Post-Term Practice Questions (Test #3 Fall 2020)

A client with a fetal demise is admitted to labor and delivery in the latent phase of labor. Which of the following behaviors would the nurse expect this client to exhibit? 1. Crying and sad. 2. Talkative and excited. 3. Quietly doing rapid breathing. 4. Loudly chanting songs.

1 1. The nurse would expect the client to be crying and sad. 2. It is unlikely that the client would be talkative and excited. 3. It is unlikely that the client would be quietly doing rapid breathing. 4. It is unlikely that the client would be loudly chanting. TEST-TAKING TIP: A client in the latent phase of labor who is carrying a healthy fetus is likely to be talkative and excited, but a woman whose fetus has died is likely to be crying and sad throughout her labor. Clients in the latent phase usually are performing slow chest breathing.

The neonate in the nurse's care has a pneumothorax. The nurse knows the signs of early decompensation and to carefully assess which of the following? Select all that apply. 1.B/P. 2.Temperature. 3.Urinary output. 4.Color. 5.Heart rate.

1,4,5. The pneumothorax may affect cardiac output, thus affecting perfusion causing a decrease in B/P and color. As the neonate attempts to compensate, bradycardia or tachycardia may be exhibited. A change in temperature and urinary output are very late signs of decompensation.

When developing the initial plan of care for a neonate who was born at 41 weeks' gestation with meconium aspiration syndrome (MAS) requiring mechanical ventilation, which of the following should the nurse include? 1.Care of an umbilical arterial line. 2.Frequent ultrasound scans. 3.Orogastric feedings as soon as possible. 4.Assessment for symptoms of hyperglycemia.

1 Care of an umbilical arterial line would be included in the neonate's plan of care because an umbilical arterial line is commonly inserted to monitor arterial blood pressures, blood pH, blood gases, and infusion of intravenous fluids, blood, or medications. Frequent ultrasound scans are not indicated at this time. However, chest radiographs may be used to detect lung densities, because pneumonia is a major complication of this disorder. Orogastric feeding may not be feasible while the health care team focuses on interventions to establish adequate oxygenation. The neonate with MAS commonly experiences hypoglycemia, not hyperglycemia. Hypoglycemia occurs because of depletion of glucose stores related to hypothermia.

A 42-week gravida is delivering her baby. A nurse and pediatrician are present at the birth. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? Select all that apply. 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Prepare to assist with intubation. 4. Place the baby in the prone position. 5. Place the baby under the overhead warm

1,2,3,5 1. Even though meconium is present in the amniotic fluid, the baby should be stimulated to breathe. 2. The baby's heart rate is a critical piece of information. If the heart rate is below 100 bpm, positive pressure ventilation and pulse oximetry should be initiated. In addition, direct ECG assessment may be appropriate. 3. Although not universally recommended. the physician may determine that intubation is needed to remove meconium-contaminated fluid from the baby's airway and/or to provide direct ventilation. 4. The baby should be kept in a head-down, supine position. 5. Hypothermic neonates are at high risk of morbidity and mortality. When in need of resuscitation, they should be kept warm under an overhead heat source. TEST-TAKING TIP: The nurse, once the fluid was seen, should have paged the appropriate healthcare professional to be present at the birth. If the baby fails to breathe spontaneously, all neonatal resuscitation efforts should be instituted. It is important to note that the recommendation for intubation to remove meconium-stained fluid in all babies who fail to initiate spontaneous respirations has changed. The decision whether or not to intubate is currently to be determined by the resuscitating professional

The nurse is assessing the Bishop score on a postdates client. Which of the following measurements will the nurse assess? Select all that apply. 1. Gestational age. 2. Rupture of membranes. 3. Cervical dilation. 4. Fetal station. 5. Cervical position.

1. Gestational age is not part of the Bishop score. 2. The status of the membranes is not part of the Bishop score. 3. Cervical dilation is part of the Bishop score. 4. Fetal station is part of the Bishop score. 5. Cervical position is part of the Bishop score. TEST-TAKING TIP: The Bishop score is calculated to determine the inducibility of the cervix. Although gestational age and rupture of the membranes may be indications for calculating the score, neither has a direct impact on the inducibility of the cervix.

A client, 42 weeks' gestation, is admitted to the labor and delivery suite with a diagnosis of acute oligohydramnios. The nurse must carefully observe this client for signs of which of the following? 1. Fetal distress. 2. Dehydration. 3. Oliguria. 4. Jaundice.

1. The nurse should carefully monitor the client for fetal distress. 2. It is unlikely that the client is dehydrated. 3. It is unlikely that the client will have oliguria. 4. It is unlikely that the client will develop jaundice. TEST-TAKING TIP: Oligohydramnios is often seen in post-term pregnancies. When the placenta begins to deteriorate, the hydration of the baby drops. Because the predominant component of amniotic fluid is fetal urine, when the baby is dehydrated, the quantity of amniotic fluid drops. Fetal distress can occur because of two factors: cord compression, because there is insufficient fluid to cushion the umbilical cord, and uteroplacental insufficiency, because the placenta is functioning sub-optimally

A nurse in the newborn nursery suspects that a new admission, 42 weeks' gestation, was exposed to meconium in utero. What would lead the nurse to suspect this? 1. The baby is bradycardic. 2. The baby's umbilical cord is green. 3. The baby's anterior fontanel is sunken. 4. The baby is desquamating.

2 1. Bradycardia is a sign of neonatal distress but it is not related to meconium exposure. 2. Because meconium is a dark green color, when it is expelled in utero, the baby can be stained green. 3. A sunken fontanel is an indication of dehydration, not of meconium exposure. 4. A baby's skin often desquamates when he or she is post-term. Although meconium may be expelled by a post-term baby, desquamation is not related to the meconium. TEST-TAKING TIP: The test taker may choose response 4 because he or she remembers that there is a relationship between babies who expel meconium and those who desquamate. That is true, but it is not a direct relationship. The fact that the baby is postdates is the common denominator between the two. The test taker should choose the response that is clearly correct: Because meconium is green it can stain the baby's tissues green. "Desquamation" is merely a fancy term for "skin peeling."

At a home visit, the nurse assesses a neonate born vaginally at 41 weeks' gestation 5 days ago. Which of these findings warrants further assessment? 1.Frequent hiccups. 2.Loose, watery stool in diaper. 3.Pink papular vesicles on the face. 4.Dry, peeling skin.

2 A loose, watery stool in the diaper is indicative of diarrhea and needs immediate attention. The infant may become severely dehydrated quickly because of the higher percentage of water content per body weight in the neonate, compared with the adult. Frequent hiccups are considered normal in a neonate and do not warrant additional investigation. Pink papular vesicles (erythema toxicum) on the face are considered normal in a neonate and disappear without treatment. Dry, peeling skin is normal in a postterm neonate.

When performing an initial assessment of a postterm male neonate weighing 4,000 g (9 lb) who was admitted to the observation nursery after a vaginal birth with low forceps, the nurse detects Ortolani's sign. Which of the following actions should the nurse do next? 1.Determine the length of the mother's labor. 2.Notify the primary health care provider immediately. 3.Keep the neonate under the radiant warmer for 2 hours. 4.Obtain a blood sample to check for hypoglycemia.

2 Ortolani maneuver involves flexing the neonate's knees and hips at right angles and bringing the sides of the knees down to the surface of the examining table. A characteristic click or "clunk," felt or heard, represents a positive Ortolani sign, suggesting a possible hip dislocation. The nurse should notify the primary health care provider promptly because treatment is needed, while maintaining the dislocated hip in a position of flexion and abduction. It should be noted that many institutions now limit performing the Ortolani's maneuver to APNs or physicians. Determining the length of the mother's labor provides no useful information related to the nurse's finding. Keeping the infant under the radiant warmer is necessary only if the neonate's temperature is low or unstable. Checking for hypoglycemia is not indicated at this time, unless the neonate is exhibiting jitteriness.

Which of the following developmental features would the nurse expect to be absent in a 41-week gestation fetus? 1. Fingernails. 2. Eyelashes. 3. Lanugo. 4. Milia.

3 1. Fingernails would likely be quite long. 2. Eyelashes would be present. 3. Because this baby is post-term, lanugo would likely not be present. 4. Milia would be present. TEST-TAKING TIP: Lanugo is a fi ne hair that covers the body of the fetus. It begins to disappear at about 38 weeks and very likely has completely vanished by 41 weeks' gestation.

A 42-week-gestation neonate is being assessed. Which of the following findings would the nurse expect to see? 1. Folded and flat pinnae. 2. Smooth plantar surfaces. 3. Loose and peeling skin. 4. Short pliable fingernails.

3 1. Folded and flat pinnae are seen in preterm newborns, not postmature babies. 2. Smooth plantar surfaces are seen in preterm newborns, not postmature babies. 3. The skin of the post-term baby is loose because the baby has depleted most of the subcutaneous fat stores and is peeling because of dehydration and the advanced age of the baby. 4. The nurse would expect to see long fingernails that may be tinged green from exposure to meconium. TEST-TAKING TIP: If the test taker were unsure of the answer to this question, an educated response could have been made. Post-term babies are in utero beyond the normal life of the placenta. They are deprived of nourishment, hydration, and oxygenation because of this. Loose skin often connotes a loss of weight, and peeling skin is seen in poorly nourished and hydrated individuals. The test taker could dedu

A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.

4 1. Abundant lanugo is seen in the preterm baby, not the post-term baby. 2. Absence of breast tissue is seen in the preterm baby, not the post-term baby. 3. Prominent clitoris is seen in the preterm baby, not the post-term baby. 4. The post-term baby does have dry, wrinkled, and often desquamating skin. The baby's dehydration is secondary to a placenta that progressively deteriorates after 40 weeks' gestation. TEST-TAKING TIP: The test taker should be familiar with the characteristic presentations of preterm and postmature neonates. Studying the items on the New Ballard Scale and the corresponding gestational ages when the items are seen is an excellent way to associate certain characteristics with dysmature babies.

A 42-week-gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following neonatal care actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress

4 1. Although the fluid is green tinged because the baby expelled meconium in utero, the baby's skin is not at high risk for injury. 2. The conjunctivae are not at high risk for irritation from the meconium-stained fluid. 3. There is nothing in the scenario that suggests that this baby is currently septic. 4. Meconium aspiration syndrome (MAS) is a serious complication seen in post-term neonates who are exposed to meconiumstained fluid. Respiratory distress would indicate that the baby has likely developed MAS. TEST-TAKING TIP: Although meconium appears black in a newborn's diaper, it is actually a very dark green color. When diluted in the amniotic fl uid, therefore, the fl uid takes on a greenish tinge. Because meconium is a foreign substance, when aspirated by the baby, a chemical and, secondarily, a bacterial pneumonia often develop.

A woman, G3 P2002, 42 weeks' gestation, is admitted to the labor suite for induction. A biophysical profile (BPP) report on the client's chart states BPP score of 6 of 10. The nurse should monitor this client carefully for which of the following? 1. Maternal hypertension. 2. Maternal hyperglycemia. 3. Increased fetal heart variability. 4. Late fetal heart decelerations.

4 1. There is nothing in the scenario that indicates that the woman is at high risk for hypertensive illness. 2. There is nothing in the scenario that indicates that the woman is at high risk for hyperglycemia. 3. Increased fetal heart variability is not expected in this situation. 4. The baby is at high risk for late fetal heart decelerations secondary to a postmature placenta. TEST-TAKING TIP: A BPP of 8 or lower indicates that the fetus is in jeopardy. The five assessments that constitute the BPP are nonstress test (NST), fetal movement, fetal breathing, amniotic fluid volume, and fetal tone. Each assessment is given a score of 0 or 2.

A neonate born by cesarean at 42 weeks' gestation, weighing 4.1 kg (9 lb, 1 oz), with Apgar scores of 8 at 1 minute and 9 at 5 minutes after birth, develops an increased respiratory rate and tremors of the hands and feet 2 hours postpartum. Which of the following is the priority problem? 1.Ineffective airway clearance. 2.Hyperthermia. 3.Decreased cardiac output. 4.Hypoglycemia.

4 Increased respiratory rate and tremors are indicative of hypoglycemia, which commonly affects the postterm neonate because of depleted glycogen stores. There is no indication that the neonate has ineffective airway clearance, which would be evidenced by excessive amounts of mucus or visualization of meconium on the vocal cords. Lethargy, not tremors, would suggest infection or hyperthermia. Furthermore, the postterm neonate typically has difficulty maintaining temperature, resulting in hypothermia, not hyperthermia. Decreased cardiac output is not indicated, particularly because the neonate was born by cesarean section, which is not considered a difficult birth.

A neonate is admitted to the neonatal intensive care unit for observation with a diagnosis of probable meconium aspiration syndrome (MAS). The neonate weighs 10 lb, 4 oz (4,650 g) and is at 41 weeks' gestation. Which of the following would be the priority problem? 1.Impaired skin integrity. 2.Hyperglycemia. 3.Risk for impaired parent-infant-child attachment. 4.Impaired gas exchange.

4 The priority problem for the neonate with probable MAS is impaired gas exchange related to the effects of respiratory distress. Obstruction of the airways may be complete or partial. Meconium aspiration may lead to pneumonia or pneumothorax. Establishing adequate respirations is the primary goal. Impaired skin integrity is a concern, but establishing and maintaining an airway and gas exchange is always the priority. Hypoglycemia tends to be a problem for large-for-gestational-age babies, not hyperglycemia. If the parents do not express interest or concern for the neonate, then risk for impaired parent-infant-child attachment may be appropriate once the airway is established