A nurse is observing an adolescent client who is oﬀering her newborn a bottle while he is lying in the bassinet.
When the nurse oﬀers to pick the newborn up and place him in the client's arms, the mother states, "No, the baby is too tired to be held." Which of the following actions should the nurse take?

Insist that the mother pick up the newborn to feed him.

Demonstrate how to hold the newborn and allow the client to practice.

Persuade the client to breastfeed the newborn to promote bonding.

Oﬀer to take the newborn to the nursery to finish his feeding.

Answer and Explanation

The Correct Answer is B

The nurse should demonstrate how to hold the newborn and allow the client to
practice.
This will help the mother learn how to properly hold her baby and feel more conﬁdent in her ability to care for her newborn.

Choice A is not the best answer because insisting that the mother pick up the
newborn to feed him may make her feel uncomfortable or pressured.
Choice C is not the best answer because persuading the client to breastfeed the newborn to promote bonding may not be appropriate if the mother has chosen to botle-feed her baby.
Choice D is not the best answer because oﬀering to take the newborn to the nursery to ﬁnish his feeding may not address the mother’s concerns about holding her baby.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A client who is postpartum and experiencing hypovolemic shock would have cool, clammy skin.
This is because hypovolemic shock severely limits the body’s ability to get blood
to all of its organs.

Choice B is not correct because a urinary output of 30 mL/hr is within the
normal range.
Choice C is not correct because a client experiencing hypovolemic shock would have a weak pulse, not a bounding one.
Choice D is not correct because a respiratory rate of 18/min is within the normal range, while a client experiencing hypovolemic shock would have an increased respiratory rate.

A. BP 88/58 mm Hg B. Urinary output 40 mL/hr C. FHR 120/min. D. Fasting blood glucose 75 mg/dL

Correct Answer is A

Explanation

Terbutaline is a medication that can cause serious side eﬀects such as ante (low blood pressure).
A blood pressure reading of 88/58 mm Hg is considered low and could be a sign
of hypotension.

The nurse should withhold the medication and report this ﬁnding to the provider.

Choice B is not an answer because a urinary output of 40 mL/hr is within the
normal range.

Choice Cis not an answer because a fetal heart rate (FHR) of 120/min is within the normal range.

Choice Dis not an answer because a fasting blood glucose level of 75 mg/dL is
within the normal range.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is postpartum and experiencing hypovolemic shock. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

A nurse is assessing a client who is in preterm labor and has a new prescription for terbutaline 0.25 mg subcutaneous. For which of the following findings should the nurse withhold the medication and report to the provider?

Correct Answer is A

Explanation

A nurse is using Nägele's Rule to calculate the expected delivery date of a client who reports that the first day of her last menstrual cycle was July 28th. Which of the following dates should the nurse document as the client's expected delivery date?

A nurse is caring for a client who is in labor and just received epidural anesthesia. The client's blood pressure is 90/50 mm Hg. Which of the following actions should the nurse take?

A nurse is providing dietary teaching to a client who is at 32 weeks of gestation and has cholelithiasis. Which of the following foods should the nurse recommend for the client to include in her diet?

A nurse is assessing a newborn who was exposed to cocaine in utero. Which of the following findings should the nurse expect?

A nurse is providing discharge teaching to a postpartum client about caring for her 3-day-old male newborn at home. Which of the following statements should the nurse make to the client?

After completing post anesthesia recovery assessments, the registered nurse (RN) asks the practical nurse (PN) to transfer four clients, each two hours post-birth, to the postpartum unit. Which client should the PN ask the RN to reassess prior to transfer?

A nurse in a provider's office is caring for a 20-year-old client who is at 12 weeks of gestation and requests an amniocentesis to determine the sex of the fetus. Which of the following responses should the nurse make?

A nurse is planning care for a newborn who is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan?