RN Learning System Maternal Newborn Final Quiz ATI
A nurse is caring for a newborn whose mother received magnesium sulfate to treat preterm labor. Which of the following clinical manifestations in the newborn indicates toxicity due to the magnesium sulfate therapy? Respiratory depression Hypothermia Hypoglycemia Jaundice
Respiratory depression
A nurse is caring for a preterm newborn who is receiving oxygen therapy. Which of the following findings should the nurse identify as a potential complication from the oxygen therapy? Atelectasis Retinopathy Interstitial emphysema Necrotizing enterocolitis
Retinopathy
A nurse in a prenatal clinic is caring for a client who is within the recommended guideline for weight. The client asks the nurse how much weight is safe for her to gain during her pregnancy. Which of the following responses should the nurse make? "Your provider can discuss an appropriate amount of weight gain with you." "A weight gain of about 14 pounds each trimester is suggested." "If you eat nutritious foods when you feel hungry, the amount of weight gain is insignificant." "A weight gain of about 25 to 35 pounds is good."
"A weight gain of about 25 to 35 pounds is good."
A nurse is discussing epidural anesthesia with a client who is receiving oxytocin for induction of labor. Which of the following statements should the nurse make? "An epidural given too early during labor can cause maternal hypertension." "An epidural given too early during labor will not be effective in active labor." "An epidural given too early can cause fetal depression." "An epidural given too early can prolong labor."
"An epidural given too early can prolong labor."
A nurse is providing discharge teaching to a client following the removal of a hydatidiform mole. Which of the following statements should the nurse include in the teaching? "Do not become pregnant for at least 1 year." "Seek genetic counseling for yourself and your partner prior to getting pregnant again." "You should have an hCG level drawn in 6 weeks." "Have your blood pressure checked weekly for the next month."
"Do not become pregnant for at least 1 year."
A nurse is discussing diaphragm use with a client. Which of the following statements by the client indicates an understanding of the teaching? "I should clean my diaphragm with alcohol each time I use it." "I should leave the diaphragm in place 4 hours after intercourse." "I should replace my diaphragm every 2 years." "I should use a vaginal lubricant to insert my diaphragm."
"I should replace my diaphragm every 2 years."
A nurse is teaching a client about a nonstress test. Which of the following statements by the client indicates an understanding of the teaching? "I know not to eat anything after midnight." "I will have medication given to me to cause contractions." "I should press the button on the handheld marker when my baby moves." "I will have to stimulate my breast to cause contractions."
"I should replace my diaphragm every 2 years."
A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. Which of the following actions should the nurse include in the plan of care? Keep four side rails up while the client is in bed. Monitor fetal heart rate every hour. Insert an indwelling urinary catheter. Check the cervix prior to analgesic administration.
Check the cervix prior to analgesic administration.
A nurse is caring for a client who is at 34 weeks of gestation and has a prescription for terbutaline for preterm labor. Which of the following statements by the client is the priority? "My ankles are swollen at the end of the day." "I can feel the baby kicking my ribs, and it is very uncomfortable." "I'm growing more and more worried every day." "My heart feels as if it is racing."
"My heart feels as if it is racing."
A nurse is preparing to administer naloxone to a newborn. Which of the following conditions can require administration of this medication? IV narcotics administered to the mother during labor Maternal drug use Hyaline membrane disease Meconium aspiration
IV narcotics administered to the mother during labor
A nurse is speaking with an expectant father who says that he feels resentful of the added attention others are giving to his wife since the pregnancy was announced several weeks ago. Which of the following responses should the nurse make? "Has your wife sensed your anger toward her and the baby?" "These feelings are common to expectant fathers in early pregnancy." "I'm sure that it's really hard to accept this when it's your baby, too." "It would be wise for you to speak to a therapist about these feelings."
"These feelings are common to expectant fathers in early pregnancy."
A nurse is caring for a client who is at 8 weeks of gestation with twins and primigravida. The client states that even though she and her husband planned this pregnancy, she is experiencing many ambivalent feelings about it. Which of the following responses should the nurse make? "Have you told your husband about these feelings?" "These feelings are quite normal at the beginning of pregnancy." "Perhaps you should see a counselor to discuss these feelings." "I am quite concerned about these feelings. Could you explain more?"
"These feelings are quite normal at the beginning of pregnancy."
A nurse is caring for a client who is in labor. The client questions the application of an internal fetal scalp monitor. Which of the following responses should the nurse make? "Don't worry. Your baby is fine." "You will need to ask your provider." "Your provider feels it would be best." "We need to observe your baby more closely."
"We need to observe your baby more closely."
A nurse is caring for a client who has trichomoniasis and a prescription for metronidazole. Which of the following instructions should the nurse provide to the client about the treatment plan? "Your partner needs to be cultured and be treated with metronidazole only if his cultures are positive." "You and your partner need to take the medication and use a condom during intercourse until cultures are negative." "If both you and your partner are treated simultaneously, you may continue to engage in sexual intercourse." "Only you will need to take the metronidazole, but you should not have intercourse until your culture is negative."
"You and your partner need to take the medication and use a condom during intercourse until cultures are negative."
A nurse is caring for a client who is pregnant and reports nausea and vomiting. Which of the following instructions should the nurse provide the client? "You should eat some crackers before rising from bed in the morning." "You should eat foods served at warm temperatures." "You should sip whole milk with breakfast." "You should brush your teeth immediately after meals."
"You should eat some crackers before rising from bed in the morning."
A nurse is teaching a client who has active genital herpes simplex virus, type 2. Which of the following statements should the nurse include in the teaching? "You will have a cesarean birth prior to the onset of labor." "Your baby will receive erythromycin eye ointment after birth to treat the infection." "You should take oral metronidazole for 7 days prior to 37 weeks of gestation." "You should schedule a cesarean birth after your water breaks."
"You will have a cesarean birth prior to the onset of labor."
A nurse is caring for a client who has a prescription for naloxone. Which of the following is the intended action of the medication in relation to the central nervous system (CNS)? Accentuate effects of narcotics on the CNS Depress activity of the CNS Block effects of narcotics on the CNS Stimulate activity of the CNS
Block effects of narcotics on the CNS
A nurse is caring for four newborns. Which of the following newborns is at greatest risk for hypoglycemia? A newborn who is large for gestational age A newborn who has an Rh incompatibility A newborn who has pathologic jaundice A newborn who has fetal alcohol syndrome
A newborn who is large for gestational age
A nurse is planning care for a client who has a prescription for oxytocin. Which of the following is a contraindication for the use of this medication? Prolonged rupture of membranes at 38 weeks of gestation Intrauterine growth restriction Postterm pregnancy Active genital herpes
Active genital herpes
A nurse is assessing a client on the first postpartum day. Findings include fundus firm and one fingerbreadth above and to the right of the umbilicus, moderate lochia rubra with small clots, temperature 37.3° C (99.2° F), and pulse rate 52/min. Which of the following actions should the nurse take? Report the vital signs to the provider. Massage the fundus. Ask the client when she last voided. Administer an oxytocic agent.
Ask the client when she last voided.
A nurse is planning care for a client who is pregnant and is Rh-negative. In which of the following situations should the nurse administer Rh(D) Immune Globulin? While the client is in labor Following an episode of influenza during pregnancy Prior to a blood transfusion At 28 weeks of gestation
At 28 weeks of gestation
A nurse is caring for a newborn who has irregular respirations of 52/min with several periods of apnea lasting approximately 5 seconds. The newborn is pink with acrocyanosis. Which of the following actions should the nurse take? Administer oxygen. Place the newborn in an isolette. Continue to routinely monitor the newborn. Assess the newborn's blood glucose.
Continue to routinely monitor the newborn.
A nurse receives report on a client who is in labor and is experiencing contractions 4 min apart. Which of the following patterns should the nurse expect on the fetal monitoring tracing? Contractions that last for 60 seconds each with a 4-min rest between contractions Contractions that last for 60 seconds each with a 3-min rest between contractions A contraction that lasts 4 min followed by a period of relaxation Contractions that last 45 seconds each with a 3-min rest between contractions
Contractions that last for 60 seconds each with a 3-min rest between
A nurse administers betamethasone to a client who is at 33 weeks of gestation to stimulate fetal lung maturity. When planning care for the newborn, which of the following conditions should the nurse identify as an adverse effect of this medication? Hyperthermia Decreased blood glucose Rapid pulse rate Irritability
Decreased blood glucose
A nurse is planning care for a newborn who requires phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan of care? Swaddle the newborn in a receiving blanket during the treatment. Maintain NPO status until the newborn's bilirubin is within the expected reference range. Ensure the newborn's eyes are closed before applying the eye shield. Apply lotion to the newborn's skin twice per day.
Ensure the newborn's eyes are closed before applying the eye shield. Rationale: Overexposure to the lights during treatment can cause damage to the newborn's corneas. Therefore, the nurse should gently close the newborn's eyes prior to applying the eye shield
A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following clinical findings should the nurse expect? Extended periods of sleep Poor muscle tone Respiratory rate 50/min Exaggerated reflexes
Exaggerated reflexes
A nurse is caring for a newborn who was born to a client who has a narcotic use disorder. Which of the following nursing actions should the nurse identify as a contraindication for the care of the newborn? Promoting maternal-newborn bonding Tight swaddling of the newborn Small frequent feedings Frequent stimulation
Frequent stimulation
A nurse is planning care for a client who is at 35 weeks of gestation. Which of the following laboratory tests should the nurse obtain? Rubella titer Blood type Group B streptococcus ß-hemolytic 1-hour glucose tolerance test
Group B streptococcus ß-hemolytic
A nurse is caring for a client who is in labor and has an epidural for pain relief. Which of the following is a complication from the epidural block? Nausea and vomiting Tachycardia Hypotension Respiratory depression
Hypotension
A nurse in an antepartum clinic answers a phone call from a client who is at 37 weeks of gestation and reports, "I became very dizzy while lying in bed this morning, but the feeling went away when I turned on my side." Which of the following actions should the nurse take? Instruct the client about vena cava syndrome and measures to prevent it. Arrange for the client to come to the clinic for an assessment. Check the client's chart for gestational diabetes mellitus. Schedule a nonstress test for the client.
Instruct the client about vena cava syndrome and measures to prevent it.
A nurse is caring for a client who is 2 hr postpartum. The nurse notes the client's perineal pad has a large amount of lochia rubra with several clots. Which of the following actions should the nurse take first? Check for a full bladder. Massage the fundus. Measure vital signs. Administer carboprost IM.
Massage the fundus.
A nurse is caring for a client who desires an intrauterine device (IUD) for contraception. Which of the following findings is a contraindication for the use of this device? Hypertension Menorrhagia History of multiple gestations History of thromboembolic disease
Menorrhagia
A nurse is caring for a client who is at 36 weeks of gestation and has pre-eclampsia. Which of the following findings should the nurse identify as the priority? 1+ proteinuria Blood pressure 140/98 mm Hg Nonreactive nonstress test Fundal height 33 cm
Nonreactive nonstress test
A nurse is assessing a newborn who is 12 hr old and notes mild jaundice of the face and trunk. Which of the following actions should the nurse take? Administer phytonadione IM. Obtain a stat prescription for a bilirubin level. Obtain a bagged urine specimen. Perform a gestational age assessment.
Obtain a stat prescription for a bilirubin level.
A nurse is caring for a client who has clinical manifestations of an ectopic pregnancy. Which of the following findings is a risk factor for an ectopic pregnancy? Anemia Frequent urinary tract infections Previous cesarean birth Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID)
A nurse is caring for a client who is receiving oxytocin for induction of labor. Which of the following actions should the nurse take? Perform continuous fetal heart rate monitoring. Measure maternal temperature every hour. Evaluate maternal contraction pattern every hour. Check blood pressure every 5 min.
Perform continuous fetal heart rate monitoring.
A nurse is caring for a client whose membranes have ruptured and is in active labor. The fetal monitor tracing reveals late decelerations. Which of the following actions should the nurse take first? Turn the client onto her left side. Palpate the client's uterus. Administer oxygen to the client. Increase the client's IV fluids.
Turn the client onto her left side.
A nurse is assessing a client who is receiving magnesium sulfate as treatment for pre-eclampsia. Which of the following clinical findings is the nurse's priority? Respirations 16/min Urinary output 40 mL in 2 hr Reflexes +2 Fetal heart rate 158/min
Urinary output 40 mL in 2 hr
A nurse is caring for a client who is at 16 weeks of gestation and has severe iron-deficiency anemia. The provider prescribes an injection of iron dextran IM. Which of the following methods should the nurse use to administer the medication? Use a 20-gauge needle, and administer the medication using the Z-track method. Use a 22-gauge needle, and administer the medication deep into the thigh. Use a 25-gauge needle, and administer the medication into the deltoid muscle. Use an 18-gauge needle, and administer the medication into the rectus femoris muscle.
Use a 20-gauge needle, and administer the medication using the Z-track method.
A nurse is caring for a client who is in labor. A vaginal examination reveals the following information: 2 cm, 50%, +1, right occiput anterior (ROA). Based on this information, which of the following fetal positions should the nurse document in the medical record? Transverse Breech Vertex Mentum
Vertex