NUR 404 Exam 2 SU25 Community Health Nursing
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Free NUR 404 Exam 2 SU25 Community Health Nursing Questions
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.
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.
Kawasaki syndrome is a diagnosis of exclusion. Treatment for this diagnosis may include IVIG and high-dose aspirin therapy to prevent (1), which can lead to coronary artery aneurysms and other long-term cardiac complications
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Gastrointestinal Symptoms
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Respiratory Symptoms
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Visual Disturbances
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Integumentary Symptoms
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Hearing Loss
Explanation
Correct Answer D. Integumentary Symptoms
Explanation:
Kawasaki syndrome is a pediatric vasculitis that often presents with prominent integumentary symptoms, such as a rash, peeling of the hands and feet, conjunctival redness, and strawberry tongue. These skin and mucous membrane changes are characteristic of the acute phase of the disease. While the major concern is cardiac involvement (like coronary artery aneurysms), the initial signs are largely integumentary.
Why the Other Options Are Wrong:
A. Gastrointestinal Symptoms
Gastrointestinal symptoms may be present (e.g., abdominal pain), but they are not the hallmark nor the key symptom that leads to the diagnosis or complications of Kawasaki disease.
B. Respiratory Symptoms
Kawasaki disease is not primarily a respiratory illness and does not usually begin with cough, congestion, or breathing difficulty. These symptoms are not central to its presentation.
C. Visual Disturbances
Visual issues are not typically associated with Kawasaki disease. The eye involvement seen (non-exudative conjunctivitis) does not usually cause vision loss or disturbances.
E. Hearing Loss
Although rare cases may report transient hearing loss, it is not a defining or primary symptom and is not central to the diagnosis or treatment strategy.
What is the expected language skill level for the 2-3 year old toddler? The toddler would
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Not speak but be able to follow commands
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Speak in two-word sentences using both a noun and verb
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Speak clearly with all words understandable
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Know 800-900 words by age 2
Explanation
Correct Answer B. Speak in two-word sentences using both a noun and verb
Explanation:
By age 2 to 3, toddlers are expected to begin forming simple two-word sentences such as "want juice" or "go park," often combining a noun and a verb. This stage marks a major developmental milestone in expressive language and indicates growing communication skills.
Why the Other Options Are Wrong:
A. Not speak but be able to follow commands
This is more typical of a child closer to 12–18 months. By age 2, children are generally using spoken words and phrases.
C. Speak clearly with all words understandable
Clarity of speech improves over time. At age 2–3, many toddlers still mispronounce words. Full clarity is not expected until around age 4.
D. Know 800–900 words by age 2
While vocabulary grows rapidly, the average 2-year-old typically knows about 200–300 words. Knowing 800–900 words is more aligned with children closer to age 3–4.
A toddler is being treated for acetaminophen toxicity after an accidental overdose. The nurse should prepare to administer which medication
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Succimer
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Atropine
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Syrup of Ipecac
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Acetylcysteine
Explanation
Correct Answer D. Acetylcysteine
Explanation:
Acetylcysteine is the antidote for acetaminophen (paracetamol) toxicity. It works by replenishing glutathione, a substance that helps detoxify the harmful metabolite of acetaminophen in the liver. When given early, it can prevent or reduce liver damage. It may be administered orally or IV depending on the situation.
Why the Other Options Are Wrong:
A. Succimer
Succimer is used to treat lead poisoning, not acetaminophen toxicity. It acts as a chelating agent to remove heavy metals.
B. Atropine
Atropine is used in cases of organophosphate poisoning or to treat bradycardia, not for acetaminophen overdose.
C. Syrup of Ipecac
Syrup of Ipecac induces vomiting but is no longer recommended in poisoning cases due to the risk of aspiration and because activated charcoal and antidotes are safer and more effective.
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.
After delivery of the placenta, a client's uterus is slow to contract. Which of the following is a priority nursing intervention
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Measure blood pressure hourly
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Prepare to administer blood products as prescribed
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Administer intravenous fluids
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Initiate oxytocin infusion as prescribed
Explanation
Correct Answer D. Initiate oxytocin infusion as prescribed
Explanation:
The priority action when the uterus is slow to contract after placental delivery is to stimulate uterine contraction to prevent postpartum hemorrhage. Oxytocin is the first-line uterotonic medication prescribed for this purpose. It promotes uterine muscle contraction, helping to reduce bleeding and promote involution.
Why the Other Options Are Wrong:
A. Measure blood pressure hourly
Monitoring vital signs is important but not the immediate intervention to address uterine atony or bleeding.
B. Prepare to administer blood products as prescribed
This may be necessary if bleeding is severe, but the first step is to address the cause—in this case, poor uterine contraction—by giving oxytocin.
C. Administer intravenous fluids
Fluids may support circulation if bleeding occurs, but they do not treat uterine atony directly. Oxytocin must be given to stop the bleeding source.
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 postpartum client has been diagnosed with postpartum depression. Which of the following symptoms would the nurse anticipate the client was exhibiting, aiding in the diagnosis
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Insomnia
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Intermittent crying in the first 1 week postpartum, now resolved
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Delusions
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Induced vomiting
Explanation
Correct Answer A. Insomnia
Explanation:
Insomnia is a common symptom of postpartum depression. It may persist even when the baby is sleeping, and is often accompanied by fatigue, feelings of hopelessness, irritability, and difficulty bonding with the baby. It is a red flag when paired with other mood symptoms beyond the typical “baby blues.”
Why the Other Options Are Wrong:
B. Intermittent crying in the first 1 week postpartum, now resolved
This describes postpartum blues, which is temporary and self-resolving. It is not considered postpartum depression unless symptoms last longer than 2 weeks or worsen.
C. Delusions
Delusions are more indicative of postpartum psychosis, a severe and rare condition that is a psychiatric emergency, not postpartum depression.
D. Induced vomiting
This behavior is more consistent with an eating disorder, such as bulimia nervosa, and is not characteristic of postpartum depression.
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.
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