A nurse is assessing a client who is at 37 weeks of gestation and reports sudden, severe abdominal pain with moderate vaginal bleeding and persistent uterine contractions. The client's blood pressure is 88/50 mm Hg and her abdomen is rigid. The nurse should identify these findings as Indicating which of the following complications?

Placental abruption

Amniotic fluid embolus

Placenta previa

Uterine rupture

Answer and Explanation

The Correct Answer is A

A. Placental abruption – This is the correct answer because placental abruption occurs when the placenta detaches prematurely from the uterine wall, leading to severe abdominal pain, vaginal bleeding, uterine rigidity, and signs of hypovolemic shock (low blood pressure). The hallmark sign is a painful, rigid abdomen with contractions.

B. Amniotic fluid embolus – This condition presents with sudden respiratory distress, hypotension, and disseminated intravascular coagulation (DIC), but it does not typically cause uterine rigidity or persistent contractions.

C. Placenta previa – Placenta previa typically presents with painless vaginal bleeding rather than severe abdominal pain and a rigid uterus.

D. Uterine rupture – Uterine rupture is usually associated with a history of uterine surgery (e.g., previous cesarean section). It presents with sudden, severe pain followed by cessation of contractions, not persistent contractions.

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Correct Answer is D

Explanation

A. Influenza – The first dose of the influenza vaccine is recommended at 6 months, not 2 months.

B. Hepatitis A – Hepatitis A vaccine is typically given at 12-23 months, not at 2 months.

C. Varicella – The varicella (chickenpox) vaccine is given at 12-15 months, so it is not appropriate for a 2-month-old.

D. Rotavirus – This is the correct answer. The rotavirus vaccine is recommended at 2 months, 4 months, and possibly 6 months, depending on the vaccine brand used.

A. "I will be sure that all of my bottles contain BPA." B. "I can keep a can of concentrated formula in the refrigerator for 3 days after I open it." C. "I should boil tap water for 2 minutes and cool it before I mix it with the powdered formula." D. "I can dilute the ready-to-feed formula with water when my baby wants more than 4 ounces at a feeding."

Correct Answer is C

Explanation

A. BPA (bisphenol A) is harmful, and bottles should be BPA-free.

B. Concentrated formula should be used within 24–48 hours after opening if refrigerated, not 3 days.

C. This is the correct answer. Boiling tap water for 1–2 minutes and cooling it before mixing with powdered formula helps eliminate bacteria, ensuring safe consumption for newborns.

D. Diluting ready-to-feed formula is unsafe and can lead to inadequate nutrition for the baby.

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Naxlex Comprehensive Predictor Exams

A nurse at a health department is providing anticipatory guidance to the parent of a 1-month-old infant. The nurse should inform the parent that the infant should receive which of the following immunizations at the age of 2 months?

Correct Answer is D

Explanation

A nurse is teaching about safe handling of formula to a client who is postpartum and chooses to bottle feed her newborn. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

A nurse is teaching a newly licensed nurse about informed consent. Which of the following information should the nurse include in the teaching?

A nurse is caring for a client following an involuntary admission to an acute mental health facility. The client states, "I'm afraid they will give me drugs that put me to sleep." Which of the following statements should the nurse make?

A charge nurse observes smoke coming from a trash receptacle in the unit's waiting room. Which of the following actions should the nurse take first?

A nurse in an acute care facility is caring for a client who has anorexia nervosa. During the first week of care, which of the following actions should the nurse take?

A nurse is performing a physical assessment of a newborn whose mother used cocaine throughout the pregnancy. Which of the following findings should the nurse expect?

A nurse is caring for a client who is taking disulfiram for alcohol use disorder and reports ingestion of alcohol. For which of the following adverse effects should the nurse monitor?

A nurse is preparing regular and NPH insulin in the same syringe for a client who has diabetes mellitus. Which of the following actions should the nurse take?

A nurse is providing discharge teaching to a client who is 1 day postoperative following a right modified radical mastectomy. Which of the following instructions should the nurse include in the teaching?