Midterm Review 1

MIDTERM
REVIEW
The nurse is monitoring the amount of lochia drainage in a client
who is 2 hours postpartum and notes that the client has saturated
a perineal pad in 15 minutes. How should the nurse respond to
this finding initially?
TITLE LOREM IPSUM
Lorem ipsum dolor sit amet
a. Document the finding.
b. Encourage theDOLOR
Lorem ipsum dolor sit amet Lorem ipsum dolor sit amet
client to ambulate.
2017 2018 2019
c. Encourage the client to increase fluid intake.

2017 2018 2019
d. Contact the health care provider (HCP) and inform the HCP of
this finding Lorem ipsum dolor sit amet

The nurse is monitoring the amount of lochia drainage in a client
who is 2 hours postpartum and notes that the client has saturated
a perineal pad in 15 minutes. How should the nurse respond to
this finding initially?
TITLE LOREM IPSUM
a. Document the finding.
b. Encourage theDOLOR
client to ambulate.
2017 2018 2019
c. Encourage the client to increase fluid intake.

2017 2018 2019
d. Contact the health care provider (HCP) and inform the

HCP of this finding Lorem ipsum dolor sit amet

After a precipitous delivery, the nurse notes that the new mother is passive
Title Lorem Ipsum Dolor
and touches her newborn infant only briefly with her fingertips. What
should
the nurse does to help the woman process the delivery?
a. Encourage the mother to breast-feed soon after birth. Lorem ipsum dolor sit amet
b. Support the mother inLoremher
ipsum reaction
dolor sit amet to the newborn infant.Lorem ipsum dolor sit amet
c. Tell the mother that it is important to hold the newborn infant.
d. Document a complete account 2017
2017 of the mother’s 2018 reaction on the birth
2018 2019
2019
record.
After a precipitous delivery, the nurse notes that the new mother is passive
and touches her newborn infant only briefly with her fingertips. What
should
the nurse does to help the woman process the delivery?
a. Encourage the mother to breast-feed soon after birth. Lorem ipsum dolor sit amet
b. Support the motherLorem inipsum
her dolorreaction
sit amet to the newborn infant. Lorem ipsum dolor sit amet
c. Tell the mother that it is important to hold the newborn infant.

d. Document a complete account 2017
2017 of the mother’s 2018 reaction on the birth
2018 2019
2019
record.
The nurse is monitoring a client in the immediate postpartum period for
signs of hemorrhage. Which sign, if noted, would be an early sign of
excessive blood loss?
a. A temperature of 100.4 °F (38 °C)

b. An increase in the pulse rate from 88 to 102 beats/minute
c. A blood pressure change from 130/88 to

124/80 mm Hg 2017
2017
2018
2018
2019
2019
d. An increase in the respiratory rate from 18 to 22

breaths/minute Lorem ipsum dolor sit amet
The nurse is monitoring a client in the immediate postpartum period for
signs of hemorrhage. Which sign, if noted, would be an early sign of
excessive blood loss?
a. A temperature of 100.4 °F (38 °C)

b. An increase in the pulse rate from 88 to 102 beats/minute
c. A blood pressure change from 130/88 to

124/80 mm Hg 2017
2017
2018
2018
2019
2019
d. An increase in the respiratory rate from 18 to 22

breaths/minute Lorem ipsum dolor sit amet
Title Lorem
The nurse is providing Ipsum
instructions Dolor to prevent
about measures
postpartum mastitis to a client who is breast-feeding her
newborn. Which client statement would indicate a need for
further instruction?
a. “I should breast-feed every 2 to 3 hours.”
b. “I should change the breast pads frequently.”

2017 2018 2019
c. “I should wash my hands well before breastfeeding.”

2017 2018 2019
d. “I should wash my nipples daily with soap and water.”

Title Lorem
The nurse is providing Ipsum
instructions Dolor to prevent
about measures
postpartum mastitis to a client who is breast-feeding her
newborn. Which client statement would indicate a need for
further instruction?
a. “I should breast-feed every 2 to 3 hours.”
b. “I should change the breast pads frequently.”

2017 2018 2019
c. “I should wash my hands well before breastfeeding.”

2017 2018 2019
d. “I should wash my nipples daily with soap and water.”

A client in a postpartum unit complains of sudden sharp chest
pain and dyspnea.Title Lorem
The nurse Ipsum
notes that Dolor
the client is tachycardic
and the respiratory rate is elevated. The nurse suspects a
pulmonary embolism. Which should be the initial nursing action?
a. Initiate an intravenous line.

b. Assess the client’s blood pressure.

c. Prepare to administer morphine sulfate.
2017
2017
2018
2018
2019
2019
d. Administer oxygen, 8 to 10 L/minute, by face mask.

A client in a postpartum unit complains of sudden sharp chest
pain and dyspnea.Title Lorem
The nurse Ipsum
notes that Dolor
the client is tachycardic
and the respiratory rate is elevated. The nurse suspects a
pulmonary embolism. Which should be the initial nursing action?
a. Initiate an intravenous line.

b. Assess the client’s blood pressure.

c. Prepare to administer morphine sulfate.
2017
2017
2018
2018
2019
2019
d. Administer oxygen, 8 to 10 L/minute, by face mask.

Title aLorem
The nurse is assessing client in Ipsum
the fourthDolor
stage of labor and
notes that the fundus is firm, but that bleeding is excessive.
Which should be the initial nursing action?
a. Record the findings.

b. Massage the fundus.

c. Notify the health care provider (HCP).
2017
2017
2018
2018
2019
2019
d. Place the client in Trendelenburg’s position.

Title aLorem
The nurse is assessing client in Ipsum
the fourthDolor
stage of labor and
notes that the fundus is firm, but that bleeding is excessive.
Which should be the initial nursing action?
a. Record the findings.

b. Massage the fundus.

c. Notify the health care provider (HCP).
2017
2017
2018
2018
2019
2019
d. Place the client in Trendelenburg’s position.

Title toLorem
The nurse is preparing care forIpsum Dolor
four assigned clients. Which
client is at most risk for hemorrhage?
a. A primiparous client who delivered 4 hours ago
b. A multiparous client who delivered 6 hours ago
c. A multiparous client who delivered a large baby after oxytocin
induction
d. A primiparous client who delivered 6 hours ago and had
2017
2017
2018
2018
2019
2019
epidural anesthesia
Title toLorem
The nurse is preparing care for Ipsum Dolor
four assigned clients. Which
client is at most risk for hemorrhage?
a. A primiparous client who delivered 4 hours ago
b. A multiparous client who delivered 6 hours ago
c. A multiparous client who delivered a large baby after
oxytocin induction
d. A primiparous client who delivered 6 hours ago and had
2017
2017
2018
2018
2019
2019
epidural anesthesia
Title
A postpartum client Loremwith
is diagnosed Ipsum Dolor
cystitis. The nurse should
plan for which priority action in the care of the client?
a. Providing sitz baths

b. Encouraging fluid intake
c. Placing ice on the perineum

d. Monitoring hemoglobin and hematocrit levels
2017
2017
2018
2018
2019
2019

Title
A postpartum client Loremwith
is diagnosed Ipsum Dolor
cystitis. The nurse should
plan for which priority action in the care of the client?
a. Providing sitz baths

b. Encouraging fluid intake
c. Placing ice on the perineum

d. Monitoring hemoglobin and hematocrit levels
2017
2017
2018
2018
2019
2019

The nurse is monitoring a postpartum client who received
epidural anesthesia for delivery for the presence of a vulvar
hematoma. Which assessment finding would best indicate the
presence of a hematoma?
a. Changes in vital signs

b. Signs of heavy bruising2017 2018 2019

2017 2018 2019
c. Complaints of intense pain
d. Complaints of a tearing sensation Lorem ipsum dolor sit amet
The nurse is monitoring a postpartum client who received
epidural anesthesia for delivery for the presence of a vulvar
hematoma. Which assessment finding would best indicate the
presence of a hematoma?
a. Changes in vital signs

b. Signs of heavy bruising2017 2018 2019

2017 2018 2019
c. Complaints of intense pain
d. Complaints of a tearing sensation Lorem ipsum dolor sit amet
Title
The nurse is creating Lorem
a plan of careIpsum Dolorclient with a
for a postpartum
small vulvar hematoma. The nurse should include which specific
action during the first 12 hours after delivery?
a. Encourage ambulation hourly.

b. Assess vital signs every 4 hours.

c. Measure fundal height every 4 hours.
2017
2017
2018
2018
2019
2019
d. Prepare an ice pack for application to the area.

Title
The nurse is creating Lorem
a plan of careIpsum Dolorclient with a
for a postpartum
small vulvar hematoma. The nurse should include which specific
action during the first 12 hours after delivery?
a. Encourage ambulation hourly.

b. Assess vital signs every 4 hours.

c. Measure fundal height every 4 hours.
2017
2017
2018
2018
2019
2019
d. Prepare an ice pack for application to the area.

On assessment of Title Loremclient,
a postpartum Ipsum Dolor
the nurse notes that the
uterus feels soft and boggy. The nurse should take which initial
action?
a. Document the findings.

b. Elevate the client’s legs.

2017 2018 2019
c. Massage the fundus until it is firm.
2017 2018 2019
d. Push on the uterus to assist in expressing clots.

On assessment of Title Loremclient,
a postpartum Ipsum Dolor
the nurse notes that the
uterus feels soft and boggy. The nurse should take which initial
action?
a. Document the findings.

b. Elevate the client’s legs.

2017 2018 2019
c. Massage the fundus until it is firm.
2017 2018 2019
d. Push on the uterus to assist in expressing clots.

Titlewith
The nurse assisted Lorem Ipsum
the birth of a Dolor
newborn. Which
nursing action is most effective in preventing heat loss
by evaporation?
a. Warming the crib pad

b. Closing the doors to the room

2017
2017
2018
2018
2019
2019
c. Drying the infant with a warm blanket

d. Turning on the overhead radiant warmer Lorem ipsum dolor sit amet
Titlewith
The nurse assisted Lorem Ipsum
the birth of a Dolor
newborn. Which
nursing action is most effective in preventing heat loss
by evaporation?
a. Warming the crib pad

b. Closing the doors to the room

2017
2017
2018
2018
2019
2019
c. Drying the infant with a warm blanket

d. Turning on the overhead radiant warmer Lorem ipsum dolor sit amet
The mother of a newborn calls the clinic and reports that when cleaning the
umbilical cord,
she noticed that the cord was moist and that discharge was present. What is
the most appropriate nursing instruction for this mother?
a. Bring the infant to the clinic.
b. This is a normal occurrence and no further action is needed.

2017 2018 2019
c. Increase the number of times that the cord is cleaned per day. 2019
2017 2018
d. Monitor the cord for another 24 to 48 hours and call the clinic if the
discharge continues. Lorem ipsum dolor sit amet
The mother of a newborn calls the clinic and reports that when cleaning the
umbilical cord,
she noticed that the cord was moist and that discharge was present. What is
the most appropriate nursing instruction for this mother?
a. Bring the infant to the clinic.
b. This is a normal occurrence and no further action is needed.

2017 2018 2019
c. Increase the number of times that the cord is cleaned per day. 2019
2017 2018
d. Monitor the cord for another 24 to 48 hours and call the clinic if the
discharge continues. Lorem ipsum dolor sit amet
The nurse is assessing a newborn after circumcision and notes
that the circumcised area is red with a small amount of bloody
drainage. Which nursing action is most appropriate?
a. Apply gentle pressure.

b. Reinforce the dressing.2017 2018 2019

2017 2018 2019
c. Document the findings.
d. Contact the health care provider (HCP). Lorem ipsum dolor sit amet
The nurse is assessing a newborn after circumcision and notes
that the circumcised area is red with a small amount of bloody
drainage. Which nursing action is most appropriate?
a. Apply gentle pressure.

b. Reinforce the dressing.2017 2018 2019

2017 2018 2019
c. Document the findings.
d. Contact the health care provider (HCP). Lorem ipsum dolor sit amet
The postpartum nurse is providing instructions to the mother of a newborn
with hyperbilirubinemia who is being breast-fed. The nurse should provide
which instruction to the mother?
a. Feed the newborn less frequently.
b. Continue to breast-feed every 2 to 4 hours.

2017 2018 2019
c. Switch to bottle-feeding the infant for 2 weeks.
2017 2018 2019
d. Stop breast-feeding and switch to bottle-feeding permanently.

The postpartum nurse is providing instructions to the mother of a newborn
with hyperbilirubinemia who is being breast-fed. The nurse should provide
which instruction to the mother?
a. Feed the newborn less frequently.
b. Continue to breast-feed every 2 to 4 hours.

2017 2018 2019
c. Switch to bottle-feeding the infant for 2 weeks.
2017 2018 2019
d. Stop breast-feeding and switch to bottle-feeding permanently.

The nurse creates a plan of care for a woman with human
immunodeficiency virus (HIV) infection and her newborn. The nurse should
include which intervention in the plan of care?
a. Monitoring the newborn’s vital signs routinely

b. Maintaining standard precautions at all times while caring for the
newborn Lorem ipsum dolor sit amet
c. Initiating referral to evaluate for blindness, deafness, learning problems,

or behavioral 2017
2017
2018
2018
2019
2019
problems
d. Instructing the breast-feeding mother Lorem regarding
ipsum dolor sit amet the treatment of the
nipples with nystatin ointment
The nurse creates a plan of care for a woman with human
immunodeficiency virus (HIV) infection and her newborn. The nurse should
include which intervention in the plan of care?
a. Monitoring the newborn’s vital signs routinely

b. Maintaining standard precautions at all times while caring for the
newborn Lorem ipsum dolor sit amet
c. Initiating referral to evaluate for blindness, deafness, learning problems,

or behavioral 2017
2017
2018
2018
2019
2019
problems
d. Instructing the breast-feeding mother Lorem regarding
ipsum dolor sit amet the treatment of the
nipples with nystatin ointment
A couple who wants to conceive but has been unsuccessful during the last
two years has undergone many diagnostic procedures. When discussing the
situation with a nurse, one partner states, “We know several friends in our
age group and all of them have their own child already, why can’t we have
one?”. Which of the following would be the most pertinent nursing
diagnosis for this couple?
a. Fear related to unknown
b. Pain related to numerous2017procedure 2018 2019
c. Ineffective family coping related to fertility
2017 2018 2019
d. Self esteem disturbance related to infertility

A couple who wants to conceive but has been unsuccessful during the last
two years has undergone many diagnostic procedures. When discussing the
situation with a nurse, one partner states, “We know several friends in our
age group and all of them have their own child already, why can’t we have
one?”. Which of the following would be the most pertinent nursing
diagnosis for this couple?
a. Fear related to unknown
b. Pain related to numerous2017procedure 2018 2019
c. Ineffective family coping related to fertility
2017 2018 2019
d. Self esteem disturbance related to infertility

A primigravid client at 34 weeks gestation is experiencing contraction every
3 to 4 minutes lasting for 35 seconds. Her cervix is 2 cm dilated and 50%
effaced. While the nurse is assessing the client’s vital signs. The client says
“I think my bag of water just broke.” Which is the nurse priority?
a. Check the status of the fetal heart rate
b. Perform a sterile vaginal examination every 2-3 hours to check the

cervical dilation. 2017
2017
2018
2018
2019
2019
c. Turn the client to her right side

d. Test the leaking fluid with nitrazine paper.
A primigravid client at 34 weeks gestation is experiencing contraction every
3 to 4 minutes lasting for 35 seconds. Her cervix is 2 cm dilated and 50%
effaced. While the nurse is assessing the client’s vital signs. The client says
“I think my bag of water just broke.” Which is the nurse priority?
a. Check the status of the fetal heart rate
b. Perform a sterile vaginal examination every 2-3 hours to check the

cervical dilation. 2017
2017
2018
2018
2019
2019
c. Turn the client to her right side

d. Test the leaking fluid with nitrazine paper.
2017 2018 2019

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MIDTERM

c. Encourage the client to increase fluid intake.

this finding Lorem ipsum dolor sit amet

c. Encourage the client to increase fluid intake.

d. Contact the health care provider (HCP) and inform the

HCP of this finding Lorem ipsum dolor sit amet

c. Tell the mother that it is important to hold the newborn infant.

a. A temperature of 100.4 °F (38 °C)

c. A blood pressure change from 130/88 to

d. An increase in the respiratory rate from 18 to 22

a. A temperature of 100.4 °F (38 °C)

c. A blood pressure change from 130/88 to

d. An increase in the respiratory rate from 18 to 22

b. “I should change the breast pads frequently.”

c. “I should wash my hands well before breastfeeding.”

d. “I should wash my nipples daily with soap and water.”

b. “I should change the breast pads frequently.”

c. “I should wash my hands well before breastfeeding.”

d. “I should wash my nipples daily with soap and water.”

a. Initiate an intravenous line.

b. Assess the client’s blood pressure.

d. Administer oxygen, 8 to 10 L/minute, by face mask.

a. Initiate an intravenous line.

b. Assess the client’s blood pressure.

d. Administer oxygen, 8 to 10 L/minute, by face mask.

a. Record the findings.

b. Massage the fundus.

d. Place the client in Trendelenburg’s position.

a. Record the findings.

b. Massage the fundus.

d. Place the client in Trendelenburg’s position.

a. Providing sitz baths

c. Placing ice on the perineum

a. Providing sitz baths

c. Placing ice on the perineum

a. Changes in vital signs

b. Signs of heavy bruising2017 2018 2019

a. Changes in vital signs

b. Signs of heavy bruising2017 2018 2019

a. Encourage ambulation hourly.

b. Assess vital signs every 4 hours.

d. Prepare an ice pack for application to the area.

a. Encourage ambulation hourly.

b. Assess vital signs every 4 hours.

d. Prepare an ice pack for application to the area.

a. Document the findings.

b. Elevate the client’s legs.

d. Push on the uterus to assist in expressing clots.

a. Document the findings.

b. Elevate the client’s legs.

d. Push on the uterus to assist in expressing clots.

a. Warming the crib pad

b. Closing the doors to the room

c. Drying the infant with a warm blanket

a. Warming the crib pad

b. Closing the doors to the room

c. Drying the infant with a warm blanket

b. This is a normal occurrence and no further action is needed.

b. This is a normal occurrence and no further action is needed.