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 concerned that a pregnant client is developing polyhydramnios in the second trimester. What assessment findings confirm this concern? Select all that apply.
- Increased pain with urination
- Tense (firm) uterus
- Difficulty auscultating heart sounds
- Sudden weight loss
- Maternal shortness of breath
- Uterus larger than expected for gestational week
Explanation
B. Tense (firm) uterus With excessive amniotic fluid, the uterus becomes overdistended and feels unusually firm or tense on palpation. This increased pressure is due to the large volume of fluid filling the uterus, which can make it difficult for the uterus to relax between assessments. C. Difficulty auscultating heart sounds Excess fluid cushions fetal movements and heart sounds, making it harder for the nurse to hear fetal heart tones. Polyhydramnios increases the distance between the fetus and abdominal wall, reducing clarity of auscultation. E. Maternal shortness of breath The enlarged uterus presses upward on the diaphragm, restricting lung expansion. This leads to maternal dyspnea, especially in the second and third trimesters as fluid volume increases significantly. F. Uterus larger than expected for gestational week A uterus measuring larger than gestational age is one of the hallmark findings of polyhydramnios. Fundal height will exceed expected measurements due to excessive amniotic fluid volume.
2. The nurse is caring for a primigravida at 42 weeks' gestation with the following assessment data recorded in the patients record.
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?
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?
- Amniotomy should be implemented
- The mother is in the second stage of labor
- The fetus is demonstrating signs of distress
- 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.
3. Which complication would the nurse consider for a client with a fetus in a breech presentation?
- Stronger contractions, indicating progression of labor
- Nonreassuring fetal signs, indicating prolapse of the cord
- Rapid dilation of the cervix, indicating precipitate labor
- Cessation of contractions, indicating overstretching of the uterus
Explanation
Breech presentation increases the risk of umbilical cord prolapse because the fetal buttocks or feet do not create an effective seal in the birth canal, unlike a cephalic (head-down) presentation. When the cord prolapses, it becomes compressed, resulting in nonreassuring fetal heart rate signs, such as variable or prolonged decelerations. This is an obstetric emergency requiring prompt action to protect fetal oxygenation.
4. A provider orders an infusion of oxytocin to prevent postpartum hemorrhage at 20 mU/min. The available solution is 20 units in 1000 mL of normal saline. How many mL/hr will the oxytocin infuse? Record numerical answer only. Round to the nearest whole number.
- 30
- 60
- 120
- 90
Explanation
20 units = 20,000 mU in 1000 mL 20,000 mU / 1000 mL = 20 mU/mL Ordered: 20 mU/min mL/min = 20 mU ÷ 20 mU/mL = 1 mL/min Convert to mL/hr: 1 × 60 = 60 mL/hr
5. The nurse is educating a client about postpartum complications. Which complication will be included for a primipara with a second degree perineal laceration and repair?
- Difficulty voiding spontaneously
- Delayed onset of milk production
- Maladaptive bonding with the newborn
- Posterior vaginal varicosities
Explanation
A second-degree perineal laceration involves perineal muscles and tissues but not the anal sphincter. After repair, swelling, perineal pain, and pelvic floor trauma can lead to difficulty voiding spontaneously due to pain, edema, and reflex inhibition of the bladder. Monitoring voiding patterns and providing comfort measures (ice, sitz baths, analgesics) support normal recovery and prevent urinary retention.
6. 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.
7. Vital Signs
Heart Rate: 96 beats/minute
Respiratory Rate: 18 breaths/minute
Blood Pressure: 170/110
Fetal monitor
Fetal Heart Rate. 160 with moderate baseline variability
Uterine Contractions none noted
Neuro Assessment
Edema
Alert and oriented x 3
Patellar Reflexes 3+, no clonus noted
3+ pitting pretibial edema bilaterally
Which interventions are appropriate? Select all that apply.
Heart Rate: 96 beats/minute
Respiratory Rate: 18 breaths/minute
Blood Pressure: 170/110
Fetal monitor
Fetal Heart Rate. 160 with moderate baseline variability
Uterine Contractions none noted
Neuro Assessment
Edema
Alert and oriented x 3
Patellar Reflexes 3+, no clonus noted
3+ pitting pretibial edema bilaterally
Which interventions are appropriate? Select all that apply.
- Monitor vital signs and reflexes at least every hour or more as client condition dictates
- Keep intravenous calcium gluconate on hand
- Move client to a private room next to the nurses' station
- Obtain magnesium levels at least every 8 hours or more often if client condition dictates
- Run magnesium sulfate in a secondary line to prevent seizures
- Run magnesium sulfate via infusion pump as a primary line
Explanation
A. Monitor vital signs and reflexes at least every hour Clients on magnesium sulfate for severe preeclampsia require hourly monitoring of BP, respiratory rate, urine output, and deep tendon reflexes to detect worsening disease and magnesium toxicity. B. Keep intravenous calcium gluconate on hand Calcium gluconate is the antidote for magnesium toxicity (e.g., respiratory depression, loss of reflexes), so it must be immediately available. D. Obtain magnesium levels at least every 8 hours Serum magnesium must be monitored every 4–8 hours or more if symptoms change to ensure therapeutic range and prevent toxicity. E. Run magnesium sulfate in a secondary line to prevent seizures Magnesium is typically run as a secondary (IV piggyback) on a maintenance fluid line so the primary line remains available if emergency fluids or medications are needed.
8. The nurse is caring for a large-for-gestational-age infant born to a client with diabetes mellitus. What is priority when assessing this infant?
- Monitor the infant’s blood glucose every six hours for 24 hours
- Monitor for signs and symptoms of hypoglycemia
- Explain the effects of maternal hyperglycemia on the baby to the parents
- Estimate the amount of calories to provide the infant through supplemental formula
Explanation
Infants of diabetic mothers—especially large-for-gestational-age newborns—are at high risk for hypoglycemia immediately after birth due to persistent fetal hyperinsulinemia once the maternal glucose supply stops. Hypoglycemia can occur rapidly and lead to seizures and neurologic damage. Therefore, the priority nursing action is monitoring for signs such as jitteriness, lethargy, apnea, poor feeding, or cyanosis, and checking glucose promptly if symptoms occur.
9. During a home visit, the nurse learns that a new mother is experiencing breast engorgement. What would the nurse recommend to help alleviate this problem?
- Having her apply lanolin cream to each breast
- Encouraging her to wear a firm-fitting bra
- Decreasing her fluid intake to below 500 ml per 24 hours
- Discontinuing breastfeeding for 24 hours
Explanation
Breast engorgement occurs when the breasts become overly full, firm, and painful due to milk buildup and increased blood flow. A supportive, firm-fitting bra helps provide comfort, reduce swelling, and support the breasts while breastfeeding continues. Additional helpful strategies often include frequent breastfeeding, warm compresses before feeding, and cold compresses after.
10. The nurse is assessing the breast of a woman who is 1 month postpartum. The woman reports a painful area on the left breast, a temperature of 38.2°C, and malaise. The nurse notes a local area on the same breast to be red and warm to touch. The nurse calls the healthcare provider to report which suspected issue?
- Mastitis
- Plugged milk duct
- Unilateral engorgement
- Breast yeast infection
Explanation
Mastitis is a breast infection often occurring in breastfeeding mothers, typically 2–4 weeks postpartum but can happen anytime during lactation. Symptoms include localized breast pain, redness, warmth, fever, and flu-like malaise. The presence of systemic symptoms (temperature 38.2°C and malaise) alongside localized inflammation strongly indicates mastitis and requires provider notification for antibiotic therapy.
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