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NUR421 Exam 2 Questions And Correct Answers
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NUR421 Exam 2 Questions AndCorrect Answers
A postpartum nurse caring for a patient 3 days post-delivery notes brown vaginal
discharge. How should the nurse document this finding in the electronic health record?
A. Lochia rubra
B. Lochia serosa
C. Lochia alba
D. Brown vaginal discharge - Answer B. Lochia serosa
A nurse is caring for a patient 2 hours post-vaginal delivery of a term neonate. The
patient suddenly complains of heavy bleeding, nausea, and dizziness. Vital signs are BP
85/49, HR 110, RR 18, O2 saturation 90%, temp 98.3 F. Based on these assessment
findings, what is the priority nursing intervention?
A. Administer oxygen per nasal cannula.
B. Achieve free-flowing venous access
C. Increase frequency of vital signs.
D. Prepare for emergency dilation and curettage. - Answer A. Administer oxygen per
nasal cannula.
A nurse is caring for a patient 6 hours post-vaginal delivery of a term neonate. She notes
a white blood cell count of 20,000/mm. What is the priority nursing intervention for this
patient?
A. Notify the physician or midwife.
B. Interpret as a normal finding.
C. Administer Tylenol 1,000mg PO.
D. Order a repeat CBC for the next morning. - Answer B. Interpret as a normal finding.
White blood cell (WBC) levels may increase to 30,000/mm within a few hours of birth as
the result of the stress of labor and birth, and return to normal levels within 7 days.
A nurse is caring for a postpartum patient who had an uncomplicated delivery 12 hours
ago. Vital signs are: BP 125/88, HR 90, O2 saturation 98%, temperature 100.0 F. What is
the priority nursing intervention?
A. Document as within normal limits.
,B. Administer Acetaminophen 650mg PO prn.
C. Notify the physician or midwife.
D. Remove extra blankets and recheck in 1 hour. - Answer A. Document as within normal
limits.
A postpartum patient reports urinary frequency, urgency, and pain with urination. What
is the priority nursing intervention for this patient?
A. Assess the patient's temperature.
B. Instruct the patient to use the peri-bottle when she voids.
C. Assist the patient with a sitz bath.
D. Send a urine specimen for culture and sensitivity. - Answer A. Assess the patient's
temperature.
A G4P4 patient who is 6 hours post-delivery is complaining of severe cramp-like uterine
pains. What is a therapeutic nursing response?
A. "The cramping should go away when you start breastfeeding."
B. "The pains are caused by your uterus contracting and should get better in a few
days."
C. "Afterpains are usually the worse with your first baby."
D. "The contractions will subside over the next 6 weeks as your uterus goes back to its
normal size." - Answer B. "The pains are caused by your uterus contracting and should
get better in a few days."
During routine assessment, a nurse caring for a postpartum patient notes the uterus is
shifted to the side. What is the priority nursing action?
A. Notify the physician or midwife.
B. Document the findings in the electronic medical record.
C. Perform gentle fundal massage.
D. Assist the woman to the bathroom. - Answer D. Assist the woman to the bathroom.
A postpartum nurse is caring for multiple patients on the mother-baby unit. Which
patient should the nurse evaluate first?
A. A G1P1 who gave birth 30 minutes ago and reports uncontrollable shaking.
B. A G6P5 who gave birth 6 hours ago and reports passing a basketball-sized blood clot.
C. A G3P1 who is 3 days post-op cesarean section and reports cracked and bloody
, nipples.
D. A G2P1 who is 2 days post-op cesarean section and reports 7/10 abdominal pain. -
Answer B. A G6P5 who gave birth 6 hours ago and reports passing a basketball-sized
blood clot.
The nurse has just completed discharge teaching for a primiparous patient. Which
statement by the patient indicates to the nurse understanding of discharge instructions
following vaginal delivery of a term infant?
A. "I will call my doctor if my uterus is squishy when I massage it."
B. "I will experience heavy bleeding for the first week."
C. "I should change my peripad twice a day."
D. "I might notice a foul smell to my discharge." - Answer A. "I will call my doctor if my
uterus is squishy when I massage it."
The postpartum nurse is educating a patient who is receiving the Measles, Mumps, and
Rubella (MMR) vaccine. What statement made by the patient indicates the need for
further teaching?
A. "My arm might be sore where I was given a shot."
B. "I will avoid pregnancy for 4 weeks."
C. "I will need to receive this vaccine again during my next pregnancy."
D. "I am being vaccinated against German measles." - Answer C. "I will need to receive
this vaccine again during my next pregnancy."
A postpartum patient asks the nurse if she needs to use contraception while
breastfeeding. What is the most therapeutic response by the nurse?
A. "Yes, because breastfeeding is not an effective contraceptive method."
B. "You cannot get pregnant as long as you are breastfeeding."
C. "It takes 9 to 10 weeks for your hormone levels to allow you to get pregnant."
D. "That is a question for your doctor to answer." - Answer A. "Yes, because
breastfeeding is not an effective contraceptive method."
When discussing feeding options with a lesbian couple for their newborn, the nurse
notes that both women would like to breastfeed. What is the appropriate nursing
response?
A. "Because only one of you conceived, only one of you can breastfeed."
B. "It's not uncommon for both mothers to breastfeed. I will get you in touch with a
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