Maternal Newborn

A nurse is teaching a group of teenage clients about the use of condoms for the prevention of sexually transmitted infections (STIs). Which of the following statements should the nurse include in the teaching?

"Female condoms can help prevent transmission of sexually transmitted viruses." The client who uses a female condom can prevent sexually transmitted viruses when the polyurethane or nitrile sheath is placed in the vagina.

A nurse in a prenatal clinic is teaching a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching?

"I will reduce my exercise schedule to 3 days a week." Increased exercise benefits the client and can result in improved management of gestational diabetes.

A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations? A. "It is used to stop preterm labor contractions." B. "It halts cervical dilation." C. "It promotes fetal lung maturity." D. "It increases the fetal heart rate."

"It promotes fetal lung maturity." Betamethasone is a glucocorticoid that enhances fetal lung maturity by promoting the release of certain enzymes that help produce surfactant.

A nurse is providing teaching about Kegel exercises to a group of clients who are in the third trimester of pregnancy. Which of the following statements by a client indicates understanding of the teaching?

"These exercises help pelvic muscles to stretch during birth." Kegel exercises improve the strength of perineal muscles, facilitating stretching and contracting during childbirth.

A nurse is caring for a client who is at 6 weeks of gestation with her first pregnancy and asks the nurse when she can expect to experience quickening. Which of the following responses should the nurse make?

"This will occur between the fourth and fifth months of pregnancy." Quickening is defined as the first time the client is able to feel her fetus move. In a primigravida client, this usually occurs at 18 weeks of gestation or later. In a multigravida client, this can occur as early as 14 to 16 weeks.

A nurse is caring for a client who is postpartum and is breastfeeding. The client states that she is concerned about dietary precautions since she has a family history of food allergies .The nurse offers which of the following responses?

"You might want to avoid eating peanuts." There are no standard foods that are contraindicated during breastfeeding. With a family history of food allergies, it is important to avoid eating highly allergenic foods, such as peanuts, as well as other foods to which the client has a known allergy.

A nurse is assisting a client who is postpartum with her first breastfeeding experience. When the client asks how much of the nipple she should put into the newborn's mouth, which of the following responses should the nurse make?

"You should place your nipple and some of the areola into her mouth." Placing the nipple and 2 to 3 cm of areolar tissue around the nipple into the baby's mouth aids in adequately compressing the milk ducts. This placement decreases stress on the nipple and prevents cracking and soreness.

A nurse is providing education to a client who is in labor and has a prescription for a continuous IV infusion of oxytocin. Which of the information should the nurse include?

"Your contractions will become stronger and more frequent." Oxytocin is diluted with sodium chloride and administered IV via an infusion pump device to induce or strengthen uterine contractions during labor. The client who is receiving an oxytocin drip is closely monitored to promote a safe delivery and prevent maternal and/or fetal complications. The desired concentration of oxytocin medication is determined by the desired labor contraction pattern that should increase in frequency, duration, and intensity. The nurse closely monitors risks of continuous IV infusion of oxytocin to determine when to discontinue the medication. Risks include fetal distress (fetal bradycardia) caused by hyper-stimulation of the uterus compromising blood flow to the fetus. Uterine contractions lasting longer than 90 seconds should prompt the nurse to discontinue the medication.

A nurse in a prenatal clinic is caring for a client who is pregnant and asks the nurse for her estimated date of birth (EDB). The client's last menstrual period began on July 27. What is the client's EDB? (State the date in MMDD. For example, July 27 is 0727)

0504 Using Nägele's rule, the nurse subtracts three months from the date of the last menstrual period, then adds 7 days. July minus 3 months equals April. There are 30 days in April, so 27 + 7 = May 4. The client's EDB is May 4, which would be written as 0504 in the MMDD format.

A nurse is caring for a client during a nonstress test (NST). At the end of a 30-min period of observation, the nurse notes the following findings: The fetal heart rate baseline is 120/min with minimal variability and no accelerations. There are two decelerations of 15 /min in the fetal heart rate during a period of fetal movement, each lasting 20 seconds. Which of the following interpretations of these findings should the nurse make?

A nonreactive test An NST that does not produce two or more qualifying accelerations within a 20-min period is interpreted as nonreactive. Qualifying accelerations peak at least 15 /min above the FHR baseline and last at least 15 seconds.

A nurse on a postpartum unit is giving discharge instructions to a client whose newborn had a circumcision with the Plastibell technique. Which of the following client statements indicates understanding of circumcision care? (Select all that apply.) A. "I'll expect the plastic ring to fall off by itself within a week." B. "I'll apply petroleum jelly to his penis with diaper changes." C. "I'll wash his penis with warm water and mild soap each day." D. "I'll call the doctor if I see any bleeding." E. "I'll make sure his diaper is loose in the front."

A, D, E "I'll expect the plastic ring to fall off by itself within a week" is a correct statement. With the Plastibell procedure, the plastic ring detaches in about 5 to 8 days."I'll apply petroleum jelly to his penis with diaper changes" is an incorrect statement. With the Plastibell technique, no petroleum jelly is necessary."I'll wash his penis with warm water and mild soap each day" is an incorrect statement. The client should not use soap or commercial cleansing wipes until the circumcision has healed, which takes at least 5 to 6 days."I'll call the doctor if I see any bleeding" is a correct statement. The client should report any bleeding immediately."I'll make sure his diaper is loose in the front" is a correct statement. Applying a loose diaper prevents pressure over the circumcision area.

A nurse in the antepartum unit is caring for a client who is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

Abruptio placentae The classic signs of abruptio placentae include vaginal bleeding, abdominal pain, uterine tenderness, and contractions.

A nurse is admitting a client who is at 37 weeks of gestation and has severe gestational hypertension. Which of the following actions should the nurse expect to implement? (Select all that apply.)

Administer magnesium sulfate IV is correct. Magnesium sulfate IV is given as a tocolytic medication for preterm labor to relax smooth muscle of the uterus and as a treatment for preeclampsia. The underlying pathophysiology of preeclampsia is vasospasm. The nurse should closely monitor the client for signs of magnesium toxicity, such as loss of patellar reflexes, respiratory depression, cardiac arrhythmias, cardiac arrest, urinary retention, and serum magnesium levels higher than 8 mEq/L.Provide a dark, quiet environment is correct. A dark, quiet environment helps to decrease CNS stimulation, which minimizes the risk of seizures. Ensure that calcium gluconate is readily available is correct. Calcium gluconate is the antidote for magnesium sulfate and should be readily available when administering magnesium sulfate. The nurse should be prepared to administer the medication in response to manifestations of magnesium toxicity, such as depressed respirations, oliguria, sudden drop in BP, loss of deep-tendon reflexes, and fetal distress. Assess respiratory status every 4 hr is incorrect. The nurse should monitor the client's respiratory status closely because the client is at risk for respiratory depression. During an infusion of magnesium sulfate, the nurse should monitor the respiratory rate every 5 min and every 15 min during maintenance infusion. Depending on the client's response to the medication, the provider will prescribe for the vital signs to be monitored every 30 to 60 min thereafter.Evaluate neurologic status every 8 hr is incorrect. The nurse should evaluate the client's level of consciousness every hour.

A nurse in a clinic is reviewing the medical records of a group of clients who are pregnant. The nurse should anticipate the provider will order a maternal serum alpha-fetoprotein (MSAFP) screening for which of the following clients?

All of the clients MSAFP is a screening tool to detect open spinal and abdominal wall defects in the fetus. This maternal blood test is recommended for all pregnant woman.

A nurse is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification?

Ambulate twice daily. A provider's order to allow the client to ambulate requires clarification. The client who has severe preeclampsia should be placed on bedrest in a quiet, nonstimulating environment to prevent seizures and promote optimal placental blood flow.

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?

Changes in the cervix Assessment of progressive changes in the effacement and dilation of the cervix is the most accurate indication of true labor.

A nurse is caring for a client who is in the active phase of the first stage of labor. When monitoring the uterine contractions, which of the following findings should the nurse report to the provider? a. conterm-32tractions lasting longer than 90 seconds b. contractions occurring every 3 to 5 min c. contractions are strong in intensity d. client reports feeling contractions in lower back

Contractions lasting longer than 90 seconds A pattern of prolonged uterine contractions lasting more than 90 seconds is an indication that there is inadequate uterine relaxation and should be reported to the provider.

A nurse is caring for a client following an amniotomy who is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?

Encourage the client to empty her bladder every 2 hr. A client in labor should be encouraged to empty her bladder every 2 hr. Bladder distention can impede the descent of the fetus and slow the progression of labor. It can also contribute to uterine atony after delivery, increasing the client's risk of postpartum hemorrhage.

A nurse is providing preconception counseling for a client who is planning a pregnancy. Which of the following supplements should the nurse recommend to help prevent neural tube defects in the fetus?

Folic acid Adequate amounts of folic acid before conception and during the first trimester of pregnancy are necessary for fetal neural tube development. This vitamin helps prevent spina bifida and other neurological disorders.

A nurse is caring for a client who is at 22 weeks of gestation and has been unable to control her gestational diabetes mellitus with diet and exercise. The nurse should anticipate a prescription from the provider for which of the following medications for the client?

Glyburide With the exception of glyburide, clients who are pregnant do not take oral hypoglycemics because they cross the placenta and can injure the fetus. Approximately 20% of clients who have gestational diabetes mellitus will require insulin. Insulin lowers blood glucose levels without harming the fetus.

A nurse is caring for a client who experienced a vaginal birth 3 hr ago. Upon palpation, the fundus is displaced to the right of midline, is firm, and is two fingerbreadths above the umbilicus. Which of the following actions should the nurse complete at this time?

Have the client urinate A full bladder displaces the uterine fundus and elevates it above the level of the umbilicus. This can lead to uterine atony and excessive bleeding. Having the client urinate allows the uterus to return to midline and remain below the umbilicus.

A nurse is caring for a client who is at 12 weeks of gestation on an antepartum unit. For each potential provider's prescription, click to specify if the potential prescription is anticipated, or contraindicated for the client. Physical Exam: Client is a 20 years old, gravida 1 para 0, and at 12 weeks of gestation with twins by serial ultrasound. Admitted for hyperemesis gravidarum. The client reports being severely nauseated and reports vomiting with all meals since being at 8 weeks of gestation.

Initiate lactated Ringer's IV bolus of 500 mL followed by 150 mL/hr is anticipated. Fluid volume replacement with isotonic fluids such as lactated ringers can reverse fluid volume deficit associated with hyperemesis. Administer pyridoxine 25 mg every 8 hr slow IV bolus is anticipated. Administering pyridoxine, a vitamin B supplement for this client is anticipated to help decrease their symptoms of nausea. Give ondansetron 4 mg every 6 hr slow IV bolus, as needed is anticipated. Administering ondansetron, a 5HT3 receptor antagonist is anticipated for this client to help decrease their symptoms of nausea. Give magnesium IV bolus at 4 g/hr is contraindicated. Magnesium is indicated to be given to preeclamptic clients to prevent seizures. Using this medication will not be appropriate for this client. Administer terbutaline 0.25 mg SC as needed is contraindicated. Terbutaline is a tocolytic agent to stop uterine contractions. Using this medication will not be appropriate for this client. Monitor basic metabolic panel is anticipated. Monitoring the client's labs to assess fluid volume status with the current complaint of nausea and vomiting and with the initiation of fluid replacement is essential to determine therapeutic outcomes. Diet NPO is anticipated. A NPO diet is necessary until nausea subsides. The initiation of fluid replacement via IV with support nutrition needs for the short term. High fat full liquid is contraindicated. The client is exhibiting nausea and vomiting. The client should be NPO until nausea subsides. Hight fat diet is not recommended for this client and would exacerbate the client's fluid volume status.

A nurse in a clinic is caring for a client who is at 11 weeks of gestation and reports that she has had slight occasional vaginal bleeding over the past 2 weeks. Following an examination by the provider, the client is told that the fetus has died and that the placenta, fetus, and tissues remain in the uterus. How should the nurse document these findings?

Missed Miscarriage With a missed miscarriage, the fetus has died but the client retains the products of conception for several weeks. The client might have spotting or no bleeding at all.

A nurse is providing teaching to a client who is pregnant and has phenylketonuria (PKU). Which of the following foods should the nurse instruct the client to eliminate from her diet? Peanut butter Potatoes Apple juice Broccoli

Peanut Butter The nurse should instruct the client to eliminate protein-rich foods that contain phenylalanine from the diet. These include meats, eggs, milk, nuts, and wheat products.

A nurse is caring for a preterm newborn who is in an incubator to maintain a neutral thermal environment. The father of the newborn asks the nurse why this is necessary. Which of the following responses should the nurse make? "Preterm newborns have a smaller body surface area than normal newborns." "The added brown fat layer in a preterm newborn reduces his ability to generate heat." "Preterm newborns lack adequate temperature control mechanisms." "The heat in the incubator rapidly dries the sweat of preterm newborns."

Preterm newborns have poor body control of temperature and need support to avoid losing heat. Preterm newborns lack adequate temperature control mechanisms. They require an external heat source, such as an incubator.

A nurse in a prenatal clinic is caring for a client. Using Leopold maneuvers, the nurse palpates a round, firm, moveable part in the fundus of the uterus and a long, smooth surface on the client's right side. In which abdominal quadrant should the nurse expect to auscultate fetal heart tones?

Right upper Fetal heart tones are best auscultated directly over the location of the fetal back, which, in this breech presentation, would be in the right upper quadrant.

A nurse is caring for a client who is at 36 weeks of gestation and is on the antepartum unit for continuous close observation. The client confides to the nurse that she doesn't think she will ever be a mother and begins to cry. Which of the following responses should the nurse make?

Sit quietly with the client and follow her cues This demonstrates using silence and active listening, therapeutic techniques that offer support and acceptance and encourage further communication

A nurse is reinforcing teaching about contraceptive methods with a client. Which of the following should the nurse recognize as a contraindication for diaphragm use?

The client has pelvic relaxation. Pelvic relaxation and large cystocele are contraindications for diaphragm use.

A nurse is assessing a client who is receiving magnesium sulfate to treat pre-eclampsia. Which of the following findings should the nurse report to the provider?

Urinary output 40 mL in 2 hr Urinary output is critical for the excretion of magnesium from the body. The nurse should report an hourly output below 30 mL/hr to the provider immediately and discontinue the medication.

A nurse is observing the electronic fetal heart rate monitor tracing for a client who is at 40 weeks of gestation and is in labor. The nurse should suspect a problem with the umbilical cord when she observes which of the following patterns?

Variable decelerations Variable decelerations occur when the umbilical cord becomes compressed and disrupts the flow of oxygen to the fetus.