FA25 NUR 404 W Exam Two at Massachusetts College of Pharmacy and Health Sciences
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Free FA25 NUR 404 W Exam Two at Massachusetts College of Pharmacy and Health Sciences Questions
1. The nurse is assessing a new mother at a health care facility. Which symptom would the nurse identify as a symptom of postpartum blues?
- Mild irritability
- Hallucinations
- Unwillingness to sleep
- Frantic energy
Explanation
Postpartum blues typically occur within the first few days after birth and are characterized by mood swings, tearfulness, mild irritability, fatigue, and anxiety. The mother may be emotionally labile and sensitive, but symptoms are mild and self-limiting, resolving within about two weeks. Mild irritability is a common and expected finding during postpartum blues.
2. A pregnant client presents with painless bleeding caused by placenta previa at 37 weeks' gestation. Which assessment is the most important for the nurse to perform?
- Measurement of fundal height
- Digital vaginal examination for dilation
- Assessment of maternal temperature
- Monitor fetal heart rate and contraction patterns
Explanation
Placenta previa causes painless vaginal bleeding, and the priority is to assess fetal well-being and uterine activity. Monitoring fetal heart rate and contractions helps determine if the fetus shows signs of distress and whether labor has begun. At 37 weeks, bleeding + contractions may require urgent delivery, so continuous fetal and uterine monitoring is essential to guide safe care.
3. A client had undergone suction curettage for the removal of a hydatidiform mole (gestational trophoblastic disease). What would the nurse emphasize when planning for the client's discharge?
- The reasons for postponing another pregnancy for at least three months
- The necessity of at least six weeks of follow-up care
- The risk factors for the development of another hydatidiform mole
- The basis for chemotherapy if the human chorionic gonadotropin levels decrease
Explanation
Following removal of a hydatidiform mole, it is essential to avoid pregnancy during the hCG surveillance period, typically 6–12 months, though some protocols may permit as early as three months depending on provider guidance. Avoiding pregnancy ensures accurate monitoring of hCG levels to detect persistent trophoblastic disease or choriocarcinoma, which could be masked by pregnancy-related hCG elevation.
4. A nurse is caring for a postpartum client who is a G2 P2002, delivered a 4200-gram neonate vaginally after 4 hours of labor. Based on the client's delivery information, what postpartum complication is the client at risk for?
- Postpartum hemorrhage
- Vaginal laceration
- Uterine involution
- Postpartum hypertension
Explanation
Delivering a macrosomic infant (4200 g) and experiencing a rapid labor (precipitous labor ~4 hours) both increase the risk of uterine atony, which is the most common cause of postpartum hemorrhage. Over-distension of the uterus from a large baby can impair uterine muscle contraction postpartum, leading to excessive bleeding. Therefore, this client is at high risk for postpartum hemorrhage and requires close monitoring.
5. A pregnant client has a history of chronic hypertensive disease. Which medication would the nurse not question for this client?
- Labetalol
- Digoxin
- Warfarin
- Nitroglycerin
Explanation
Labetalol is a commonly prescribed antihypertensive medication considered safe for use during pregnancy. It is a first-line choice for managing chronic hypertension in pregnant clients because it effectively lowers blood pressure without reducing uteroplacental blood flow. Using safe, pregnancy-approved antihypertensives like labetalol helps prevent maternal complications such as stroke and preeclampsia while supporting fetal well-being.
6. A pregnant client who is Rh negative asks the nurse how many children they will be able to have before Rh incompatibility causes the fetus to die. What is the nurse's best response?
- If Rho(D) immune globulin is given within 72 hours of delivery or invasive procedures during pregnancy, there is no limit
- If Rho(D) immune globulin is given within 72 hours of delivery, no more than two children is recommended
- If Rho(D) immune globulin is not given, only the next child will be affected
- If Rho(D) immune globulin is not given, only a male child will be affected
Explanation
Rho(D) immune globulin (RhoGAM) prevents maternal sensitization to Rh-positive fetal blood cells. When administered at recommended times (during pregnancy at 28 weeks, within 72 hours postpartum, and after procedures such as amniocentesis, trauma, or bleeding), it protects future pregnancies from Rh hemolytic disease. With proper prophylaxis, Rh-negative clients can have unlimited pregnancies safely without harming future fetuses.
7. After an emergency cesarean birth, the client tells the nurse that she was hoping for a natural childbirth but is glad that she and her baby are healthy. Which postpartum phase of adjustment does this statement reflect?
- Taking-in
- Taking-hold
- Working-through
- Letting-go
Explanation
The letting-go phase occurs when the mother reconciles her birth experience with her expectations and begins to accept her new role. In this stage, the mother processes emotions about how birth occurred (e.g., grieving a desired natural birth) while simultaneously expressing gratitude for her and her baby’s well-being. Acceptance and emotional adjustment to the reality of childbirth and motherhood define this phase.
8. 4 g/hr. What is the starting rate of the infusion? Record numerical answer only. Round to the nearest whole number.
- 50
- 67
- 100
- 120
Explanation
The concentration is 60 g in 1000 mL. 60 g ÷ 1000 mL = 0.06 g/mL Desired dose: 4 g/hr 4 g ÷ 0.06 g/mL = 66.67 mL/hr Rounded to nearest whole number = 67 mL/hr
9. A pregnant client late in the second trimester comes to the emergency department with a report of painless, bright red vaginal bleeding. The client states, "It started all of a sudden and now it seems to have stopped." What action is the priority for this client on admission?
- Prepare the client for an immediate cesarean birth
- Perform a vaginal examination
- Ultrasound assessment
- Assess uterine contractions by intrauterine pressure catheter (IUPC)
Explanation
Painless, bright red bleeding in the second or third trimester strongly suggests placenta previa. The priority is to confirm fetal position and placental location with ultrasound before any vaginal exam or invasive procedure. This prevents disruption of the placenta, which could trigger massive hemorrhage and endanger the mother and fetus. Ultrasound is the safest and most appropriate first action to confirm the diagnosis and guide care.
10. A client at 31 week's gestation is admitted in preterm labor. Which medication would the nurse provide education for?
- An analgesic
- A corticosteroid
- A tocolytic
- An oxytocic
Explanation
A tocolytic is given in preterm labor to suppress uterine contractions and delay delivery, typically to allow time for fetal lung maturity interventions such as corticosteroids. At 31 weeks gestation, delaying labor can significantly improve neonatal outcomes by reducing the risks of respiratory distress syndrome, intraventricular hemorrhage, and other prematurity-related complications.
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