ABSN Hybrid Summer -NURS428 Reassessment 1 EBR Roseman University of Health Sciences School of Nursing.
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Free ABSN Hybrid Summer -NURS428 Reassessment 1 EBR Roseman University of Health Sciences School of Nursing. Questions
The nurse is assessing a client who gave birth 72 hours ago to a healthy infant and is formula-feeding only. The nurse notices that both of the client's breasts are swollen, warm, and tender on palpation. What is the most appropriate nursing intervention for this client?
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Run warm water on the breasts during a shower.
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Apply ice compresses and or cabbage leaves to the breasts.
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Express small amounts of milk from the breasts to relieve pressure.
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Instruct client to wear a loose-fitting bra to prevent nipple irritation.
Explanation
Explanation
Correct Answer: B) Apply ice compresses and/or cabbage leaves to the breasts
This client is experiencing breast engorgement secondary to milk coming in while not breastfeeding. For non-breastfeeding clients, the goal is to suppress lactation — not stimulate further milk production. Ice compresses reduce swelling, pain, and inflammation, while cabbage leaves (a well-supported evidence-based remedy) contain compounds that help reduce engorgement and suppress milk production when applied to the breasts.
Warm water or heat on the breasts (A) stimulates milk letdown and would worsen engorgement — contraindicated for a non-breastfeeding client. Expressing milk (C) signals the body to produce more milk, perpetuating the problem. A well-fitting, supportive bra — not a loose one (D) — provides compression that helps suppress lactation and reduce discomfort.
The neonatal nurse is providing discharge education to first-time parents about their newborn. They ask about the benefits of breastfeeding versus bottle feeding their infant. Which statement by the parent would indicate that they understand the benefits of breastfeeding?
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"I won't have to use contraception while I am breastfeeding since I have not yet resumed my periods."
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"The commercial grade formula I can buy at the store has the same composition as my breastmilk."
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"As my baby grows, I will need to supplement, since the volume of breastmilk I produce stays the same."
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"The amount and composition of my breastmilk will change to meet my baby's needs as they grow."
Explanation
Explanation
Correct Answer: D) "The amount and composition of my breastmilk will change to meet my baby's needs as they grow."
One of the most remarkable and unique benefits of breastfeeding is that breast milk dynamically changes in both volume and composition as the baby grows and develops. It transitions from colostrum (rich in antibodies and protein) in the first days, to transitional milk, and then to mature milk — continually adapting its nutritional content, immunological factors, and caloric density to meet the infant's evolving needs.
Breastfeeding reduces but does not eliminate the risk of pregnancy — contraception is still recommended (A is a dangerous misconception). Commercial formula cannot replicate the full immunological and bioactive properties of breastmilk (B is incorrect). Breast milk production increases with demand as the baby grows — supplementation is not routinely needed if breastfeeding is well established (C is incorrect).
The nurse is caring for a couple at a fertility clinic. After determining the client has a low sperm count, they have opted for artificial insemination. What should the nurse include in the teaching to prepare them for this procedure?
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You will be fully numbed before the abdominal needle insertion.
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There will be a speculum inserted in the vagina to get the sperm closer to the uterus.
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We will use the embryo that was fertilized in the laboratory.
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This procedure is highly successful and will only need to be performed one time.
Explanation
Explanation
Correct Answer: B) There will be a speculum inserted in the vagina to get the sperm closer to the uterus.
Artificial insemination (intrauterine insemination) involves placing prepared sperm directly into the uterus using a catheter, typically after inserting a speculum. This is a minimally invasive procedure and does not involve abdominal needles or anesthesia.
Option A describes procedures like amniocentesis. Option C refers to in vitro fertilization. Option D is incorrect because multiple attempts are often needed, and success rates vary.
The nurse is educating a laboring client who is about to receive epidural anesthesia. Which statement by the nurse best describes the side effects the client may experience?
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"It is possible to experience a drop in blood pressure afterward."
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"You may experience some drowsiness as the medication gets in your bloodstream."
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"You may feel a frequent need to urinate after the effects set in."
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"It is possible to feel more numbness on one side, so you should lie flat on your back."
Explanation
Explanation
Correct Answer: A) "It is possible to experience a drop in blood pressure afterward."
Hypotension is the most common and well-documented side effect of epidural anesthesia. The epidural blocks sympathetic nerve fibers, causing vasodilation and a subsequent drop in blood pressure. This is why IV fluid preloading is performed before epidural placement and blood pressure is monitored frequently afterward.
Epidurals are regional anesthetics affecting the lower body — significant drowsiness or systemic sedation (B) is not a typical effect, as the medication remains largely localized. Epidurals typically cause urinary retention, not frequency (C is incorrect). If unilateral numbness occurs, the client should be repositioned to their side — not placed flat on their back — as supine positioning causes aortocaval compression in pregnancy (D is incorrect and potentially harmful).
The nurse reviews the documentation in the electronic health record (EHR) and evaluates the most recent assessment findings. Match each finding with the appropriate status.
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Urine output – Concerning; DTR’s – Improved; Weakness – Expected; Headache – Concerning
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Urine output – Expected; DTR’s – Unchanged; Weakness – Improved; Headache – Expected
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Urine output – Improved; DTR’s – Expected; Weakness – Unchanged; Headache – Expected
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Urine output – Unchanged; DTR’s – Concerning; Weakness – Expected; Headache – Improved
Explanation
Explanation
Correct Answer: A) Urine output – Concerning; DTR’s – Improved; Weakness – Expected; Headache – Concerning
Decreased urine output is concerning in conditions such as preeclampsia because it may indicate worsening renal perfusion. Deep tendon reflexes (DTRs) may improve with appropriate treatment such as magnesium sulfate. Weakness can be an expected side effect of treatment, especially with magnesium therapy. A persistent headache remains a concerning sign, indicating possible worsening of the hypertensive condition and risk for complications.
The nurse is caring for a client who has been prescribed an IV infusion of oxytocin to induce labor. The client is gravida 1 para 0. The fetus is in a vertex/cephalic presentation and the patient’s cervix is dilated 1 cm. Which is the priority action for the nurse before starting the oxytocin induction?
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Administer a 1000cc bolus of IV fluid to prevent hypotension
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Educate the family about risks and benefits of the medication
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Notify the provider of malposition of the fetus and hold the medication
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Place monitors to evaluate fetal heart rate and contraction pattern
Explanation
Explanation
Correct Answer: D) Place monitors to evaluate fetal heart rate and contraction pattern
Before initiating oxytocin, baseline fetal heart rate and uterine activity must be established using continuous electronic fetal monitoring. This ensures that the fetus can tolerate labor and allows early detection of complications such as tachysystole or fetal distress once the medication begins.
Fluid bolus is not routinely required, education is important but not the immediate priority, and the fetus is already in a normal vertex position, so no need to notify the provider.
The nurse is caring for a 3-hour old newborn infant and is completing an assessment. The nurse observes cyanosis on the infant's hands and feet. What is the priority nursing intervention?
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Check infant's temperature for hypothermia.
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Activate a code blue or emergency response.
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Administer blow-by oxygen to the infant.
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Continue to monitor because this is normal.
Explanation
Explanation
Correct Answer: D) Continue to monitor because this is normal.
Acrocyanosis — bluish discoloration of the hands and feet — is a normal and expected finding in newborns, particularly within the first few hours after birth. It occurs because the newborn's peripheral circulation is still immature and adjusting to extrauterine life. The core of the body (trunk, lips, and mucous membranes) should remain pink. Acrocyanosis isolated to the extremities requires no intervention other than continued monitoring.
Checking temperature for hypothermia (A) may be warranted if cold stress is suspected, but acrocyanosis alone in the first hours is a normal finding. Activating a code blue (B) is a severe overreaction to a normal newborn assessment finding. Blow-by oxygen (C) is reserved for central cyanosis affecting the lips, tongue, and trunk — not peripheral acrocyanosis.
The nurse is assessing a 36-week gestation client who has been diagnosed with worsening preeclampsia and is concerned about HELLP syndrome. The laboratory assessment findings are as follows. Which finding is the priority to report to the provider?
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ALT
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Hematocrit
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Deep tendon reflexes
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Oxygen saturation
Explanation
Explanation
Correct Answer: A) ALT
HELLP syndrome involves hemolysis, elevated liver enzymes, and low platelets. An elevated ALT reflects liver involvement and hepatocellular injury, which is a critical component of HELLP syndrome and indicates worsening disease. This can progress rapidly to liver rupture, hemorrhage, or maternal and fetal compromise, making it the priority finding to report.
A low hematocrit indicates anemia but is not as immediately life-threatening as liver dysfunction in this context. Deep tendon reflexes are important for monitoring neurologic status, especially with magnesium therapy, but do not directly indicate HELLP progression. Oxygen saturation is important but not the primary indicator of HELLP syndrome severity.
The nurse is caring for a client with A+ blood who has been prescribed a blood transfusion. The nurse places a 20-gauge peripheral intravenous (IV) line, flushes it with normal saline, and verifies the client has signed consent. What is the next step in the transfusion process?
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Pick up blood from the blood bank
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Double check the blood with another registered nurse (RN)
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Prime Y tubing with blood and saline
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Initiate the blood transfusion within one hour of obtaining blood
Explanation
Explanation
Correct Answer: A) Pick up blood from the blood bank
After ensuring IV access and consent, the next step is to obtain the blood from the blood bank. Verification with another nurse and initiation occur after the blood is obtained.
Priming tubing and starting transfusion are done after proper verification procedures.
The labor and delivery nurse is preparing for the delivery of their client's newborn infant. The nurse brings a stack of warm blankets into the room and places them at the bedside. Which statement by the nurse best educates the parents on why warm blankets are needed?
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"We will use the warm blankets to dry the baby which will help to prevent cold stress"
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"We will wrap the baby in warm blankets after delivery so that they will not shiver."
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"We will use the blankets to warm the baby's hands and feet to prevent acrocyanosis."
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"We will use the warm blankets only if the baby has a low temperature."
Explanation
Explanation
Correct Answer: A) "We will use the warm blankets to dry the baby which will help to prevent cold stress"
Newborns are at high risk for cold stress (hypothermia) immediately after birth because they are wet with amniotic fluid and transition from a warm intrauterine environment to a cooler external environment. Drying the newborn promptly with warm blankets is the primary intervention to prevent evaporative heat loss — the most significant mechanism of heat loss at birth — thereby preventing cold stress and its metabolic consequences such as hypoglycemia and acidosis.
Newborns do not shiver effectively as a thermoregulatory mechanism — they rely on non-shivering thermogenesis through brown fat metabolism (B is inaccurate). Acrocyanosis (bluish hands and feet) is a normal finding in newborns and is not caused by temperature loss requiring blankets (C). Warm blankets are used routinely for all newborns at delivery, not only for those with documented low temperature (D).
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