KAPLAN Maternity New Born Pracitce Exam with Answers (201 Solved Questions)

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The nurse returns to the nurse's station after making client rounds and finds four phone messages.Which message should the nurse return FIRST?2.A client with a cast on the right leg who states, "I have a funny feeling in my right leg."Following total hip arthroplasty, an elderly client is ordered to begin ambulation with a walker. Whichstatement by the nurse is correct?2."Make sure rubber caps are in place on all four legs of the walker."4."Have someone help you tie your shoes before you begin ambulating."6."Always wear non skid footwear when you walk."The OB client comes to the hospital at term in the early stages of labor. A diagnosis of completeplacenta previa is made. It is MOST important for the nurse to take which action?2.Prepare the client for an immediate cesarean section.The RN cares for the 4-year-old diagnosed with epiglottitis. Which observation indicates to the nursethat the child is experiencing an early complication of hypoxemia?Select all that apply.1.Heart rate of 148 beats per minute (bpm).4.Throwing toys and kicking the bed.6.Nasal flaring with activity.Strategy: Determine how each answer choice relates to EARLY hypoxemia.The nurse stabilizes the client with severe multiple trauma injuries from a motor vehicle accident.Which action does the nurse take next?2.Arranges for clergy to visit with the client and family as requested.The nursing assistive personnel comes to take the client by wheelchair for a magnetic resonanceimaging (MRI) scan of the head and neck. Which observation, if made by the nurse, requires anintervention?3.The client has a nitroglycerine patch on the right chest area.The neonatal nurse instructs the family of a newborn about an apnea monitor. The nurse is MOSTconcerned if a family member makes which statement?4."A family member will closely watch the monitor all the time.(4) correct—indicates a feeling that monitor may not let them know if their infant stops breathingThe client has a cast applied for a fracture of the right femur. Three hours later, the client reportsfeelings of heat and pain under the cast. Which is the MOST appropriate action for the nurse to take?2.Check the circulation in the casted extremity and change the client's position.The client is admitted to the hospital with dry mucous membranes and decreased skin turgor. Theclient's vital signs are BP 120/70, temperature 101°F (38.3°C), pulse 88, respirations 14. Laboratorytests indicate the serum sodium is 150 mEq/L and the Hct is 48%. The nurse expects the health careprovider to order which IV fluids? 2.0.45% NaCl.Which plan is most appropriate for the nurse to use to prepare a 10-year-old for a cardiaccatheterization?3.Draw a picture of a heart and explain where the tube will go and what the health careprovider will see.The nurse cares for the client reporting moderate pain. Which nursing action is MOST important toprovide the client with effective pain relief?2.Establish a trusting relationship with the client.KAPLAN QUESTION TRAINER 6

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A client diagnosed with a necrotizing spider bite is to perform dressing changes at home. The nursedetermines which statement, if made by the client, indicates a correct understanding of aseptictechnique?2."I should wash my hands before redressing my wound."3."I should keep the wound covered at all times."4."I should only use whatever my health care provider orders for the dressing change."5."I should make sure someone looks at my wound every dressing change."6."I will throw the dressing away in the kitchen garbage wrapped in my glove."An adult client is admitted to an acute locked psychiatric unit one month prior to an election. Theclient requests the opportunity to vote in the upcoming election. Which response by the nurse is best?2."I'll make the appropriate arrangements for you to vote."The nurse administers sublingual nitroglycerin to the client reporting chest pain. Which observation isMOST important for the nurse to report to the next shift?2.Blood pressure has decreased from 140/80 to 90/60.One of the goals the nurse and a client diagnosed with posttraumatic stress disorder (PTSD) mutuallyagreed upon is that the client will increase participation in out-of-the apartment activities. Whichrecommendation, if made by the nurse, is MOST therapeutic to achieve this goal?3.Join a support group, and participate in a victim assistance organization.The client is scheduled for a traditional abdominal cholecystectomy. Which statement, if made by thenurse to the client the night before surgery, is MOST important?2."Place the pillow against your abdomen, take three deep breaths, hold your breath, and thencough two or three times."The mother of a 4-year-old boy comes to the prenatal clinic to confirm her second pregnancy. Duringthe initial visit, it is MOST important for the nurse to take which action?4.Identify the client's general health needs.The nurse prepares the client for a skin biopsy. Which client statement should the nurse report to thehealth care provider?1."I've been taking aspirin for my sore knees."5."I have changed my mind about having this done."The nurse cares for the client diagnosed with a perforated bowel secondary to a bowel obstruction. Atthe time the diagnosis is made, which should be the priority in the nursing care plan?3.Prepare the client for emergency surgery.The health care provider writes an order for piperacillin 3 g IV q6h for the adult client. Beforeadministering this drug, the nurse should take which action appropriate to this medication?1.Check for known allergies to medications.2.Obtain specimen for culture and sensitivity4.Obtain client's current creatinine clearance results.The mother brings her 17-month-old son to the well-baby clinic for a routine checkup. She confides tothe nurse that she is concerned because her son sucks his thumb, especially at night when he is putto bed. Which suggestion by the nurse BEST?2."Don't intervene at this time. This behavior usually subsides after 24 months of age."KAPLAN QUESTION TRAINER 6

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The nurse cares for clients in the outpatient clinic. The young adult female arrives for help with weightloss. The client's weight is 257 pounds, and the client is 5'7". Which diet choice indicates the MOSTappropriate choice for breakfast? 1.Applesauce, cream of wheat, toast.The toddler admitted with an elevated blood lead level is to be treated with intramuscular (IM)injections of calcium disodium edetate and dimercaprol. Which nursing action has the highestPRIORITY?4.Rotate the injection sites.The nurse instructs the client being discharged on tranylcypromine sulfate. The nurse determinesfurther teaching is needed if the client makes which statement?1."To celebrate, my wife and I are going out for pepperoni pizza and wine tonight."The triage nurse receives 4 phone messages. In which order does the nurse return the phone calls?(Please arrange in order. All options must be used.)1.Multipara client at 6 weeks' gestation reports colicky abdominal pain and shoulder tip pain.2.Multigravida client at 6 weeks' gestation reports red vaginal bleeding, moderate cramping.3.Primigravida client at 5 weeks' gestation has light vaginal spotting, mild cramping.4.Primipara client at 7 weeks' gestation reports increase in milky white vaginal secretions.Strategy: Determine the least stable client and keep prioritizing the clients left.1)Abdominal pain at 6 weeks needs to be evaluated for a possible ectopic pregnancy. Initially, thepain may be described as "dull" and "unilateral" but can progress to colicky, sharp, severe pain ifrupture occurs. The pain may become generalized throughout the lower abdomen. Referred shoulderpain is caused by diaphragmatic irritation secondary to blood in the peritoneal cavity. Referredshoulder pain increases the suspicion for a ruptured ectopic pregnancy, which can lead to shock anddeath. This client is unstable and has a circulation concern that needs to be immediately addressed.2)Moderate cramping and bright red bleeding are symptomatic of threatened abortion.This client ispotentially unstable and has an issue that can impact circulation, but the client with a suspectedruptured ectopic pregnancy is at greater risk. This client should be seen second.3) This client has symptoms of spontaneous abortion."Light vaginal spotting" poses a potential risk tocirculation.This client should be seen third.4)Milky white vaginal secretions (leukorrhea) are expected during the first trimester of pregnancy.The nurse would be concerned about infection if the vaginal discharge were green, yellow, or foul-smelling.The RN cares for the client just admitted after sustaining a second-degree thermal injury to the rightarm. Which observation is MOST important to report to the health care provider?2.Gastric pH less than 5.0.A college student reports a history of a motor vehicle accident six months ago. The client wasminimally injured but a friend was killed. The client comes to Student Health Services reportinginability to study or sleep. The client also reports thinking they are "going crazy." Which action by thenurse is MOST important?4.Explore the client's coping methods over the crash and the friend's death.The RN obtains a urinalysis from the client reporting dysuria, urinary frequency, and discomfort in thesuprapubic area. After evaluating the results, the nurse should order a repeat urinalysis based onwhich finding?No WBCs or RBCs reported.The RN talks to the parents of a 6-month-old. They discuss ways to minimize the adverse effects of aDTaP immunization. Which actions are important for the RN to discuss?2.Administer acetaminophen for discomfort.KAPLAN QUESTION TRAINER 6

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3.Place a cool cloth on the injection site for 15 minutes.5.Wrap and comfort the child for signs of irritability.The clinic nurse observes that a 10-year-old child with leukemia has a large burn on her arm. Theburn appears to be oily. The child tells the nurse that she touched a hot pan, and her mother putcooking fat on it so that it would not blister. Which action should the nurse take FIRST?4.Wash the burn with soap and water to remove the oil.The nurse instructs a client about how to perform self-monitoring blood glucose (SMBG) using ablood glucose monitor. Which action, if performed by the client, indicates to the nurse the need forfurther teaching?4.The client milks the finger after sticking it.(4) correct—forces interstitial fluid to mix with capillary blood and dilutes the bloodA client is to receive the afternoon dose of nifedipine. The nurse notes this rhythm on the cardiacmonitor of 50 bpm. Which action is most appropriate for the nurse to take?1.Withhold the medication.The multipara client comes to the prenatal clinic during her fifth month of pregnancy. The clientreports that her breasts are sensitive and sore. Which suggestion by the nurse is best?3.Apply cool compresses to the sides of your breasts."5.Wear a well fitting supportive bra."Strategy: All answers are implementations. Determine the outcome of each answer choice. Is itdesired?(3) correct—during pregnancy there is an increase in lactiferous ducts and lobule-alveolar tissue coolpacks will decrease the discomfort caused by this change(5) correct—appropriate support of the breast will help decrease the feeling of pulling and thediscomfort associated with that occurrence.The nurse cares for the client diagnosed with hyperparathyroidism. Which symptom is most importantfor the nurse to report to the next shift?2.Hematuria.Two days after the client is admitted, the client's sputum culture is reported as positive fortuberculosis. While awaiting orders from the health care provider, the nurse should take which action?2.Institute measures to initiate airborne precautions.The nursing assistive personnel(NAP) is assigned to constant observation of a suicidal client. Thenurse overhears the NAP talking with the client. Which statement made by the NAP requiresIMMEDIATE intervention by the nurse? 4."I'll be right back with something for you to eat."The nurse obtains a history from the client just admitted to the unit. The client informs the nurse thatany information shared with the nurse during the interview is to remain confidential. Which responseby the nurse is BEST?2."If the information you share is important to your care, I'll need to share it with the staff."The nurse performs discharge teaching for the client diagnosed with multiple sclerosis. It is MOSTimportant for the nurse to include which instruction?1.Ambulate as tolerated every day.2.Avoid overexposure to heat or cold.3.Perform stretching and strengthening exercises.4.Participate in social activities.KAPLAN QUESTION TRAINER 6

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The client diagnosed with lung cancer undergoes a pneumonectomy. In the immediate postoperativeperiod, which assessment is MOST important? 2.Position of the trachea in the sternal notch.A client undergoes admission from the recovery room with an intravenous fluid infusing at 100mL/hour. There are 900 mL left in the bag. One hour later, the client has received 850 mL. The nurseis most concerned by which assessment finding?4.Rales and tachycardia.The nurse admits the client from the postoperative recovery area after abdominal exploratory surgery.In which order should the nurse perform the actions?1.Assess the respiratory rate,2.Determine client's pulse.3.Check the dressing for evidence of bleeding.4.Position the client on her left side.5.Check the chart for surgical notes.6.Monitor the incision site for purulent drainage.Strategy: Place the actions in order. Consider priority of each action.(1) This is the first action. respiratory assessment is highest priority.(2) 2nd action to perform. assessment of cardiac status is second priority.(3) assessment; dressing should be checked on admission to the room and frequently for the nextseveral hours(4) 4th action; implementation but priority assessments should be completed first(5) 5th action; knowing what occurred in surgery is an action but assessment and position the clientwill take priority.(6) 6th action; baseline assessment would be required but much to soon for infection assessmentThe client comes to the local outpatient clinic reporting dizziness and palpitations. The physical examand laboratory results are normal. The client reports the family-owned company is on the verge ofbankruptcy. Which response, if made by the nurse to the client, is BEST?1."When did you first notice these symptoms?"The nurse cares for the client after a radical mastectomy of the right breast. Upon return to the unit,which position is most appropriate for the nurse to assist the client into?3.Position the client in semi-Fowler's position with the right arm elevated.The nurse walks into the client's room. The client states, "I just love hot-blooded redheads." The clientpats the bed and says, "Why don't you sit down here and get off your feet for a while." Whichresponse by the nurse is BEST?1."I feel very uncomfortable when you make those suggestive remarks. It makes it difficult forme to do my job."The nurse answers the phone on the psychiatric unit. The caller identifies himself as the spouse of aclient and inquires about the client's condition. Which response by the nurse is MOST appropriate?2."Clients are not allowed access to this phone. Please call the number you were given."Several days after the client's myocardial infarction, the health care provider places the client on a 2-gm sodium diet. Which selection indicates to the nurse an understanding of the diet?1.Scrambled egg, orange slices, and milk.The nurse leads a class for expectant mothers. Which comment indicates to the nurse that thepregnant woman understands the recommended dietary caloric increase for pregnancy?3."I need to add 300 calories by increasing my intake of the basic food groups."KAPLAN QUESTION TRAINER 6

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The nurse cares for the 17-year-old married male scheduled for a hernia repair. The nurseadministers fentanyl 100 mcg with hydroxyzine pamoate 25 mg IM. Thirty minutes later the nursediscovers that the informed consent is unsigned. Which action by the nurse is best?3.Notify the health care provider.The nurse instructs a client receiving naproxen 250 mg enteric-coated tablets PO bid. Whichresponse, if made by the client, indicates that the nurse's instruction about the medication iseffective?3."I should call my health care provider if my stools turn very dark."The client at 39 weeks gestation in active labor screams, "I have to push, I have to push." The nursenotes that the client is 8 cm dilated. The nurse should take which action?4.Tell the client to pant with pursed lips.The nurse observes a graduate nurse perform a moist-to-dry dressing change on a client's 2-inchincision. In which order does the student perform the procedure?1.Gently remove dressing.2.Dry skin surrounding the wound.3.Moisten prescribed number of gauze with prescribed amount of solution.4.Apply moist gauze as a single layer.5.Cover with dry dressings.Strategy: Think about the process. Find the first and the last step then insert the steps in the middle.All the steps must be used but all the steps are not listed.1) Attempt to remove dry unless dressing sticks. If dressing does stick, apply NS to help withremoval.2) The exposed skin around the wound is cleaned and dried.3) Because this is a moist-to-dry dressing, the first clean layer of gauze is moistened with prescribedamount of prescribed solution.4) Moist gauze is applied in a single layer.5) Dry gauze is then applied.The client is presently employed as a night watchman. When the client comes to the clinic for a visit,the client reports difficulty sleeping and fatigue. Which response by the nurse is BEST?1."Tell me about your usual sleeping habits."The nurse cares for the client in the emergency room. Before administering calcium gluconate 10%500 mg IV stat, which assessment should the nurse complete FIRST?3.Patency of the vein.Strategy: Determine how each answer choice relates to calcium gluconate.(3) correct —if injected into the extravascular tissues, calcium gluconate can cause a severechemical burnAn 18-month-old is brought by her parent to the well-baby clinic for a routine immunization. Justbefore the nurse gives the child the injection, the toddler begins to cry. Which comment by the nurseis the MOST appropriate?2."I know you are frightened. It will be over with soon."The child admitted with failure to thrive has just had a positive sweat test. The nurse anticipates whichchanges in the child's plan of care?1.Administration of replacement enzymes.5.Social service referral.KAPLAN QUESTION TRAINER 6

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