The nurse is planning care for a client at 30-weeks gestation who is experiencing
preterm labor.
Terbutaline (Brethine) 0.25 mg subcutaneously q15 minutes x 3
Ampicillin 1 gram IV push q8h.
Betamethasone (Celestone) 12 mg deep IM
Butorphanol (Stadol) 1 mg IV push q2h PRN pain
2. A pregnant woman in the first trimester of pregnancy has hemoglobin of 8.6 mg/dl
and a hematocrit of 25.1 %. What food should the nurse encourage this client to include in her
diet?
Carrots
Chicken
Yogurt
Cheese
3. The nurse is preparing to administer methylergonovine maleate (Methergine) to a
postpartum client. Based on what assessment finding should the nurse withhold the drug?
Respiratory rate of 22 breaths/min
A large amount of lochia rubra
Blood pressure 149/90
Positive Homan’s sign
, 4. The nurse is planning care for a 16-year-old, who has juvenile rheumatoid arthritis
(JRA). The nurse includes activities to strengthen and mobilize the joints and surrounding
muscle. Which physical therapy regimen should the nurse encourage the adolescent to
implement?
Begin a training program lifting weights and running
Splint affected joints during activity
Exercise in a swimming pool
Perform passive range of motion exercises twice daily
5. A client receiving oxytocin (Pitocin) to augment early labor. Which assessment is most
important for the nurse to obtain each time the infusion rate is increased?
Pain level
Blood pressure
Infusion site
Contraction pattern
6. One day after vaginal delivery of a full term baby, a postpartum client’s white blood cell
count is 15.000/mm. What action should the nurse take first?
Check the differential, since the WBC is normal for this client
Assess the client’s temperature, pulse, and respirations q4h
Assess the client’s perineal area for signs of a perineal hematoma
Notify the healthcare provider, since this finding is indicative of infection
7. A neonate who has congenital adrenal hypoplasia (CAH) presents with ambiguous
genitalia. What is the primary nursing consideration when supporting the parents of a child
with this anomaly?
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