin Gestational Diabetes the following is a risk factor for developing jonal diabetes? delivery of @ baby greater than 7Ib a body mass Hidex greater than 25 ‘degree relative with diabetes mellitus “younger than 30 years 1-year-oidpiégnant. ent comes into the clinic for an ‘screening at 28 weeks’ gestation. After the nurse notes that the client's blood glucose mg/dl, 1 hour after the test. Which of the indication ofthis result? Type 2 diabetes Impaired fasting glucose C._ Gestational diabetes D. A:second glucose test is indicated 13, The nurse is caring for a 34 week pregnant cient with Gestational diabetes. Despite nutitional and pharmacological interventions, the client's glucose has been poorly controlled What clucose monitering is most accurate in measuring blood alucose level and compliance in therapy? ‘A. 50 gram OGTT 8. 100 gram ocTT C. CBG (Capillary Blood glucose) D. HbAc (glycosylated hemoglobin) 14. A dient with gestational dabetes is scheduled to have a 50 4 glucose tolerance test. What result is consdered normal? Page 1| 4Two-hour glucose level less than 140 mg/dl One-hour glucose level less than 140 mg/dL C. Fasting glucose level greater than 126 mg/dL. D. Fasting glucose level greater than 95 mg/dL. 15, A nurse is educating a client on the physiologic changesil Pregnancy. What 5 true about the pregnant woman's insulin needs atthe beaming of a resnancy? Insulin needs rapdly increase because of insulin resistance Insulin needs stay the same in the beginning €. Insulin needs first decrease then will increase later in pregnancy 1D. Insulin needs don't change during preanancy Situation 3: Third trimester bleeding is an occurrencé! that poses great risks to both the mother and the baby. The most common causes of third trimester bleeding is. placenta previa and abruptio placentae. 16. A 26-year-old female, who is 31 weeks preanant with her second child, has uncontrolled hypertension. What risk factor below found in the patient's health history places her at rick for abruptio placentae? ‘A. childhood polo B. preeclampisa C. c-section D._her age 17. Which of patients below is at risk for developing placenta previa? ‘A. A 37-year-old woman who is pregnant with her 7th child. B.A. 28-year-old pregnant female with chronic hypertension. C. A 25-year-old female who is 36 weeks pregnant that hhas experienced trauma to abdomen. D. A 20-year-old primigrevide 18. You're performing a head-to-toe assessment on a patient admitted with abrupuo placentae. Which of the following assessment findings would you immediately report to the physician? ‘A. Oozing around the IV site BL Tender uterus Hard abdomen D. Vaginal bleeding 19. A patient who is 25 weeks pregnant has partial placenta previa, As the nurse you're educating the\patient about the condition and self-care. Which statement by the patient. requires you to re-educate the patient? ‘A. “L will avoid sexual intercourse and douching throughout the rest ofthe pregnancy” B. “I may start to experience dark red bleeding with pain.” C. "I will have anether ultrasound at 32 weekS)to re-assess the placenta's location.” D. “My uterus should be soft and, nan-tender 20, Disseminated intravascular coagulation (DIC) can occur in Ths happens because when the placenta becomes damaged and detaches from the uterine wall, large amounts. of are released into moms circulation, leading t@ det formation and then dotting Factor depletion. ‘A. Placenta preva, fibrinogen B. Placenta previa, patelets CC. Abruptio placentae, fibrinogen D. Abruptio placentae, thromboplastin 21, The home care nurse is monitoring a pregnant client with (gestational hypertension who ie at risk for preedampsia. At each home care vsit, the nurse assesses the client for classic Signs of preecampsia, which includes the following excent; ‘A. Proternuria B. Edema CC. Low-grade fever D. Increased BI 22, While assessing @ 29-year-old gravida 2, para 2 patient who had a normal spontaneous vaginal delivery 30 minutes ‘ago, the nurse notes large amount of red vaginal bleeding. \What would be the priority nursing action? ‘A. Check vital signs B. Notify heath care provider C. Firmly massage the uterine fundus TOP RANK REVIEW ACADEMY, INC. Dipput the baby to breast 23. A client inithefirst trimester of pregnancy arrives at 2 hrealth Care clinic and reports that she has beer experiencing vaginal bleeding, A threatened abortion’ is suspested, and the Hnuse. instructs the client regarding management of care. ‘Which statemert_made by the dient indicates a need for further instruction? ‘A. "I will weteh)for-the evidence of the passage of sue 8. "I will maintain strict bed) rest throughout the remainder of the pregnancy” "Twillicount the number of perineal pads used on 2 dally basis and note the amount and color of blood ‘on the pad.” "I will avoid sexual intercoufS®\until the bleeding has» stopped, and for 2 weeks following the last ‘evidence'of bleeding 24. The nurse Is performing an assessment on a client diagnosed with placenta previa. "Al. but which of the assessment findings should the nurse expéct to note? ’A. Bright red vaginal bleedin B. Soft, relaxed, rontender uterus €. Abnormally low funds in proportion to gestational age D. 4. Fundal height may be greater than expected 25. Rho (D) immune globulin (Rhogam) is prescribed for 2 int before she is discharged after spontaneous abortion. The nurse instructs the client that ths drug is used to prevent Which condltion? A. Development of a future Rh-positve fetus B. An antibody response to Rh-negative blood _Afuture pregnancy resutting in abortion D. Development of Rh-positive antibodies Situation 4: Hypertensive Disorders during pregnancy 26, The nurse knows that preedampsia terds to ocaur during wat te in a pregnancy? ‘A. before 20 weeks B. in the thrd timester and postpartum €._ after 20 weeks . im the first and second trimester 27, ou patient with preeclampsi is strted en Magnesium Sufate The nurse krows to have whatimedeation on standby A Acetycysteine 8 Nalcxone C. Onfocin ._ Calcium gluconate 28. 39 week pregrant patient isin labor The patient has preeclempsa. Tve patient Is receiing IV Magnesiim Suiate Which finding below indeates Magnesum Sulfte tity anc requires you to notify the physician? 1K. Deep tendon reflex present B. Respiratory rate of 11 breaths per minute > Urinary outputof 150 mL over 3 hours D._ Patent reports fishing or feeling hot 23, A 37 week pregnant fatiert is admitted with severe preeclempsia. The patient beains to experiences a tonic-clonic Sezure, Which ofthe folowing weuld the nurse AVOID during the seizure? ‘A. Placing the patent in aside-ying postion Bi Holding down the patient's head to prevent injury Staying with the patient and actveting the emergency response team D. Timing the seizure 30. A’ woman with preeclampsia is receiving. magnesium sulfate. The nurse assigned to care for the cient determines that the magnesium therepy effective if ‘Ankle conus in noted 8. The Hood pressure decreases C. Seizures do not occur D._Scotomas are present Situation 5: Vaginal bleeding during pregnancy is always a deviation from the normal, is always potentially serious, may occur at any point during pregnancy, and is’ always frightening. The nurse is knowledgeable in acceseing and managing bleeding at different points in pregnancy. Page 2| 431. Bevery, 20 years old is 10 weeks pregnant. She fie to the dinic and stated “T have had epsodes of vaginal beedng in the past 2 days, I think I am miscarring’. Which advice is best given to Bevery at this point? ‘A. Lie down and remain on bed rest for 24 hrs to stop the bleeding B. Continue ight activty as usual! because most spotting during pregnancy is Rermless ©. Save any clots or material passed for your healthcare provider to examine D. Use a tampon to put pressure on your cerfik and stop the bleeding 32, Gina is a 32-year-old teacher who Wsited the clinic. She complains of sharp stabbing pain in her right lower abdomen and stated she has been having vaginal spotting, Upon uitrasound, Gina was dagnosed to have an Ectopic pregnancy. She asked you what was Seen inthe ultrasound exem. ‘A. “Degenerated cels were seen which are fluid ited and they appear as fluid-filled, rape-sized vesicles” = Hmole oF gestational trophoblastic disease B. “Implantation of fertilized ovum outside the uterine cavity” . “normal growing fetus of § weeks AOG wes seen” “A sloughing off ofthe endometrial ayer” 33, Rose 37 years did came to the cinic reporting she is pregnant afte having a urine gregnancy test at home. After careful assessment of diagnostic work ups, she was diagnosed to have Hydatidiform mole. Which assecsment findings are consstent with the diagnosis? Select al that apply. 1. Fundic height larger than AOG I. HCG levels lower than normal ~ higher (1-2 milion 1U compared to normal 400,000 IU) IL. Stronaly postive HCG after 100th day of pregnancy 1V. Symptoms of PIH at 1st trimester \. Fetal Heart sound is heard ~ ro fetal heart sound as there is no viable fetus 4.1, 111, 1V cm BLM .11, 1, 1V 34, Missy has an RH-negatve biood type. Her electronic record shows she had a previous miscarriage at 16 weeks into her last pregnancy. What medication should the nurse check she received following the miscarriage for isoinmunization protection in future childbearing? ‘A. Packed red tlood cell transfusion 8. Misoprostol(Cytotec) C. Fercous Sulfete D. RAIG (RhoGAM) 35, Anje, who s 16 weeks pregnant was rushed to the ER after having Reavy vagiral bleeding, passage of dots, atdominal pain. and cramping. Expelled materials were exemined and itwas determined that part of the conceptus were expelled but the placenta was retained. The nurse ufiderstands that this is what type of miscartioge? ‘A. Missed miscarriage B, Imminent miscarriage C. Threatened miscarriage D. Incomplete miscarriage Situation 6: 10 days postpartum, Ivy Visited back to the linic presenting with fever and complained ‘that her her breast feels painful and appears red and swollen: Assessment revealed Mastitis. 36. vy verbalzed to the nurse “I hurt too much to breastfeed any longer. How can I be a good mather if I don't breastfeed my baby” What is the pricrty nursing diagnosis of the nurse for Ivy? ‘A. Risk for impaired parenting B. Risk for impaired attachment . Ineffective Role performance D. Pain related to development of mastitis 37. Assessment shows extent of mastitis localized in the left breast. What nursing intervention should Nurse Dar implement for the patient? ‘A. Encourage patient to cortinue breastfeeding as usual B. Temporary cessation of breastfeeding until pain is relieved CC. Recommend that they shift to bottle-feed their infant D. Teach patient to start breastfeeding in the TOP RANK REVIEW ACADEMY, INC. Unaffected breast then shift to the affected breast 38, The patientasked the nurse what could have led to the ‘development of this infection, How wil nurse Dar respond to the mether ensuring that mother infant relationship will not be fected? ‘A. "MMhis,s caused by an organism that came from the nnasal-oral cavity of your infant and invaded your breast” BB. “This infection ls caled epidemic masttis because it ‘spreads from the infant to the mother” C. “This happens when the nipple becomes Gidcked and an acquired bacteria in the hospital infects your infant and infection spreads to the breast” 1D. “This is infection is most Commonly caused by lack of proper hygiene” 29, Nurse Dar provide instructions about measures to prevent sm mastitision, mothers breastfeeding their newborn, “THs Includes all of the folowing, except? ‘A. Wiping the breast area with cotton and alcohol £8 Exposing nipples to air for at least part of the day Using Vitamin E ointment ally to soften the ripple . Making certain the Baby is postioned correctly 40. Active infection cause a lot of pain to the patient. Ivy raised questions on possible ways of relieving her breast discomfort. Which of the following indicated understanding? ‘A.“I will nurse my infant as often as possible” B. “I may apply moist heat such as warm packs at home” (C.“Lcanindt Wea a bra during actve infection” D, “Breastfeeding starts in the affected breast then shift tothe other breast” Situation 7: Miscarriage 41. A nurse is caring for a client vino has had a missed abortion, a! 9 weeks gestation Which of the following treatments should the nurse prepare the client for? A. MyS04 B D&C © Utrasound DB. Oxytocin 42. A client who is 13 wets pregnant comes tothe dlinic. During the ultrasound, no heart tenes are detected. The client denies having had any bleeding. Thejnrse would be correct in exlairing this to thes client as what type of abortion/miscarriage? A. Complete B. Inevitable Incomplete D. Missed 43. K client is upsetabout a miscariage that she had and wants, tookRigW Why it happened. What is the best response by the nurse? ‘A. “Unfortunately most losses are from genetic ‘abnormalities we can’t contro!” 8. “Itisinot your fault, Lam sure the next pregnancy willbe tine" € "You were probably over doing it and not getting enough rest” D. “It just _wasiifit the right timing, everything happens for a reason” 44._Agaiit who has been diagnosed with an inevitable mmigtartiage at 12 weeks wants miscarry at home instead of having 2 D&C. The nurse should instruct the client to ‘ell immediately for which scenario? ‘A. If the bleeding stops B. Lose of tesue C. Cramping D. Heavy Bleeding 445. Kim, who is 16 weeks pregnant was rushed to the ER after having heavy vaginal bleedirg & passage of clots. Expelled materials were examined and it was determined that all parts of the conceptus were expelled. The nurse understands that thé is what type of miscarriage? ‘A. Complete miscarriage B. Missed miscarriage C._ Imminent miscarriage D. Threatened miscarriage Situation 8: Nuree Analynn is a nurse educator. She visited a birthing center where three multigravida Page 3| 4women just gave birth. The nurse educator optéd to conduct health education on postpartum hemorrhage. 46. Nurse Analyn explains to the mother indications of post partum hemorrhage leading to hypovolemia. Early ‘manifestations include Pale mucous membrane Dizziness and Letharay Falling blocd pressure-and Fapid weak pulses Decreasing level of consciousness 47. One of the clients asked nurse Analynn what are the sis factors for postpartum hemorrhage. The nurse explained the following risk factors except ‘A Uterine atony Bo Trauma Retained tissue D. Anteverted uterus 48, During a normal postpartum course, whiéf® does the nurse expect to palpate the uterus the day after the delivery? Inline with the Umblicus 1 fingerbreadth below the umbilicus 1 inch below the umbilicus halfway between the umbilcus and symphysis pubis 49, The nurse wants to assess the mothers’ level of, Understanding regarding post-partum discharges. Which statement from a client wil nurse Analynn determines as in need of further teaching? A. “I know about lochia; I'll use tampons just like Ido for my periods.” 5. “I admit I don't like having lochla, but I understand its purpese” “I-should wash my hands after I change perineal pads end before handling the baby” D. “TIl watch out for the color changes occuring in iy discharges” 50. Two days postpartum, Nurse Analynn assessed and. Performed massage of a mother’s fundus. What assessment Finding should prompt the rurse to immediately refer the client to a primary health care provider? ‘A. Fundal height 2em below the umbilicus B. Uterus does not become firm when massaged CC. Firm massages of the fundus resuits in pain D. Gient reparts afterpains pop ope TOP RANK REVIEW ACADEMY, INC. Page 4| 4