FA25 NUR 404 W Exam Two at Massachusetts College of Pharmacy
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Free FA25 NUR 404 W Exam Two at Massachusetts College of Pharmacy Questions
1. The nurse and student are discussing clients who are laboring on the unit. Which clients would the nurse encourage to attempt a vaginal birth after having a cesarean section? Select all that apply.
- A) A client who had rupture of membranes 26 hours ago
- B) A client with a current separation of symphysis pubis
- C) A client who had a cesarean section because of placenta previa
- D) A client who had a cesarean section because of a breech presentation
- E) A client who was positive for Group B streptococcal infection
- F) A client who has a gynecoid shaped pelvis
- G) A client with a traditional cesarean incision
Explanation
D. A client who had a cesarean section because of a breech presentation A prior cesarean due to fetal positioning (breech) is an excellent candidate for VBAC because the reason for the cesarean was not related to labor complications or pelvic issues. In most cases, the same issue will not recur, making vaginal birth safe and appropriate. E. A client who was positive for Group B streptococcal infection GBS status does not prevent VBAC. These clients only require appropriate intrapartum antibiotic prophylaxis. GBS positivity does not impact uterine scar integrity or labor safety, therefore they can safely attempt a vaginal birth after cesarean. F. A client who has a gynecoid shaped pelvis A gynecoid pelvis is the most favorable pelvic shape for vaginal birth. Adequate pelvic dimensions support a safe VBAC, reducing the likelihood of obstructed labor and complications. This is a desirable characteristic in VBAC candidates.
2. A client has a precipitous delivery and subsequently develops a postpartum hemorrhage that does not respond to fundal massage and oxytocin administration. What is the nurse's next action?
- A) Administer methylergonovine (Methergine) 0.2 mg oral if her hematocrit level is over 45%
- B) Administer methylergonovine (Methergine) 0.2 mg intramuscular if her urine output is less than 50 mL/h
- C) Administer methylergonovine (Methergine) 0.2 mg intravenous push slowly over greater than 1 minute as long as her blood pressure is below 140/90
- D) Administer methylergonovine (Methergine) 0.2 mg subcutaneous if her fundus measures +1 above umbilicus
Explanation
Methylergonovine (Methergine) 0.2 mg IM is the correct next medication when postpartum hemorrhage does not respond to fundal massage and oxytocin. It promotes strong uterine contractions to control bleeding. The most important safety check is blood pressure — Methergine is contraindicated if the client has hypertension. Although this option includes an unrelated condition (urine output), it is still the only answer with the correct emergency route and dose.
3. A client at 31 week's gestation is admitted in preterm labor. Which medication would the nurse provide education for?
- A) An analgesic
- B) A corticosteroid
- C) A tocolytic
- D) 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.
4. A single pregnant adolescent has decided to continue the pregnancy and keep the baby. Which intervention would the nurse use?
- A) Explore other problems that the client may be experiencing
- B) Praise and give approval for making a wise decision
- C) Making an appointment for the client to visit a prenatal clinic
- D) Provide information about resources and assistance
Explanation
The priority nursing role when caring for a pregnant adolescent is to support, educate, and connect them to resources. Adolescents often lack financial, emotional, and social support systems. Providing access to community resources, parenting programs, financial support services, prenatal care services, and support groups helps promote maternal and fetal well-being and encourages a healthy transition into parenthood.
5. 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?
- A) Amniotomy should be implemented
- B) The mother is in the second stage of labor
- C) The fetus is demonstrating signs of distress
- D) 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.
6. 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?
- A) Place in a prone position
- B) Apply ice packs to the lower back
- C) Massage the lower back
- D) 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.
7. 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?
- A) Preterm labor
- B) Placenta previa
- C) Abruptio placentae
- D) 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.
8. 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?
- A) Difficulty voiding spontaneously
- B) Delayed onset of milk production
- C) Maladaptive bonding with the newborn
- D) 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.
9. A client with a history of three spontaneous abortions is now at 16 weeks' gestation and expresses a concern about remaining at home during pregnancy. Which question will elicit a response most helpful to the nurse developing the client's plan of care?
- A) Are you aware of how a healthy lifestyle affects a pregnancy?
- B) Do you know the causes related to the spontaneous abortions?
- C) What are the characteristics of an impending spontaneous abortion?
- D) What have you been told about the status of your pregnancy?
Explanation
This question helps the nurse assess the client's current understanding and beliefs about the pregnancy and fetal health. Knowing what information the client has already received and how she interprets it allows the nurse to identify misconceptions, provide emotional support, and tailor education appropriately. This promotes therapeutic communication and individualized care planning in a high-anxiety situation.
10. On the third postpartum day after an unexpected cesarean birth, the nurse finds the client crying. The client states, "I know my baby is fine, but I can't help crying. I wanted a natural childbirth so much. Why did this have to happen to me?" What is the nurse's best response to the client?
- A) A woman can feel upset after an urgent cesarean birth. Can you tell me more about your feelings?
- B) Your feelings about this will improve after you have bonded more with your infant. I'm sorry you're upset.
- C) You are probably suffering from postpartum depression. Do you want a referral to counseling?
- D) Most women understand a cesarean birth is a possible outcome during birth. Did you discuss this during your prenatal visits?
Explanation
This mother is expressing grief, disappointment, and emotional adjustment after an unexpected cesarean birth — a normal part of the taking-hold to letting-go phase. The best response acknowledges her feelings and encourages further communication, providing emotional support and validating her experience. Offering an open-ended question allows her to express and process the experience safely.
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