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
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?
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If Rho(D) immune globulin is given within 72 hours of delivery or invasive procedures during pregnancy, there is no limit
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If Rho(D) immune globulin is given within 72 hours of delivery, no more than two children is recommended
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If Rho(D) immune globulin is not given, only the next child will be affected
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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.
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?
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Taking-in
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Taking-hold
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Working-through
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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.
A primipara about to be discharged with a newborn asks the nurse multiple questions regarding how to care for the infant. Which phase of maternal adjustment does this behavior illustrate?
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Taking in
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Letting go
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Taking hold
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Early parenting
Explanation
The taking-hold phase occurs after initial recovery, typically on postpartum days 2–4, when the mother begins to assume responsibility for newborn care. During this period, she is eager to learn, asks many questions, and seeks guidance to build confidence in infant-care skills. This behavior reflects growing independence and readiness to parent with support.
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?
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Prepare the client for an immediate cesarean birth
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Perform a vaginal examination
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Ultrasound assessment
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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.
The nurse is caring for a client in labor whose fetus is in an occiput posterior position. Which intervention would the nurse use to reduce this client's discomfort?
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Place in a prone position
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Apply ice packs to the lower back
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Massage the lower back
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Place in the Trendelenburg position
Explanation
In the occiput posterior (OP) fetal position, the fetal head presses against the maternal sacrum, causing intense back labor pain. Applying firm pressure or massage to the lower back, including counterpressure over the sacrum, helps relieve discomfort by reducing pressure and improving maternal comfort during contractions.
A primigravida at 39 weeks' gestation has dark red vaginal bleeding and complains of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. Which complication does the nurse suspect?
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Preterm labor
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Placenta previa
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Abruptio placentae
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Placenta accreta
Explanation
Abruptio placentae involves premature separation of the placenta from the uterine wall, causing dark red bleeding, constant abdominal pain, and a firm, board-like uterus that does not relax between contractions. These characteristics distinguish it from other causes of third-trimester bleeding. It is a medical emergency due to the risk of fetal hypoxia and maternal hemorrhage, requiring rapid evaluation and intervention.
A client with diabetes in the second trimester of pregnancy notes that the usual dose of insulin to maintain blood glucose levels has been increasing over the last few weeks. What would the nurse explain to the client about insulin during pregnancy?
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Insulin resistance develops because of human placental lactogen hormone and other hormones
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The fetus is using insulin to maintain adequate blood glucose levels in utero
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An increase in circulating blood volume during pregnancy makes insulin less available
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The change in diet causes an increased need for insulin to maintain normal blood glucose levels
Explanation
During the second and third trimesters, hormone levels such as human placental lactogen, estrogen, progesterone, and cortisol rise significantly. These hormones create insulin resistance to ensure the fetus has an adequate glucose supply. As a result, mothers with diabetes need higher doses of insulin to maintain normal blood glucose levels. This is a normal physiologic change during pregnancy, not a sign of worsening diabetes control.
The nurse is assessing a fetus via ultrasound after a 15 beat/minute decelerations of the fetal heart rate below the baseline lasting 15 seconds. Based on the information in the image, what intervention would the nurse perform?
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Increase intravenous fluids
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Place the client's legs knee to chest
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Assist the client to change positions
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Administer oxygen via face mask
Explanation
B. Place the client's legs knee-to-chest The knee-to-chest (or hands-and-knees) position immediately lifts the presenting part off the umbilical cord, relieving compression. This is the priority emergency maneuver during cord compression/prolapse and helps restore fetal oxygen delivery while preparing for further emergency interventions if needed.
A multipara client in labor is having contractions which are 2 minutes apart and rarely over 50 mm Hg in strength; the resting uterine tone is high, 20 to 25 mm Hg. The client asks what she can do to make contractions more effective. What is the nurse's best response to the client?
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I will request oxytocin to strengthen the contractions
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Be patient as contractions will strengthen by themselves
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Try to rest between contractions
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Ambulate to make the contractions regular
Explanation
The client has uterine hypertonus (elevated resting tone) and ineffective contractions (<50 mm Hg). Excessive uterine tone prevents the uterus from relaxing fully and interferes with uteroplacental perfusion, making contractions ineffective and exhausting the client. Rest and relaxation can help reduce uterine tone, allowing more effective contractions and improving fetal oxygenation.
Fetal Assessment
Experiencing early decelerations
Presenting part floating
Fetal heart rate of 140 beats/min in the right lower quadrant
Maternal Assessment
Cervix 2 cm dilated
Cervix 70% effaced
Streaks of fluid and blood from vagina
Fetal back in right lower quadrant
Contractions every 3-4 min. lasting 30-45 sec
What care would the nurse plan for this client?
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Amniotomy should be implemented
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The mother is in the second stage of labor
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The fetus is demonstrating signs of distress
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Cesarean birth is anticipated
Explanation
The client is 42 weeks gestation (post-term) with a floating presenting part at 2 cm dilation, which indicates the fetal head is not engaged. In a post-term primigravida, this increases risk for labor complications such as cephalopelvic disproportion and cord prolapse. Because induction is less successful with an unengaged head and the fetus is not yet descending, cesarean birth is likely planned.
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