NUR 404 Exam 2 SU25 Community Health Nursing
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Free NUR 404 Exam 2 SU25 Community Health Nursing Questions
A client who is now a G6 P6006 is 15 minutes postpartum from a normal vaginal delivery. The newborn weighed 10 lbs 13 ounces (4595 grams) at birth. Which of the following complications should the nurse monitor for in this client
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Hemorrhage
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Thrombosis
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Seizures
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Infection
Explanation
Correct Answer A. Hemorrhage
Explanation:
The client is grand multipara (G6 P6006) and delivered a macrosomic baby (over 4000 grams). Both are significant risk factors for postpartum hemorrhage (PPH). Grand multiparity may lead to uterine atony (a uterus that doesn’t contract well), and a large baby can overstretch the uterus, further increasing the risk of bleeding.
Why the Other Options Are Wrong:
B. Thrombosis
While postpartum women are at some risk for thrombosis, there’s no specific evidence or condition here (like immobility or thrombophilia) making it the top concern at this moment.
C. Seizures
Seizures would typically be associated with eclampsia, which isn’t indicated in this scenario. There are no signs or history of preeclampsia.
D. Infection
Postpartum infection is a concern but not an immediate priority at 15 minutes postpartum unless other signs (e.g., fever, foul discharge) develop. Hemorrhage is the most acute threat in this context.
A nurse is caring for a client who had a vaginal birth 2 hours ago. They are currently receiving IV Oxytocin, 20 Units in 1000 ml Lactated Ringers solution infusing at 125 ml/hr. Which of the following findings indicates that the medication is effective
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There is a large amount of bright red lochia with large clots
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Fundus is firm to palpation at the umbilicus
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Fundus is boggy to palpation at the umbilicus
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Lochia is absent
Explanation
Correct Answer B. Fundus is firm to palpation at the umbilicus
Explanation:
Oxytocin promotes uterine contractions to prevent postpartum hemorrhage. A firm uterine fundus at the umbilicus level indicates that the uterus is contracting effectively and minimizing blood loss, showing the medication is working as intended.
Why the Other Options Are Wrong:
A. There is a large amount of bright red lochia with large clots
This suggests excessive bleeding and possible uterine atony, which indicates that the oxytocin is not effective.
C. Fundus is boggy to palpation at the umbilicus
A boggy uterus is soft and indicates poor contraction, increasing the risk for hemorrhage. This is a sign of oxytocin being ineffective.
D. Lochia is absent
Complete absence of lochia may indicate retained products of conception or uterine blockage, which is not a typical or desired outcome after birth. Some lochia is expected postpartum.
An 18-month-old girl is diagnosed as having atopic dermatitis. When interviewing her parents, they describe the following care measures. Which one would lead you to think more health teaching is needed
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To dry lesions, the father applies alcohol to lesions daily
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To aid healing, the father applies hydrocortisone cream to the lesions
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After a bath, the mother applies Eucerin cream
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The mother gives her a daily bath without using soap
Explanation
Correct Answer A. To dry lesions, the father applies alcohol to lesions daily
Explanation:
Applying alcohol to lesions is harmful and inappropriate for atopic dermatitis. Alcohol is extremely drying and irritating, which worsens the skin barrier breakdown and increases itching and inflammation. This indicates a lack of understanding of proper skin care for eczema and calls for immediate education.
Why the Other Options Are Wrong:
B. To aid healing, the father applies hydrocortisone cream to the lesions
Hydrocortisone cream is a standard topical treatment for mild to moderate atopic dermatitis and helps reduce inflammation and itching when used as directed.
C. After a bath, the mother applies Eucerin cream
Eucerin is a thick emollient, and applying it after bathing helps lock in moisture — a highly recommended practice in eczema care.
D. The mother gives her a daily bath without using soap
Daily bathing without soap helps hydrate the skin without introducing irritants. It’s a correct approach for children with eczema.
Which is the most common characteristic associated with Nephrotic syndrome
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Increasing weight loss
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Increased urinary output
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Generalized edema
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Hypertension
Explanation
Correct Answer C. Generalized edema
Explanation:
Generalized edema is the hallmark feature of nephrotic syndrome and is usually the most noticeable clinical sign. It results from massive protein loss in the urine (proteinuria), which reduces oncotic pressure in the blood, causing fluid to shift into interstitial spaces. This leads to swelling in the face, abdomen, and extremities.
Why the Other Options Are Wrong:
A. Increasing weight loss
Children with nephrotic syndrome usually experience weight gain due to fluid retention, not weight loss. Weight loss is not a primary symptom.
B. Increased urinary output
Nephrotic syndrome typically presents with decreased urinary output due to fluid retention and kidney dysfunction. Polyuria is not a common feature.
D. Hypertension
Although high blood pressure can occur in kidney conditions, it is not the most common or defining feature of nephrotic syndrome. Edema is more prominent in early presentation.
A 2-year-old toddler is seen for croup (acute laryngotracheobronchitis). What observation would lead the nurse to suspect airway occlusion
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The nasal discharge is increasing
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The cough is becoming harsher
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The respiratory rate is gradually increasing
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The toddler states being tired and wanting to sleep
Explanation
Correct Answer C. The respiratory rate is gradually increasing
Explanation:
An increasing respiratory rate is an early and important sign of respiratory distress and potential airway occlusion in a child with croup. As the airway becomes more inflamed or obstructed, the child compensates by breathing faster to maintain oxygenation. If not addressed, this can progress to exhaustion and respiratory failure.
Why the Other Options Are Wrong:
A. The nasal discharge is increasing
Increased nasal discharge is typical in upper respiratory infections but is not a direct sign of airway occlusion or distress.
B. The cough is becoming harsher
A harsh, barking cough is expected in croup and does not necessarily indicate worsening airway obstruction.
D. The toddler states being tired and wanting to sleep
Fatigue is non-specific. While it can be concerning if paired with other signs like lethargy or decreased responsiveness, it is not as reliable a sign of acute airway compromise as increased respiratory rate.
. If the fetal monitor demonstrates the following pattern, which action would the nurse perform first?
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Prepare for vaginal delivery
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Administer oxygen at 3–4 liters via nasal cannula
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Turn the client or ask the client to turn on their side
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Perform a vaginal exam to assess for the umbilical cord
Explanation
Correct Answer C. Turn the client or ask the client to turn on their side
Explanation:
The image shows variable decelerations, which are abrupt drops in fetal heart rate and are often caused by umbilical cord compression. The first nursing action is to reposition the client, typically to a side-lying position, to relieve cord pressure and improve fetal oxygenation. This is a rapid and non-invasive intervention that can immediately impact fetal status.
Why the Other Options Are Wrong:
A. Prepare for vaginal delivery
This is premature. Delivery may be necessary if the condition persists, but initial interventions to relieve the decelerations must be attempted first.
B. Administer oxygen at 3–4 liters via nasal cannula
Oxygen may be helpful, but repositioning is more immediate and effective in relieving cord compression, making it the priority action.
D. Perform a vaginal exam to assess for the umbilical cord
This is appropriate after repositioning, especially if variable decelerations persist or worsen, to rule out cord prolapse. However, it's not the first step.
A client with sickle cell disease is in a vaso-occlusive crisis and reporting a severe headache with blurry vision. What intervention should the nurse perform first
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Administer analgesic medication
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Assess the client's neurological status
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Increase the client's intravenous fluids
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Administer 2 L of oxygen via nasal cannula
Explanation
Correct Answer B. Assess the client's neurological status
Explanation:
A severe headache with blurry vision in a client with sickle cell disease could indicate a stroke or other neurologic complication, which is a medical emergency. The first priority is to perform a focused neurological assessment to detect signs of increased intracranial pressure or neurologic compromise, guiding the urgency of medical intervention.
Why the Other Options Are Wrong:
A. Administer analgesic medication
Pain control is important in vaso-occlusive crisis, but it is not the priority when new or worsening neurological symptoms are present. Analgesics could mask changes in mental status.
C. Increase the client's intravenous fluids
Hydration helps reduce sickling, but it is a supportive measure. It does not address the immediate risk of a possible neurologic event.
D. Administer 2 L of oxygen via nasal cannula
Oxygen may be beneficial in sickle cell crisis, but it is not the first action when symptoms suggest potential neurological impairment, which takes precedence.
A nurse receives a call from a parent concerned that their toddler ingested half of a bottle of ferrous sulfate vitamins. What should the nurse instruct the parent to do
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Have the child take docusate sodium
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Have the child drink orange juice
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Induce vomiting to remove as much medication as possible
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Contact the poison control center
Explanation
Correct Answer D. Contact the poison control center
Explanation:
Ferrous sulfate (iron) overdose in children is a medical emergency and can be fatal. The nurse's first and most appropriate action is to instruct the parent to immediately contact the poison control center, which will provide expert guidance on next steps, which may include emergency treatment or transport to the hospital.
Why the Other Options Are Wrong:
A. Have the child take docusate sodium
Docusate is a stool softener and does not treat iron toxicity. It is irrelevant and ineffective in this scenario.
B. Have the child drink orange juice
Orange juice can increase iron absorption and would worsen the toxicity, making this a dangerous recommendation.
C. Induce vomiting to remove as much medication as possible
Inducing vomiting is no longer recommended due to the risk of aspiration and ineffectiveness. Treatment should be guided by poison control or emergency services.
The nurse is assessing a client who is 2 weeks postpartum. The nurse would be concerned about mastitis if which of the following were noted
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Urinary frequency
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Flu-like symptoms
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Unilateral breast tenderness
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Unilateral breast erythema
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Uterine tenderness
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Bilateral breast firmness
Explanation
Correct Answers:
B. Flu-like symptoms
C. Unilateral breast tenderness
D. Unilateral breast erythema
Explanation of Correct Answers:
B. Flu-like symptoms
Clients with mastitis often experience fever, chills, fatigue, and body aches, which mimic flu symptoms. These are systemic signs of infection.
C. Unilateral breast tenderness
Mastitis usually affects one breast and causes localized pain or tenderness. This is a common early symptom.
D. Unilateral breast erythema
Redness or warmth over one breast is a hallmark of mastitis, often indicating inflammation or infection in a localized area.
Explanation of Incorrect Answers:
A. Urinary frequency
This symptom is more commonly associated with a urinary tract infection (UTI) and is not related to mastitis.
E. Uterine tenderness
Uterine tenderness may suggest endometritis, not mastitis. It involves a different postpartum complication.
F. Bilateral breast firmness
This could be related to engorgement or milk production, which is normal in lactating clients and not specific to mastitis.
The nurse is caring for a client who had a cesarean section birth. Which of the following would be the most important assessment to make
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If signs of infection are present at the incision site
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If they plan to return to work postpartum
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If signs of infection are present at the perineal site
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If their breasts fill by the 1st postpartum day
Explanation
Correct Answer A. If signs of infection are present at the incision site
Explanation:
For a client recovering from a cesarean section, the incision site is a primary area of concern. The nurse must monitor for signs of infection, such as redness, swelling, warmth, drainage, or increased pain, as this can lead to serious complications like wound dehiscence or sepsis if untreated.
Why the Other Options Are Wrong:
B. If they plan to return to work postpartum
While this is important for discharge planning and support, it is not a priority assessment during the immediate post-op recovery period.
C. If signs of infection are present at the perineal site
Perineal assessment is more relevant for vaginal births. After a cesarean, the abdominal incision is the main focus.
D. If their breasts fill by the 1st postpartum day
Breast fullness usually begins around day 2–3 postpartum. While important for lactation assessment, it is not the most urgent concern compared to the risk of surgical site infection.
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