NUR 404_Exam One
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Free NUR 404_Exam One Questions
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.
While caring for a pregnant 17 year old, the client states, "I want to deliver my baby at an alternative birth center." Which information would be most important for the nurse to keep in mind when responding to the client?
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Adolescent pregnancy is considered a high-risk situation
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Typically, the adolescent's support group would disapprove of this choice
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Alternative birth centers only admit clients over the age of 21 years
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Alternative birth centers are a suitable option for all pregnant women
Explanation
Correct Answer:
A Adolescent pregnancy is considered a high-risk situation
Explanation of Correct Answer
Adolescent pregnancy is classified as high-risk because younger mothers face increased chances of complications such as preterm labor, low-birth-weight infants, hypertensive disorders, and psychosocial challenges. Alternative birth centers are generally designed for low-risk pregnancies, making this option less appropriate for a 17-year-old. The nurse must prioritize safety by considering maternal and fetal risk factors before supporting delivery in an alternative setting.
The nurse is caring for a client whose fetus is +4 station and in vertex presentation. The nurse notices the fetus heart rate drops from 160 to 120. The nurse plans and implements care with which consideration in mind?
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Severe back discomfort will occur for the client
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A cesarean birth probably will be necessary
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The fetus is experiencing increased intracranial pressure
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The decreased heart rate is from meconium in the amniotic fluid
Explanation
Correct Answer:
C The fetus is experiencing increased intracranial pressure
Explanation of Correct Answer
At a +4 station, the fetal head is deep in the maternal pelvis, very close to delivery. A temporary drop in fetal heart rate at this point usually represents an early deceleration, which occurs from head compression. This compression increases intracranial pressure, stimulating the vagus nerve and causing a predictable slowing of the fetal heart rate. It is considered a benign, expected finding in the second stage of labor, not requiring a cesarean or emergent intervention.
Immediately following an epidural block, a client's blood pressure falls to 90/50. Which priority action would the nurse take?
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Administer Oxytocin
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Administer 6L oxygen via face mask
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Turn client on their left side and increase intravenous fluids
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Raise the head of the bed and elevate the patient's legs
Explanation
Correct Answer:
C Turn client on their left side and increase intravenous fluids
Explanation of Correct Answer
The priority action for hypotension following an epidural block is to position the client on their left side to enhance venous return and improve uteroplacental perfusion, while also increasing IV fluids to correct hypovolemia. This directly addresses the cause of low blood pressure and prevents fetal compromise. Oxygen may be added later if needed, but repositioning and fluid bolus come first in management.
The nurse is assessing the fetal position using the Leopold maneuver, what position based on the photograph is the fetus in?
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LOP
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ROA
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ROP
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LOA
Explanation
Correct Answer:
D LOA
Explanation of Correct Answer
The illustration shows the fetus in vertex presentation with the occiput (back of the head) pointing toward the mother’s left anterior quadrant. This is the left occiput anterior (LOA) position, the most common and favorable fetal position for vaginal delivery. In LOA, the baby’s spine aligns with the mother’s left side, and the occiput faces anteriorly toward the maternal symphysis pubis, promoting efficient descent through the birth canal.
The client is inquiring to the health care provider about what pelvis is rounded, forward facing, with a wide pubic arch ideal for childbirth. Place the correct pelvis from the possible answers row into the correct pelvis based on the description.
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Android -
Anthropoid -
Gynecoid -
Platypelloid
Explanation
Correct Answer:
C. Gynecoid
Explanation of Correct Answer
The gynecoid pelvis is the most common and is considered the ideal pelvic shape for childbirth. It is characterized by a rounded inlet, forward orientation, and a wide pubic arch, which provides ample space for the fetal head to descend. This shape minimizes the risk of obstructed labor and is associated with favorable birth outcomes.
The other pelvic shapes (android, anthropoid, and platypelloid) may pose varying degrees of difficulty during labor and delivery, but the gynecoid pelvis (picture 3) is the correct and ideal one described.
The nurse is caring for a client who is in active labor, is 75 % effaced, 4 cm dilated and at +1 station. Which stage of labor will the nurse document that the client has reached?
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Transition Phase
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First Stage
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Third Stage
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Second Stage
Explanation
Correct Answer:
B First Stage
Explanation of Correct Answer
The first stage of labor begins with the onset of true labor contractions and continues until full cervical dilation (10 cm). It has three phases: latent (0–3 cm), active (4–7 cm), and transition (8–10 cm). At 4 cm dilation, 75% effacement, and +1 station, the client is in the active phase of the first stage of labor.
A pregnant client asks the nurse the purpose of the maternal serum alpha-fetoprotein (MSAFP) test. How would the nurse respond?
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It measures maternal liver function
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It is a screening test for placental function
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It tests the ability of her heart to accommodate the pregnancy
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It is a screening test for neural tube defects
Explanation
Correct Answer:
D It is a screening test for neural tube defects
Explanation of Correct Answer
The maternal serum alpha-fetoprotein (MSAFP) test is performed during the second trimester (typically 15–20 weeks) to screen for neural tube defects such as spina bifida and anencephaly. Elevated levels suggest possible defects, while low levels may be associated with chromosomal abnormalities such as Down syndrome. It does not assess maternal liver function, placental function, or cardiac ability. This test is only a screening tool, and abnormal results require follow-up diagnostic testing like amniocentesis or ultrasound.
An amniotomy is performed on a laboring client at 42 weeks' gestation. What priority intervention should the nurse perform?
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Assessing the characteristics of the amniotic fluid
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Monitoring the client for signs of infection
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Inspecting the perineum for bloody discharge
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Checking the fetal heart rate
Explanation
Correct Answer:
D Checking the fetal heart rate
Explanation of Correct Answer
The priority nursing action after an amniotomy is to immediately assess the fetal heart rate. This is done to detect possible complications such as umbilical cord prolapse or compression, which can occur when the amniotic sac is ruptured. Prompt evaluation ensures the fetus is not compromised and allows for immediate intervention if abnormalities are detected. Monitoring fluid and infection are important but secondary to fetal safety.
A pregnant client had decided to breastfeed the infant but, after delivery, tells the nurse that formula feeding would be the best choice for her now. What nursing diagnosis should the nurse use to plan this client's care?
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Anxiety
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Ineffective coping
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Imbalanced nutrition
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Risk for impaired parenting
Explanation
Correct Answer:
D. Risk for impaired parenting
Explanation of Correct Answer
A sudden change in the decision regarding infant feeding may indicate potential challenges in establishing effective parenting behaviors. Using formula feeding contrary to prior intentions could reflect uncertainty or difficulty in adapting to newborn care, which may affect the parent–infant bond. Identifying this risk allows the nurse to provide support, education, and guidance to promote positive parenting practices. Anxiety, coping, or nutrition concerns are secondary unless further issues are evident.
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