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ECT ANSWERS (VERIFIED ANSWERS) LATEST2024/2025
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At 14- w
weeks gestation, a client arrives at the Emergency Center complaining of a dull pai
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n in the right lower quadrant of her abdomen. The nurse obtains a blood sample an
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d initiates an IV. Thirty minutes after admission, the client reports feelinga sharp a
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bdominal pain and a shoulder pain. Assessment findings include diaphoresis, a hea
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rt rate of 120 beats/minute, and a blood pressure of 86/48. Whichaction should the
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nurse implement next? w w
a. Check the hematocrit results. w w w
b. Administer pain medication. w w
c. Increase the rate of IV fluids. w w w w w
d. Monitor client for contractions. - w w w w
CORRECT ANSWER c. increase the rate ofIV fluids
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A woman who thinks she could be pregnant calls her neighbor, a nurse, to ask we
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nshe could use a home pregnancy test to diagnose pregnancy. Which response is
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best?
a. a home pregnancy test can be used right after your first missed period
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b. these tests are most accurate after you have missed your second period
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c. home pregnancy tests often give false positives and should not be trusted
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d. the test can provide accurate information when used right after ovulation -
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CORRECT ANSWER a. a home pregnancy test can be used right after your firs
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tmissed period
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,A newborn, whose mother is HIV positive, is scheduled for follow-
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up assessments.The nurse knows that the most likely presenting symptom for a pe
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diatric client with AIDS is:
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a. shortness of breath w w
b. joint pain w
c. a persistent cold
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d. organmegaly - CORRECT ANSWER c. a persistent cold w w w w w w w
Twenty minutes after a continuous epidural anesthetic is administered, a laboring
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client's blood pressure drops from 120/80 to 90/60. What action should the nurse
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take?
a. notify the healthcare provider or anesthesiologist
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b. continue to assess the blood pressure q5min
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c. place the woman in a lateral position
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d. turn off continuous epidural -
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wCORRECT ANSWER c. place the woman in alateral position
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In developing a teaching plan for expectant parents, the nurse plans to include info
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rmation about when the parents can expect the infant's fontanels to close. Thenurse
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wbases the explanation on knowledge that for the normal newborn, the
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a. anterior fontanel closes at 2 to 4 months and the posterior by the end of the firs
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tweek
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b. anterior fontanel closes at 5 to 7 months and the posterior by the end of the week
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c. anterior fontanel closes at 8 to 11 months and the posterior by the end of th
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esecond week
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d. anterior fontanel closes at 12 to 18 months and the posterior by the end of th
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esecond month -
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wCORRECT ANSWER d. anterior fontanel closes at 12 to 18 months and the
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posterior by the end of the second month
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,A client in active labor is admitted with preeclampsia. Which assessment finding i
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smost significant in planning this client's care?
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a. patellar reflex 4+ w w
b. blood pressure 158/80 w w
c. four hour urine output 240 ml
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d. respiration 12/minute - CORRECT ANSWER a. patellar reflex 4+
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A 4 week old premature infant has been receiving epoetin alfa for the last three we
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eks. Which assessment finding indicates to the nurse that the drug is effective?
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a. slowly increasing urine output over the last week
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b. respiratory rate changes from the 40s to the 60s w w w w w w w w
c. changes in apical heart rate from the 180 to the 140s
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d. change in indirect bilirubin from 12 mg/dl to 8 mg/dl - CORRECT ANSWER
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c. changes in apical rate from the 180s to the 140s
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A pregnant client tells the nurse that the first day of her last menstrual period was
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August 2, 2006. Based on Nagele's rule, what is the estimated date of delivery?
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a. April 25, 2007
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b. May 9, 2007
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c. May 29, 2007
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d. June 2, 2007 - CORRECT ANSWER b. May 9, 2007
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The nurse is performing a AGA on a full-
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term newborn during the first hour oftransition using the Dubowitz scale. Bas
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ed on this assessment, the nurse determines that the neonate has a maturity rati
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ng of 40 weeks. Which findings should the nurse identify to determine if the n
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eonate is SGA? (Select all that apply.)
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a. admission weight of 4 lbs 15 oz w w w w w w
, b. head to heel length of 17 in
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c. frontal occipital circumference of 12.5 in
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d. skin smooth with visible veins and abundant vernix
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e. anterior plantar crease and smooth heel surfaces
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f. full flexion of all extremities in resting supine position - CORRECT ANSWER
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a, b, c
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The nurse assess a client admitted to the labor and delivery unit and obtains thefol
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lowing data: BP 110/68, FHR 110 bpm, cervix 1 cm dilated and uneffaced. Based
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won these assessment findings, what intervention should the nurse implement?
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a. insert a fetal monitor
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b. assess for cervical changes q1H
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c. monitor bleeding from IV sites w w w w
d. perform Leopold's maneuvers - w w w
wCORRECT ANSWER c. monitor for bleedingfrom IV sites
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Immediately after birth a newborn infant is suctioned, dried, and placed under arad
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iant warmer. The infant has spontaneous respirations and the nurse assess anapical
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heart rate of 80 bpm and respirations 20. What action should the nurse perform ne
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xt?
a. initiate positive pressure ventilation
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b. intervene after one minute APGAR is assessed
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c. initiate CPR on the infant w w w w
d. assess the infant's blood glucose level -
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wCORRECT ANSWER a. initiatepositive pressure ventilation
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A client with no prenatal care arrives at the labor unit screaming, "The baby is comi
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ng!" The nurse performs a vaginal examination that reveals the cervix is 3 cm
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