WorksheetsNC1 SET 3
Total questions: 75
Worksheet time: 4hrs 17mins
A primigravida at 12 weeks requests guidance on prenatal vitamins and nausea. Which advice is most appropriate today?
Begin iron at 60-120 mg elemental daily and avoid vitamin B6 entirely
Use prenatal with folic acid 400-800 µg daily; try small meals and B6 as tolerated
Delay all supplements until the second trimester for better tolerance
Replace prenatal vitamins with high-dose herbal ginger formulations exclusively
A 22-week client asks about exercise while pregnant. Which action is best?
Discontinue all aerobic activity until 36 weeks
Continue moderate activity most days if no contraindication; avoid contact or high-fall sports
Start high-intensity interval training to reduce gestational weight
Begin hot yoga classes to improve flexibility and sleep
At 18 weeks, a client reports lightheadedness when supine. What should the nurse teach first?
Increase dietary sodium at dinner to raise intravascular volume
Lie in left lateral tilt when resting to relieve vena cava compression
Wear a tight abdominal binder during sleep for support
Reduce fluid intake after 1700 to limit nocturia
A 26-week client asks whether new mild ankle edema is normal. What response is best?
Physiologic edema can occur; elevate legs, use left-side rest, and evaluate if sudden or with symptoms
Any leg swelling is a red flag and requires ED triage now
Salt tablets should be taken twice daily to improve swelling
Diuretics should be started to prevent skin breakdown
A 28-week client asks about fetal movement counting. What instruction is most accurate?
Movements must reach 15 in 30 minutes to be normal
Aim for 10 movements within up to 2 hours during usual active times
Count only after large meals to standardize results
Stop counting after 30 weeks because patterns stabilize
During routine prenatal labs, which tests are standard in low-risk pregnancy at the first visit? Select all that apply.
ABO/Rh type and antibody screen
HIV, Hep B surface antigen, and syphilis screening
Rubella immunity and varicella history or titer as indicated
D-dimer and troponin to establish baseline values
CBC and urine culture to screen for anemia and asymptomatic bacteriuria
A 32-week client with a healthy pregnancy asks about air travel for a 2-hour domestic flight. What should the nurse recommend?
Avoid all flights after 28 weeks due to thrombosis risk
Travel is acceptable if uncomplicated; hydrate, walk periodically, and wear a seatbelt low across hips
Use sedatives to sleep through turbulence and contractions
Choose an aisle seat and decline seatbelt use to reduce pressure
At 34 weeks, the client asks about TDaP timing. What is the best response?
Postpone TDaP to the postpartum period for passive transfer
Receive TDaP during 27-36 weeks to optimize neonatal antibody levels
Avoid TDaP in third trimester due to maternal syncope risk
Give TDaP only if there is a local pertussis outbreak
A 39-week client in early labor requests nonpharmacologic pain measures. Which nursing action is best now?
Keep the client supine to reduce fatigue and conserve energy
Encourage upright and mobile positions, rhythmic breathing, heat or counter-pressure as desired
Begin directed Valsalva breathing between contractions
Start restriction of oral fluids to limit gastric contents
A healthy term newborn in the first hour of life is vigorous and crying. Which immediate actions support a physiologic transition? Select all that apply.
Dry thoroughly and place skin-to-skin with the mother if stable
Delay cord clamping when feasible per protocol
Routine separation for a full bath before feeding
Initiate breastfeeding when infant shows feeding cues
Provide glucose water to prevent early hypoglycemia
During second stage, the FHR tracing is reassuring. Which pushing support is most appropriate?
Coach physiologic spontaneous pushing in positions of comfort
Require continuous lithotomy to standardize delivery
Direct sustained Valsalva for at least 10 seconds each effort
Delay all pushing until crowning is visible
A term multipara requests hydrotherapy in active labor without complications. What is the best nursing action?
Offer hydrotherapy with safety screening and temperature control per unit protocol
Avoid water immersion because it increases infection rates
Approve hydrotherapy only during second stage pushing
Limit immersion to five minutes to prevent fetal tachycardia
Immediately after a routine vaginal birth, the fundus is firm at the umbilicus, midline; lochia is moderate rubra; vitals are stable. What is the next best nursing step?
Support skin-to-skin and initiate breastfeeding within the first hour
Catheterize the bladder to prevent overdistention
Begin oxytocin infusion only if bleeding increases
Transfer immediately to nursery for newborn exam and bath
A breastfeeding parent reports nipple pain on day 3. Which teaching promotes a deep latch? Select all that apply.
Align nose to nipple and wait for a wide gape, then bring baby to breast
Aim an asymmetric latch with more areola visible above than below
Place the nipple at the center of the closed mouth quickly
Ensure chin contacts breast and cheeks remain rounded without dimpling
Pull the infant's head forward by the occiput during attachment
On postpartum day 2, which lochia pattern is expected for a stable client?
Lochia alba with minimal volume
Lochia rubra with decreasing volume and no clots
Lochia serosa with foul odor and moderate clots
Absent lochia with increasing uterine size
A term newborn at 12 hours of life has RR 48, irregular breathing, acrocyanosis, and vigorous cry. What action is indicated?
Begin oxygen via mask because of acrocyanosis
Observe and keep warm; findings are normal for age
Start continuous positive airway pressure immediately
Delay feeds until breathing rate is consistently below 40
A 2-day newborn is due for discharge. What safe sleep teaching should the nurse include? Select all that apply.
Place supine for every sleep on a firm, flat surface
Room-share without bed-sharing for the first months
Use soft pillows and positioners to prevent flat spots
Avoid smoke exposure and overheating of the sleep environment
Let the infant sleep overnight in a car seat to reduce reflux
A postpartum parent asks about engorgement on day 4 while breastfeeding. What is the best guidance?
Skip feeds to allow swelling to subside
Feed frequently with good latch; warm before feeds and cool packs after
Bind breasts tightly to reduce milk volume
Restrict fluids until breasts soften
A 30-minute-old term infant, vigorous and pink on room air, is scheduled for a bath. What is the nurse's priority action?
Delay the bath until thermoregulation and bonding are established
Proceed with a full bath to reduce skin colonization
Bathe only the head and keep the body uncovered
Apply alcohol wipes to remove vernix thoroughly
At a 6-week postpartum visit, which findings require urgent evaluation rather than routine reassurance? Select all that apply.
Severe headache with visual changes
Heavy lochia with large clots and dizziness
Mild perineal soreness improving each day
Persistent fever ≥38.0 °C with uterine tenderness
Brief 'baby blues' resolving within two weeks
A healthy exclusively breastfed infant at 2 weeks has surpassed birth weight and has 6-8 wets and several yellow seedy stools daily. The parent asks about supplementation. What should the nurse recommend?
Begin daily vitamin D supplementation for the infant
Add water between feeds to prevent constipation
Start iron drops now to prevent anemia
Replace one breastfeed daily with formula
A term infant 24 hours old has a bilirubin in the low-intermediate risk zone and is feeding well. What is the best nursing plan?
Encourage frequent effective feeds and arrange routine follow-up bilirubin checks
Begin prophylactic phototherapy for 24 hours
Keep the infant NPO to reduce bilirubin production
Supplement glucose water to prevent kernicterus
A multip at 41 weeks in early labor asks how to optimize progress without medications. Which nursing strategies are appropriate? Select all that apply.
Upright and mobile positions to enhance pelvic diameters
Hydration, light nutrition, and bladder emptying regularly
Supine bedrest to conserve energy throughout labor
Continuous labor support and relaxation techniques
Early directed Valsalva pushing before full dilation
A postpartum client asks about resuming sexual activity. Which guidance is most appropriate?
Wait six months regardless of recovery
Resume when bleeding has ceased, perineum or incision is healed, it is comfortable, and contraception is in place
Resume at one week to reduce dyspareunia
Avoid condoms while breastfeeding because of estrogen changes
A rooming-in term newborn is sleepy and feeding ineffectively at 20 hours. What is the best initial nursing action?
Switch fully to formula for the next 24 hours
Place skin-to-skin, assess latch and transfer, and wake for feeds every 2-3 hours
Offer a pacifier between feeds to organize sleep
Delay feeds until the infant is more alert spontaneously
A 10-week client asks how to lower nausea while continuing a prenatal vitamin. Which advice is best today?
Take the vitamin with a small snack and try vitamin B6 as needed
Take the vitamin at bedtime and avoid all liquids after dinner
Take the vitamin on an empty stomach and walk briskly after meals
Take the vitamin every other day and add high-dose ginger capsules
A 20-week client wants to begin a new exercise routine. Which plan is most appropriate?
Start high-intensity intervals four days weekly with heat exposure
Begin moderate aerobic activity most days and avoid contact sports
Perform heavy powerlifting with breath-holding to increase tone
Use hot yoga daily to reduce swelling and improve sleep
A 24-week client develops lightheadedness when lying flat. What should the nurse teach first?
Sleep supine with two pillows for chest expansion
Rest in left lateral tilt to relieve vena cava pressure
Wear a tight abdominal binder throughout the night
Restrict evening fluids to prevent nocturnal symptoms
A 28-week client asks about travel on a two-hour domestic flight. Which counsel is most appropriate?
Avoid all flights after the second trimester regardless of risk
Fly if uncomplicated, hydrate, move often, and wear seatbelt low
Use sedatives to sleep and keep legs extended during flight
Decline seatbelts to prevent pressure on the gravid abdomen
A 30-week client reports mild dependent ankle edema by evening only. What is the best reply?
Physiologic swelling is common; elevate legs and rest left-side
Any leg swelling is an emergency that requires ED evaluation
Sodium tablets twice daily help remove interstitial fluid
Daily diuretics prevent skin breakdown in late pregnancy
A 32-week client asks when to start counting fetal movements. Which instruction is most accurate?
Ten movements in thirty minutes are required every evening
Ten movements within two hours during usual active periods
Five movements after meals are adequate for reassurance
Movement counting ends after thirty weeks as patterns stabilize
At the first prenatal visit, which routine labs should be obtained in a low-risk pregnancy? Select all that apply.
ABO/Rh type and antibody screen
HIV, hepatitis B surface antigen, and syphilis testing
Rubella immunity and varicella history or titer as indicated
Complete blood count and urine culture
D-dimer and troponin to establish a baseline
A 34-week client asks about TDaP timing in pregnancy. Which response is best?
Defer to postpartum to reduce third-trimester syncope risk
Administer during 27-36 weeks to optimize infant antibodies
Provide only if there is a current community pertussis outbreak
Administer in the first trimester to avoid late reactions
A 39-week client in early labor requests nonpharmacologic pain measures. Which action is best now?
Supine bedrest to conserve energy and slow descent
Upright mobility, rhythmic breathing, heat or counter-pressure
Directed Valsalva pushing between every contraction
Restrict oral fluids to minimize gastric volume
A vigorous term newborn is placed on the warmer immediately after birth. Which next step best supports physiologic transition?
Dry thoroughly and place skin-to-skin with the parent
Complete a full bath before attempting the first feed
Give glucose water to prevent early hypoglycemia
Separate for routine measurements before contact
In the first hour after an uncomplicated vaginal birth, which practices promote optimal newborn adaptation? Select all that apply.
Delayed cord clamping when feasible
Early breastfeeding when feeding cues appear
Continuous separation for nursery observation
Thermal protection and avoidance of heat loss
Routine suctioning of mouth and nares without indication
During second stage with a reassuring tracing, which pushing support is most appropriate?
Lithotomy with sustained Valsalva for timed cycles
Physiologic spontaneous pushing in positions of comfort
Breath-holding counts of ten with each contraction
Delayed pushing until crowning is visible
A term multip requests hydrotherapy in active labor without risk factors. What should the nurse do?
Offer hydrotherapy using unit screening and temperature control
Decline hydrotherapy due to infection concerns in labor
Approve hydrotherapy only during second-stage pushing
Limit immersion to five minutes to avoid tachycardia
Immediately after birth, the fundus is firm at the umbilicus and bleeding is moderate rubra. Vitals are stable. What is the next best step?
Support skin-to-skin and initiate the first breastfeed
Place a Foley catheter to prevent bladder distention
Begin oxytocin infusion only if bleeding increases
Transfer the infant to nursery for bathing and weights
On postpartum day two, which lochia pattern is expected for a stable client?
Alba with minimal volume and no odor
Rubra with decreasing volume and no clots
Serosa with foul odor and moderate clots
No flow with a rising uterine fundal height
A breastfeeding parent reports nipple pain on day three. Which latch cues should the nurse emphasize? Select all that apply.
Nose-to-nipple alignment and wait for a wide gape
Asymmetric latch with more areola visible above
Chin contact with rounded cheeks without dimpling
Center the nipple in a closed mouth and push quickly
Pull the infant's head forward by the occiput firmly
A 12-hour-old term newborn has RR 48 with irregular pattern, acrocyanosis, and a strong cry. What action is indicated?
Provide oxygen via mask due to peripheral cyanosis
Observe, keep warm, and proceed with routine care
Initiate CPAP to prevent early respiratory fatigue
Delay feeds until respiratory rate is under forty
A parent asks when to bathe a healthy term infant born thirty minutes ago. What is the priority action?
Bathe now to reduce bacterial colonization of the skin
Delay bathing until thermal stability and bonding are established
Bathe the scalp only and leave the body uncovered
Remove vernix completely using alcohol wipes
At a six-week postpartum visit, which concern requires urgent evaluation?
Mild perineal soreness that improves daily
Severe headache with visual disturbance
Brief 'baby blues' that resolved within two weeks
Light serosa with no clots or foul odor
A healthy exclusively breastfed infant at two weeks has surpassed birth weight with six to eight wets and several yellow stools daily. What supplement is indicated?
Daily vitamin D drops for the infant
Daily water between feeds for stool softening
Daily iron drops beginning at two weeks
Daily formula substitution to increase intake
A term infant at twenty-four hours has a bilirubin in the low-intermediate risk zone and is feeding well. What is the best plan today?
Encourage frequent effective feeds and schedule routine follow-up
Begin prophylactic phototherapy for one full day
Keep the infant NPO to reduce bilirubin production
Supplement glucose water to prevent kernicterus
A multip at 41 weeks requests strategies to improve labor progress without medications. Which nursing measures are appropriate? Select all that apply.
Upright and mobile positions to open pelvic diameters
Hydration, light nutrition, and regular bladder emptying
Continuous labor support and relaxation techniques
Supine rest for the majority of labor to conserve energy
Directed pushing prior to complete dilation for momentum
A postpartum client asks when sexual activity may safely resume. Which guidance is most appropriate?
Resume at one week to reduce perineal stiffness
Resume when bleeding has ceased, healing is complete, comfort is present, and contraception is arranged
Resume at exactly six months regardless of recovery
Avoid barrier contraception while breastfeeding
A rooming-in term newborn is very sleepy at twenty hours and feeds poorly at the breast. What is the best initial action?
Switch to exclusive formula for the next twenty-four hours
Place skin-to-skin, assess latch and transfer, wake to feed every two to three hours
Offer a pacifier between feeds to organize sleep cycles
Delay all feeds until the infant becomes more alert
A 34-week client asks about car safety for the newborn. Which instruction is most accurate?
Use a forward-facing seat if birthweight is under three kilograms
Use a rear-facing, rear-seat, properly fitted seat for all tra
A 34-week client presents with BP 168/112, headache, RUQ pain, and brisk reflexes. What is the first nursing action?
Institute seizure precautions and start magnesium per protocol (correct)
Obtain a 24-hour urine for protein quantification
Encourage fluids and reassess symptoms later
Prepare oxytocin for immediate induction of labor
A 29-week client has PPROM with clear fluid, afebrile, and a Category I tracing. What is the priority nursing plan now?
Begin latency antibiotics and arrange antenatal corticosteroids (correct)
Perform sterile vaginal exams every two hours
Discharge on pelvic rest with daily home checks
Start oxytocin to shorten latency period
During oxytocin induction, contractions reach 6 in 10 minutes with recurrent late decelerations. What should the nurse do first?
Increase oxytocin one increment
Stop oxytocin and begin intrauterine resuscitation (correct)
Start amnioinfusion immediately
Apply fundal pressure during each contraction
A shoulder dystocia is declared. Which maneuver should the nurse facilitate first?
McRoberts position with suprapubic pressure (correct)
Fundal pressure with maternal hyperextension
Vacuum extraction without repositioning
Supine position with straightened legs
A postpartum client with uterine atony and asthma needs a second uterotonic. Which medication should the nurse avoid?
Oxytocin IV infusion
Misoprostol PR dosing
Carboprost IM (correct)
Tranexamic acid IV
A 10-week client with hyperemesis gravidarum has ketonuria and orthostasis. Which nursing actions are indicated now? Select all that apply.
Start IV fluids with thiamine before dextrose (correct)
Correct electrolytes and monitor I&O closely (correct)
Begin high-fat meals to slow gastric emptying
Administer antiemetics per protocol and reassess response (correct)
Discharge with ginger tea instructions only
A 28-week client with GDM on insulin shows fasting 92 mg/dL and 2-hr PP 120-130 mg/dL. What is the nurse's best interpretation?
Poor control that requires insulin escalation today
Targets are met; reinforce monitoring and surveillance plan (correct)
Over-control; discontinue all insulin therapy
Lab error; repeat values before any counseling
A 36-week client with placenta previa has painless vaginal bleeding. What is the best nursing action?
Avoid vaginal exam; monitor FHR, secure IV access, and prepare for cesarean if bleeding persists (correct)
Perform a sterile vaginal exam to assess dilation
Ambulate to test hemodynamic stability
Start oxytocin to accelerate birth
A 32-week client with suspected abruption has constant pain, a firm abdomen, and FHR 90. What is the priority?
Activate obstetric emergency, establish large-bore IVs, and prepare for urgent birth (correct)
Encourage ambulation and oral hydration
Begin tocolysis to stop contractions
Discharge with strict bed rest instructions
A client experiences a generalized seizure in labor. Which immediate nursing actions are appropriate? Select all that apply.
Protect airway and turn to the left lateral position (correct)
Administer magnesium sulfate per protocol (correct)
Insert a tongue blade to prevent biting
Assess FHR and maternal status after the event (correct)
Delay any delivery planning for 24 hours
A 37-week VBAC labor shows sudden abdominal pain, loss of station, and fetal bradycardia. What is the priority nursing action?
Encourage pushing with strong bearing down
Call an obstetric emergency and stop oxytocin if infusing (correct)
Obtain a urine sample for ketone evaluation
Begin amnioinfusion to relieve cord compression
A 16-week client has heavy bleeding and cramping; ultrasound shows products of conception in the uterus. Which nursing actions are indicated now? Select all that apply.
Assess hemodynamic stability and obtain IV access (correct)
Review Rh type and prepare RhIG if indicated (correct)
Discharge with NSAIDs and rest only
Prepare for uterine evacuation per orders (correct)
Delay all interventions for 48 hours
A client in second stage with chorioamnionitis has a fetal baseline of 170 with maternal fever. What is the best nursing plan?
Continue assisted second stage with broad-spectrum antibiotics and prepare neonatal sepsis evaluation (correct)
Defer delivery until fever resolves spontaneously
Stop antibiotics during pushing to avoid nausea
Convert to cesarean for all chorio cases
On postoperative day 1 after cesarean, a client has dyspnea and a tender swollen calf. What is the priority?
Initiate PE/DVT protocol, apply oxygen, and arrange diagnostic imaging (correct)
Ambulate briskly to mobilize the clot
Massage the calf to promote circulation
Apply heat and reassess the next morning
A postpartum client on methylergonovine develops BP 172/106. What is the nurse's best action?
Continue methylergonovine to control bleeding
Hold methylergonovine and treat severe hypertension per protocol (correct)
Switch to carboprost despite reactive airway disease
Recheck blood pressure in four hours without changes
An Rh-negative client delivered an Rh-positive infant 26 hours ago with a fetomaternal hemorrhage of ~20 mL. What must the nurse ensure?
No further care because the window has closed
Administer an appropriate dose of RhIG now based on FMH volume (correct)
Provide MMR vaccine instead of immunoglobulin
Delay any injections until the two-week visit
A hemodynamically stable ectopic pregnancy (β-hCG 2500, no cardiac activity) is diagnosed. Which nursing actions are appropriate? Select all that apply.
Educate on methotrexate precautions and avoidance of folate supplements (correct)
Arrange serial β-hCG monitoring until undetectable (correct)
Encourage vigorous exercise to promote resolution
Teach emergency symptoms of rupture and when to seek care (correct)
Begin oxytocin to expedite uterine evacuation
A near-complete dilation labor shows persistent Category III tracing despite resuscitation. What is the priority?
Continue observation for another hour
Prepare for operative delivery while continuing resuscitation (correct)
Start oxytocin to quicken descent
Discontinue all monitoring equipment
At 30 weeks with preterm labor, the cervix is 3 cm/80% and membranes are intact. What is the best nursing plan?
Administer betamethasone and consider tocolysis to allow steroid course (correct)
Begin immediate induction of labor
Strict bed rest without medications
Prophylactic broad-spectrum antibiotics for all
A postpartum day-3 client has fever 38.6 °C, uterine tenderness, and foul lochia. Which nursing actions are indicated now? Select all that apply.
Initiate broad-spectrum IV antibiotics promptly (correct)
Assess for retained tissue and arrange imaging if indicated (correct)
Manage pain, hydration, and monitor response (correct)
Routine douching to clear discharge
Reinforce hand hygiene and perineal care education (correct)
A laboring client has recurrent variable decelerations with intact membranes. What is the best nursing sequence?
Increase oxytocin and continue supine position
Reposition, give IV bolus, consider O₂, and prepare for amnioinfusion after ROM (correct)
Apply fundal pressure during contractions
Discontinue monitoring to decrease maternal anxiety
A postpartum client presents with insomnia, pressured speech, and fixed delusions about the infant. What is the priority nursing action?
Offer teas and schedule routine follow-up
Initiate emergency psychiatric evaluation and ensure dyad safety (correct)
Encourage journaling about emotions daily
Discharge with telephone support numbers
An oxytocin induction patient becomes drowsy with headache; labs show Na 124. Which immediate steps are appropriate? Select all that apply.
Stop oxytocin and evaluate for water intoxication (correct)
Notify provider and correct sodium per protocol (correct)
Increase oxytocin to finish labor sooner
Reassess fluid intake and limit excess free water (correct)
Ignore values and repeat labs tomorrow
A 28-week client with a history of cerclage reports regular contractions. What is the best nursing action?
Increase activity and oral hydration only
Notify the provider urgently and assess for cerclage removal (correct)
Start oxytocin to achieve effective labor
Reassure that cerclage prevents labor progression
A 30-week client hospitalized for pyelonephritis has fever, flank pain, and CVA tenderness. What is the priority nursing plan?
Oral antibiotics and discharge with follow-up
Begin IV antibiotics and fluids; monitor for preterm labor (correct)
Delay antibiotics until culture results return
Encourage cranberry juice as sole therapy
