Question

A nurse is reviewing a client’s medical record and notes that the client is taking tamoxifen. The nurse should identify that tamoxifen is used to treat which of the following conditions?

Answer 1

Correct Answers:

Breast cancer.

Rationale :

✍️ Tamoxifen is a selective estrogen receptor modulator (SERM) commonly used in the treatment of hormone receptor-positive breast cancer.

✍️ It works by blocking estrogen receptors in breast tissue, reducing cancer cell growth.

✍️ Tamoxifen is not used to treat Non-Hodgkin’s lymphoma, endometriosis, or polycystic ovary syndrome.

✍️ Understanding the medication’s primary use guides safe and effective nursing care.

✍️ Nurses must monitor for side effects like increased risk of thromboembolism.

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Answer 2

Correct Answers:

Frequently assess maternal heart rate.
Initiate bed rest with bathroom privileges.

Rationale :

Frequently assess maternal heart rate:

🟢 Monitoring maternal heart rate frequently helps detect early signs of hypovolemia or hemorrhage, which are common complications of placenta previa.

🟢 Changes in heart rate can indicate the severity of bleeding and guide timely interventions.

🟢 Continuous assessment supports maternal safety by allowing prompt responses to hemodynamic instability.

Initiate bed rest with bathroom privileges:

🌿 Bed rest reduces physical activity, minimizing the risk of triggering or worsening bleeding in placenta previa.

🌿 Allowing bathroom privileges ensures the client can meet basic needs without excessive exertion.

🌿 This intervention balances safety with patient comfort and promotes optimal outcomes.

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Answer 3

Correct Answers:

"You should expect the test to take about 30 minutes."

Rationale :

🟢 A nonstress test (NST) typically lasts 20–40 minutes to monitor fetal heart rate and movement.

🟢 No medications are administered for NST; it is non-invasive and safe.

🟢 Eating or drinking is generally not restricted prior to NST.

🟢 The NST assesses fetal well-being, not lung maturity (which is assessed by amniocentesis).

🟢 Clear patient teaching improves compliance and reduces anxiety.

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Answer 4

Correct Answers:

"l should check for the string each month after menstruation."

Rationale :

✍️ Clients with an IUD should regularly check for the presence of the string to ensure the device remains properly positioned.

✍️ IUDs do not need annual replacement; some last 3–10 years depending on type.

✍️ Spermicide is not necessary when using an IUD.

✍️ Periods may become irregular or lighter but usually do not completely stop for all clients.

✍️ Educating on self-monitoring promotes early detection of displacement or expulsion.

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Answer 5

Correct Answers:

"You should keep the car seat rear-facing until your baby is at least 2 years old."

Rationale :

🟢 The American Academy of Pediatrics recommends infants and toddlers use a rear-facing car seat until at least age 2 for optimal protection.

🟢 The retainer clip should be positioned at the armpit level, not over the abdomen.

🟢 Car seats should be installed at a 45-degree angle to prevent airway obstruction, not 90 degrees.

🟢 The shoulder harness straps should be at or just below the shoulders for rear-facing seats, not an inch above.

🟢 Correct car seat use is crucial for infant safety in vehicle travel.

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Answer 6

Correct Answers:

Nasal flaring.

Rationale :

💎 Nasal flaring indicates respiratory distress in a newborn and requires immediate reporting to the provider.

💎 An axillary temperature of 36.5°C (97.7°F) is within normal range for a newborn.

💎 A heart rate of 158/min is expected in a healthy 10-hour-old infant.

💎 Having one void since birth is typical in the first 24 hours and not a concern.

💎 Early detection of respiratory issues ensures prompt treatment and reduces complications.

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Answer 7

Correct Answers:

Massage the client's fundus.

Rationale :

✍️ Fundal massage is the first priority to help control excessive vaginal bleeding postpartum by promoting uterine contractions.

✍️ Elevating legs helps circulation but is secondary after massaging the fundus.

✍️ Inserting a catheter assists with monitoring output but doesn’t stop bleeding.

✍️ Oxytocin infusion is important but comes after assessing uterine tone.

✍️ Prompt fundal massage reduces risk of postpartum hemorrhage complications.

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Answer 8

Correct Answers:

Encourage the client to use a pant-blow breathing pattern.

Rationale :

📙 The pant-blow breathing pattern helps the laboring client manage intense contractions and avoid pushing too early.

📙 Assisting voiding every 3 hours is important but not the immediate priority during transition.

📙 Monitoring contractions every 30 minutes is insufficient during this critical phase.

📙 The lithotomy position is not routinely recommended during transition labor.

📙 Correct breathing reduces maternal fatigue and supports labor progression.

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Answer 9

Correct Answers:

"l will check the identification badge of anyone who removes my baby from our room."

Rationale :

📚 Checking identification badges is essential for newborn safety to prevent accidental or intentional abduction.

📚 Posting baby photos publicly raises privacy and security concerns.

📚 Letting the baby sleep on the bed unattended increases the risk of injury or suffocation.

📚 Nurses generally keep babies in the room with the mother unless medically necessary.

📚 Awareness and vigilance protect newborns in hospital settings.

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Answer 10

Correct Answers:

"This shot may be given after birth to protect future pregnancies."

Rationale :

📗 Rh(D) immune globulin is administered postpartum to Rh-negative mothers to prevent sensitization.

📗 If the partner is Rh-negative, the shot is usually unnecessary.

📗 The injection is only needed if the newborn is Rh-positive.

📗 There is no requirement to avoid immunizations for 3 months after this shot.

📗 This preventive measure protects future pregnancies from hemolytic disease.

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QLexNursing

1 :
A nurse is reviewing a client’s medical record and notes that the client is taking tamoxifen. The nurse should identify that tamoxifen is used to treat which of the following conditions?

2 :
A nurse is caring for a client who has placenta previa. Which of the following interventions should the nurse implement for this client? (Select all that apply.)

3 :
A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test. Which of the following statements should the nurse plan to make?

4 :
A nurse is teaching a client about using an intrauterine device (IUD) for contraception. Which of the following client statements indicates an understanding of the teaching?

5 :
A nurse is teaching the parent of a newborn about car seat safety. Which of the following statements should the nurse make?

6 :
A nurse is assessing a newborn who is 10 hr old. Which of the following findings should the nurse report to the provider?

7 :
A nurse is caring for a client who gave birth 4 hr ago and is experiencing excessive vaginal bleeding. Which of the following actions should the nurse plan to take first?

8 :
A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take?

9 :
A nurse is providing teaching about newborn safety to a client who is being admitted for induction of labor. Which of the following client statements indicates an understanding of the teaching?

10 :
A nurse is teaching a pregnant client who is Rh-negative about Rh(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching?

QLexNursing

1 : A nurse is reviewing a client’s medical record and notes that the client is taking tamoxifen. The nurse should identify that tamoxifen is used to treat which of the following conditions?

2 : A nurse is caring for a client who has placenta previa. Which of the following interventions should the nurse implement for this client? (Select all that apply.)

3 : A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test. Which of the following statements should the nurse plan to make?

4 : A nurse is teaching a client about using an intrauterine device (IUD) for contraception. Which of the following client statements indicates an understanding of the teaching?

5 : A nurse is teaching the parent of a newborn about car seat safety. Which of the following statements should the nurse make?

6 : A nurse is assessing a newborn who is 10 hr old. Which of the following findings should the nurse report to the provider?

7 : A nurse is caring for a client who gave birth 4 hr ago and is experiencing excessive vaginal bleeding. Which of the following actions should the nurse plan to take first?

8 : A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take?

9 : A nurse is providing teaching about newborn safety to a client who is being admitted for induction of labor. Which of the following client statements indicates an understanding of the teaching?

10 : A nurse is teaching a pregnant client who is Rh-negative about Rh(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching?

1 :
A nurse is reviewing a client’s medical record and notes that the client is taking tamoxifen. The nurse should identify that tamoxifen is used to treat which of the following conditions?

2 :
A nurse is caring for a client who has placenta previa. Which of the following interventions should the nurse implement for this client? (Select all that apply.)

3 :
A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test. Which of the following statements should the nurse plan to make?

4 :
A nurse is teaching a client about using an intrauterine device (IUD) for contraception. Which of the following client statements indicates an understanding of the teaching?

5 :
A nurse is teaching the parent of a newborn about car seat safety. Which of the following statements should the nurse make?

6 :
A nurse is assessing a newborn who is 10 hr old. Which of the following findings should the nurse report to the provider?

7 :
A nurse is caring for a client who gave birth 4 hr ago and is experiencing excessive vaginal bleeding. Which of the following actions should the nurse plan to take first?

8 :
A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take?

9 :
A nurse is providing teaching about newborn safety to a client who is being admitted for induction of labor. Which of the following client statements indicates an understanding of the teaching?

10 :
A nurse is teaching a pregnant client who is Rh-negative about Rh(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching?