Question

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

Answer 1

Correct Answers:

"It promotes fetal lung maturity."

Rationale :

🫁 Betamethasone is a corticosteroid given to pregnant clients at risk for preterm birth to enhance fetal lung development.

🫁 It stimulates the production of surfactant, a substance that prevents alveolar collapse and supports effective neonatal breathing.

🫁 Increased surfactant levels reduce the risk of respiratory distress syndrome (RDS) in premature infants.

🫁 Administration of betamethasone also lowers the incidence of intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality.

🫁 This medication is most effective when administered between 24 and 34 weeks of gestation in cases of threatened preterm labor.

🫁 Incorrect Option: “It is used to stop preterm labor contractions.”

🫁 Betamethasone does not suppress uterine contractions or stop labor.

🫁 Tocolytic medications are used when the goal is to delay labor.

🫁 Incorrect Option: “It increases the fetal heart rate.”

🫁 Betamethasone does not directly affect fetal cardiac activity.

🫁 Its therapeutic effect is limited to organ maturation, not heart rate changes.

🫁 Incorrect Option: “It halts cervical dilation.”

🫁 Cervical dilation is a mechanical labor process not altered by corticosteroids.

🫁 Betamethasone prepares the fetus rather than stopping labor progression.

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Answer 2

Correct Answers:

Depo-Provera

Rationale :

🌸 Depo-Provera is a progestin-only injectable contraceptive, making it appropriate for clients who smoke and should avoid estrogen.

🌸 It provides long-acting contraception without requiring daily adherence, which supports consistent pregnancy prevention.

🌸 This method reduces menorrhagia by thinning the endometrial lining and suppressing ovulation.

🌸 It also improves dysmenorrhea and helps regulate irregular menstrual cycles, often leading to lighter or absent menses.

🌸 Because it lacks estrogen, it avoids the increased thromboembolic risk associated with combined hormonal contraceptives in smokers.

🌸 Incorrect Option: Barrier methods such as female condoms

🌸 Barrier methods do not regulate menstrual cycles or reduce heavy bleeding.

🌸 They are also less reliable for pregnancy prevention when used alone.

🌸 Incorrect Option: Contraceptive implant

🌸 Implants commonly cause irregular or prolonged bleeding, which may worsen menorrhagia.

🌸 This makes it a less suitable option for this client’s menstrual history.

🌸 Incorrect Option: Combination oral contraceptives

🌸 These contain estrogen, which increases cardiovascular risk in clients who smoke.

🌸 Estrogen-containing contraceptives are contraindicated in smokers due to thromboembolic risk.

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Answer 3

Correct Answers:

"l can use the morning-after pill as a regular form of birth control."

Rationale :

🔔 Levonorgestrel is intended strictly for emergency contraception, not for routine or ongoing pregnancy prevention.

🔔 It works primarily by delaying ovulation, which makes it effective only when used around the time of unprotected intercourse.

🔔 Using it repeatedly as a regular method can lead to hormonal disruption, irregular bleeding, and reduced overall contraceptive reliability.

🔔 Emergency contraception does not provide consistent suppression of ovulation, which is necessary for dependable birth control.

🔔 Clients should be counseled to use regular contraceptive methods such as hormonal contraception, implants, or barrier methods for ongoing protection.

🔔 Incorrect Option: “I should take the morning-after pill as soon as possible after unprotected intercourse.”

🔔 This statement is correct because earlier administration significantly improves effectiveness.

🔔 Emergency contraception works best when taken immediately after intercourse.

🔔 Incorrect Option: “The morning-after pill does not protect against sexually transmitted infections.”

🔔 This is accurate because levonorgestrel only prevents pregnancy, not infections.

🔔 Barrier methods are required for STI prevention.

🔔 Incorrect Option: “The morning-after pill can be less effective if I take it more than 72 hours after unprotected sex.”

🔔 Effectiveness declines as time passes beyond the recommended window.

🔔 This statement reflects appropriate understanding of timing.

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Answer 4

Correct Answers:

Swelling and redness in one breast, accompanied by flu-like symptoms

Rationale :

🌡️ Mastitis is an infection of the breast tissue that commonly occurs during breastfeeding due to milk stasis or nipple trauma.

🌡️ It typically presents as localized redness, swelling, warmth, and pain in one breast rather than both.

🌡️ Systemic manifestations such as fever, chills, fatigue, and flu-like symptoms strongly indicate an infectious process.

🌡️ Bacteria often enter through cracked nipples, leading to inflammation and infection of the milk ducts.

🌡️ Prompt recognition is essential to prevent complications such as breast abscess formation.

🌡️ Incorrect Option: Symmetrical breast swelling with a sudden increase in milk production

🌡️ This finding is characteristic of breast engorgement, not infection.

🌡️ Engorgement is usually bilateral and lacks systemic symptoms.

🌡️ Incorrect Option: A white patch on a nipple

🌡️ This finding is consistent with candidal (yeast) infection, not mastitis.

🌡️ Yeast infections typically cause burning pain without systemic illness.

🌡️ Incorrect Option: Bilateral breast tenderness and engorgement with no fever

🌡️ Absence of fever and bilateral involvement suggest physiologic engorgement.

🌡️ Mastitis is usually unilateral and associated with systemic signs.

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Answer 5

Correct Answers:

"This could result in profound bleeding."

Rationale :

🩸 Placenta previa occurs when the placenta implants in the lower uterine segment, partially or completely covering the cervical os.

🩸 Performing an internal vaginal examination can mechanically disrupt the placental attachment.

🩸 This disruption can cause sudden, severe, and painless hemorrhage, which is life-threatening to both the mother and fetus.

🩸 Even minimal cervical manipulation may tear placental vessels, leading to rapid blood loss.

🩸 For this reason, internal examinations are strictly contraindicated in clients with known or suspected placenta previa.

🩸 “This could initiate preterm labor.”

🩸 While examinations can stimulate uterine activity, this is not the primary concern in placenta previa.

🩸 The major risk is hemorrhage, not labor initiation.

🩸 “There is an increased risk of introducing infection.”

🩸 Infection risk exists with any invasive procedure, but it is not the most critical danger here.

🩸 Bleeding poses a far more immediate and severe threat.

🩸 “There is an increased risk of rupture of the membranes.”

🩸 Membrane rupture is not the central concern with placenta previa.

🩸 The priority risk remains uncontrolled bleeding from placental separation.

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Answer 6

Correct Answers:

"We will assess for a decrease in seizure activity and improved reflexes."

Rationale :

⚡ Magnesium sulfate is administered in severe preeclampsia to prevent seizures, not primarily to lower blood pressure.

⚡ Its therapeutic effect is achieved by depressing neuromuscular excitability and stabilizing the central nervous system.

⚡ Effectiveness is evaluated by monitoring deep tendon reflexes, level of consciousness, and the absence of seizure activity.

⚡ Therapeutic magnesium levels produce slightly diminished but present reflexes, indicating adequate seizure prophylaxis.

⚡ Continuous assessment is essential to balance seizure prevention while avoiding magnesium toxicity.

⚡ “We will check for a reduction in swelling and fluid retention.”

⚡ Magnesium sulfate does not act as a diuretic or reduce edema.

⚡ Swelling changes do not reflect medication effectiveness.

⚡ “We will monitor your blood pressure to see if it decreases.”

⚡ Antihypertensives, not magnesium sulfate, are used to control blood pressure.

⚡ Blood pressure reduction alone does not indicate magnesium effectiveness.

⚡ “You should feel less pain and have fewer headaches.”

⚡ Symptom relief may occur with other treatments but is not a reliable indicator of seizure prevention.

⚡ Neurologic assessment provides the most accurate evaluation.

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Answer 7

Correct Answers:

Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.

Rationale :

🧺 Delegation to an assistive personnel (AP) is appropriate for routine, non-invasive, and non-assessment tasks that follow an established plan of care.

🧺 A sitz bath is a comfort measure that does not require clinical judgment or evaluation of new findings.

🧺 At 2 days postpartum, a client with a fourth-degree laceration has already been assessed and stabilized by the nurse.

🧺 The AP can safely perform the sitz bath after receiving clear instructions on procedure and safety.

🧺 The nurse remains responsible for evaluating the client’s response and overall perineal healing.

🧺 Change the initial perineal pad of a client who just transferred from labor and delivery.

🧺 The first perineal pad change requires assessment of lochia amount, color, and clots.

🧺 Initial postpartum assessments must be completed by the nurse.

🧺 Monitor vital signs during admission of a client who has gestational hypertension.

🧺 Gestational hypertension places the client at risk for preeclampsia and complications.

🧺 Admission vital signs require nursing judgment and interpretation.

🧺 Observe an area of redness on the breast of a client who is 1 day postpartum.

🧺 Redness may indicate mastitis or infection, requiring assessment.

🧺 APs cannot evaluate or interpret abnormal findings.

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Answer 8

Correct Answers:

"You will not need another dose since this is a one-time treatment for your entire pregnancy."

Rationale :

🧬 Rho(D) immune globulin is administered to Rh-negative clients to prevent Rh sensitization.

🧬 The routine antenatal dose is given at 28 weeks of gestation to protect against fetal-maternal blood mixing during pregnancy.

🧬 If the newborn is found to be Rh-positive, an additional dose is required within 72 hours after delivery.

🧬 This postpartum dose prevents the mother from forming anti-Rh antibodies that could harm future pregnancies.

🧬 The need for repeat dosing depends on the baby’s Rh status, not solely on the pregnancy timeline.

🧬 Incorrect Option: “You will not need another dose since this is a one-time treatment for your entire pregnancy.”

🧬 This is incorrect because postpartum exposure can still occur.

🧬 Additional protection may be required after delivery.

🧬 Incorrect Option: “You will need to come back for a dose only if you experience bleeding or trauma.”

🧬 Bleeding and trauma may require additional dosing, but this is not the routine plan.

🧬 Post-delivery Rh status remains the primary determinant.

🧬 Incorrect Option: “You will need Rho(D) immune globulin again in 72 hours to protect any future pregnancies.”

🧬 The timing is inaccurate without considering delivery and infant Rh status.

🧬 Rho(D) immune globulin is not given routinely every 72 hours.

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Answer 9

Correct Answers

Monitor the length, strength, and duration of contractions [ Oxytocin (Pitocin) ]
Ensure the client has an empty bladder before administrationOxytocin (Pitocin) [ Oxytocin (Pitocin) ]
Monitor for nausea, vomiting, and diarrhea [ Prostaglandin (Carboprost/Hemabate) ]
Administer 1M for postpartum hemorrhage [ Misoprostol (Cytotec) ]
Keep client in supine position with lateral tilt for 30 minutes after administration [ Misoprostol (Cytotec) ]
Monitor for manifestations of hypertensive crisis [ Methylergonovine Maleate (Methergine) ]

Rationale :

💉 Oxytocin (Pitocin)

✅ Correct Nursing Actions

Monitor the length, strength, and duration of contractions

Ensure the client has an empty bladder before administration

💉 Oxytocin (Pitocin) is a synthetic hormone used to induce or augment labor and to manage postpartum hemorrhage by stimulating uterine contractions.

💉 Continuous monitoring of the frequency, duration, and intensity of contractions is essential because excessive uterine activity can lead to uterine tachysystole, fetal distress, or uterine rupture.

💉 Close observation allows the nurse to promptly identify non-reassuring fetal heart rate patterns related to excessive contractions.

💉 Ensuring the client has an empty bladder is important because a distended bladder can interfere with uterine contraction efficiency and slow labor progress.

💉 Proper bladder management also reduces discomfort and supports effective uterine response to oxytocin.

💉 Incorrect Option: Administer intravaginally for cervical ripening

💉 Oxytocin is administered IV, not intravaginally.

💉 Prostaglandins are used for cervical ripening.

🌿 Prostaglandin (Carboprost / Hemabate)

✅ Correct Nursing Action

Monitor for nausea, vomiting, and diarrhea

🌿 Carboprost (Hemabate) is a prostaglandin F2α used to treat postpartum hemorrhage caused by uterine atony.

🌿 Prostaglandins strongly stimulate smooth muscle contraction, including the uterus and gastrointestinal tract.

🌿 As a result, nausea, vomiting, diarrhea, and abdominal cramping are very common adverse effects.

🌿 The nurse must closely monitor fluid status and electrolyte balance due to the risk of fluid loss from GI symptoms.

🌿 Early recognition of these effects helps prevent dehydration and supports patient comfort and safety.

🌿 Incorrect Option: Ensure the client has a full bladder before administration

🌿 A full bladder does not enhance medication effectiveness.

🌿 Bladder distention can actually impair uterine contraction.

🌿 Incorrect Option: Administer orally for preeclampsia

🌿 Carboprost is administered IM, not orally.

🌿 It is not used to treat preeclampsia.

🔥 Misoprostol (Cytotec)

✅ Correct Nursing Actions

Administer IM for postpartum hemorrhage

Keep client in supine position with lateral tilt for 30 minutes after administration

🔥 Misoprostol is a prostaglandin E1 analog used to prevent or treat postpartum hemorrhage by promoting uterine contraction.

🔥 It can be administered IM, oral, rectal, or vaginally, depending on the clinical indication and protocol.

🔥 Maintaining the client in a supine position with lateral tilt allows optimal uterine response and medication absorption while preventing supine hypotensive syndrome.

🔥 This positioning also promotes uterine tone and reduces the risk of ongoing bleeding.

🔥 Close monitoring following administration is essential to assess uterine firmness and bleeding response.

🔥 Incorrect Option: Avoid use in clients with a history of liver disease

🔥 Liver disease is not a primary contraindication for misoprostol.

🔥 The major concern is uterine hyperstimulation in pregnancy.

🩺 Methylergonovine Maleate (Methergine)

✅ Correct Nursing Action

Monitor for manifestations of hypertensive crisis

🩺 Methylergonovine (Methergine) is an ergot alkaloid that causes strong, sustained uterine contractions to control postpartum hemorrhage.

🩺 It also produces systemic vasoconstriction, which can significantly elevate blood pressure.

🩺 Clients receiving this medication are at risk for hypertensive crisis, including severe headache, chest pain, visual changes, and stroke.

🩺 Continuous monitoring of blood pressure and cardiovascular status is essential.

🩺 The medication is contraindicated in clients with hypertension or preeclampsia due to this risk.

🩺 Incorrect Option: Encourage PO intake of grapefruit juice

🩺 Grapefruit juice can increase drug levels and worsen adverse effects.

🩺 It should be avoided.

🩺 Incorrect Option: Administer IV before passage of placenta

🩺 Methergine is never given IV due to severe vasospasm risk.

🩺 It is given after placental delivery only.

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Answer 10

Correct Highlights :

Blood pressure of 164/112 mmHg
Persistent frontal headache
Blurry vision lasting over 24 hours
Platelet count of 120,000/mm³
Creatinine of 1.3 mg/dL
Facial and hand swelling
Gestational age of 34 weeks, 2 days

Rationale :

🚨 Cues Supporting Preeclampsia With Severe Features

🩸 Severe Blood Pressure Elevation

🩸 Blood pressure of 164/112 mmHg clearly meets the definition of severe-range hypertension in pregnancy.

🩸 Severe preeclampsia is diagnosed when systolic BP is ≥160 mmHg or diastolic BP is ≥110 mmHg, even if only one reading is documented.

🩸 This level of hypertension reflects widespread vasospasm and significantly increases the risk of maternal stroke, placental abruption, and fetal compromise.

🩸 Severe BP alone is sufficient to classify preeclampsia as severe, even before lab abnormalities are considered.

🩸 This finding immediately escalates the client to a high-risk obstetric emergency.

🧠 Neurologic Irritability (Severe Feature)

🧠 Persistent frontal headache indicates cerebral vasoconstriction and increased intracranial pressure.

🧠 Blurry vision lasting over 24 hours reflects retinal vasospasm and cerebral involvement, not normal pregnancy discomfort.

🧠 3+ brisk reflexes with mild ankle clonus demonstrate neuromuscular hyperexcitability, a classic precursor to seizures.

🧠 These findings together signal imminent risk for eclampsia.

🧠 Neurologic symptoms are among the most dangerous severe features and require immediate intervention.

🧬 Hematologic Abnormality

🧬 Platelet count of 120,000/mm³ indicates thrombocytopenia, which is a severe diagnostic criterion.

🧬 Low platelets result from endothelial damage and platelet consumption due to widespread inflammation.

🧬 This places the client at increased risk for bleeding complications, especially during delivery.

🧬 Thrombocytopenia may signal progression toward HELLP syndrome.

🧬 This lab finding confirms systemic disease involvement, not isolated hypertension.

🧪 Liver Dysfunction

🧪 Elevated AST (76 U/L) and ALT (68 U/L) indicate hepatic involvement, a defining severe feature.

🧪 Liver enzyme elevation reflects reduced hepatic perfusion and hepatocellular injury caused by vasospasm.

🧪 This condition may progress to subcapsular liver hematoma or rupture, which is life-threatening.

🧪 Hepatic dysfunction differentiates severe preeclampsia from mild disease.

🧪 These findings further confirm multi-organ involvement.

🧠 Renal Impairment

🧠 Creatinine of 1.3 mg/dL exceeds normal pregnancy values and indicates reduced renal perfusion.

🧠 2+ proteinuria reflects glomerular endothelial damage and impaired filtration.

🧠 Urine specific gravity of 1.030 suggests hemoconcentration and decreased renal blood flow.

🧠 Renal involvement demonstrates that preeclampsia is affecting vital organ systems.

🧠 Kidney dysfunction increases the risk of fluid overload, pulmonary edema, and worsening hypertension.

🌊 Pathologic Edema and Rapid Weight Gain

🌊 Facial and hand swelling are concerning because they reflect capillary leak, not dependent edema.

🌊 A 38-pound weight gain exceeds expected pregnancy weight gain and suggests fluid retention.

🌊 Endothelial injury causes fluid to shift into interstitial spaces.

🌊 This finding supports the presence of systemic vascular dysfunction.

🌊 Edema in combination with hypertension and proteinuria strengthens the diagnosis.

🤰 Risk Factors and Clinical Context

🤰 Gestational age of 34 weeks, 2 days places the fetus at risk if early delivery is required.

🤰 A history of gestational hypertension increases recurrence risk and severity.

🤰 Anxiety reflects awareness of potential maternal and fetal complications.

🤰 The absence of labor symptoms confirms that findings are disease-driven, not labor-related.

🤰 These contextual cues support a diagnosis of severe preeclampsia rather than transient hypertension.

🧠 NGN Clinical Synthesis

🧠 This client demonstrates severe-range hypertension, neurologic symptoms, thrombocytopenia, liver dysfunction, renal impairment, and pathologic edema, which together confirm preeclampsia with severe features.

🧠 The combination of findings places her at high risk for eclampsia, stroke, HELLP syndrome, placental abruption, and fetal compromise.

🧠 Immediate escalation of care, seizure prophylaxis, and delivery planning are indicated.

Distractor Analysis :

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Nursing actions	Oxytocin (Pitocin)	Prostaglandin (Carboprost/Hemabate)	Misoprostol (Cytotec)	Methylergonovine Maleate (Methergine)
Administer intravaginally for cervical ripening
Monitor the length, strength, and duration of contractions
Ensure the client has an empty bladder before administrationOxytocin (Pitocin)
Ensure the client has a full bladder before administration
Monitor for nausea, vomiting, and diarrhea
Administer orally for preeclampsia
Avoid use in clients with a history of liver disease
Administer 1M for postpartum hemorrhage
Keep client in supine position with lateral tilt for 30 minutes after administration
Encourage intake of grapefruit juice
Administer IV before passage of placenta to stimulate uterine contractions
Monitor for manifestations of hypertensive crisis

Temp	164/112 mmHg
SpO:	88 bpm
Reflexes	18 breaths/min
Fetal Heart Rate	98.4°F
Temp	98% on room air
SpO:	3+ brisk with mild ankle clonus
Reflexes	140 bpm, moderate variability

	Lab Result	Normal Range
Platelets	120,000/mm3	150,000-400,000
AST	76 U/L	10-40 U/L
ALT	68 U/L	7-56 U/L
Creatinine	1.3 mg/dL	0.6-1.1 mg/dL
Urine Protein (dipstick)	2+	Negative
Urine Specific Gravity	1.030	1.005-1.030

Custom: NUR209 91.2026 Midpoint Assessment

No.

1 :
A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

3 :
A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception. Which of the following statements made by the client indicates a need for further teaching?

4 :
A nurse is caring for a client who is 3 days postpartum and is attempting to breastfeed. Which of the following findings indicate mastitis?

5 :
A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

6 :
A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

7 :
A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

8 :
A pregnant client at 28 weeks of gestation, who is receiving Rho(D) immune globulin for her Rh-negative status, asks the nurse if she will need another dose later. What is the most appropriate response from the nurse?

9 :
An assessment was made

Correct Answers

10 :
Patient data

Correct Highlights :

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Custom: NUR209 91.2026 Midpoint Assessment

No.

1 : A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

3 : A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception. Which of the following statements made by the client indicates a need for further teaching?

4 : A nurse is caring for a client who is 3 days postpartum and is attempting to breastfeed. Which of the following findings indicate mastitis?

5 : A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

6 : A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

7 : A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

8 : A pregnant client at 28 weeks of gestation, who is receiving Rho(D) immune globulin for her Rh-negative status, asks the nurse if she will need another dose later. What is the most appropriate response from the nurse?

9 : An assessment was made

Correct Answers

10 : Patient data

Correct Highlights :

1 :
A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?

3 :
A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception. Which of the following statements made by the client indicates a need for further teaching?

4 :
A nurse is caring for a client who is 3 days postpartum and is attempting to breastfeed. Which of the following findings indicate mastitis?

5 :
A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination. Which of the following explanations of the primary reason should the nurse provide?

6 :
A nurse is monitoring a client who is receiving magnesium sulfate for severe preeclampsia. The client asks, "How will I know if the medication is working?" Which response by the nurse is most appropriate?

7 :
A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

8 :
A pregnant client at 28 weeks of gestation, who is receiving Rho(D) immune globulin for her Rh-negative status, asks the nurse if she will need another dose later. What is the most appropriate response from the nurse?

9 :
An assessment was made

10 :
Patient data