OB rn-45 skill viedos

How long would the nurse expect ephedrine's vasopressor effects to last? A. 1 hour B. 2 hours C. 30 minutes D. 45 minutes

A. 1 hour Rationale: Ephedrine's vasopressor effects last approximately 1 hour.

A new nurse is being oriented to the labor and delivery unit. During preparation of a patient for a cesarean delivery, where should the nurse place the dispersive grounding pad for the electrocautery device? A. As close to the surgical site as possible, avoiding bony prominences B. Around the area of skin to be prepared for incision to prevent pooling of solutions under the patient C. On a bony prominence D. As close to the anesthesia provider as possible so the pad can be monitored closely

A. As close to the surgical site as possible, avoiding bony prominences Rationale: The dispersive grounding pad for the electrocautery device should be placed as close to the surgical site as possible, usually on the thigh.

A laboring patient at 39 weeks' gestation just received an epidural bolus for breakthrough pain, and the bolus resulted in severe hypotension. The patient received ephedrine 5 minutes ago. When the nurse completes an initial assessment, the patient's blood pressure is 120/72 mm Hg, and the FHR is Category I (normal). The patient is reporting heart palpitations, dizziness, and nausea. How should the nurse respond? A. Continue to monitor the patient closely and explain that these symptoms are possible adverse reactions to ephedrine. B. Notify the practitioner that the patient may be having an allergic reaction to the medication. C. Reassure the patient that her symptoms are from the epidural bolus. D. Tell the patient she is just experiencing a normal progression of labor symptoms.

A. Continue to monitor the patient closely and explain that these symptoms are possible adverse reactions to ephedrine Rationale: The patient is experiencing recognized adverse reactions to ephedrine; however, monitoring should continue to rule out more significant adverse reactions or continued elevation of blood pressure.

The nurse is caring for a full-term newborn who was delivered vaginally and has a cephalohematoma. The newborn, who is breastfed, has O-positive blood, and the mother has O-negative blood. Based on this history, what is the newborn's risk of hyperbilirubinemia? A. High risk because of the presence of multiple risk factors B. High risk because of vaginal birth C. Low risk because of delivery at term D. Low risk because of being breastfed

A. High risk because of the presence of multiple risk factors Rationale: ABO and Rh blood incompatibilities, bruising, and exclusive breastfeeding resulting in a suboptimal lactation are risk factors for hyperbilirubinemia. Vaginal birth is not a risk factor unless bruising or infection occurs as a result. Although a term newborn is less likely than a preterm newborn to develop hyperbilirubinemia, the newborn described in this scenario is not at low risk.

A patient admitted to the postanesthesia care unit 1 hour after cesarean delivery reports nausea and has a blood pressure of 90/52 mm Hg and diaphoresis. After reporting the symptomatic hypotension to the practitioner, the nurse should anticipate which intervention? A. IV fluid bolus B. Ephedrine IV C. Antiemetic D. Ephedrine via piggyback IV

A. IV fluid bolus Rationale: Ephedrine is a vasopressor used to treat maternal hypotension, usually resulting from epidural anesthesia; it would be administered only if other measures to treat hypotension (e.g., repositioning, IV fluid bolus, oxygen administration) were ineffective

The nurse has just administered ephedrine 5 mg IV to a patient who is at 38 weeks' gestation following the administration of an epidural. Which effects on the patient should the nurse expect? A. Increased cardiac output and peripheral vasoconstriction B. Decreased cardiac output and peripheral vasoconstriction C. Increased cardiac output and peripheral vasodilation D. Decreased cardiac output and peripheral vasodilation

A. Increased cardiac output and peripheral vasoconstriction

A patient who is gravida 1, para 0 is about to undergo a cesarean delivery. The surgical team calls a time-out. The patient is worried that this indicates that something is wrong. What should the nurse tell the patient about the time-out? A. It is performed immediately before the start of the procedure to make a final verification of the correct patient, procedure, and site. B. It is performed immediately before the start of the procedure so the patient can review her decision. C. It is performed immediately before the procedure to conduct a count of the surgical instruments. D. It is performed immediately during long surgeries so the staff can take a break.

A. It is performed immediately before the start of the procedure to make a final verification of the correct patient, procedure, and site.

A primipara presents to the labor unit for delivery after the demise of her fetus at 22 weeks' gestation. After delivery, the nurse notices that the practitioner has ordered a 50-mcg dose of Rho(D) IG. What is the most appropriate nursing intervention? A. Question the practitioner regarding the dose because it may not be appropriate for the patient. B. Question the practitioner about the need for Rho(D) IG because the delivery involved fetal demise. C. Administer the Rho(D) IG because this indication and dose are appropriate. D. Administer the Rho(D) IG and ask the practitioner whether a second dose should be administered in the future.

A. Question the practitioner regarding the dose because it may not be appropriate for the patient. Rationale: The nurse should question the dose because a 50-mcg dose of Rho(D) IG is administered only when the possibility exists that less than 2.5 ml of fetal blood has crossed the placenta into the maternal blood; this amount is appropriate for gestations of less than 13 weeks. In gestations of 13 weeks and longer, more than 2.5 ml may cross the placenta; therefore, the appropriate dose for this patient is 300 mcg of Rho(D) IG. Unless there is an indication that more than 15 ml of fetal blood crossed the placenta, only one dose is needed. Fetal demise is an appropriate indication for Rho(D) IG administration.

The anesthesia provider asks the nurse to obtain a vial of medication for a patient's epidural. As is standard with all medications, the nurse should check the name, dose, and expiration date on the medication vial before giving it to the anesthesia provider. What additional information should the nurse check because the medication is for epidural administration? A. Whether it is preservative free B. Whether it is short acting C. Whether it is long acting D. Whether it is epinephrine free

A. Whether it is preservative free Rationale: The nurse must be sure that the medication being administered via the epidural is preservative free because a preservative could cause nerve damage.

A new mother reports extreme pain and tenderness of her nipples. During the initial nipple assessment, the nurse discovers dried, cracked, and bleeding nipples and suspects nipple trauma related to removal of the newborn from the breast. The nurse asks for a breastfeeding demonstration to assess how the patient is removing the newborn from the breast. The teaching plan for this breastfeeding mother should include which instruction? A. Do nothing; a newborn will instinctively remove himself or herself from the breast. B. Break suction by inserting a finger into the side of the newborn's mouth before removing him or her from the breast. C. Roll, twist, or pull on the nipple to break the suction. D. Break suction by gently compressing both of the newborn's cheeks.

B

A new nurse is being oriented to the unit. During her admission assessment, a patient who is gravida 3, para 2 states that she wants to have a vaginal birth because her last delivery was a cesarean delivery, and she developed postoperative complications. The new nurse performs a physical assessment and reviews the patient's record to see whether she has any contraindications to vaginal birth after cesarean delivery. What should the new nurse know is the most important contraindication for vaginal birth after cesarean delivery? A. Low transverse cesarean incision B. Classic cesarean incision C. Obesity D. Pfannenstiel cesarean incision

B. Classic cesarean incision Rationale: Three types of uterine incisions are possible: low transverse, low vertical, and classic. A classic cesarean incision is made vertically into the upper body of the uterus. Because the procedure is associated with a higher incidence of blood loss and uterine rupture in subsequent pregnancies, vaginal birth after a classic cesarean delivery is contraindicated.

A nurse is caring for a low-risk patient who has an epidural catheter in place. The patient's cervix is dilated 8 cm, and her pre-epidural blood pressure was 130/78 mm Hg. Ten minutes after epidural placement and an epidural bolus, the patient reports nausea and is restless. When the nurse assesses her vital signs and the FHR pattern, the patient's blood pressure is 100/42 mm Hg, and the FHR has minimal variability and a new onset of recurrent late decelerations. Administration of an IV fluid bolus is started, the patient is repositioned in the left-lateral position, and oxygen is administered; however, her blood pressure decreases to 96/40 mm Hg. Ephedrine is ordered. What is the most likely cause of the change in the FHR tracing, indicating a disruption of oxygenation? A. Imminent delivery because the patient's cervix is at 8 cm dilation B. Decreased uteroplacental perfusion caused by rapid reduction in blood pressure C. Decreased uteroplacental perfusion caused by cord compression D. Contracted intravascular volume

B. Decreased uteroplacental perfusion caused by rapid reduction in blood pressure

A patient who is 39 weeks pregnant presents to the labor and delivery unit with severe preeclampsia. Her blood pressure is 210/110 mm Hg. Her initial fetal tracing shows a baseline FHR of 140 bpm, moderate variability, accelerations, and no decelerations. When the patient's cervix is dilated to 6 cm, an epidural infusion is started to manage her pain. Fifteen minutes after the bolus dose of the anesthesia medication, her blood pressure is 130/68 mm Hg. The patient states that she is dizzy and lightheaded, and the FHR assessment shows a baseline FHR of 160 bpm, minimal variability, no accelerations, and recurrent late decelerations. The anesthesia provider orders ephedrine 5 mg IV. Why should the nurse clarify this order? A. The recommended dose of ephedrine during labor is 20 mg. B. Ephedrine is contraindicated in a pregnant patient with hypertension during labor. C. Administering ephedrine is inappropriate for a normotensive blood pressure reading.

B. Ephedrine is contraindicated in a pregnant patient with hypertension during labor. Rationale: Ephedrine is contraindicated in a pregnant patient with hypertension during labor because of the risk of severe hypertension.

The anesthesia provider requests that the nurse position a laboring patient in a sitting position with the knees flexed and shoulders parallel for epidural placement. The nurse asks the patient to curve her back outward toward the anesthesia provider. What is the purpose of this positioning? A. It places the patient closer to the anesthesia provider for easier placement of the epidural catheter. B. It opens the space between the vertebrae for easier placement of the epidural catheter. C. It helps the nurse or support person maintain the patient in position to prevent adverse effects from the epidural. D. It helps the nurse see the insertion site and offer assistance as needed to the anesthesia provider.

B. It opens the space between the vertebrae for easier placement of the epidural catheter. Rationale: Arching the back outward opens the space between the vertebrae, allowing access to the epidural space.

The nurse is caring for a term newborn who is 18 hours old, has a TcB level of 7.4 mg/dl, and is lethargic. How should the nurse respond? A. Recognize that these signs are abnormal and start phototherapy immediately. B. Recognize that these signs are abnormal and notify the practitioner. C. Recognize that these signs are normal and recheck the reading in 12 hours. D. Recognize that these signs are normal but increase the newborn's feeding frequency to prevent an increase in TcB levels.

B. Recognize that these signs are abnormal and notify the practitioner. Rationale: The practitioner should be notified immediately for further investigation. Jaundice presenting before 24 hours of age may indicate a pathologic process, and lethargy may be a sign of bilirubin encephalopathy. A TcB level of 7.4 mg/dl falls in the high-risk range, is abnormal, and requires further assessment and treatment. Phototherapy should not be started without a practitioner's order.

A pregnant woman, gravida 2 para 1, is brought to the emergency department at 25 weeks' gestation after a motor vehicle crash. She states that she was wearing her seat belt, and the nurse notices bruising across the abdomen. Blood work indicates that the patient has A-negative blood. Which statement most accurately describes this patient? A. She is a candidate for Rho(D) IG if the result of Coombs testing is positive. B. She is a candidate for Rho(D) IG if the result of Coombs testing is negative. C. She is not a candidate for Rho(D) IG because she has not reached 28 weeks' gestation. D. She is not a candidate for Rho(D) IG because she is not in labor.

B. She is a candidate for Rho(D) IG if the result of Coombs testing is negative. Rationale: Because the patient has sustained abdominal trauma, she is a candidate for Rho(D) IG if the result of the Coombs test is negative. A positive Coombs result would indicate that the patient is already sensitized to Rh antigens; therefore, Rho(D) IG would not be of value. Rho(D) IG administration is not indicated for labor. Rho(D) IG may be administered before 28 weeks' gestation if indications for its administration exist.

A 16-year-old primipara presents to the labor unit at term. She has not had any prenatal care. The nurse obtains orders for a complete prenatal panel, which includes a blood type and screen and a Coombs test. The tests indicate that the patient has AB-negative blood and a negative Coombs test result. What should the nurse do? A. Request an order for Rho(D) IG administration before delivery because the patient did not get a dose at 28 weeks' gestation. B. Wait until after delivery to determine whether the newborn's blood type warrants Rho(D) IG administration to the patient. C. Understand that Rho(D) IG is not necessary after the birth of a woman's first child. D. Understand that Rho(D) IG is not necessary because the patient is already sensitized.

B. Wait until after delivery to determine whether the newborn's blood type warrants Rho(D) IG administration to the patient. Rationale: The nurse should wait for the birth to confirm the newborn's blood type and the need for Rho(D) IG administration. Although Rho(D) IG administration after delivery does not affect the outcome for a first child, it improves outcomes for the patient's subsequent pregnancies and births. Rho(D) IG administration before delivery is appropriate for subsequent pregnancies when the first newborn's blood type is known to conflict with the maternal Rh value. The negative result of Coombs testing indicates that the patient is not sensitized to fetal Rh antigens.

A patient about to have a cesarean delivery tells the nurse, "I'm so afraid." What is the nurse's best reply? A. "Surgery has some risks, but the likelihood of a problem is very low." B. "There's no reason to be afraid." C. "Tell me what you're afraid of." D. "You'll be just fine; don't worry."

C. "Tell me what you're afraid of."

A primigravida is having a cesarean section for breech presentation. She requests that the newborn be placed skin-to-skin so she can start to breastfeed while she is in the OR. What would be the appropriate response by the nurse? A. "We can bring the newborn to you in the recovery room to breastfeed." B. "We need to maintain sterility of the cesarean section; we will need to wait until you are leaving the OR." C. "We can place the newborn skin-to-skin to promote breastfeeding." D. "We will finish the assessment with the newborn on the warmer and provide formula supplementation until you are feeling better."

C. "We can place the newborn skin-to-skin to promote breastfeeding."

As the nurse prepares to administer ephedrine to her patient who has low blood pressure post-epidural, the patient states, "I don't want that medication." How should the nurse respond? A. "It will be OK, don't worry." B. "If I don't give this, your baby might have a deceleration." C. "What is your concern about receiving the medication?" D. "I'll let your doctor know."

C. "What is your concern about receiving the medication?"

A new mother is preparing to take her newborn home. The nurse confirms identification by visually comparing the newborn's and mother's ID bands. The nurse removes one ID band from the newborn and secures it to the footprint sheet per the organization's policy. The mother and nurse sign documentation stating they have verified the newborn's information, and the discharge is almost completed. What should the nurse do now? A. Emphasize the importance of protecting all ID bands from damage and liquids; family should not remove any ID bands. B. Assess for family knowledge of newborn safety that may put the newborn at risk for abduction. C. Accompany the newborn to the vehicle in which the family will be riding, with the newborn in a car seat or with the mother in a wheelchair. D. Advise family never to leave the newborn unattended and to position the bassinet next to the mother's bed farthest from the door.

C. Accompany the newborn to the vehicle in which the family will be riding, with the newborn in a car seat or with the mother in a wheelchair. Upon discharge, the nurse should accompany the newborn to the vehicle in which the family will be riding, with the newborn in a car seat or with the mother in a wheelchair.

The nurse is caring for a 3-day-old term newborn who was born by cesarean delivery after a failed oxytocin induction. The mother, age 40, is of Chinese descent. The nurse notes that the sclera of the newborn's eyes are yellow-tinged. How should the nurse respond? A. Feed the newborn extra formula at the next feeding. B. Recognize this as an advanced stage of jaundice and immediately begin phototherapy. C. Assess the newborn for other areas of jaundice, obtain a TcB reading, and report the findings to the practitioner. D. Instruct the family to undress the newborn and keep him or her by the window in the mother's room.

C. Assess the newborn for other areas of jaundice, obtain a TcB reading, and report the findings to the practitioner. Rationale: Jaundiced sclera is a fairly early sign of hyperbilirubinemia. The nursing assessment and the newborn's multiple risk factors for hyperbilirubinemia should prompt the nurse to obtain a TcB reading and report the findings to the practitioner. Other areas of jaundice should also be reported because a correlation between the severity of hyperbilirubinemia and total bilirubin levels may exist. Phototherapy should not be started without a practitioner's order. Forcing extra formula is unnecessary and may be harmful. Holding a naked newborn by a window puts him or her at high risk of hypothermia.

A nurse determines that a term newborn who is 36 hours old falls below the 40th percentile on the Bhutani curve with a TcB level of 6 mg/dl. The nurse also finds jaundice on the newborn's forehead and nose. The practitioner has written discharge orders, and the newborn has a follow-up appointment with the pediatric practitioner in 2 days. What is the appropriate nursing intervention? A. Involve the newborn's case manager in order to obtain a home phototherapy unit for the newborn. B. Notify the discharging practitioner that the bilirubin levels are too high for discharge. C. Discharge the newborn and instruct the parents to keep the early follow-up appointment with the pediatric practitioner. D. Advise the mother that the newborn has a normal bilirubin level and that she does not need to notify the pediatric practitioner of any change in newborn behavior before the scheduled appointment.

C. Discharge the newborn and instruct the parents to keep the early follow-up appointment with the pediatric practitioner. Rationale: This newborn falls in the low-risk area on the Bhutani curve with a normal bilirubin level for a newborn of this age. The pediatric practitioner will examine the newborn within 5 days after birth, when the bilirubin is likely highest, so problems will be identified. No home phototherapy unit is necessary. However, the mother should be instructed to notify the pediatric practitioner of any change in newborn behavior before the follow-up appointment.

A patient who is gravida 2, para 0 is having a cesarean delivery. She has asked to be awake during the procedure, so the anesthesia provider plans to use regional anesthesia. The patient is extremely anxious about the procedure and expresses concerns about feeling pressure and a pulling sensation during the birth. How should the nurse address her anxiety? A. Inform the anesthesia provider that the patient needs additional anesthesia. B. Call a time-out and inform the practitioner that the patient is having doubts about the procedure. C. Explain that these sensations are normal and offer emotional support. D. Call a time-out for a count of surgical sponges because the sensations indicate loss of a sponge.

C. Explain that these sensations are normal and offer emotional support.

A gravida 2 para 0 patient's baseline blood pressure is 124/72 mm Hg, pulse is 88 bpm, and respirations are 24. The patient has just received a test dose of lidocaine with epinephrine. The nurse notes that the patient's pulse has increased to 120 bpm and that her blood pressure is now elevated to 140/86 mm Hg. Which nursing intervention is most appropriate? A. Increase the rate of the patient's IV infusion to flush out the medication. B. Initiate oxygen therapy to prevent poor uteroplacental perfusion. C. Notify the anesthesia provider of probable venous cannulation of the epidural catheter. D. Notify the practitioner in case an emergency birth is required.

C. Notify the anesthesia provider of probable venous cannulation of the epidural catheter. Rationale: Lidocaine with epinephrine is commonly used as a test dose via the epidural catheter because of its sympathomimetic characteristics. These effects are transitory and do not require emergency management. However, the anesthesia provider should be notified because this patient's response indicates that unintentional epidural vein cannulation has occurred, and the catheter needs to be adjusted or replaced.

A new mother asks to breastfeed her newborn immediately after delivery. The mother had a negative drug screen upon admission; however, the nurse is aware that the mother has a recent history of IV drug use and that she is infected with HBV. How should the nurse advise the mother? A. There is no concern for the newborn, and breastfeeding may be started if the mother is taking medications to treat the HBV. B. The session must be canceled because breastfeeding by a mother with HBV is always unsafe for the newborn, and the mother must use prepared infant formula. C. She can breastfeed immediately after delivery, but the newborn should receive hepatitis B immune globulin and a first dose of hepatitis B vaccine within 12 hours. D. She can never breastfeed because of her history of HBV infection.

C. She can breastfeed immediately after delivery, but the newborn should receive hepatitis B immune globulin and a first dose of hepatitis B vaccine within 12 hours.

Three hours after a laboring patient is admitted, her cervix has dilated to 5 cm and is 100% effaced; the fetal station is -1. Her membranes ruptured 1 hour ago, and the fluid remains clear. Contractions are every 2 to 3 minutes, lasting 60 to 90 seconds, and her uterus is firm on palpation. The FHR pattern is Category 1 (normal). The patient reports persistent low back pain and is having difficulty relaxing between contractions. She also expresses frustration that her labor is not progressing more quickly. Although she has been using breathing techniques learned in childbirth preparation classes, she no longer finds them effective and rates her pain as 9 on a scale of 0 to 10. The patient asks her nurse if she might benefit from an epidural. Epidural analgesia would provide which benefit for this patient? A. Labor may progress better if the patient is able to maintain one position. B. The patient's contractions may slow and cause less pain. C. The active phase of labor may progress at a faster rate if the patient is able to relax. D. The patient will be ready for a cesarean delivery.

C. The active phase of labor may progress at a faster rate if the patient is able to relax.

The nurse notes that her patient who is at 41 weeks' gestation and was admitted for labor at 5 cm has a pulse pressure of 35 mm Hg. What effect will this finding have on the nurse's preparation of the patient for an epidural? A. The nurse will administer less IV fluid during the pre-epidural fluid bolus. B. The nurse will have ephedrine available at the bedside. C. The nurse will administer more IV fluid during the pre-epidural fluid bolus. D. The nurse will not change patient preparation because the patient's pulse pressure is normal.

C. The nurse will administer more IV fluid during the pre-epidural fluid bolus. Rationale: An admission pulse pressure of less than 45 mm Hg may indicate the need for higher volumes of IV fluid, not lower volumes.

A primipara who delivered vaginally 2 hours ago is transferred with her newborn to the postpartum unit. During the change-of-shift report, the nurse assuming the patient's care is told that she has B-negative blood and that cord blood has been sent to the laboratory. What is the first step the nurse should take in following up with the care of this patient and newborn? A. Administer Rho(D) IG within 72 hours of the delivery. B. Draw blood for a blood type and screen on the newborn. C. Verify that a Coombs test was ordered for the patient. D. Verify the father's blood type.

C. Verify that a Coombs test was ordered for the patient. Rationale: Before administering Rho(D) IG, the nurse must confirm that the patient is not already sensitized by checking the results of the Coombs test, which is routinely performed after an Rh-negative patient gives birth. Theoretically, Rho(D) IG is unnecessary if the newborn's father is also Rh negative; however, the standard of care does not factor this into the decision when determining whether to administer the IG. Although Rho(D) IG should be administered within 72 hours of delivery, a blood product should not be administered without an order and a Coombs test result. Because cord blood was obtained and sent to the laboratory, drawing a specimen from the newborn is unnecessary. The Rho(D) IG should not be administered until the Coombs test results have been returned and the practitioner has written the appropriate order.

A laboring patient received an epidural infusion approximately 2 hours ago and is resting comfortably. However, the nurse notices that the patient is continually rubbing her nose and scratching her abdomen. When asked, the patient states, "I guess I must be allergic to something; the itching started about an hour ago." What is the most appropriate response? A. "Have you ever had this problem before? I doubt it's related to anything here." B. "You're probably having an allergic reaction. I'll let the anesthesia provider know about it." C. "You're probably sensitive to the detergent they use to wash our linens. Let me ask the practitioner if we can give you an antihistamine." D. "The itching is a fairly common reaction to the medication in your epidural. Would you like me to talk to the anesthesia provider about some medicine to provide relief?"

D. "The itching is a fairly common reaction to the medication in your epidural. Would you like me to talk to the anesthesia provider about some medicine to provide relief?"

A 40-year-old multipara presents to the antepartum unit for amniocentesis at 18 weeks' gestation. The patient has A-negative blood and a negative response to the Coombs test. Which treatment should the nurse anticipate? A. Defer Rho(D) IG administration because the patient does not currently have an indication for it. B. Defer Rho(D) IG administration because the patient is Rh negative but already is sensitized to the Rh factor. C. Defer Rho(D) IG administration because the patient is Rh negative but not yet at 28 weeks' gestation. D. Administer Rho(D) IG because the patient is Rh negative, is not sensitized to the Rh factor, and will undergo an invasive procedure that may cause fetal blood to cross into the maternal blood.

D. Administer Rho(D) IG because the patient is Rh negative, is not sensitized to the Rh factor, and will undergo an invasive procedure that may cause fetal blood to cross into the maternal blood. Rationale: Undergoing amniocentesis is an indication for a multipara patient who is Rh negative to receive Rho(D) IG because it is an invasive procedure that may cause fetal blood to cross into the maternal blood. The negative result on the Coombs test indicates that the patient is not already sensitized to the Rh factor. Rho(D) IG may be administered before 28 weeks' gestation if an indication for its administration exists.

Organizations with labor and delivery services should have the capability of beginning a cesarean delivery within what length of time? A. The time required for arrival of the support person B. Less than 60 minutes of the decision to operate C. A reasonable amount of time D. An appropriate time period for the clinical situation

D. An appropriate time period for the clinical situation not-a,c,b

A patient in labor at 40 weeks' gestation requires a dose of ephedrine for post-epidural hypotension. After administering ephedrine 10 mg IV, the nurse can expect which effect? A. A decrease in FHR B. No change in FHR C. Bradycardia D. An increase in FHR

D. An increase in FHR Rationale: Ephedrine crosses the placenta and may cause an increase, not a decrease, in the FHR.

A patient is to receive IV ephedrine for hypotension after epidural placement. The order reads "ephedrine 50 mg IV every 10 minutes as needed." Based on this order, what should the nurse do? A. Not administer ephedrine and continue with other methods to treat hypotension (e.g., administering an IV fluid bolus). B. Administer the ephedrine as soon as possible so it will take effect before the patient experiences adverse reactions of hypotension. C. Assume the practitioner meant to order hydralazine because 50 mg of hydralazine is a recommended dose. D. Clarify the order because the usual dose for IV ephedrine is 5 to 10 mg.

D. Clarify the order because the usual dose for IV ephedrine is 5 to 10 mg. Rationale: The nurse should clarify the order because the recommended dose for IV ephedrine is 5 to 10 mg. A recommended oral dose of hydralazine may be 50 mg;

As soon as the newborn is stabilized after birth, and before leaving the delivery room, the nurse must verify exact ID band information with the mother's ID band and apply ID bands securely to the newborn's limbs. Which detail, if it were to be included on the newborn's ID bands, would indicate that the nurse needs more training? A. Time of birth B. Record number C. Sex of the newborn D. Mother's room number

D. Mother's room number

A new mother rings the call bell and begins screaming and crying loudly. She reports she just woke up from a nap and her baby is gone. The nurse suspects that the newborn has been abducted. Which action by the nurse would indicate that the nurse needs more training? A. Position available staff at unit exit points. B. Notify facility personnel by initiating the appropriate level emergency code call. C. Check the computer tracking system to pinpoint the newborn's location. D. Remove all visitors from the unit.

D. Remove all visitors from the unit.

A 28-week preterm newborn has been under phototherapy for 12 hours for an earlier sternal TcB reading of 8 mg/dl. The present sternal TcB reading is 3 mg/dl. What is the significance of this reading? A. The reading indicates that phototherapy can be discontinued. B. The reading indicates that the phototherapy is effective for this newborn. C. The reading indicates that phototherapy needs to be doubled. D. The reading is unreliable because the newborn's sternum has been exposed to phototherapy.

D. The reading is unreliable because the newborn's sternum has been exposed to phototherapy. Rationale: TcB readings are unreliable after a newborn's exposure to phototherapy; therefore, the current reading is not an effective indicator of the newborn's response to phototherapy. The treatment course of phototherapy should be guided by total serum bilirubin levels after phototherapy has been started. No orders for changes in the number of phototherapy lights should be determined based on a TcB reading after phototherapy has been initiated.

A new mother reports breast engorgement and nipple pain on day 2 after the delivery of a healthy newborn. She tells the nurse, "I'm not sure that breastfeeding the baby is for me." What should the nurse advise the patient to do to help relieve her discomfort and encourage her to persevere with breastfeeding? A. Explain that plugged milk ducts are probably causing the pain and swelling. B. Advise the patient to limit the duration of breastfeeding to 5 minutes on each side. C. Advise the patient to offer the baby just one breast at each feeding session and to alternate with each feeding. D. Inform the patient that breastfeeding her baby more frequently will help decrease the pain and swelling in her breasts.

DD In many cases, breasts become swollen and painful 2 or 3 days after a woman gives birth; the best way to decrease the pain and swelling is to breastfeed the newborn more frequently.

A first-time mother rings the call bell, distraught because her newborn had "black diarrhea" after the third breastfeeding session. The birth was 8 hours ago. What should the nurse tell the patient? A. "This black stool, called meconium, is normal in the first 24 to 48 hours; frequent breastfeeding helps your baby pass it." B. "At 8 hours old, your baby should have yellow, seedy stool, which is perfectly normal for a breastfed newborn." C. "This type of stool from the baby indicates that you need to boost your caloric intake." D. "Your baby should have three to five wet diapers and three to six stools daily by day 3 to 5."

a

A new mother begins to cry because her newborn will not burp despite multiple attempts, and she worries that her burping technique is a failure. What should the nurse teach the mother about newborns who are breastfed? A. They may not need to burp with each feeding because they do not swallow as much air as do bottle-fed newborns. B. They must be burped after feeding at the first breast and before nursing at the second breast. C. They do not need to burp during the switch between breasts but must burp at the end of every breastfeeding session. D. They do not need burping at all because they do not swallow any air.

a

A new mother is concerned about her baby getting enough nutrition. She reports to the nurse that the baby is always fussy and will not stop crying despite breastfeeding every hour. The baby's diaper has not needed changing for several hours. For what should the nurse assess? A. Proper latch, which helps ensure that the newborn is obtaining enough milk from the breast B. Breast infection, then recommend a switch to a suitable replacement formula C. Mastitis, then recommend that the patient stop breastfeeding to prevent infection D. Breast size

a

The nurse is instructing a new mother on how to breastfeed. The patient is extremely anxious about breastfeeding, and she complains of tingling and tenderness in her nipples. Which nursing intervention is most appropriate? A. Educate the mother about the letdown reflex and continue to encourage her through the breastfeeding process. B. Stop the breastfeeding session and ask the practitioner to prescribe antibiotics for the patient's mastitis. C. Stop the breastfeeding session and instruct the mother to avoid the use of soaps and harsh washing of the breasts. D. Provide the mother with formula for the newborn.

a

While preparing to apply the ID bands to a newborn in the delivery room, the nurse notes that the time of birth on the newborn's bands differs from the time of birth on the mother's band. What action should the nurse take? A. Do not apply the bands until all details match the mother's band. B. Apply the bands as long as the other information is correct. C. Bundle the newborn and transport to the nursery to get new bands. D. Tape the footprint sheet to the newborn, as it carries all the accurate information.

a

During a busy day on the maternity unit, the nursery is full of newborns and nurse staffing is low. In addition, the security bracelet computer system has malfunctioned and is out of service. What essential key to newborn security must the nurse keep in mind while caring for several newborns in this situation? A. Newborns should not be transported while the security system is malfunctioning. B. Newborns should not be left unattended. C. Newborns may remain without staff in the nursery behind a self-locking door while the security system is malfunctioning. D. Newborns should stay in mothers' rooms.

b