FA25 NUR 404 W Exam Two
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Free FA25 NUR 404 W Exam Two Questions
1. 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?
- A) Postpartum hemorrhage
- B) Vaginal laceration
- C) Uterine involution
- D) 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.
2. Methylergonovine is prescribed for a client to treat postpartum hemorrhage caused by uterine atony. Prior to the nurse administering the medication, what assessment is the priority?
- A) Amount of blood loss
- B) The blood pressure
- C) The level of consciousness
- D) The uterine tone
Explanation
Methylergonovine (Methergine) is contraindicated in clients with hypertension because it causes intense vasoconstriction and can lead to hypertensive crisis, stroke, or seizures. Before giving Methergine, the nurse must check the client’s blood pressure to ensure it is within a safe range. If the blood pressure is elevated, the medication should not be administered, and the provider must be notified.
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.
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?
- A) Increase intravenous fluids
- B) Place the client's legs knee to chest
- C) Assist the client to change positions
- D) 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.
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. Which healthcare provider order for a client with cephalopelvic disproportion would the nurse question?
- A) Start a peripheral intravenous infusion of normal saline at 100mL/hr
- B) Record fetal heart tones every 15 minutes
- C) Maintain clear liquid diet status
- D) Titrate oxytocin infusion per protocol
Explanation
Oxytocin increases the strength and frequency of uterine contractions. In a client with cephalopelvic disproportion (CPD), the fetus cannot pass safely through the maternal pelvis, so stimulating labor further increases the risk of fetal distress, uterine rupture, and maternal injury. CPD most often requires cesarean delivery rather than labor augmentation. Therefore, oxytocin administration is unsafe and must be questioned.
7. 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?
- A) Taking in
- B) Letting go
- C) Taking hold
- D) 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.
8. A woman who underwent a primary cesarean birth for a breech presentation states that her neonate seems to have so much more mucus than her first baby. Concerned, she asks why this has happened. What is the best response by the nurse?
- A) There is no scientific reason for this occurrence, your baby will be fine in a few hours
- B) All babies are different so it is unwise to make comparisons between your first baby and your new baby
- C) Babies born by cesarean section do not have the benefit of having the mucus in their lungs removed by the pressure experienced in the birth canal
- D) The pain medication given during the surgery may have contributed to the mucus build up in the neonate after birth
Explanation
During vaginal birth, pressure from the birth canal helps expel amniotic fluid and mucus from the newborn’s lungs. Cesarean-born infants do not receive this natural compression, so they may retain more mucus and secretions initially. This is a normal physiologic finding and typically improves as the newborn clears the mucus through coughing and crying or with gentle suctioning if needed.
9. The nurse is assessing a new mother at a health care facility. Which symptom would the nurse identify as a symptom of postpartum blues?
- A) Mild irritability
- B) Hallucinations
- C) Unwillingness to sleep
- D) 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.
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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