PN 136-01 Maternal Health Nursing Exam at Nightingale College
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Free PN 136-01 Maternal Health Nursing Exam at Nightingale College Questions
Which is the most likely reason for preeclampsia in a pregnant patient during the second trimester of her pregnancy?
- Body mass index (BMI) of 34.2 kg/m²
- Severe hypotension
- Hypervitaminosis
- Lower extremity edema
Explanation
A BMI of 34.2 kg/m² indicates obesity, which is a major risk factor for preeclampsia. Obesity contributes to endothelial dysfunction, insulin resistance, and chronic inflammation, all of which impair placental perfusion and increase blood pressure. Preeclampsia typically develops after 20 weeks of gestation and is characterized by hypertension and proteinuria due to abnormal placental vascular development. Obese women are at higher risk for complications such as gestational hypertension, preeclampsia, and eclampsia.
The nurse instructs a pregnant patient to breathe through the mouth and keep it open while pushing during labor. Which is the rationale for this nursing intervention?
- To decrease the efforts required for pushing
- To avoid nasal congestion in the patient
- To facilitate increased oxygen to the fetus
- To avoid deceleration in the fetal heart rate
Explanation
During labor, open-mouth breathing ensures a steady flow of oxygen to both the mother and the fetus. Controlled breathing helps the woman avoid prolonged breath-holding (Valsalva maneuver), which can reduce venous return and cardiac output, thereby decreasing uteroplacental blood flow and leading to fetal hypoxia. By keeping the mouth open and breathing rhythmically, the patient maintains better oxygenation, which supports effective contractions and reduces stress on the fetus.
Which guidance will the nurse provide to a pregnant patient with iron-deficiency anemia who was recently started on iron supplementation, when the patient reports nausea?
- Take the supplement at bedtime
- Take the supplement between meals
- Take a double dose of iron if a dose is missed
- Take the supplement with a glass of whole milk
Explanation
Iron supplements often cause gastrointestinal discomfort, including nausea, constipation, and stomach upset. Taking the supplement at bedtime may help reduce nausea because the patient is lying down and less likely to feel the side effects. This adjustment improves adherence while still allowing for adequate absorption. The nurse should also encourage taking iron with vitamin C (e.g., orange juice) to enhance absorption and avoid taking it with dairy, tea, or coffee.
Which actions does the nurse take to provide improved and efficient care to a patient? Select all that apply.
- Uses advanced technology
- Uses the internet and social media
- Suggests expensive treatments
- Involves the patient in decision-making
- Implements traditional nursing practices
Explanation
A. Uses advanced technology:
Integrating modern medical technologies—such as electronic health records, telehealth, and monitoring devices—enhances accuracy, efficiency, and safety in nursing care. Technology allows for faster communication, real-time assessment, and evidence-based interventions.
D. Involves the patient in decision-making:
Engaging the patient in shared decision-making promotes patient-centered care, improves satisfaction, and enhances adherence to the care plan. Collaboration fosters trust and empowers patients to take an active role in their health outcomes.
Which will the nurse teach the patient about the benefits of combining relaxation with walking, slow dancing, or rocking?
- This method may help increase abdominal pressure.
- This method may help manage stress throughout life.
- This method may help the baby rotate through the pelvis.
- This method may help distract and divert from pain.
Explanation
Combining relaxation with gentle movements such as walking, slow dancing, or rocking encourages optimal fetal positioning and helps the baby rotate through the pelvis during labor. These rhythmic motions promote pelvic mobility and alignment, allowing gravity to assist in fetal descent. Relaxation prevents muscle tension that can hinder labor progress, while movement facilitates uterine contractions and improves maternal comfort, supporting a smoother, more efficient labor process.
A patient who gave birth 4 days ago reports that her vaginal discharge has an offensive odor. Which patient clinical condition does the nurse infer from this?
- Postpartum hemorrhage
- Infection
- High oxytocin levels
- Normal lochia discharge
Explanation
A foul or offensive odor from vaginal discharge (lochia) after childbirth is an abnormal finding and typically indicates a uterine or vaginal infection, such as endometritis. Normally, lochia has a fleshy or musty odor, but never a strong or foul smell. Infection may also be accompanied by fever, uterine tenderness, and increased lochia volume. The nurse should notify the healthcare provider immediately for evaluation and treatment with antibiotics to prevent complications like sepsis.
Which of the following are one of the 5 Ps of labor? Select all that apply.
- Position
- Psychological response
- Powers
- Passenger
- Passageway
- Placenta
Explanation
A. Position
Position refers to the posture and movements of the laboring mother. The woman’s position affects the mechanics of labor by influencing pelvic dimensions, fetal alignment, and uterine efficiency. Positions such as squatting, side-lying, or hands-and-knees can facilitate descent and rotation of the fetus. Frequent position changes also promote comfort and enhance circulation to both the mother and fetus.
B. Psychological response
Psychological response refers to the emotional and mental state of the mother during labor. Anxiety, fear, and tension can release catecholamines that reduce uterine contractility and blood flow to the uterus, slowing labor. A calm, supported, and confident mother typically experiences more effective contractions and smoother labor progression.
C. Powers
Powers represent the forces that expel the fetus. These include the primary powers (involuntary uterine contractions) and secondary powers (voluntary maternal pushing efforts). Effective contractions lead to cervical dilation, effacement, and fetal descent. Coordination between contractions and pushing ensures safe and efficient delivery.
D. Passenger
Passenger refers to the fetus and its relationship to the maternal pelvis. Key aspects include fetal size, presentation, lie, attitude, and position. For example, a cephalic presentation and proper fetal alignment usually lead to an easier labor, while abnormal presentations like breech can complicate delivery.
E. Passageway
Passageway encompasses the mother’s bony pelvis and soft tissues through which the baby passes. The size, shape, and flexibility of the pelvis, along with the condition of the cervix, vagina, and perineum, affect how smoothly the baby descends. Adequate pelvic dimensions and tissue elasticity are crucial for safe delivery.
Which will the nurse mention to the patient about the effect of secondary powers during labor?
- Contractions are expulsive in nature
- Contractions begin at pacemaker points
- Contractions move downward in waves
- The intraabdominal pressure is decreased
Explanation
Secondary powers refer to the voluntary bearing-down efforts made by the mother during the second stage of labor, which aid in expelling the fetus. These powers work in conjunction with uterine contractions (primary powers) and are expulsive in nature, generated by increased intra-abdominal pressure from the diaphragm and abdominal muscles. The effectiveness of secondary powers largely determines the progress of fetal descent and delivery.
A patient gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the patient's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, what is the most serious consequence likely to occur from bladder distention?
- Excessive uterine bleeding
- Urinary tract infection
- Bladder wall atony
- Ruptured bladder
Explanation
Bladder distention displaces the uterus upward and to the side, preventing effective uterine contraction. A relaxed (boggy) uterus cannot compress blood vessels at the placental site, leading to excessive postpartum bleeding or hemorrhage. Prompt bladder emptying—either through spontaneous voiding or catheterization—restores uterine tone and position, reducing the risk of hemorrhage and promoting normal postpartum recovery.
A 5-month pregnant female reports to the nurse that she feels dizzy after waking up in the morning. Which advice would the nurse give to the patient?
- "Use two pillows for your head while sleeping."
- "Try sleeping in the side-lying (lateral) position."
- "Try to spend less of your time sleeping."
- "Keep your legs elevated while sleeping."
Explanation
At around 20 weeks of gestation and beyond, the enlarging uterus can compress the inferior vena cava when the woman lies flat on her back. This causes supine hypotensive syndrome, leading to dizziness, pallor, and lightheadedness due to decreased venous return and cardiac output. The side-lying (especially left lateral) position prevents this compression, promotes optimal blood flow to the heart and placenta, and relieves dizziness.
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