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.
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 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.
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.
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.
Which medication would the nurse expect the primary health care provider to prescribe to a postpartum patient with uterine atony?
- Methylergonovine
- Misoprostol
- Ergonovine
- Oxytocin
Explanation
Oxytocin (Pitocin) is the first-line medication used to treat uterine atony, which is the failure of the uterus to contract effectively after childbirth—a major cause of postpartum hemorrhage. Oxytocin stimulates the smooth muscle of the uterus, promoting strong, rhythmic contractions that compress blood vessels and reduce bleeding. It can be given intravenously (IV) or intramuscularly (IM) and is usually administered immediately after delivery of the placenta as part of active management of the third stage of labor.
Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet?
- Iron and folate
- Calcium and zinc
- Vitamins C and B6
- Vitamins A and D
Explanation
Iron and folate (folic acid) are the most commonly recommended supplements during pregnancy. Folate is crucial in the first trimester to prevent neural tube defects such as spina bifida, while iron supports the increased production of maternal red blood cells and prevents iron-deficiency anemia. Both nutrients are vital for fetal growth, placental development, and adequate oxygen delivery to the fetus.
The nurse advises a pregnant patient to take an iron supplement as well as incorporate whole grains, bran, vegetables, and nuts in the diet, while also drinking adequate amounts of fluids. The most likely rationale is that iron supplements can cause which complication?
- Pyrosis and peptic ulcers
- Nausea and vomiting
- Black or dark green stools
- Severe constipation
Explanation
Iron supplements commonly cause gastrointestinal side effects, the most significant being constipation. Iron slows intestinal motility by binding with digestive enzymes, which reduces peristalsis. Pregnant women are especially prone to constipation due to progesterone-induced smooth muscle relaxation. Therefore, the nurse recommends high-fiber foods (whole grains, bran, vegetables, and nuts) and adequate fluid intake to promote bowel regularity and minimize discomfort.
A pregnant patient is receiving tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest discontinuing the therapy?
- Urine output is 40 mL/hr.
- Respiratory rate is 10 breaths/min.
- Blood pressure is 120/80 mm Hg.
- Serum magnesium level is 5 mEq/L.
Explanation
Magnesium sulfate can cause respiratory depression when serum magnesium levels become toxic. A respiratory rate below 12 breaths per minute indicates potential magnesium toxicity and requires immediate discontinuation of the drug. The nurse should notify the provider, stop the infusion, and administer calcium gluconate as the antidote if ordered. Continuous monitoring of reflexes, respiratory rate, and urine output is critical during magnesium sulfate therapy to ensure maternal safety.
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