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Questions 158

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Question 1 of 5

A female client at 36 weeks' gestation has been treated successfully for premature labor for 4 weeks. She has begun having uterine contractions today and has been admitted to the labor and delivery suite. Her amniocentesis results reveal a lecithin/sphingomyelin (L/S) ratio of 2 and positive phosphatidylglycerol (PG). These lab values indicate:

Correct Answer: D

Rationale: Placental maturity is assessed by a biophysical profile. L/S ratio and presence of phosphatidylglycerol are not used to determine fetal asphyxia. A biophysical profile score of 6 may indicate this condition. Cord compression is not reflected by the L/S ratio or presence of phosphatidylglycerol. Variable decelerations observed through electronic fetal monitoring could reflect umbilical cord compression. An L/S ratio >2 and the presence of phosphatidylglycerol in amniotic fluid indicate fetal lung maturity.

Question 2 of 5

Which of the following signs and symptoms indicates a tension pneumothorax as compared to an open pneumothorax?

Correct Answer: C

Rationale: The tension pneumothorax acts like a one-way valve so that the pneumothorax increases with each breath. Eventually, it occupies enough space to shift mediastinal tissue toward the unaffected side away from the midline. Tracheal deviation, movement of point of maximum impulse, and decreased cardiac output will occur. The other three options will occur in both types of pneumothorax.

Question 3 of 5

The client is admitted with a diagnosis of preeclampsia. Which symptom is most characteristic?

Correct Answer: A

Rationale: Proteinuria is a hallmark of preeclampsia reflecting renal involvement alongside hypertension. Fetal macrosomia painful bleeding and fever are not characteristic of this condition.

Question 4 of 5

The nurse is caring for a client with scalding burns across the face, neck, upper half of the anterior chest, and entire right arm.

Correct Answer: 32

Rationale: Rule of nines: face (4.5%), neck (4.5%), upper half anterior chest (9%), right arm (9%) = 4.5 + 4.5 + 9 + 9 = 27%. The closest answer is 32% (
C), possibly due to rounding or partial overlap.

Question 5 of 5

The nurse is caring for an eight-year-old following a routine tonsillectomy. Which finding should be reported immediately?

Correct Answer: D

Rationale: Respiratory stridor post-tonsillectomy suggests airway obstruction, a life-threatening complication requiring immediate reporting. The other findings are normal or less urgent.

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