Maternal And Child Health Nursing NCLEX Quiz 17

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  • 1/10 Questions

    When preparing to administer the vitamin K injection to a neonate. the nurse would select which of the following sites as appropriate for the injection?

    • Deltoid muscle
    • Anterior femoris muscle
    • Vastus lateralis muscle
    • Gluteus maximus muscle
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  • 2. 

    After 4 hours of active labor. the nurse notes that the contractions of a primigravida client are not strong enough to dilate the cervix. Which of the following would the nurse anticipate doing?

    • Obtaining an order to begin IV oxytocin infusion

    • Administering a light sedative to allow the patient to rest for several hours

    • Preparing for a cesarean section for failure to progress

    • Increasing the encouragement to the patient when pushing begins

    Correct Answer
    A. Obtaining an order to begin IV oxytocin infusion
    Explanation
    The client’s labor is hypotonic. The nurse should call the physical and obtain an order for an infusion of oxytocin. which will assist the uterus to contract more forcefully in an attempt to dilate the cervix.Option B: Administering light sedative would be done for hypertonic uterine contractions.Option C: Preparing for cesarean section is unnecessary at this time.Option D: Oxytocin would increase the uterine contractions and hopefully progress labor before a cesarean would be necessary. It is too early to anticipate client pushing with contractions.

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  • 3. 

    A multigravida at 38 weeks’ gestation is admitted with painless. bright red bleeding and mild contractions every 7 to 10 minutes. Which of the following assessments should be avoided?

    • Maternal vital sign

    • Fetal heart rate

    • Contraction monitoring

    • Cervical dilation

    Correct Answer
    A. Cervical dilation
    Explanation
    The signs indicate placenta previa and vaginal exam to determine cervical dilation would not be done because it could cause hemorrhage.Option A: Assessing maternal vital signs can help determine maternal physiologic status.Option B: Fetal heart rate is important to assess fetal well-being and should be done.Option C: Monitoring the contractions will help evaluate the progress of labor.

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  • 4. 

    During a pelvic exam. the nurse notes a purple-blue tinge of the cervix. The nurse documents this as which of the following?

    • Braxton-Hicks sign

    • Chadwick’s sign

    • Goodell’s sign

    • McDonald’s sign

    Correct Answer
    A. Chadwick’s sign
    Explanation
    Chadwick’s sign refers to the purple-blue tinge of the cervix.Option A: Braxton Hicks contractions are painless contractions beginning around the 4th month.Option C: Goodell’s sign indicates softening of the cervix.Option D: Flexibility of the uterus against the cervix is known as McDonald’s sign.

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  • 5. 

    When performing a pelvic examination. the nurse observes a red swollen area on the right side of the vaginal orifice. The nurse would document this as enlargement of which of the following?

    • Clitoris

    • Parotid gland

    • Skene’s gland

    • Bartholin’s gland

    Correct Answer
    A. Bartholin’s gland
    Explanation
    Bartholin’s glands are the glands on either side of the vaginal orifice.Option A: The clitoris is female erectile tissue found in the perineal area above the urethra.Option B: The parotid glands are open into the mouth.Option C: Skene’s glands open into the posterior wall of the female urinary meatus.

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  • 6. 

    During a prenatal class. the nurse explains the rationale for breathing techniques during preparation for labor based on the understanding that breathing techniques are most important in achieving which of the following?

    • Eliminate pain and give the expectant parents something to do

    • Reduce the risk of fetal distress by increasing uteroplacental perfusion

    • Facilitate relaxation. possibly reducing the perception of pain

    • Eliminate pain so that less analgesia and anesthesia are needed

    Correct Answer
    A. Facilitate relaxation. possibly reducing the perception of pain
    Explanation
    Breathing techniques can raise the pain threshold and reduce the perception of pain. They also promote relaxation.Options A. B. and D: Breathing techniques do not eliminate pain. but they can reduce it. Positioning. not breathing. increases uteroplacental perfusion.

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  • 7. 

    Which of the following would be the nurse’s most appropriate response to a client who asks why she must have a cesarean delivery if she has a complete placenta previa?

    • “You will have to ask your physician when he returns.”

    • “You need a cesarean to prevent hemorrhage.”

    • “The placenta is covering most of your cervix.”

    • “The placenta is covering the opening of the uterus and blocking your baby.”

    Correct Answer
    A. “The placenta is covering the opening of the uterus and blocking your baby.”
    Explanation
    A complete placenta previa occurs when the placenta covers the opening of the uterus. thus blocking the passageway for the baby. This response explains what a complete previa is and the reason the baby cannot come out except by cesarean delivery.Option A: Telling the client to ask the physician is a poor response and would increase the patient’s anxiety.Option B: Although a cesarean would help to prevent hemorrhage. the statement does not explain why the hemorrhage could occur.Option C: With a complete previa. the placenta is covering all the cervix. not just most of it.

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  • 8. 

    To differentiate as a female. the hormonal stimulation of the embryo that must occur involves which of the following?

    • Increase in maternal estrogen secretion

    • Decrease in maternal androgen secretion

    • Secretion of androgen by the fetal gonad

    • Secretion of estrogen by the fetal gonad

    Correct Answer
    A. Secretion of estrogen by the fetal gonad
    Explanation
    The fetal gonad must secrete estrogen for the embryo to differentiate as a female.Option A: An increase in maternal estrogen secretion does not effect differentiation of the embryo. and maternal estrogen secretion occurs in every pregnancy.Option B: Maternal androgen secretion remains the same as before pregnancy and does not affect differentiation.Option C: Secretion of androgen by the fetal gonad would produce a male fetus.

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  • 9. 

    The nurse documents positive ballottement in the client’s prenatal record. The nurse understands that this indicates which of the following?

    • Palpable contractions on the abdomen

    • Passive movement of the unengaged fetus

    • Fetal kicking felt by the client

    • Enlargement and softening of the uterus

    Correct Answer
    A. Passive movement of the unengaged fetus
    Explanation
    Ballottement indicates passive movement of the unengaged fetus.Option A: Ballottement is not a contraction.Option C: Fetal kicking felt by the client represents quickening.Option D: Enlargement and softening of the uterus is known as Piskacek’s sign.

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  • 10. 

    A client at 8 weeks’ gestation calls complaining of slight nausea in the morning hours. Which of the following client interventions should the nurse question?

    • Taking 1 teaspoon of bicarbonate of soda in an 8-ounce glass of water

    • Eating a few low-sodium crackers before getting out of bed

    • Avoiding the intake of liquids in the morning hours

    • Eating six small meals a day instead of three large meals

    Correct Answer
    A. Taking 1 teaspoon of bicarbonate of soda in an 8-ounce glass of water
    Explanation
    Using bicarbonate would increase the amount of sodium ingested. which can cause complications.Option B: Eating low-sodium crackers would be appropriate.Option C: Since liquids can increase nausea avoiding them in the morning hours when nausea is usually the strongest is appropriate.Option D: Eating six small meals a day would keep the stomach full. which often decrease nausea.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Sep 04, 2017
    Quiz Created by
    Santepro
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