Question

A nurse is caring for a client who is postpartum and received Carboprost (Hemabate). Which of the following findings indicates that the medication was effective?

Answer 1

Correct Answers:

Fundus firm to palpation

Rationale :

🌺 Carboprost is a uterotonic used to treat postpartum hemorrhage by causing strong uterine contractions.

🌺 The clearest sign it is working is a firm, contracted fundus, showing improved uterine tone.

🌺 A firm uterus compresses uterine blood vessels, which helps reduce bleeding.

🌺 Carboprost is given when uterine atony is suspected, so the goal is a tight, well-contracted uterus.

🌺 A firm fundus supports stabilization and prevents continued excessive lochia from atony.

Increase in blood pressure

🌺Blood pressure can change for many reasons and does not directly confirm improved uterine tone.

🌺 Medication effectiveness is judged by uterine firmness and decreased bleeding, not BP alone.

Increase in lochia

🌺Increased lochia suggests ongoing bleeding, which can indicate uterine atony is not controlled.

🌺Effective uterotonics should support decreased excessive bleeding, not increased flow.

Report of absent breast pain

🌺Breast pain is unrelated to carboprost’s uterine action.

🌺Carboprost targets uterine smooth muscle, not breast symptoms.

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Answer 2

Correct Answers:

"The fetus is at increased risk of developing congenital malformations."

Rationale :

🟧 Poorly controlled maternal diabetes in early pregnancy increases the risk of congenital malformations (especially cardiac and neural tube defects).

🟧 High maternal glucose during organ formation acts as a teratogen, disrupting normal fetal development.

🟧 Tight glycemic control before conception and in the first trimester reduces these risks.

🟧 Diabetes can also contribute to macrosomia and birth complications later in pregnancy due to fetal hyperinsulinemia.

🟧 The key teaching point is that uncontrolled diabetes can affect fetal structure and growth, not just blood sugars.

“The fetus is at an increased chance of developing Down syndrome.”

🟧Down syndrome is primarily related to chromosomal nondisjunction and maternal age, not diabetes control.

🟧Diabetes is linked more to structural malformations than chromosomal trisomies.

“The fetus’s risk of developing hypoglycemia after birth is always decreased.”

🟧Infants of diabetic mothers are at increased risk of neonatal hypoglycemia due to fetal hyperinsulinemia.

🟧After birth, maternal glucose stops suddenly while insulin remains high.

“The fetus’s chance of developing obesity later in life is decreased.”

🟧Exposure to maternal hyperglycemia is associated with higher risk of later obesity and metabolic disease, not decreased risk.

🟧Fetal programming can increase long-term metabolic vulnerability.

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Answer 3

Correct Answers:

Administer intravenous penicillin G during labor as prescribed.

Rationale :

🟦 The priority action for GBS-positive clients is intrapartum antibiotic prophylaxis to prevent neonatal infection.

🟦 IV penicillin G given during labor significantly reduces newborn exposure to GBS during delivery.

🟦 This intervention targets early-onset neonatal GBS disease, including sepsis, pneumonia, and meningitis.

🟦 Antibiotics are timed in labor because colonization risk becomes critical as the infant passes through the birth canal.

🟦 Administering the prescribed IV antibiotic is the most direct, evidence-based prevention strategy.

Administer metronidazole orally to the client during labor.

🟦Metronidazole treats anaerobic infections (e.g., BV, trichomoniasis), not GBS colonization prevention.

🟦GBS prophylaxis requires IV beta-lactam therapy (like penicillin).

Encourage early breastfeeding within the first hour after birth.

🟦Breastfeeding provides immune benefits, but it does not replace intrapartum antibiotics for preventing early-onset GBS infection.

🟦The highest priority is still IV prophylaxis during labor.

Apply topical clotrimazole to the vaginal area

🟦Clotrimazole is an antifungal and does not eradicate GBS bacteria.

🟦Topical antifungals do not prevent neonatal GBS infection.

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Answer 4

Correct Answers:

Rapid increasing in human chorionic gonadotropin (hCG) levels

Rationale :

🟪 A hydatidiform mole is abnormal trophoblastic growth that produces very high and rapidly rising hCG.

🟪 Excess trophoblastic tissue drives hCG levels higher than expected for gestational age.

🟪 Clients often have symptoms like vaginal bleeding, severe nausea/vomiting, and uterine size discrepancies (often large for dates).

🟪 Fetal heart tones are typically absent in a complete mole because there is no viable fetus.

🟪 Rapidly increasing hCG is a key diagnostic clue and helps guide further evaluation and management.

Irregular fetal heart rate

🟪In a complete mole, fetal heart activity is usually absent, not irregular.

🟪Irregular FHR suggests a fetus is present, which conflicts with classic complete mole findings.

Profuse, clear vaginal discharge

🟪Molar pregnancy is more associated with abnormal bleeding (often dark or brown) rather than profuse clear discharge.

🟪The hallmark lab clue is markedly elevated hCG.

Fundus location in the pelvic cavity

🟪At 8 weeks the uterus is normally still pelvic, so this is not a distinguishing finding for a mole.

🟪The mole is suggested by disproportionate uterine size and high hCG, not simply pelvic location.

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Answer 5

Correct Answers:

With a tennis ball, apply pressure on the lower back.

Rationale :

🟠 Gate control theory suggests nonpainful input (touch/pressure) can “close the gate” to painful stimuli in the spinal cord.

🟠 Applying counterpressure with a tennis ball stimulates large nerve fibers and can reduce the perception of contraction pain.

🟠 This is especially helpful for back labor and sacral discomfort by providing focused, continuous pressure.

🟠 It is a nonpharmacologic technique that enhances comfort while allowing the client to remain engaged in labor.

🟠 Counterpressure is a classic nursing intervention aligned with gate control mechanisms.

Turn the client onto her left side.

🟠Left lateral positioning improves uteroplacental perfusion and comfort, but it is not the best example of gate control sensory stimulation.

🟠Gate control focuses on competing sensory input like massage/pressure.

Encourage the client to rest between contractions.

🟠Rest supports coping and energy conservation, but it does not specifically use sensory input to block pain transmission.

🟠Gate control requires tactile stimulation such as rubbing or pressure.

Administer prescribed analgesic medication.

🟠Pharmacologic analgesia reduces pain through medication effects, not gate control sensory pathways.

🟠Gate control is classically demonstrated by touch/counterpressure/massage.

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Answer 6

Correct Answers:

0430

Rationale :

🔵 Use Naegele’s rule: start with the first day of the LMP (July 23).

🔵 Add 7 days → July 30.

🔵 Subtract 3 months → April 30.

🔵 Add 1 year → April 30 (next year).

🔵 In MMDD format, April 30 is written as 0430.

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Answer 7

Correct Answers:

Administer a 500 mL bolus of NSS 0.9% prior the procedure.

Rationale :

🟢 Epidurals can cause maternal hypotension due to sympathetic blockade and vasodilation.

🟢 A 500 mL IV fluid bolus helps support circulating volume and reduce hypotension risk.

🟢 Preventing hypotension is critical because decreased maternal BP can reduce uteroplacental perfusion and affect fetal oxygenation.

🟢 This action is a standard nursing preparation before epidural placement, along with monitoring and safety checks.

🟢 Preloading (or co-loading) with isotonic fluids supports both maternal stability and fetal well-being.

Obtain a 2 hours electronic fetal monitoring (EFM) strip prior the procedure.

🟢Fetal monitoring is important, but 2 hours is not required before epidural initiation.

🟢The immediate priority is preventing hypotension that can compromise fetal perfusion.

Inform the client the anesthetic effect will last for approximately 6 hr.

🟢Duration varies and epidurals are often titrated/continuous, so this is not reliable pre-procedure teaching.

🟢The priority action is physiologic preparation (fluid bolus) to prevent complications.

Have the client stand at the bedside with her arms at her side.

🟢Epidurals are placed with the client sitting or side-lying in a flexed position, not standing.

🟢Standing increases fall risk and is unsafe during epidural placement.

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Answer 8

Correct Answers:

Administer betamethasone 12 mg IM.

Rationale :

🌟 An L/S ratio of 1:1 indicates immature fetal lungs and a high risk for respiratory distress syndrome (RDS) if birth occurs soon.

🌟 Betamethasone is an antenatal corticosteroid that accelerates fetal lung maturation by increasing surfactant production.

🌟 At 29 weeks, the priority is to improve neonatal outcomes by reducing RDS, intraventricular hemorrhage, and necrotizing enterocolitis risk.

🌟 Betamethasone is routinely given when preterm birth is threatened between about 24–34 weeks.

🌟 This order aligns with the goal of supporting fetal readiness while attempts are made to delay delivery when safe.

Administer hydralazine 25 mg IV.

🌟Hydralazine is used for severe hypertension/preeclampsia, not for fetal lung immaturity.

🌟The scenario points to immature lungs and preterm labor support, not BP control.

Prepare the client for immediate delivery.

🌟An L/S ratio of 1:1 suggests the fetus may not tolerate early delivery well due to lung immaturity.

🌟The plan is usually to optimize fetal lungs first when possible.

Infuse Oxytocin in NSS IV via Pump.

🌟Oxytocin stimulates uterine contractions and would worsen preterm labor.

🌟The goal is typically to reduce risk of preterm birth, not intensify contractions.

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Answer 9

Correct Answers:

"Positive pregnancy test (HCG) can be seen in other health conditions."

Rationale :

🔷 A urine/serum pregnancy test detects hCG, which is a strong but not absolutely conclusive indicator of pregnancy.

🔷 Some conditions can produce false-positive hCG results, such as certain trophoblastic diseases and some tumors.

🔷 Lab errors, interfering antibodies, and recent pregnancy loss can also lead to misleading positives.

🔷 Confirmatory evidence of pregnancy includes findings like fetal heart tones, visualization of the gestational sac on ultrasound, or fetal movement felt by the examiner.

🔷 Teaching the client that hCG can appear in other conditions promotes accurate expectations and follow-up care.

“Only one positive pregnancy test guaranty 100% pregnancy.”

🔷No single test is guaranteed 100% due to false positives/false negatives and timing issues.

🔷Confirmation often requires clinical correlation and/or ultrasound.

“Positive pregnancy test is always an effective pregnancy predictor.”

🔷Always” is inaccurate because hCG can appear in nonpregnant states and results can be affected by testing variables.

🔷A positive test is strong evidence but not absolute proof.

“This test is a positive indicator of pregnancy.”

🔷This is true but incomplete because it does not address that hCG can occur in other conditions.

🔷The safest patient teaching is that it is highly suggestive but not universally conclusive.

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Answer 10

Correct Answers:

Irritability
Pelvis pain
Changing mood
Headache

Rationale :

Irritability

💎 PMS commonly includes emotional and behavioral symptoms triggered by cyclic hormonal changes.

💎 Irritability is a classic symptom that often appears in the luteal phase before menstruation.

💎 It may be related to fluctuations in serotonin and sensitivity to progesterone changes.

💎 Irritability can affect relationships, sleep, and coping, which is why symptom tracking is useful.

💎 When irritability resolves shortly after menses starts, it strongly supports PMS patterns.

Pelvic pain

💎 PMS can include cramping, pelvic heaviness, and lower abdominal discomfort before menstruation.

💎 These symptoms are linked to prostaglandin activity and uterine sensitivity as menses approaches.

💎 Pelvic pain that occurs cyclically and improves with menstruation aligns with PMS timing.

💎 It is often accompanied by bloating and breast tenderness in many clients.

💎 Identifying the cyclical pattern helps differentiate PMS-type pain from persistent pelvic pathology.

Changing mood

💎 Mood changes (mood swings, sadness, anxiety) are core features of PMS and reflect hormonal cycling.

💎 Symptoms typically start 1–2 weeks before menses and improve after bleeding begins.

💎 Mood changes can range from mild irritability to more disruptive emotional shifts.

💎 Tracking symptoms across cycles helps confirm the diagnosis and supports targeted interventions.

💎 This finding strongly supports PMS when it is cyclic and predictable.

Headache

💎 PMS commonly includes headaches or migraines due to hormonal fluctuations (especially estrogen shifts).

💎 Headaches that occur repeatedly in the premenstrual period support PMS.

💎 Some clients experience fluid shifts and vascular sensitivity that worsens headaches.

💎 Recognizing the cyclic pattern supports prevention strategies (sleep, hydration, trigger control).

💎 A premenstrual headache that resolves after menstruation is consistent with PMS.

Constipation

💎While bowel changes can occur, PMS more commonly involves bloating and variable GI symptoms rather than constipation being a hallmark diagnostic clue.

💎Constipation may be influenced by diet, hydration, and activity rather than a classic PMS indicator.

Diarrhea

💎Diarrhea is more strongly associated with prostaglandin effects during menstruation rather than classic PMS presentation.

💎It can occur, but it is not one of the most reliable core PMS findings compared to mood changes and headaches.

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☑️Maternity and Newborn Nursing

No.

1 :
A nurse is caring for a client who is postpartum and received Carboprost (Hemabate). Which of the following findings indicates that the medication was effective?

2 :
A nurse is teaching a client about possible effects of uncontrolled type 1 and type 2 diabetes mellitus (DM) on the developing fetus. Which of the following statements by the client indicates that the teaching was effective?

3 :
A pregnant client at 36 weeks gestation has a positive Group B streptococcus (GBS) vaginal and rectal culture. During labor, which nursing intervention is the highest priority to prevent neonatal infection?

4 :
A nurse in a prenatal clinic is caring for a 8 weeks pregnant client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?

5 :
A nurse is caring for a client who is in labor. Which of the following nursing actions reflects application of the gate control theory of pain?

6 :
A nurse in a prenatal clinic is caring for a client who is pregnant and asks the nurse for her estimated date of birth (EDB). The client's last menstrual period (LMP) began on July 23 and ended Aug 1. What is the client's EDB? [Answer format requested in MMDD]

7 :
A nurse is preparing a client who is in active labor for epidural analgesia. Before the procedure, which of the following actions should the nurse take?

8 :
A nurse is caring for a client who is in preterm labor (29 weeks) with a current L/S ratio of 1:1. Which of the following physician's order should the nurse anticipate?

9 :
A nurse is caring for a client who is at 6 weeks of amenorrhea and asks the nurse if her positive pregnancy test is a conclusive test of pregnancy? Which of the following responses should the nurse make?

10 :
A nurse is assessing a client who has premenstrual syndrome (PMS). Which of the following findings support this diagnosis? (Select all that apply.)

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☑️Maternity and Newborn Nursing

No.

1 : A nurse is caring for a client who is postpartum and received Carboprost (Hemabate). Which of the following findings indicates that the medication was effective?

2 : A nurse is teaching a client about possible effects of uncontrolled type 1 and type 2 diabetes mellitus (DM) on the developing fetus. Which of the following statements by the client indicates that the teaching was effective?

3 : A pregnant client at 36 weeks gestation has a positive Group B streptococcus (GBS) vaginal and rectal culture. During labor, which nursing intervention is the highest priority to prevent neonatal infection?

4 : A nurse in a prenatal clinic is caring for a 8 weeks pregnant client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?

5 : A nurse is caring for a client who is in labor. Which of the following nursing actions reflects application of the gate control theory of pain?

6 : A nurse in a prenatal clinic is caring for a client who is pregnant and asks the nurse for her estimated date of birth (EDB). The client's last menstrual period (LMP) began on July 23 and ended Aug 1. What is the client's EDB? [Answer format requested in MMDD]

7 : A nurse is preparing a client who is in active labor for epidural analgesia. Before the procedure, which of the following actions should the nurse take?

8 : A nurse is caring for a client who is in preterm labor (29 weeks) with a current L/S ratio of 1:1. Which of the following physician's order should the nurse anticipate?

9 : A nurse is caring for a client who is at 6 weeks of amenorrhea and asks the nurse if her positive pregnancy test is a conclusive test of pregnancy? Which of the following responses should the nurse make?

10 : A nurse is assessing a client who has premenstrual syndrome (PMS). Which of the following findings support this diagnosis? (Select all that apply.)

1 :
A nurse is caring for a client who is postpartum and received Carboprost (Hemabate). Which of the following findings indicates that the medication was effective?

2 :
A nurse is teaching a client about possible effects of uncontrolled type 1 and type 2 diabetes mellitus (DM) on the developing fetus. Which of the following statements by the client indicates that the teaching was effective?

3 :
A pregnant client at 36 weeks gestation has a positive Group B streptococcus (GBS) vaginal and rectal culture. During labor, which nursing intervention is the highest priority to prevent neonatal infection?

4 :
A nurse in a prenatal clinic is caring for a 8 weeks pregnant client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?

5 :
A nurse is caring for a client who is in labor. Which of the following nursing actions reflects application of the gate control theory of pain?

6 :
A nurse in a prenatal clinic is caring for a client who is pregnant and asks the nurse for her estimated date of birth (EDB). The client's last menstrual period (LMP) began on July 23 and ended Aug 1. What is the client's EDB? [Answer format requested in MMDD]

7 :
A nurse is preparing a client who is in active labor for epidural analgesia. Before the procedure, which of the following actions should the nurse take?

8 :
A nurse is caring for a client who is in preterm labor (29 weeks) with a current L/S ratio of 1:1. Which of the following physician's order should the nurse anticipate?

9 :
A nurse is caring for a client who is at 6 weeks of amenorrhea and asks the nurse if her positive pregnancy test is a conclusive test of pregnancy? Which of the following responses should the nurse make?

10 :
A nurse is assessing a client who has premenstrual syndrome (PMS). Which of the following findings support this diagnosis? (Select all that apply.)