NUR 404 Exam 2 SU25 Community Health Nursing
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Free NUR 404 Exam 2 SU25 Community Health Nursing Questions
. 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.
Which measure would be most effective in aiding bronchodilation in a child with croup (laryngotracheobronchitis)
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Assisting with racemic epinephrine nebulizer therapy
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Teaching the child to take long, slow breaths
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Administering an oral analgesic
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Urging the child to continue to take oral fluids
Explanation
Correct Answer A. Assisting with racemic epinephrine nebulizer therapy
Explanation:
Racemic epinephrine is the most effective treatment for moderate to severe croup. It provides rapid bronchodilation and reduces airway swelling by vasoconstricting the mucosa of the upper airway, improving oxygenation and breathing. It's commonly used in emergency or hospital settings to relieve stridor and respiratory distress.
Why the Other Options Are Wrong:
B. Teaching the child to take long, slow breaths
While calm breathing can help reduce distress, it does not provide actual bronchodilation or reduce airway inflammation, making it insufficient alone for managing croup.
C. Administering an oral analgesic
Analgesics may reduce discomfort or fever, but they have no direct effect on airway constriction or inflammation. They do not assist with bronchodilation.
D. Urging the child to continue to take oral fluids
Maintaining hydration is important but does not directly aid in bronchodilation or reduce airway obstruction, which is the priority in acute croup management.
A client who gave birth 5 hours ago has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first
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Assess the fundus
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Begin an IV infusion of Ringer's lactate solution
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Assess vital signs
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Notify the health care provider
Explanation
Correct Answer A. Assess the fundus
Explanation:
The first action is to assess the fundus, as uterine atony (a boggy or soft uterus) is the most common cause of early postpartum hemorrhage. If the fundus is found to be boggy, the nurse should immediately begin fundal massage to stimulate contraction and reduce bleeding. Identifying and treating the source is the priority.
Why the Other Options Are Wrong:
B. Begin an IV infusion of Ringer's lactate solution
Fluids may be necessary if hemorrhage continues, but they are supportive, not diagnostic. The cause of the bleeding must be addressed first.
C. Assess vital signs
While vital signs are important to monitor for shock, they do not address the cause of bleeding and are not the first step.
D. Notify the health care provider
The nurse must assess and intervene immediately. Waiting for the provider without taking action could delay life-saving measures.
A client who is in the transition phase reports the narcotic pain medication they last received 3 hours ago has worn off. The client asks if they can have another dose of the narcotic. How should the nurse respond to the request
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It is too early as the medication should be given only every 4 hours
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I will get permission from your health care provider
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Since it has been over 3 hours, you should be able to have more of the medication
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Your phase of labor makes giving another dose unsafe for the fetus
Explanation
Correct Answer D. Your phase of labor makes giving another dose unsafe for the fetus
Explanation:
During the transition phase of labor (usually 7–10 cm dilation), labor is progressing quickly, and birth is approaching. Giving narcotics at this time can cause respiratory depression in the newborn if birth occurs before the drug wears off. The timing, not just the interval since the last dose, must be considered. Safety of the fetus is the priority.
Why the Other Options Are Wrong:
A. It is too early as the medication should be given only every 4 hours
This assumes a fixed schedule without considering the stage of labor. The issue isn’t only time—it’s the proximity to delivery.
B. I will get permission from your health care provider
While provider input is necessary, this response avoids informing the client about the reason for withholding the medication and delays proper communication.
C. Since it has been over 3 hours, you should be able to have more of the medication
This ignores the critical safety concern about administering narcotics close to delivery. Time alone doesn’t determine appropriateness.
What information would the nurse document regarding a patient's reported allergies
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Family history of allergies
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Type of allergic reaction
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Medication names
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Epi Pen use for allergic reactions
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Date of allergic reaction
Explanation
Correct Answers:
B. Type of allergic reaction
C. Medication names
D. Epi Pen use for allergic reactions
Explanation of Correct Answers:
B. Type of allergic reaction
It is essential to document what kind of reaction the patient experiences (e.g., rash, anaphylaxis, nausea). This helps differentiate true allergies from side effects.
C. Medication names
The nurse must document the specific medications or substances the patient is allergic to in order to prevent future exposure.
D. Epi Pen use for allergic reactions
If a patient has used or carries an Epi Pen, this suggests a history of severe allergic reactions (e.g., anaphylaxis), which is critical information for care planning.
Explanation of Incorrect Answers:
A. Family history of allergies
While useful, family history is not directly relevant when documenting the patient’s personal allergies. The focus should be on the patient's own reactions.
E. Date of allergic reaction
The exact date is not always known or necessary. The type and severity of the reaction are more clinically significant for documentation and safety.
A nurse is taking care of a post-operative cesarean section patient who underwent an emergency cesarean section due to a category III fetal heart tracing 12 hours ago. The patient is upset as a cesarean section was not part of their birth plan and wants to know if they will be able to have a vaginal delivery with their next pregnancy. The best response by the nurse would be
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This is not something you should worry about right now
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There are no contraindications to a vaginal delivery in the future during the surgery
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Unfortunately you will need a cesarean section for all your future pregnancies
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The largest contributing factor to method of delivery with any future pregnancies is the type of incision the physician performed on your uterus
Explanation
Correct Answer D. The largest contributing factor to method of delivery with any future pregnancies is the type of incision the physician performed on your uterus
Explanation:
This response provides factual, non-judgmental information. The type of uterine incision (low transverse vs. classical/vertical) determines the safety of attempting a vaginal birth after cesarean (VBAC). A low transverse incision is often compatible with a VBAC in future pregnancies, while a classical incision carries higher risk and usually requires repeat cesarean.
Why the Other Options Are Wrong:
A. This is not something you should worry about right now
This dismisses the patient’s concern and undermines their right to ask about future care. It is not therapeutic or supportive.
B. There are no contraindications to a vaginal delivery in the future during the surgery
This statement is overly broad and inaccurate. It assumes surgical details that may not apply and does not take the uterine incision type into account.
C. Unfortunately you will need a cesarean section for all your future pregnancies
This is not always true. Many patients can be candidates for VBAC depending on the type of uterine incision and other clinical factors. It's too definitive and discouraging.
The nurse is administering methylergonovine 0.2 mg to a healthy postpartum client with uterine atony. Which assessment will the nurse need to make prior to administering the medication
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If blood pressure is lower than 140/90 mm Hg
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If hematocrit level is higher than 45%
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If urine output is higher than 50 ml/hr
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If the client can walk without experiencing dizziness
Explanation
Correct Answer A. If blood pressure is lower than 140/90 mm Hg
Explanation:
Methylergonovine (Methergine) is a uterotonic medication used to treat uterine atony and prevent postpartum hemorrhage. It causes vasoconstriction, which can increase blood pressure. Therefore, it is contraindicated in clients with hypertension or preeclampsia. The nurse must assess that the blood pressure is below 140/90 mm Hg before giving the medication.
Why the Other Options Are Wrong:
B. If hematocrit level is higher than 45%
Hematocrit level is not directly relevant to the safe administration of methylergonovine. This option does not assess the medication's contraindications.
C. If urine output is higher than 50 ml/hr
While monitoring output is important postpartum, urine output is not a priority assessment specifically related to methylergonovine administration.
D. If the client can walk without experiencing dizziness
Dizziness is not a direct contraindication or consideration before administering methylergonovine. Blood pressure status is the critical assessment.
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 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.
Progress Nete
June 24. 2025 10am
Vital signs: T 98.6 HR 88 BP 12B/B0 02 99 RR 22
Firm furdus palpated 1 firger breadth above umbilicus and deviated to the left. Small amount of lochia rubra noted on the perineal pad.
XXX, RN
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Firmly massage the fundus
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Ask the client to empty their bladder and reassess
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Elevate the head of bed
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Notify the healthcare provider
Explanation
Correct Answer B. Ask the client to empty their bladder and reassess
Explanation:
A fundus that is deviated from midline and elevated (even if firm) is often caused by a full bladder, which displaces the uterus and can interfere with involution and increase the risk of bleeding. The first intervention is to have the client empty their bladder, which usually helps the uterus return to the midline and descend appropriately.
Why the Other Options Are Wrong:
A. Firmly massage the fundus
The fundus is already described as firm, so massage is not necessary and could cause discomfort or uterine irritability.
C. Elevate the head of bed
There is no indication that this position change will address uterine deviation or fundal height. It does not resolve the underlying cause.
D. Notify the healthcare provider
This is not necessary at this stage. The nurse should first attempt a nursing intervention (bladder emptying) before escalating.
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