NUR 404_Exam One
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Free NUR 404_Exam One Questions
The nurse and student are discussing how to evaluate a client receiving Oxytocin in the third stage of labor. What does the nurse include as the desired outcome of this medication?
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Prevention of the occurrence of profuse bleeding after placental separation
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Limiting the discomfort of labor pains
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Stimulation of the client's breasts to begin lactating
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Relaxation of the uterus to expel the placenta
Explanation
Correct Answer:
A Prevention of the occurrence of profuse bleeding after placental separation
Explanation of Correct Answer
During the third stage of labor, oxytocin is administered to stimulate uterine contractions. The desired outcome is a firmly contracted uterus, which compresses blood vessels at the placental site and prevents postpartum hemorrhage. This is the primary purpose of oxytocin at this stage. It is not used to limit pain, stimulate lactation directly, or relax the uterus; rather, it promotes contraction and uterine tone to ensure maternal safety.
A nurse is assessing a 6-month-old infant. Which of the following reflexes should the infant exhibit?
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Moro
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Plantar grasp
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Stepping
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Tonic neck
Explanation
Correct Answer:
b) Plantar grasp
Explanation of Correct Answer
At 6 months, the plantar grasp reflex is still present and is considered a normal finding. When the sole of the infant’s foot is touched near the toes, the toes curl downward. This reflex typically disappears around 8 to 10 months of age as voluntary motor control develops.
A mother asks you how she can judge that her infant is receiving sufficient breast milk. What would be the most appropriate response?
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"You need to weigh the infant before and after each feeding."
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"The infant should sleep at least 3 hours between feedings."
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"The infant should gain weight and have six wet diapers daily."
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"The infant should not become constipated."
Explanation
Correct Answer:
C. "The infant should gain weight and have six wet diapers daily."
Explanation of Correct Answer
Adequate breastfeeding can be assessed by appropriate weight gain and urine output, typically at least six wet diapers per day after the first few days of life. This indicates sufficient milk intake. Weighing before and after feeds (A) is not routinely necessary. Sleeping 3 hours between feeds (B) or avoiding constipation (D) alone are not reliable indicators of adequate milk intake.
A 41 week gestation client in the second stage of labor has ruptured membranes and the fetus is in a breech position. During the assessment, the nurse notes green amniotic fluid. Which statement describes the nurse's findings?
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Meconium is being expelled with contractions
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Intrauterine infection has developed with late gestation
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The fetus has a neural tube defect
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Fetal well-being is compromised
Explanation
Correct Answer:
A Meconium is being expelled with contractions
Explanation of Correct Answer
Green-stained amniotic fluid indicates the presence of meconium, which is often expelled into the amniotic sac when the fetus experiences stress or hypoxia. In breech presentations, meconium passage can occur more commonly due to compression of the fetal abdomen and rectum during contractions. This does not directly confirm infection or a neural tube defect. The key finding here is that meconium is being expelled with contractions, which requires close monitoring for potential respiratory complications such as meconium aspiration after delivery.
The nurse explains to a pregnant client how ultrasound (US) can aid in the assessment of the fetus. What would the nurse include in the teaching? Select all that apply.
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Confirms placental size and location
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Estimates the amount of amniotic fluid
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Monitors fetal reactivity
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Diagnoses chromosomal abnormalities
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Estimates fetal size and gestational age
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Identifies the gender of the fetus
Explanation
Correct Answers:
A Confirms placental size and location
B Estimates the amount of amniotic fluid
E Estimates fetal size and gestational age
F Identifies the gender of the fetus
Explanation of Correct Answers
A Confirms placental size and location
Ultrasound is routinely used to visualize placental position (anterior, posterior, previa) and approximate size, helping detect complications such as placenta previa or abruption risk.
B Estimates the amount of amniotic fluid
Amniotic fluid volume can be assessed via amniotic fluid index (AFI) or the single deepest pocket method. Too little fluid (oligohydramnios) or too much (polyhydramnios) may indicate fetal or placental problems.
E Estimates fetal size and gestational age
Fetal biometry measurements such as biparietal diameter, head circumference, abdominal circumference, and femur length provide estimates of gestational age and growth patterns.
F Identifies the gender of the fetus
Visualization of external genitalia is possible by ultrasound, usually after 18–20 weeks of gestation, allowing identification of fetal sex if desired.
The nurse is explaining the process of breast milk production with a client pregnant with her first child. What should the nurse include when providing this teaching? Select all that apply.
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Breast milk is thin, yellow, and watery.
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For the first 3 to 4 days, the breast milk is colostrum.
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Uterine cramping is a contraindication to breastfeeding.
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True breast milk comes in by the 10th day after giving birth.
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Most mothers have breast milk by the first day after giving birth.
Explanation
Correct Answers:
B. For the first 3 to 4 days, the breast milk is colostrum.
D. True breast milk comes in by the 10th day after giving birth.
Explanation of Correct Answers
B. For the first 3 to 4 days, the breast milk is colostrum.
Colostrum is produced in the initial postpartum period and is rich in antibodies, nutrients, and immune factors. It provides essential protection and nutrition to the newborn before mature milk is available.
D. True breast milk comes in by the 10th day after giving birth.
Mature breast milk typically replaces colostrum by around the 10th day postpartum. This transition provides the newborn with higher volumes of milk containing adequate fat, protein, and calories necessary for growth and development.
Which of the following is an advantage of breastfeeding for the infant?
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Breast milk is more difficult to digest, so it makes the infant feel fuller longer.
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Breast milk contains antibodies and thus decreases the possibility of gastrointestinal illnesses.
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It takes less effort for an infant to suck at a breast than from a bottle.
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Breast milk leads to firmer stools, increasing bowel tone
Explanation
Correct Answer:
B. Breast milk contains antibodies and thus decreases the possibility of gastrointestinal illnesses.
Explanation of Correct Answer
Breast milk provides immunologic protection through antibodies (especially IgA), which help prevent gastrointestinal and respiratory infections in the infant. Breast milk is also easily digested (contrary to A), requires more effort to suck than a bottle (opposite of C), and typically produces softer stools (contrary to D), which are normal for healthy breastfed infants.
A nurse is conducting a well-baby visit with a 4-month-old infant. Which of the following immunizations should the nurse plan to administer to the infant? (Select all that apply)
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MMR
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Polio (IPV)
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Pneumococcal vaccine (PCV)
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Varicella
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Rotavirus vaccine (RV)
Explanation
Correct Answers:
b) Polio (IPV)
c) Pneumococcal vaccine (PCV)
e) Rotavirus vaccine (RV)
Explanation of Correct Answers
b) Polio (IPV)
The inactivated poliovirus vaccine is given at 2 months, 4 months, and again at later intervals. At the 4-month visit, IPV is part of the recommended immunization series.
c) Pneumococcal vaccine (PCV)
The pneumococcal conjugate vaccine is administered at 2 months, 4 months, 6 months, and 12–15 months. The 4-month visit includes this dose to build immunity against Streptococcus pneumoniae.
e) Rotavirus vaccine (RV)
Rotavirus immunization is given orally at 2 months and 4 months (some series also include a 6-month dose, depending on the vaccine brand). The 4-month visit includes this scheduled dose.
A nurse is creating the plan of care for a client who is at 39 weeks of gestation and in labor. A vaginal exam reveals that the client's cervix is 3 cm dilated, 50% effaced, and -1 station. The client asks for pain medication. Which action would the nurse take?
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Offer the client the option to start epidural anesthesia
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Encourage use of non-pharmacologic alternative comfort measures
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Administer narcotic analgesia per standing orders
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Offer the client ice chips and breakfast
Explanation
Correct Answer:
C Administer narcotic analgesia per standing orders
Explanation of Correct Answer
At 3 cm dilation, the client is in the latent/early phase of the first stage of labor. This is an appropriate time to provide narcotic analgesia, as it can offer effective pain relief without delaying labor progress. Epidural anesthesia is usually considered later when labor is more active, and food intake is contraindicated during active labor due to aspiration risk. Non-pharmacologic measures can be supportive but are not the primary intervention when the client specifically requests medication.
The parents of a newborn are concerned that something is wrong with their newborn's eyesight. What should the nurse instruct the parents as being an expected finding in the newborn?
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Produces tears when he cries
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Follows a light to the midline
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Has a white rather than a red reflex
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Follows the finger a full 180 degrees
Explanation
Correct Answer:
B. Follows a light to the midline
Explanation of Correct Answer
Newborns have limited visual ability and can briefly follow a light or object to the midline, but not beyond. Tear production usually begins around 2 to 3 months, not at birth. A red reflex is normal; a white reflex is abnormal and may indicate retinoblastoma or cataracts. Following a finger a full 180 degrees is beyond the visual capacity of a newborn.
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