OB Practice Questions

The nurse is assigned to care for a 2 hour old newborn in an Isolette. She checks the temp of the Isolette and knowing the temp is too high if the infant:

-Temperature is 101 degrees rectally.

When assessing the neonate's head, the following is noted. How does the nurse document this finding most accurately?

-cephalhematoma contained on the left side. It does not cross that suture line in the middle. (the caput can cross suture lines so that is how we know it is the cephal) -a kiwi, vacuum, or even forceps can cause a cephalhematoma. it can also cause the caput.

The mother is inquiring about how long and how frequent she should be breast feeding her 24 hour old infant. What is the nurses best response? 1. The newborn should be fed every 2-3 hours for at least 15 minutes 2. Smaller breastfed women should feed their infants longer than larger breastfed women 3. The newborn should be fed 4 hours for as long as it is still feeding 4. The newborn should only be fed when showing cues of hunger

1

The nurse prepares a plan of care for the client with preeclampsia and documents that if the client progresses from preeclampsia to eclampsia, the nurse should take which first action? 1. Administer oxygen by face mask. 2. Clear and maintain an open airway. 3. Administer magnesium sulfate intravenously. 4. Assess the blood pressure and fetal heart rate.

2

4 pounds 15 ounces = ______ grams ?

2226-2251

A well baby nurse is assigned three patients, which one should she see first? 1. 2 hr old neonate with a RR of 60 2. 6 hour old C/S neonate with a temp of 99.0 3. 36 hour old C/S neonate with a high pitched cry 4. 24 hr old neonate with acrocyanosis

3

Upon assessment, the nurse finds that the neonate's temperature is 97.3 and respirations are 70. Which of the next following findings would be the most concerning? 1. HR of 130 bpm 2. Baby having 2 bowel movements in the last 24 hours 3. Glucose of 22 4. Baby showing hunger cues to breastfeed every 2 hours

3

Which of the following signs would require nursing intervention? 1. blue-black skin discoloration on sacral area 2. temp of 99.1 3. glucose of 32 4. hands and feet appear blue 2 hours PP

3

A nurse is completing an assessment. Which of the following data indicate the newborn is adapting to extrauterine life? 1. Expiratory grunting 2. Inspiratory nasal flaring 3. Apnea for 10 second periods 4. Obligatory nose breathers 5. Crackles and wheezing 6. Bluish color to lips 7. Respiratory rate of 52

3 (abnormal is greater than 20 seconds) 4 (if something obstructs their nose, they will open their mouth up but it is jus not their natural breathing) 7 -grunting is never okay -fine crackles are normal b they still may have some fluid in their; wheezes though are not normal. With course crackles, you may hear it with a c section baby, but with vaginal delivery you won't because in a vaginal delivery, it is being squeezed out and the pressure helps expel some of the fluid, and in a c section baby, they can't get the fluid out as well, but the course crackles should go away soon after.

What statement from the mom indicates proper education on cord care? SATA 1. "I will full submerge my baby in the sink during bath time" 2. "I will give my baby a bath every day" 3. "I will call the doctor if I notice any drainage from the cord" 4. "I will completely dry the cord after bathing my baby" 5. "I will use mld soap and water to wash my baby's cord"

3,4,5

Upon discharge, a new mother is using the teach back method to explain her knowledge of breastfeeding. What statement made by the mother would indicate a need for further teaching? 1. "I will support my baby's. head during feedings' 2. 'Even if my baby is sleeping, I will wake my baby and feed them roughly every 2 hours" 3. "I will alternate breasts and feed for at least 15 minutes each time" 4. "I will breastfeed and use supplemental formula feedings to ensure my baby is getting enough nutrients"

4

4230 grams is _____ pounds and ounces ?

9 lbs 5 oz

1. Increase the IV rate 2. Provide supplemental oxygen 3. Record the finding on the EHR and repeat the reading in 30 min 4. Wrap the neonate to increase body temp

Answer: 2 -babies skin should not be pale, the O2 sat is abnormal at 4 hours. -blood glucose, temp, and respirations go together. 1 we don't know if baby has IV 4 we don't know what the babies temp was 3 we will need to intervene now and not just wait

After receiving change of shift report in the normal newborn nursery, the nurse should see which neonate first? 1. 3 hour-old with increased respiratory secretions 2. 5-hour old with blood glucose of 25 3. 12-hour old with temp of 97.4 4. 24-hour old with no urine output for the past 12 hours

Answer: 2 (normal blood glucose is 40-60 and the glucose is most unstable. 25 is really low and the baby needs to eat now) 1- this is pretty normal after birth and we suction to help with secretions 3 -97.6 and below is abnormal and we are concerned but glucose is most concerning 4- we are concerned with this baby, but we don't know how many wet diapers they had before

The nurse completed discharge teaching with new parents who are bottle-feeding newborn. Which statement by the parents indicates successful teaching? 1. "Our baby will require feedings through the night for the first week after birth" 2. "The baby should burp during and after each feeding with projectile feeding 3. "Our baby should have at. least one soft, formed stool per day" 4. "We should weigh our baby daily to make sure he is gaining weight"

Answer: 3 1 is wrong bc you will be feeding way longer than that 2 is wrong bc no baby should be vomiting, spit up is normal though 3 is right (breastfed babies have 1-3 looser stools and they are yellowy (bc it is easier to digest). Formula fed stools -we should have 1 a day and are more. pasty, pinky, putty look and more formed). The goal is to have 2 stool per day. 4 is not necessary to weigh baby daily; if there was a concern you would see the pediatrician or have a lactation counselor seen.

A new client asks, "Why are you doing a gestational age assessment on my baby?" The nurse's best response is: 1. "It was ordered by your physician." 2. "This is done to accurately determine the gestational age of your newborn." 3. "It helps us identify infants who are at risk for any problems." 4. "The gestational age determines how long the infant will be hospitalized."

Answer: 3 2- i will not accurately tell us, but will get us close.

The nurse is caring for a newborn of a primiparous woman with insulin-dependent diabetes. When the mother visits the neonate at 1 hour after birth, the nurse explains to the mother that the neonate is being closely monitored fro symptoms of hypoglycemia because of which reason? A. Increased use of glucose stores during a difficult labor and birth process B. Interrupted supply of maternal glucose and continued high neonatal insulin production C. A normal response that occurs during transition from intrauterine to extrauterine life D. Increased pancreatic enzyme production caused by decreased glucose stores

B

Two hours ago, a neonate at 38 weeks gestation and weighing 3175 grams was born to a primiparous client who tested positive for beta-hemolytic Streptococcus (GBS). Which finding would alert the nurse to notify the health care provider? A. Alkalosis B. Increased muscle tone C. Temperature instability D. Positive Babinski reflex

C

A 2-week old neonate is admitted to the hospital with a diagnosis of possible sepsis. Based on the information in the EHR, which order would the nurse question? A. Acetaminophen 10mg/kg per rectum, every 4-6 hours PRN pain B. Ampicillin 200mg/kg IV every 6 hours C. Mom may breastfeed ad lib D. Draw blood cultures times 3 in the AM

D -If we think someone has sepsis, we would need to draw blood cultures first, so we would question giving meds before drawing a blood cultures. We need to do cultures first so that we know what meds will need to be given.

The nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. How should the nurse document this finding in the client's medical record?•Reactive •Non-reactive •Negative •Positive

Reactive

When assessing a neonate 1 hour after birth, the nurse notes acrocyanosis of both feet and hands, measures an axillary temp or 95.5 degrees, and apical pulse of 110 beats/min, and a respiratory rate of 64 breaths. minute. Which assessment would be most concerning for the nurse?

The temp bc the baby is hypothermic, and their temp is a lot worse than the respirations, and the RR is prob high due to the temp.

A baby born 28 hours ago has yellowish skin, temp of 97.3, RR of 67, and acrocyanosis. What nursing intervention would the nurse do first? 1. Wrap baby in blanket, put cap on head and monitor temp in 30 min 2. Initiate feedings 3. Give supplemental oxygen 4. Call HCP for indication of pathologic jaundice

1

A mother who is HIV positive is really excited to breastfeed and is asking when she can begin. What is the nurse's best response? 1. Due to your HIV positive diagnosis, it is unsafe for you to breastfeed. Formula feeding is a great alternative. 2. Immediately! The baby needs to feed within an hour after birth 3. Once you've established on your HIV medication therapy. then you can breastfeed 4. Why would you ask me that? You don't want tot infect your baby do you?

1

A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The primary health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding? 1. A normal test result 2. An abnormal test result 3. A high risk for fetal demise 4. The need for a cesarean section

1

A primigravida patient is 36 hours PP and is complaining that she does not feel like she is producing enough breast milk. What should the nurse tell the patient? 1. Schedule a lactation consultant 2. Tell her to bottle feed with formula 3. Inform her this is normal 4. Assess newborn for tongue-tie and rooting reflex

1

It is standard routine to instill the ophthalmic ointment form of which medication into the eyes of a newborn infant as a preventative measure against ophthalmia neonatorum? 1. Erythromycin 2. Gentamycin 3. Vitamin K 4. Penicillin

1

On assessment of a post c-section neonate, the nurse notes fine crackles when listening to the baby's lungs. What should the nurse's next action be? 1. document the finding and continue to monitor the neonate 2. notify the HCP 3. bulb suction mouth and nose 4. provide supplemental oxygen

1

The nurse is teaching umbilical cord care to a new mother. What information would the nurse provide to the mother related to cord care? 1. The process of keeping the cord clean and dry will decrease bacterial growth 2. Alcohol is the only agent to use to clean the cord 3. It takes at least 21 days for the cord to dry up and fall off 4. Cord care is done only at birth to control bleeding

1

The nurse is collecting data from a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which findings are associated with abruptio placentae? Select all that apply. 1. Uterine tenderness 2. Acute abdominal pain 3. A hard, "board-like" abdomen 4. Painless, bright red vaginal bleeding 5. Increased uterine resting tone on fetal monitoring

1, 2, 3, 5

The nurse monitoring a preterm newborn infant for manifestations of respiratory distress syndrome (RDS) would assess the infant for which manifestations? SATA 1. Grunting 2. Acrocyanosis 3. Retractions 4. Nasal Flaring 5. Tachypnea

1,3,4,5

A 3 hour old baby who was born at term has a respiratory rate of 64. At this time, what other findings might be present? 1. decreased mucous production 2. increased muscle tone 3. HR of 85 4. meconium hasn't passed yet

2

When a mother is considering breastfeeding, thee nurse would educate the patient on which of the following benefits? 1. Decreased acne in mother 2. Reduced risk of SIDS 3. Reduced risk of clinical asthma for the child 4. Reduced risk of Type II diabetes and increased weight loss for the mother 5. Reduced risk of developing autism in child

2,3,4

Which of the following would affect a mother's ability to breastfeed? 1. current pregnancy 2. breast cancer 3. breast size 4. obesity 5. breast reduction

2,4,5

A client has just delivered a healthy 7-pound baby boy. The physician instructs the nurse to suction the baby. The procedure the nurse uses is to: 1.Suction the nose first 2. Suction the mouth first 3. Suction neither the nose nor mouth until the physician gives further instructions 4. Turn the baby on his side so mucous will drain out before suctioning

2. Suction mouth first so that the baby does not aspirate on what is around their mouth. Then you will do both nostrils

The nurse is counseling a pregnant woman diagnosed with gestational diabetes at 29 weeks' gestation. Which information should the nurse discuss with the client? Select all that apply. 1. Plan induction at 35 weeks. 2. Plan amniocentesis at this time. 3. Schedule a biophysical profile immediately. 4. Plan for weekly nonstress tests at 32 weeks. 5. Obtain nutritional counseling with a dietitian.

4,5 -the biophysical profile will begin at 32 weeks

A nonstress test is performed on a client, and the results are documented in the chart as no accelerations during a 40-minute observation. The nurse interprets these findings as which result? •A nonreactive nonstress test •Equivocal •A reactive nonstress test •Unsatisfactory

A nonreactive nonstress test

The newborn is caring for a family that is grieving the loss of their newborn. Which tokens of remembrance would be appropriate to provide? SATA A. Picture of the newborn B. Certificate of death C. Footprints D. Lock of hair

A, C, D

Based on periods of reactivity, what should the nurse encourage the mother of a term neonate to do approximately 90 minutes after birth? 1. Feed the neonate 2. All the neonate to sleep 3. Get to know the neonate 4. Change the neonate's diaper

Answer: 2; the neonate is in the period of decreased responsiveness at 90 min, so you should allow the baby to sleep. 1- feeding the neonate should occur within the first hour

1. The newborn needs to be reweighed 2. Supplementation is now needed 3. Breastfeeding is going as expected 4. The HCP needs to be notified

Answer: 3 -The have lost about 7% and that is a normal amount of weight loss.

Despite placing a newborn skin-to-skin on the mother at delivery, the infant's temp is 96.4 F. Which initial actions should be implemented? (SATA) 1. Placing a knit hat on the baby 2. Drying the baby well 3. Place the baby in an incubator 4. Use an overbed warmer 5. Wrap the infant in warmed blankets 6. Provide warmed intravenous fluids

Answers: 1,2,5 1- make sure they do this bc lose heat through head 2- make sure baby is dried extremely well bc any fluid on baby can lead to coldness 5- you would do this 3- incubator means baby is completely closed in 4-you would prefer to keep baby with mom so would not use the overbed warmer 6- we are not giving IV fluids

The nurse is assigned to care for four mothers and their term newborns. Which mother and newborn couplet requires the nurse's attention first? A. Mother: fundus firm 2 cm below umbilicus, minimal lochia rubra. Infant: color is pink on room air, respirations 67; bilateral crackles on auscultation. B. Mother: fundus is firm 3 cm above umbilicus and to the right, moderate rubra lochia. Infant: color is pink when active, currently dusky while quiet, respiratory 70 C. Mother: fundus is firm 1 cm above umbilicus, small amount lochia rubra. Infant: color is pink with acrocyanosis, respirations 68 and intermittent expiratory grunting D. Mother: fundus is firm at umbilicus, small amount lochia rubra. Infant: pale pink, quiet alert, respirations 65; periodic breathing noted.

B

A neonate born by cesarean section at 42 weeks, weight 4100 grams, with APGAR scores of 8 and 9 after birth, develops an increased respiratory rate and tremors of the hand and feet 2 hours postpartum. What is the priority problem for this neonate? A. Ineffective airway clearance B. Hyperthermia C. Decreased cardiac output D. Hypoglycemia

D tremors and respiratory rate are signs of hypoglycemia

A nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following conditions are contraindications? 1. Hypospadias 2. Hydrocele 3. Family history of hemophilia 4. Hyperbilirubinemia 5. Epispadias

1, 5 bc both are abnormal location of the meatus. 3 bc we would need to do testing to see if baby also has hemophilia before we do surgery 2 is a fluid filled testicle, but it is not a contraindication of a circ. 4 is also not a contraindication.

The newborn infant was discharged 9 days ago. The child was born at 39 weeks and weigh 8 pounds. When should mom call the pediatrician? 1. Infant is having 7 wets diapers per day 2. Infant is spitting up after eating and burping 3. Umbilical cord is red with purulent drainage after bathing the baby 4. Stool is mustard colored with cottage cheese consistency

3

A mother brings her newborn baby boy in for his 1-week checkup. She tells the nurse that he does not seem to b moving his right arm as much as his left. The nurse would observe for A. crying B. positive Ortolani sign C. limited range of motion during the Moro reflex The nurse suspects the newborn has A. facial palsy B. a fractured clavicle C. a dislocated hip

C B -baby has limited movement, absence of moro reflex -but want to observe bc they could also have brachial nerve damage. -Teach mom to have gentle handling bc babies bones heal much quickly that what adults do

Which patient should the nurse see first? 1. A 3 day old baby whose birth weight was 3600g and is now 3250g 2. A 16 hour old baby with blueish discoloration of the hands and feet 3. A 25 hour old neonate who has not yet had a wet diaper 4. A 6 minute old baby with an O2 sat of 88%

3

Baby boy Tiger was delivered at 1012 am. After reviewing the EHR, wha is the nurse's initial action? 1. Suction the nose 2. Take the infant to the overhead warmer 3. Begin chest compressions 4. Vigorously dry the infant

4; you do this first to get it warm and to stimulate respirations

The nurse is providing teaching to the mother of a newborn with earl jaundice about the condition's progression. The nurse knows that the teaching regarding hyperbilirubinemia was successful when the mother makes which response? A. "Kernicterus is a consequence of elevated bilirubin levels and has possible lifelong effects" B. "My baby should not get hyperbilirubinemia if I place him near a window in the sun light" C. "my baby will be 3 days old at discharge and I will not need to worry about hyperbilirubinemia" D. "since I'm exclusively breastfeeding, the risk of my baby having hyperbilirubinemia is very low'

A acute bilirubin encephalopathy (3 phases of this) is in the middle of hyperbilirubinemia and kernicterus (can turn into this if treatment does not work)

The newborn HR is 120, has a weak cry, muscle tone is flaccid, grimaces with bulb suction, and body is pink with blue extremities. APGAR?

Answer: 5 (0-10)

The nurse has conducted a class for pregnant clients diagnosed with diabetes mellitus about the signs/symptoms of potential complications. The nurse determines that the teaching was effective if a client makes which statement? 1. "I need to watch my weight for any sudden gains because I could develop what they call gestational hypertension 2. "I should not have ultrasounds done because I am diabetic" 3. "My insulin needs should decrease during the last 2 months because I will be using some of the baby's insulin supply 4. "I'm glad I don't have to worry about developing hypoglycemia while I am pregnant"

1

Which infant should the nurse see first? 1. An awake 6 hour old newborn with a respiratory rate of 26 2. A 48 hour old baby awaiting discharge and the mother needs education 3. A LGA baby who finished feeding 25 minutes ago 4. A baby who 30 minutes ago has a temp of 97.4 and was placed on mom's chest

1

The nurse is teaching a pregnant client with diabetes about nutrition and insulin needs during pregnancy. The nurse should provide the client with which information? 1. Glucose crosses the placenta 2. Insulin crosses the placenta 3. Increased caloric intake is needed 4. Decreased caloric intake is required

1 Babies glucose is directly proportional to what moms is always.

Which mom should we instruct not to breastfeed? 1. Mom whose had a bottle of wine an hour ago 2. Mom with extremely small breasts 3. Mom with multiples 4. Mom that just found out she is pregnant 5. Mom with active TB, whose undergoing tx 6. Mom with HIV positive

1, 5, 6

G8 P4 client just delivered baby Charlie at 0623. What is the nurse's initial action? 1. Clamp and cut the cord 2. Apply erythromycin ointment to both eyes 3. Dry and place a cap on his head 4. Obtain hand and foot prints

3; -clamping the cord is the providers job unless the nurse delivers, but the priority is to dry and put cap on the baby.

The nurse is speaking with a new mom about breastfeeding. Which statement from the mother indicates understanding? 1. "I should stop breastfeeding when my baby decides that it is time" 2. "I should begin feeding when my baby starts crying" 3. "I need to use both breastmilk and formula in order for my baby to grow" 4. "If my nipples become cracked or start bleeding, I should consult a lactation consultant."

4

At a 7 day checkup Charlie weighs 3250g. At birth, he weighed 3325g. What is the appropriate response when his mother questions his weight loss?

Say this is normal but inquire about how breastfeeding is going and offer encouragement. -Charlie lost (3325-3250=75); 3325/75= 0.022 so he lost 2.2% of his weight. -It is okay for a baby to lose 5-10%. It is fine for baby to lose less than 5%. You would be concerned if they lost more than 10%; and if they do lose weight, we will give them 10-14 days to regain their weight back.

A 24 week, 7 hour old pre-term infant is in the second stage of reactivity. The infant's mother is concerned that her child has not yet passed a meconium stool. What is the proper response of the nurse? 1. Reassure mom that this usually does not occur until 3 days everything is fine 2. Reassure the mother that since her infant is premature that he may not experience this phase 3. The baby probably has Hirschsprung's disease - we needs a STAT rectal biopsy 4. Tell the mother that she will call the HCP as this is abnormal

2

Who would the nurse see first after reviewing report? 1. A baby who turns their head when a person touches their cheek 2. A baby that has blue tint to the chest and lips 3. A 37 hr old baby who has just developed jaundice 4. A 1 day old baby who has a glucose of 45

2

Of these 4 babies born at full-term at healthy, which has the bests chance of not getting sick? 1. Baby Will who is fed infant formula by bottle exclusively 2. Baby Baylee who is breastfed and is never given other liquids 3. Baby Hannah who is breastfed and is given sips of herbal tea (they don't need anything else, they just need the calories from the milk 4. Baby Evie who is breastfed with formula supplementation (even though formula has the nutrients, by using all of the bottles, nipples, etc. they are still at risk for getting sick

2; breast fed babies are the best way of not getting sick

The nurse is performing a prenatal assessment on a pregnant client. The nurse should plan to implement teaching related to risk for abruptio placentae if which information is obtained on assessment? 1. The client is 28 years of age. 2. This is the second pregnancy. 3. The client has a history of hypertension. 4. The client performs moderate exercise on a regular daily schedule.

3

The nurse has received a shift report on a group of newborns. The nurse should make rounds on which client first? 1. "Newborn who is LGA and needs a repeat blood glucose prior to their next feeding in 15 min" 2. "Neonate born at 36 weeks gestation weighing 5 lb and due to breastfeed for the first time in 15 minutes 3. "Neonate born 24 hours ago by C/S and had a respiratory rate of 64 approximately 30 minutes ago" (normal is 30-60) 4. "Newborn who had a temp of 97.6 and was double wrapped with a hat on 30 minutes ago to bring up the temperature"

3; think ABC's to make sure the baby does not have other signs of respiratory distress.

A 24- year old primipara says "I am worried that I will not be able to breastfeed my baby because my breasts are so small" What is the best response? 1. Breast milk can be enhanced by occasional formula feeding 2. The woman's motivation to breastfeed is important 3. Because her breasts are small, she will have to feed the baby more often 4. Breast size poses no influence on a woman's ability to breastfeed a baby

4

Following the admission assessment (normally done within the first 24 hours) of a neonate born at 42 weeks of gestation, the nurse documents which findings as normal? SATA A. Three-vessel cord B. Peeling skin on the feet C. Absence of sole creases D. Absence of vernix E. Cyanosis of the hands and feet F. Large amounts of frothy oral secretions

A,B,D,E A- all babies should have a 3 vessel cord B- desquamation is the peeling and they are already going through this D-vernix goes away and skin observes it in utero, so you don't have as much when you are born E-Acrocyanosis is normal in the first 24 hours

The charge nurse in the newborn nursery and an unlicensed assistive personnel (UAP) are working together on a shift. Under their care are eight babies rooming in with their mothers, and one infant is in the nursery for the night on tube feedings. There is a new client whose infant will be brought to the nursery in 15 minutes. Which tasks would the nurse assign to the UAP? SATA A. Newborn admission B. Vital signs on all stable infants C. Tube feedings D. Document feedings of infants E. Record voids/stools F. Bath and initial feeding for new admission

B, D, E F is not right bc it is an initial feeding and you have to assess all of that.

The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? 1. "I will need to increase my insulin dosage during the first 3 months of pregnancy." 2. "My insulin dose will likely need to be increased during the second and third trimesters." 3. "Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." 4. "My insulin needs should return to prepregnant levels within 7 to 10 days after birth if I am bottle-feeding."

1 hypoglycemic episodes are common early in pregnancy, and patients will need to decrease their insulin requirements

The nurse is creating a plan of care for a pregnant client with a diagnosis of severe preeclampsia. Which nursing actions should be included in the care plan for this client? Select all that apply 1.Keep the room semi-dark. 2.Initiate seizure precautions. 3.Pad the side rails of the bed. 4.Avoid environmental stimulation. 5.Allow out-of-bed activity as tolerated.

1, 2, 3, 4 5 is not indicated; she would be on Mag if she had severe PreE and she would be at risk for falling so she would not be able to get out of the bed.

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? Select all that apply. 1. Proteinuria of 3+ 2. Urine output of 20 mL in an hour 3. Presence of deep tendon reflexes 4. Respirations of 10 breaths/minute 5. Serum magnesium level of 4 mEq/L (2 mmol/L)

2, 4

A primigravida is receiving magnesium sulfate for the treatment of gestational hypertension. The nurse who is caring for the client is performing assessments every 30 minutes. Which finding would be of most concern to the nurse? 1. Urinary output of 20 mL 2. Deep tendon reflexes of 2+ 3. Fetal heart rate of 120 beats/minute 4. Respiratory rate of 10 breaths/minute

4; bc ABC's and also, w are assessing every 30 min and 20mL is actually fine for 30 min. Respirations is going to trump urine output.

The nurse is caring for a neonate at 32 weeks gestation The assessment findings the nurse should report to the healthcare provider are _______ , ______ , and ______. (everything is normal but baby has abdominal distention, RR are 66, and O2 sat is 90%.) A. abdominal assessment B. skin color C. temperature A. respirations B. chest circumference C. weight A. heart rate B. oxygen saturation C. age The nurse suspects the newborn is developing: A. respiratory distress syndrome B. sepsis C. necrotizing enterocolitis

A A B C -In necrotizing enterocolitis, symptoms include abdominal distention, respiratory distress or hypoxemia.

When the mother of a new baby asks the nurse to feed her baby, the most appropriate response is to say: 1. "I'll feed him today. Maybe tomorrow you can try it" 2. "It's not difficult at all. He is just like a normal baby, only smaller" 3. "You can learn to feed him as well as I can; I wasn't good when I first fed a premature infant either" 4. "it's frightening sometimes to feed an infant this small, but I'll stay with you to help"

Answer: 4

What is the infant's 1 minute Apgar score?

B; We are at 1 min after birth and have just done the Apgar check, so the next most important thing is skin to skin.

The nurse is caring for a pregnant client with preeclampsia who is receiving a prescribed intravenous (IV) infusion of magnesium sulfate. To provide a safe environment, the nurse would ensure that which priority item is available? 1. Tongue blade 2. Reflex hammer 3. Calcium gluconate injection 4. Potassium chloride injection

3

The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment findings predispose the client to an ectopic pregnancy? Select all that apply. 1. Use of diaphragm 2. Use of fertility medications 3. History of Chlamydia 4. Use of an intrauterine device 5. History of pelvic inflammatory disease (PID)

2, 3, 4, 5

The nurse is providing discharge planning to a primipara patient with a 4 day old baby. What should the nurse tell the patient that warrants a call to her HCP? SATA 1. 2 consecutive green watery stools 2. 7 wet diapers 3. High pitched cry 4. One stool a day while formula feeding 5. Forceful regurgitation after feedings 6. Axillary temp of 98.0F

1,3,5

The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the primary health care provider's prescriptions and should question which prescription? 1. Prepare the client for an ultrasound. 2. Obtain equipment for a manual pelvic examination. 3. Prepare to draw a hemoglobin and hematocrit blood sample. 4. Obtain equipment for external electronic fetal heart rate monitoring.

2; never do a manual exam on someone having vaginal bleeding and we do not know the cause of it.

In assessing a newborn infant, the nurse knows that postmature infants may exhibit: 1. Heavy vernix 2. Large size for gestation age 3. Increases subcutaneous fat, absent creases on feet 4. Small size for gestation age

4; just bc you have a postmature infant, does not mean they will be big. They are not having good blood supply anymore so they have lost and used some of their sub q cat already and that gives them a very thin look and that makes them small, bc the placenta wants to stop working when postterm.

When developing a nursing care plan for an infant receiving phototherapy, the nurse should include what information? SATA 1 Adequate skin exposure to phototherapy 2. Allowing mother to hold infant as much as she wants 3. Eye protection 4. Supplemental water between feedings 5. Thermoregulation 6. Supplement formula for breastmilk

Answer: 1, 3, and 5 1 although we want mom to bond, we need baby under the lights 4 we do not need to supplement with water, but we can hydrate with formula and breastmilk (dehydration is correlated with phototherapy so we just want to make sure baby is having appropriate output and be watching for that sign of dehydration) 6 mom can still breastfeed and put baby back under light or warmer

The nurse is assisting a breastfeeding client when she asks how she will know if her baby is getting any milk. Which statements are the priority? 1. "An audible sound will be heard as your baby is swallowing breast milk" 2. "Appears content after feeding and sleeps 4 hours between feedings" 3. "Burps loudly once or twice between breasts and when finished" 4. "Finishing the feeding in 5 minutes on each breast" 5. "Urinates 6-8 times/day and 1-3 bowel movements after day 4"

Answer: 1, 5 2 is wrong bc should be feeding every 2-3 hours 3 if it had just said burps, then could be right but should not just have a number to it which makes it wrong, bc they could not burp at all or have 5 burps- it is the number in the answer choice that makes it wrong. 4 you need to feed for longer than just 5 min to get the hind milk.

The lab results show that a mother has a blood type of O negative and her infant has the blood type A positive. As part of the plan of care, the nurse should assess the infant for which condition? A. Breast milk jaundice B. Pathologic hyperbilirubinemia C. Physiologic hyperbilirubinemia D. Rh incompatibility

B ABO or Rh incompatibility are both underlying causes of pathologic hyperbilirubinemia

The pediatric nurse is being pulled to the nursery for the day. Which 3 neonates are the best client care assignment for the pediatric nurse? Select All that apply (if someone is being pulled to a different unit, they don't know everything so you need to give them the least invasive patients possible) 1. A 4 hour old with a blueish appearance to the hands and feet 2. A recent admission with APGAR score of 8 and 10 3. A 2-day old who has not passed a meconium stool (need to pass it within the first 2-8 hours after birth, so this is abnormal) 4. A 1-day old with a cleft palate and cleft lip (peds nurse may not know how to feed the baby, etc.) 5. An 18-hour postterm breastfed neonate with jaundice (pathologic appears before 24 hours old- pathologic is a little worse than physiologic; physiologic doesn't appear until after 24 hours, more like day 2,3,4 but both are abnormal) 6. A 1-day old with caput succeduem

1, 2, 6 (these are the least severe patients)

Which of the following are true regarding breastfeeding? SATA 1. It is okay for the mother to have a moderate amount of caffeine while breastfeeding 2. The infant should be fed every 2-3 hours 3. The mother cannot breastfeed within 90 minutes per breast 4. Feedings should last 15-20 minutes per breast 5. The mother should make her first attempt at breastfeeding 90 minutes after birth.

1,2,4

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply. 1.Flushing 2.Hypertension 3.Increased urine output 4.Depressed respirations 5.Extreme muscle weakness 6.Hyperactive deep tendon reflexes

1,4,5

The nurse is caring for a newborn in the NICU. The HCP has run lab tests to determine which Torch infection the newborn has. For each fetal effect listed, indicate if it is related to Rubella, Cytomegalovirus, and/or Herpes Simplex virus. 1. Microcephaly 2. Deafness/hearing loss 3. Seizures 4. Low Birth Weight 5. Blindness 6. Congenital cataracts A. Rubella B. Cytomegalovirus C. Herpes Simplex

1- B,C 2- A,B 3- C 4- B,C 5- C 6- A -Memorize the Torch infections is key- what puts baby at risk and what they can lead to.

A graduate nurse is explaining how to assess newborn jaundice and the effects of phototherapy. Which statements are correct? 1. "Therapy treatment can increase the risk for dehydration" 2. "It is best to observe for jaundice in the conjunctival sac or oral mucosa" 3. "the neonate will be irritable from the elevated bilirubin in the system" 4. "I will monitor the unconjugated bilirubin carefully as it is the dangerous one" 5. "I will carefully record the neonate's intake as limiting fluids is helpful"

1- it does increase the risk for dehydration 2- these are good places to look and are correct, however there are other places as well 4-the unconjugated is the the dangerous one

A home care nurse is monitoring a 16-year-old primigravida who is at 36 weeks' gestation and has gestational hypertension. Her blood pressure during the past 3 weeks has been averaging 130/90 mm Hg. She has had some swelling in the lower extremities and has had mild proteinuria. Which statement by the woman should alert the nurse to the worsening of gestational hypertension? 1. "My vision for the past 2 days has been really fuzzy." 2. "The swelling in my hands and ankles has gone down." 3. "I had heartburn yesterday after I ate some spicy foods." 4. "I had a headache yesterday, but I took some acetaminophen and it went away."

1; she is developing visual disturbances and shows worsening.

The nurse in the newborn nursery is planning for the admission of a large for gestational age (LGA) infant whose mother has gestational diabetes. In preparing to care for this infant, the nurse would obtain equipment to perform which diagnostic test? 1. Rh or ABO blood typing 2. Heel stick blood glucose 3. Indirect and direct bilirubin levels 4. Serum insulin levels

2

The nurse is caring for a newly delivered breastfeeding infant. Which nursing intervention would best prevent jaundice in this infant? 1. Keeping the infant NPO until it is 12 hours of life 2. Encouraging the mother to breastfeed every 2 to 3 hours 3. Initiating the infant under phototherapy 4. Encouraging the mother to breastfeed and supplement with formula

2

Which neonate should the nurse see first? 1. 24 hour old who has passed one stool 2. 36 hour old neonate with respirations of 68 and glucose of 35 3. Infant with periods of apnea for 20 seconds at a time 4. 4 day old with 5 wet diapers in a 24 hour period

2

When would be appropriate to complete baby Charlie's first physical exam? 1. At one hour, as soon as immediate care is completed 2. At 4 hours of age with an axillary temp of 98.8 3. At 36 hours of age upon discharge 4. At 4 weeks old

2; we wait a couple hours because bonding is the most important and the latest you want to feed the baby is at 1 hour of age. So, you want those things to happen first and then we would do a full physical assessment.

The nurse assess a 15-hour old infant and finds jaundice. What is the priority action the nurse needs to take? 1. Continue with the normal newborn exam 2. Notify the HCP of the finding 3. Provide an extra feeding for the infant 4. Wait and assess the skin color when the infant is over 24 hours old

2; before 24 hours is pathologic so you need to notify bc it is not normal. The HCP can give then orders of what to do next. After notifying, then I can continue my exam. -providing an extra feeding would help more with physiologic jaundice, but also you don't want to just wait.

After reading the EHR, what nursing actions are most indicated? 1. Continue recording vital signs, voiding, stooling, and eating patterns every 4 hours. 2. Place a pulse oximeter and contact the HCP for a prescription to draw blood cultures. 3. Arrange a transfer to the neonatal intensive care unit with diagnosis of possible sepsis. 4. Draw a CBC with differential and feed the infant.

2; the ruptured membranes can make mom infected, and that can cause baby to also be infected. We need to get an O2 reading and get order for culture to see if we have infection 1- need to do something now bc baby is having respiratory difficulties 3- that does not automatically mean baby has to go to NICU 4- not just going to draw this

A nurse is performing a neurologic assessment on a 1 day old neonate in the nursery. Which findings would indicate possible asphyxia in utero? 1. The neonate grasps the nurse's finger when put in the palm of the neonate's hand 2. The neonate does stomping movements when help upright with the sole of the feet touching the surface. 3. The neonate displays weak, ineffective sucking 4.The neonate does not respond when the nurse claps her hands (moro) 5. The neonate turns toward the nurse's ... 6. The feet do not flare out when the feet are touched. (babinski)

3, 4, 6

A 1-week postpartum mother calls the unit to inquire about a tender, hard area on her left breast. What is the nurse's initial response. 1. "This is a normal response at 1-week." 2. "Notify the HCP" 3. "Stop breastfeeding because you probably have an infection" 4. "Massaging the area and applying heat packs before and cold packs after"

4

The nurse is caring for a client diagnosed with preeclampsia. When the client's condition progresses from preeclampsia to eclampsia, what would the nurse's first action be? 1. Assess thee maternal blood pressure and fetal heart tones 2. Administer an intravenous infusion of magnesium sulfate 3. Prepare to administer oxygen via face mask 4. Prepare to maintain an open airway

4

A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. Which statement, if made by the client, indicates that the client is interpreting the situation correctly? 1. "I will need to remain on bed rest for 2 weeks." 2. "I will need to take a full course of antibiotic treatment." 3. "I will need to take tocolytic medication to halt the labor process." 4. "I will need to prepare myself and my family for the loss of this pregnancy."

4 -this is an inevitable miscarriage and she is going to lose the baby. Bed rest would not help at this point and the other options also are not right.

A nurse is caring for a neonate born addicted to opiates in the special care nursery. Click to specify whether each intervention is anticipated, nonessential, or contraindicated for the newborn. A. Administer antibiotics B. Administer morphine C. Swaddle and/or provide a pacifier D. Feed every 2-3 hours E. Increase environmental stimuli F. Encourage parental handling (doing things with baby)

A- B B- A (if a baby comes out addicted, we can give morphine and other meds to slowly wean them off) C- A D- A E- C (you want to reduce the stimuli- ways you can do this is turn off the lights, cluster care, decrease sounds, skin to skin contact bc it helps relax baby) F- C (bc we are still wanting to decrease all sensory stimuli)- you can encourage eye contact bc that would help bonding; you do not want to change babies diaper, pick them up, etc.

Which infant is at greatest risk to develop cold stress? 1. Full term infant delivered vaginally without complications 2. 36-week infant with an APGAR score of 7 at 5 min 3. 38-week female infant delivered via C/S bc of cephalopelvic disproportion 4. Term infant delivered vaginally with epidural anesthesia

Answer: 2; preterm with Apgar score of 7 (8-10 is out best). Your preterm infants have the most difficulty transitioning and have to figure out their thermoregulation. 4- that does not relate to the question 3- CPD does not necessarily mean the baby is in distress -Route of delivery does not play a factor in temp stability. -Cold stress is been passed of the baby's temp going down, using reserves of brown fat to keep it warm, sugar can go down faster, could have respiratory issues, etc.

A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breastfeed the neonate. What instructions about breastfeeding would be most appropriate? A. Breastfeeding is not recommended bc the neonate needs increased fat in the diet B. Once the neonate no longer needs oxygen and continuous monitoring, breastfeeding can be done C. Breastfeeding is contraindicated because the neonate needs a high-calorie formula every two hours D. Tube feedings using breast milk can be given until the neonate can coordinate sucking and swallowing

D suck and swallow is key to breast and bottle feeding.