Test Bank Maternity And Pediatric Nursing 3rd Edition By Susan Ricci, Theresa Kyle, and Susan Carman

Test Bank Maternity And Pediatric Nursing 3rd Edition By Susan Ricci, Theresa Kyle, and
Susan Carman
Course
Maternity And Pediatric Nursing 3rd EditION
Question 1
A nurse is caring for a woman in the first stage of labor. The client reports severe back pain.
Which nursing intervention is most effective?
A. Place the client in a supine position
B. Apply firm counterpressure to the sacrum
C. Administer oxygen via face mask
D. Encourage frequent ambulation
Answer: B. Apply firm counterpressure to the sacrum
Rationale: Severe back pain is often due to fetal occiput posterior position. Counterpressure
relieves pressure on the sacral nerves, reducing discomfort. Supine position worsens
uteroplacental perfusion. Oxygen and ambulation are less effective for back labor pain.


Question 2
The nurse is monitoring a fetal heart rate (FHR) strip and notes late decelerations. What is the
priority nursing action?
A. Increase oxytocin infusion
B. Place the client in left lateral position
C. Perform a vaginal exam
D. Document findings and continue monitoring
Answer: B. Place the client in left lateral position
Rationale: Late decelerations indicate uteroplacental insufficiency. Repositioning improves
placental perfusion. Increasing oxytocin worsens the problem. Vaginal exam is not priority.
Documentation alone delays intervention.


Question 3
A newborn has a respiratory rate of 65/min, nasal flaring, and intercostal retractions. Which
condition is most likely?
A. Transient tachypnea of the newborn (TTN)
B. Normal newborn adaptation

,C. Neonatal hypoglycemia
D. Cold stress
Answer: A. Transient tachypnea of the newborn (TTN)
Rationale: TTN presents with tachypnea, nasal flaring, and retractions due to delayed absorption
of fetal lung fluid. Normal adaptation should not involve significant distress. Hypoglycemia and
cold stress cause jitteriness and poor feeding, not respiratory distress.


Question 4
Which finding in a 4-year-old requires immediate intervention?
A. Uses two- to three-word sentences
B. Copies a circle
C. Is unable to hop on one foot
D. Reports frequent headaches
Answer: D. Reports frequent headaches
Rationale: Headaches in children may signal increased intracranial pressure or serious illness.
Delays in fine/gross motor skills may warrant evaluation but are less urgent.


Question 5
A nurse is teaching a postpartum client about mastitis. Which statement indicates correct
understanding?
A. "I should stop breastfeeding until the infection resolves."
B. "I should continue breastfeeding frequently."
C. "I should apply ice packs to the affected breast."
D. "I should wear a tight-fitting bra to reduce milk production."
Answer: B. "I should continue breastfeeding frequently."
Rationale: Frequent breastfeeding helps empty the breast and resolve infection. Ice and tight
bras worsen engorgement. Breastfeeding should not be stopped unless abscess develops.


Question 6
The nurse is caring for a toddler with croup. Which intervention is most appropriate?
A. Encourage oral fluids
B. Administer IV antibiotics
C. Provide cool mist humidification
D. Position the child supine

,Answer: C. Provide cool mist humidification
Rationale: Croup causes upper airway obstruction. Cool mist decreases swelling and eases
breathing. Antibiotics are not indicated (viral). Supine worsens obstruction. Oral fluids risk
aspiration in acute distress.


Question 7
Which vaccine is contraindicated in an immunocompromised child?
A. DTaP
B. IPV (inactivated polio vaccine)
C. MMR
D. Hib
Answer: C. MMR
Rationale: Live vaccines (MMR, varicella) are contraindicated in immunocompromised
children. DTaP, IPV, and Hib are inactivated vaccines and safe.


Question 8
A client at 34 weeks reports painless, bright red vaginal bleeding. Which condition is suspected?
A. Placenta previa
B. Placental abruption
C. Uterine rupture
D. Preterm labor
Answer: A. Placenta previa
Rationale: Placenta previa presents with painless bright red bleeding in the third trimester.
Abruption causes painful, dark bleeding. Uterine rupture is catastrophic with severe pain and
abnormal FHR.


Question 9
Which reflex should be present in a 6-month-old infant?
A. Moro reflex
B. Rooting reflex
C. Palmar grasp reflex
D. Babinski reflex

, Answer: D. Babinski reflex
Rationale: Babinski normally persists until about 12 months. Moro, rooting, and palmar grasp
usually disappear by 4–6 months.


Question 10
A nurse is caring for a child with sickle cell crisis. Which is the priority intervention?
A. Apply cold compresses
B. Encourage fluid intake
C. Restrict activity
D. Administer oxygen
Answer: B. Encourage fluid intake
Rationale: Hydration reduces sickling and prevents further crisis. Cold worsens
vasoconstriction. Oxygen helps but hydration is priority. Activity restriction helps but is not
primary.


Question 11
Which nursing action prevents postpartum hemorrhage?
A. Encourage early ambulation
B. Perform fundal massage
C. Maintain IV fluids
D. Place the newborn skin-to-skin
Answer: B. Perform fundal massage
Rationale: Uterine atony is the most common cause of postpartum hemorrhage. Fundal massage
promotes contraction and reduces bleeding. Ambulation and fluids are supportive but not direct
interventions.


Question 12
The best toy for a hospitalized 3-year-old is:
A. Chess set
B. Building blocks
C. Video game
D. Crossword puzzle