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MCN SET K QUESTIONS A. We will bring in clean clothes for our baby to wear today
1. Forty-eight hours after delivery, the nurse in charge plans discharge B. Our baby will have eye patches on
teaching for the client about infant care. By this time, the nurse expects C. We will be available for feedings every 2 to 3 hours.
that the phase of postpartum psychological adaptation that the client D. We understand that home phototherapy is an option
would be in would be termed which of the following? 11. A nurse admits a newborn infant to the nursery. On assessment of the
a. Taking in infant, the nurse palpates the anterior fontanel and notes that it feels
b. Letting go soft. The nurse determines that this finding indicates:
c. Taking hold a. Dehydration
d. Resolution b. A normal finding
2. Which of the following would the nurse assess in a client experiencing c. Increased intracranial pressure
abruptio placenta? d. Decreased intracranial pressure
a. Bright red, painless vaginal bleeding 12. Cervical softening and uterine souffle are classified as which of the
b. Concealed or external dark red bleeding following?
c. Palpable fetal outline a. Diagnostic signs
d. Soft and nontender abdomen b. Presumptive signs
3. A client with severe preeclampsia is admitted with of BP 160/110, c. Probable signs
proteinuria, and severe pitting edema. Which of the following would be d. Positive signs
most important to include in the client‘s plan of care? 13. Which of the following fundal heights indicates less than 12 weeks’
a. Daily weights gestation when the date of the LMP is unknown?
b. Seizure precautions a. Uterus in the pelvis
c. Right lateral positioning b. Uterus at the xiphoid c. Uterus in the abdomen d. Uterus at the
d. Stress reduction umbilicus
4. When teaching a group of adolescents about variations in the length of 14. Which of the following danger signs should be reported promptly
the menstrual during the antepartum period?
the nurse understands that the underlying mechanism is due to a. Constipation
variations in which following phases? b. Breast tenderness
a. Menstrual phase c. Nasal stuffiness
b. Proliferative phase d. Leaking amniotic fluid
c. Secretory phase 15. A client 12 weeks‘pregnant come to the emergency department with
d. Ischemic phase abdominal cramping and moderate vaginal bleeding. Speculum
5. The following would the nurse include as being produced by the Leydig examination reveals 2 to 3 cm cervical dilation. The nurse would
cells? document these findings as which of the following?
a. Follicle-stimulating hormone a. Threatened abortion
b. Testosterone b. Imminent abortion
c. Leuteinizing hormone c. Complete abortion
d. Gonadotropin releasing hormone d. Missed abortion )122
6. A nurse obtains the vital signs on a mother who delivered a healthy 16. Which of the following would be the priority nursing diagnosis for a
newborn infant 2 hours ago and notes that the mother‘s temperature is client with an ectopic pregnancy?
102°F. The appropriate nursing action would be to: a. Risk for infection
a. Notify the physician b. Pain
b. Remove the blanket from the client's bed c. Knowledge Deficit
c. Document the finding and recheck the temperature in 4 hours d. Anticipatory Grieving )123
d. Administer acetaminophen (T ylenol) and recheck the temperature in 17. When preparing a woman who is 2 days postpartum for discharge,
4 hours recommendations for which of the following contraceptive methods
7. A nurse is planning to teach a pregnant client about assessment of would be avoided?
preterm contractions. The nurse plans to use which strategy as the a. Diaphragm
effective teaching method? b. Female condom
a. Describe the process verbally in great detail c. Oral contraceptives
b. Place a monitor on the client's abdomen, and have her palpate d. Rhythm method
simultaneously 18. For which of the following clients would the nurse expect that an
c. Palpate for uterine contractions at the same time as the client intrauterine device would not be recommended?
d. Provide a pamphlet with multiple pictures and drawings a. Woman over age 35
8. A woman at 32weeks' gestation is brought into the emergency b. Nulliparous woman
department after an automobile accident. The Client is bleeding c. Promiscuous young adult
vaginally and fetal assessment indicates moderate fetal distress. Which d. Postpartum client
of the following should the nurse do first in an attempt to reduce the 19. A client in her third trimester tells the nurse, ―I‘m constipated all the
stress on the fetus? time!‖ Which of the following should the nurse recommend?
a. Start intravenous (IV) fluids at a keep open rate a. Daily enemas
B. Set up for an immediate cesarean section delivery b. Laxatives
c. Elevate the head of the bed to a semi-Fowler's position c. Increased fiber intake
d. Administer oxygen via a face mask at 7 to 10 liters per minute d. Decreased fluid intake
9. Which neonatal behavior is most commonly associated with fetal 20. The postterm neonate with meconium-stained amniotic fluid needs
alcohol syndrome (FAS)? care designed to especially monitor for which of the following?
a. Hypoactivity a. Respiratory problems