RN Maternal Newborn Online Practice 2019 A

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Which assessment finding indicates uterine rupture?

  • A. Ctx abruptly stop during labor
  • B. Fetal tachycardia occurs
  • C. Client becomes dyspneic
  • D. Labor progressing unusually quickly
Correct Answer: A

Rationale: Uterine rupture is a rare but serious obstetric emergency that can occur during labor and delivery. One of the key assessment findings indicating uterine rupture is when contractions (ctx) abruptly stop during labor. This abrupt cessation of contractions can be a sign that the uterine muscle has torn due to excessive pressure or force, leading to a disruption in the normal progress of labor. Other signs and symptoms of uterine rupture may include severe abdominal pain, abnormal fetal heart rate patterns, loss of fetal station, and signs of hypovolemic shock in the mother. Immediate intervention and surgical management are required in cases of uterine rupture to ensure the safety of both the mother and the baby.

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A nurse teaches newly pregnant clients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is which of the following?

  • A. Estrogen
  • B. Human chorionic gonadotropin (hCG)
  • C. Progesterone
  • D. Luteinizing hormone
Correct Answer: B

Rationale: hCG is a hormone secreted by the fertilized egg shortly after implantation. It signals the body to maintain the corpus luteum, which produces progesterone essential for sustaining the early stages of pregnancy.

Which finding in a 36-week pregnant client is most concerning?

  • A. Braxton Hicks contractions
  • B. Frequent urination
  • C. Proteinuria of +2
  • D. Weight gain of 2 pounds in a week
Correct Answer: C

Rationale: Proteinuria is a sign of preeclampsia, requiring immediate assessment.

The nurse is assessing a client with suspected gestational hypertension. What finding supports this diagnosis?

  • A. Blood pressure of 150/90 mmHg.
  • B. Proteinuria of +2.
  • C. Fetal heart rate of 140 beats/minute.
  • D. Mild edema in the lower extremities.
Correct Answer: A

Rationale: Gestational hypertension is diagnosed with a blood pressure of 140/90 mmHg or higher without proteinuria.

A nurse is assessing a newborn who is 48 hours old and has a maternal history of methadone use during pregnancy. Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome?

  • A. Hyporeactivity
  • B. Excessive high-pitched cry
  • C. Acrocyanosis
  • D. Respiratory rate of 50/min
Correct Answer: B

Rationale: Neonatal abstinence syndrome (NAS) occurs in newborns who were exposed to substances, such as methadone, while in the womb. Infants with NAS may exhibit excessive high-pitched crying as one of the manifestations. Other common symptoms of NAS include irritability, tremors, feeding difficulties, sweating, fever, vomiting, diarrhea, and poor weight gain. Therefore, in this case, the excessive high-pitched cry is a manifestation that the nurse should identify as an indication of neonatal abstinence syndrome.

A client in labor reports sudden pain and bright red vaginal bleeding. What should the nurse suspect?

  • A. Placenta previa.
  • B. Abruptio placentae.
  • C. Preterm labor.
  • D. Rupture of membranes.
Correct Answer: B

Rationale: Bright red bleeding and sudden pain suggest abruptio placentae, requiring urgent intervention.

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