Mother Baby Final

Which information regarding sexual intercourse would the nurse give the client with a history of preterm labor and incompetent cervix who is now 33 weeks' gestation?

It should be avoided to prevent stimulation of uterine activity.

Which expected date of birth (EDB) would the nurse, using Naegele's rule, provide to the pregnant client who states her last normal menstrual period was April 5?

January 12

7. A newborn who is born at 36 weeks' gestation weighs 8lbs 13oz (3997g). How would the nurse document this finding?

Large for gestational age (LGA) and preterm

client who is having her labor induced with oxytocin has internal fetal monitoring in place. Her contractions are occurring every 2 minutes, are lasing 70 seconds, and are reaching 65mmHg on an intrauterine pressure catheter. The baseline fetal heart rate is 130 to 140 beats/min with variability of about 15 beats/ min. The nurse notices that with the past two contractions the fetal heart rate began to drop during the peak of the contraction to 110 beats/ min, where it remained for about 40 seconds before returning to baseline. Which type of pattern is this?

Late decelerations

Which assessments and interventions are necessary once an epidural catheter has been inserted?

Maintain intravenous fluid administration, have oxygen available in case of hypotension, check the bladder for distension every 2 hours, monitor fetal heart rate and labor progress per hospital protocol.

A client informs the nurse that her home pregnancy test was positive and that her last menstrual period began on June 18. According to Naegele's rule, which is the estimated date of birth (EDB)?

March 25

. Which is the priority intervention for the nurse to perform on a client who is noted to have a relaxed and boggy uterus one hour after delivery?

Massage the uterus until firm.

. After a newborn has skin-to-skin contact with the mother, the nurse places the newborn under a radiant warmer. Which compilation is the nurse trying to prevent?

Metabolic acidosis

. The nurse is assessing a new mother at a healthcare facility. Which symptom would the nurse identify as a symptom of postpartum blues?

Mild irritability

Which combination of maternal and infant blood type would be an indication for administration of Rho (D) immune globulin (RhoGAM) to the postpartum client?

Mother O negative and infant O positive

2. Which assessment finding in a newborn of 33 weeks' gestation alerts the nurse to notify the healthcare provider?

Nasal flaring

. A client is trying to become pregnant. The nurse would teach the client that a blood test for progesterone to evaluate fertility would be performed at which time?

One week after ovulation

. Which is the most reliable birth control method for the nurse to recommend to a client with type 1 diabetes?

Oral contraceptive

. Which symptom in a pregnant client lying on her back indicates the need for emergency intervention?

Pallor

0. Which finding indicates the development of a complication from bilateral cephalohematomas?

Skin color

Where is the presenting part of the fetus when station is -1?

1cm above the ischial spines

he primigravida would be taught by the nurse to anticipate quickening in which week of pregnancy

20th week

Which recommendation would the nurse make about safe transportation of a newborn?

? You should place the baby's car seat in the rear-facing position in the backseat.

The nurse is assessing the APGAR scores of 4 different newborns in a pediatric ward. Which newborn would the nurse anticipate is experiencing severe distress? Newborn A: The newborn has a heart rate of 75 beats per minute, irregular and weak cry, limp muscle tone no reflex irritability, and blue skin tone. Newborn B: The newborn has a heart rate of 120 beats per minute, strong cry, well-flexed muscle tone, sneezing reflex, and completely pink skin. Newborn C: The newborn has a heart rate of 80 beats per minute, weak cry, slight flexion in extremities, grimacing face, and ping body with blue extremities. Newborn D: The newborn has a heart rate of 100 beats per minute, strong cry, small flexion in extremities, grimacing face, and pale body.

A.

7. What are presumptive signs of pregnancy that the nurse would expect when assessing a client at 10 weeks' gestation?

Amenorrhea, breast changes, urinary frequency

. A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. Which nursing action will help relieve this discomfort?

Applying pressure against her sacrum.

On the second postpartum day a client mentions that her nipples are becoming sore from breast-feeding. Which is the nurse's initial action in response to this information?

Assess her breast-feeding techniques to identify possible causes.

. While assessing a client during the fourth stage of labor, the nurse notes that the perineal pad is soaked with approximately 75mL of lochia rubra. Which nursing action is the priority?

Assess the uterine fundus.

Which information is essential for the nurse to explain to the client who has scheduled a vasectomy?

At least 15 ejaculations to clear the tract of sperm must occur before the semen is checked.

Which recommendation would the nurse make for a pregnant patient experiencing nausea and vomiting? Select all that apply.

Avoid an empty or excessively full stomach, drink real ginger ale or tea pr use real ginger in another recipe, try sucking on sour candies or smelling a citrus- scented food or product, eat crackers or vanilla wafers or drink a small amount of liquid before getting out of bed, eat small carbohydrate rich low fat meals throughout the day such as toast oatmeal or noodle soup, and locate the pressure points to reduce nausea located at the middle of the wrist and press firmly for 3 minutes

In which location would the doppler ultrasound transducer be placed to best auscultate fetal heart tones when the fetus is in the right occiput posterior (ROP) position?

Below the umbilicus on the right side

A client in preterm labor has a dilated cervix, and birth appears inevitable, despite medication. Which medication prescription would the nurse anticipate preparing to administer to increase the chance of the newborn's survival?

Betamethason

Which food contains at least 100mcg of folate per serving? Select all that apply.

Black eyed peas, ready to eat breakfast cereal.

. Which assessment finding would the nurse question for a client who is considering oral contraceptives?

Blood clots, heart disease, breast cancer, impaired liver function, undiagnosed vaginal bleeding, smoking more than 15 cigarettes per day.

An infant is admitted to the nursery after a shoulder dystocia vaginal delivery. For which condition would the nurse assess the newborn

Brachial plexus injury

. The nurse is teaching participants in a prenatal class regarding breast-feeding versus formula feeding. A client asks," What is the primary advantage of breast-feeding? Which response is most appropriate?

Breast-fed infants have fewer infections.

How would the nurse suction a term neonate choking on mucus using a numb syringe?

By suctioning the mouth before the nostrils

. The nurse applies fetal and uterine monitors to the abdomen of a client in active labor. When the client has contractions, the nurse notes a 15 beasts/ min deceleration of the fetal heart rate below the baseline lasting 15 seconds. Which is the next nursing action?

Changing the maternal position

. The nurse is teaching a class of expectant parents about changes that are to be expected during pregnancy. Which changes would the nurse explain result from melanocyte- stimulating hormone? Select all that apply.

Chloasma, Linea nigra

In which location will the fetal heart tones be heard if the fetus' position is left occiput anterior (LOA)?

D

When can a primigravida fetal heartbeat be heard for the first time

Doppler ultrasound at 10 to 12 weeks.

Which instruction would the nurse provide to the client in early pregnancy scheduled for her first obstetric ultrasound?

Drink water until bladder is full.

. Which dietary habit in a pregnant woman would require the nurse to provide additional education?

Drinking 1L of water every day

The nurse is caring for a postpartum client with preeclampsia being managed with a magnesium sulfate infusion. Which is the priority nursing assessment?

Eliciting deep tendon reflexes

Which nursing intervention would be needed before a client undergoes amniocentesis at 16 weeks' gestation?

Ensuring that informed consent has been obtained from the client.

. As a client enters the second stage of labor, fetal monitoring shows early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. Which is the common cause of this fetal heart rate pattern?

Fetal head compression

Which characteristics are scored on a biophysical profile? Select all that apply.

Fetal tone, fetal movement, amniotic fluid index, fetal breathing movements

Which findings would be considered normal when caring for a primigravida who gave birth by vaginal delivery 24 hours ago?

Fundus firm at the umbilicus; moderate lochia rubra, voiding quantity sufficient; colostrum present

While a client is being interviewed on her first prenatal visit, she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation. The client lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information?

G5 T1 P1 A2 L2

A pregnant client is making her first antepartum visit. She has a 2-year-old son born at 40 weeks, a 5-year-old daughter born at 38 weeks, and 7-year-old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. How would the nurse, using the GTPAL format, document the client's obstetric history?

G5 T2 P1 A1 L4

A client with a blood pressure of 150/90mmHg, 3+ proteinuria, and edema of the hands and face is diagnosed with severe preeclampsia. Which other clinical findings support this diagnosis? Select all that apply

Headache, abdominal pain, visual disturbances.

. Which is the priority nursing action when caring for a client who has just had an amniotomy and the fetal heart rate immediately decreases from 140 to 80 beats/ min?

Inspecting the vagina

. After an assessment of a male newborn, the nurse suspects post maturity. Which observations help confirm this conclusion? Select all that apply.

Profuse scalp hair, parchmentlike skin, creases covering the entire soles.

. Immediately following rupture of membranes, the fetal heart rate monitor shows variable decelerations of more than 90 seconds followed by bradycardia. Which condition does the nurse suspect?

Prolapsed cord

A client who is 38 weeks' pregnant has a nonstress test (NST). The resulting fetal monitor strip is shown. Which interpretation would the nurse assign to this finding?

Reassuring: fetal heart rate accelerates with movement

. Late declarations are present on the monitor strip of a client with an intravenous infusion who received epidural anesthesia 20 minutes ago. Which action would the nurse take immediately?

Reposition the client from supine to left lateral.

Which is the appropriate intervention for a pregnant client whose monitor strip shows fetal heart rate decelerations characterized by a rapid descent and ascent to and from the lowest point of the deceleration?

Repositioning the client from side to side

. Which intervention would the nurse suggest to a 23-year-old client whose medical history reveals that she has never had a Papanicolaou (pap) test?

Schedule a pap test immediately

What is the expected color and consistency of amniotic fluid at 36 weeks gestation?

Straw colored, clear, and containing little white specks.

. Which information would tell the nurse if a woman at 40 weeks' gestation having contractions is in true labor

The cervix dilates and becomes effaced in true labor.

5. The nurse notes in the history of the client in labor that she is a gravida 5 para 2112. Which statement would be true based on this information?

The client has two living children.

. The nurse teaches a postpartum client how to care for her episiotomy to prevent infection. Which behavior indicates that the teaching has been effective?

The client washes her hands before and after she changes a perineal pad.

Which instruction would the nurse give to the pregnant client with a positive group B streptococcus (GBS) result at 36 weeks' gestation

This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding

Which would the nurse expect to observe in a healthy newborn's cord vessels?

Three vessels: one vein and two arteries

An amniotomy is performed on a client admitted for labor augmentation with oxytocin. Immediately after the amniotomy the nurse assesses the fetal heart rate for at least 1 full minute for signs of which complication?

Umbilical cord prolapse.

. Which would the nurse expect to find when assessing a client suspected of having abruptio placentae?

Uterine tenderness and increased fetal activity.

. While caring for a client who has had a positive contraction stress test (CST), which complication would the nurse suspect?

Uteroplacental insufficiency

. During a prenatal visit a client who is at 36 weeks' gestation states that she is having uncomfortable, irregular contractions. Which direction would the nurse give?

Walk around until they subside.

. A client states her husband is a fraternal twin and asks about her probability of having twins. Which is an appropriate response by the nurse?

You have no greater probability of having twins than anyone else in the general population.

The newborn's total body response to noise or movement is often distressing to the parents. How would the nurse explain this response

his reflexive response is an expected part of development.