Try Naxlex NCLEX-RN (Free-Trial)

Patient Data

Exhibits

Click to highlight the notes that demonstrate a positive outcome.

The client is admitted to the hospital after her membranes rupture at 38 weeks gestation. A vaginal examination is done. The nurse determines that the client is 3 cm dilated, 40% effaced, and the fetal head is at -1 station. The external monitor snows that contractions are occurring every 4 minutes and lasting 70 seconds, and the nurse palpates the quality as strong. Her fasting blood glucose (FSBG) is 86 (4.8 mmol/L).

The client is transferred to the labor- delivery-recovery (LDR) suite. The client dilates quickly to 10 cm and feels a strong urge to push. The fetal heart rate is reassuring with a baseline of 145 and moderate variability. The nurse briefly reviews pushing techniques with her and her husband and notifies the obstetrician of the client's progress. After three cycles of open-glottis pushing, the baby's head is crowning. The head is born easily over an intact perineum. The infant weighs 9 lbs. 9 oz (4.34 kgs) and has an Apgar of 7 at 1 minute, then 9 at 5 minutes.

client is 3 cm dilated, 40% effaced, and the fetal head is at -1 station

contractions are occurring every 4 minutes and lasting 70 seconds

fasting blood glucose (FSBG) is 86 (4.8 mmol/L)

client dilates quickly to 10 cm and feels a strong urge to push

fetal heart rate is reassuring with a baseline of 145 and moderate variability

Apgar of 7 at 1 minute, then 9 at 5 minutes

After three cycles of open-glottis pushing, the baby's head is crowning

infant weighs 9 lbs. 9 oz

membranes rupture at 38 weeks gestation

Answer and Explanation

The Correct Answer is ["A","B","C","D","E","F"]

This blood glucose level is within the normal range, indicating that the client’s blood sugar is well-controlled at this point.

The client is 3 cm dilated, 40% effaced, with contractions every 4 minutes lasting 70 seconds and strong in quality. These are signs of active labor progressing appropriately.

The fetal heart rate is reassuring with a baseline of 145 beats per minute and moderate variability. This indicates good fetal well-being and adequate oxygenation.

The client quickly dilates to 10 cm and experiences a strong urge to push, suggesting efficient progress through labor.

The baby is born with an intact perineum, weighs 9 lbs. 9 oz (4.34 kg), and has excellent Apgar scores of 7 at 1 minute and 9 at 5 minutes. These scores indicate that the infant is in good condition and adapting well to extrauterine life.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is A

Explanation

A. Checking the femoral site for hematoma formation is crucial as the client’s pain at the groin insertion site could indicate bleeding or hematoma formation, which requires immediate attention.

B. Evaluating the IV insertion site is important but does not directly address the pain at the groin site.

C. Stimulating the client to take deep breaths helps with respiratory function but does not address the potential complications at the groin site.

D. Assessing distal lower extremity capillary refill is useful for overall circulation but is not the immediate concern in this situation.

A. Applesauce B. Fortified whole grain cereals. C. Pureed green beans. D. Full fat yogurt. E. Soft dried apricots.

Correct Answer is ["B","C","D"]

Explanation

A. Applesauce, while nutritious, does not provide a significant amount of iron and is not particularly helpful for addressing milk baby anemia.

B. Fortified whole grain cereals are a good source of iron, which helps in treating anemia.

C. Pureed green beans are a good source of iron and other essential nutrients.

D. Full fat yogurt is a nutritious option but is not particularly rich in iron. However, it can be part of a balanced diet for the infant.

E. Soft dried apricots, while a good source of iron, may not be appropriate for an 11-month-old due to choking hazards.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

While conducting dietary teaching to the parent of an 11-month-old who was diagnosed with milk baby anemia, which food(s) should the nurse encourage the parent to offer the infant? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

Patient Data Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.

Before administering an IV antibiotic, the nurse observes that the skin above the client's IV site is cool, swollen, and painful to touch. Which action should the nurse implement first?

Which problem reported by a client taking lovastatin requires the most immediate follow-up by the nurse?

The nurse is caring for a client who has a history of experiencing delusions. The client describes singing in a concert in the afternoon for thousands of people. Which action should the nurse take?

The nurse is providing discharge instructions for a client who had an above the knee amputation (AKA) and their spouse. The client expresses fear about going home and requests to stay in the hospital one more day. Which intervention is most important for the nurse to implement?

During an admission assessment, a client reports currently using heroin. Which information is most important for the nurse to consider in the plan of care?