1. A nurse is caring for a client wh o ha s uterine at on y a n d is

experiencing p ostpartu m hemorrh age . Wh i c h of th e following

actions is the nurse’s priority?

• M a s s a g e the client’s fundus

Uterine atony an d po s tpart u m h mo rrhag e indicate that thisclient is at the

greatest risk for hypo vo l emi c sho ck. This ca n co mp rom i s e the client’s vital

organs, w hi c h c an lead todeath. Therefo re, the nurse’s priority is to m a s s a g e

the client’s fundus to m inim i ze b lo od loss.

2. A n urse is caring for a client w h o is to receive oxyt oc in to

au g m e nt h er labor. Wh i c h of the following findings

contraindicates the initiation of the oxytocin infusion an d

should b e rep orted to the provid er?

• Late decelerations

Late decelerations are indicative of utero placental insufficiency. Therefo re,

this is a contraindicatio n for theadministratio n of o xytoc in an d should b e

repo rted to theprov ider.

3. A n u rse is assessing a client wh o h as severe preeclampsia. W h i c h

of the following man ifest ation s should the n u rse expect ?

• Blurred vision

The nurse should identify that a client w h o ha s severe preeclampsia c an

ha v e arteriolar v aso spasm s an d de c rea sed blo o d flo w to t he retina whi ch

c an lead to visualdisturbances, su c h as blurred vision, do uble vision, o r dark

spots in the visual field.

4. A n urse is assessing a client who is 1 d ay -po stpa rtum a n d ha s a

vaginal h ema t oma . W h i c h of the following man ifest at ion

should the nurse expect ?

• Vag inal pressu re

• T he n urse should exp ect a client wh o h as a vaginal

h e m a t o m a to report pressure in the vagi na d ue to the

b lood that leaked into th e tissues.

5. A n urse is caring for a client wh o is at 3 6 we e k s of gestation and

h a s a positive contraction stress test. Th e n urse should p lan to

p rep are the client for w h i c h of the following diagnostic tests?