N403 Final

A major nursing intervention for an infant born with myelomeningocele is to: A. Protect the sac from injury B. Prepare the parents for the child's paralysis from the waist down C. Prepare the parents for closure of the sac at around 2 years of age D. Assess for cyanosis

A

If a discrepancy is found between the measurements of a newborn and the normative criteria the nurse should: a. Perform an expanded assessment. b. Remeasure the infant. c. Inform the parents so they can follow the infant's growth. d. Consider this a normal deviation.

A

Which infant would be more likely to have Rh incompatibility? A. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor B. Infant who is Rh negative and whose mother is Rh negative C. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor D. Infant who is Rh positive and whose mother is Rh positive

A

Which is the most therapeutic response by the nurse to the new mother's statement "My baby is so thin and wrinkled. It looks like he has too much skin."? a. "You sound disappointed about how your infant looks." b. "Don't worry. In no time he'll fill out his skin and look just fine." c. "You know all the cigarettes you smoked interfered with the nourishment he needed." d. "All mothers are concerned about how their babies look."

A

Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot? a. Babinski b. Tonic neck c. Stepping d. Plantar grasp

A

Which nursing action is designed to avoid unnecessary heat loss in the newborn? a. Place a blanket over the scale before weighing the infant. b. Maintain room temperature at 70° F. c. Undress the infant completely for assessments so they can be finished quickly. d. Take the rectal temperature every hour to detect early changes.

A

With regard to congenital abnormalities of the cardiovascular and respiratory systems- nurses should be aware that: A. Cardiac disease may be manifested by respiratory signs and symptoms. B. Screening for congenital anomalies of the respiratory system need only be done for infants having respiratory distress. C. Choanal atresia can be corrected by a suction catheter. D. Congenital diaphragmatic hernias are diagnosed and treated after birth.

A

After teaching the parents of a newborn with retinopathy of prematurity (ROP) about the disorder and treatment which statement by the parents indicates that the teaching was successful? A) Can we schedule follow-up eye examinations with the pediatric ophthalmologist now? B) We can fix the problem with surgery. C) Well make sure to administer eye drops each day for the next few weeks. D) I'm sure the baby will grow out of it.

A) Can we schedule follow-up eye examinations with the pediatric ophthalmologist now?

A nurse is explaining to the parents of a child with bladder exstrophy about the care their infant requires. Which of the following would the nurse include in the explanation? (Select all that apply.) A) Covering the area with a sterile clear nonadherent dressing B) Irrigating the surface with sterile saline twice a day C) Monitoring drainage through the suprapubic catheter D) Administering prescribed antibiotic therapy E) Preparing for surgical intervention in about 2 weeks

A) Covering the area with a sterile, clear, nonadherent dressing C) Monitoring drainage through the suprapubic catheter D) Administering prescribed antibiotic therapy

A nurse is developing a plan of care for a newborn with omphalocele. Which of the following would the nurse include? A) Placing the newborn into a sterile drawstring bowel bag B) Using clean technique for dressing changes C) Preparing the newborn for incision and drainage D) Instituting gavage feedings

A) Placing the newborn into a sterile drawstring bowel bag

While reviewing a newborns medical record the nurse notes that the chest x-ray shows a ground glass pattern. The nurse interprets this as indicative of: A) Respiratory distress syndrome B) Transient tachypnea of the newborn C) Asphyxia D) Persistent pulmonary hypertension

A) Respiratory distress syndrome

The nurse is assessing a newborn and suspects that the newborn was exposed to drugs in utero because the newborn is exhibiting signs of neonatal abstinence syndrome. Which of the following would the nurse expect to assess? (Select all that apply.) A) Tremors B) Diminished sucking C) Regurgitation D) Shrill high-pitched cry E) Hypothermia F) Frequent sneezing

A) Tremors C) Regurgitation D) Shrill, high-pitched cry F) Frequent sneezing

A newborn was diagnosed with a congenital heart defect and will undergo surgery at a later time. The nurse is teaching the parents about signs and symptoms that need to be reported. The nurse determines that the parents have understood the instructions when they state that they will report which of the following? (Select all that apply.) A) Weight loss B) Pale skin C) Fever D) Absence of edema E) Increased respiratory rate

A) Weight loss C) Fever E) Increased respiratory rate

A newborn with severe meconium aspiration syndrome (MAS. is not responding to conventional treatment. Which of the following would the nurse anticipate as possibly necessary for this newborn? A)Extracorporeal membrane oxygenation (ECMO) B)Respiratory support with a ventilator C)Insertion of a laryngoscope for deep suctioning D)Replacement of an endotracheal tube via x-ray

A)Extracorporeal membrane oxygenation (ECMO)

Which action would be most appropriate for the nurse to take when a newborn has an unexpected anomaly at birth? A)Show the newborn to the parents as soon as possible while explaining the defect. B)Remove the newborn from the birthing area immediately. C)Inform the parents that there is nothing wrong at the moment. D)Tell the parents that the newborn must go to the nursery immediately.

A)Show the newborn to the parents as soon as possible while explaining the defect.

Medications used to manage postpartum hemorrhage (PPH) include (Select all that apply): a. Pitocin. b. Methergine. c.Terbutaline. d. Hemabate. e. Magnesium sulfate.

A, B, D

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? Choose all that apply. A. Tetanus B. Diphtheria C. Chickenpox D. Rubella E. Hepatitis B

A, B, E

Possible alternative and complementary therapies for postpartum depression (PPD) for breastfeeding mothers include (Select all that apply):a. Acupressure. b. Aromatherapy. c. St. John's wort. d. Wine consumption. e. Yoga.

A, B, E

Cleft lip or palate is a common congenital midline fissure or opening in the lip or palate resulting from failure of the primary palate to fuse. Multiple genetic and to a lesser extent environmental factors may lead to the development of a cleft lip or palate. Such factors include (choose all that apply): A. Alcohol consumption B. Female gender C. Use of some antiepileptics D. Maternal cigarette smoking E. Antibiotic use in pregnancy

A, C, D

The nurse is assisting a client during delivery. What measures does the nurse take to protect the infant from heat loss? A. Ensure the infant is dried immediately after birth. B. Place the naked infant on bare scales for accuracy. C. Place the naked infant on the mother's bare chest and cover with a blanket. D. Ensure the nursery temperature is 27° C (80.6° F). E. Wrap the infant and cover the head with a cap.

A, C, E

The nurse is assessing digestion and elimination in a newborn. Which enzyme helps the newborn convert starch into maltose? A. Amylase in colostrum B. Mammary lipase in breast milk C. Amylase in the salivary glands D. Lactase in the digestive system

A. Amylase in colostrum

With regard to the respiratory development of the newborn- of what should nurses be aware? A. Crying increases the distribution of air in the lungs B. Newborns must expel the fluid in utero from the respiratory system within a few minutes of birth C. Newborns are instinctive mouth breathers D. Seesaw respirations are no cause for concern in the first hour after birth

A. Crying increases the distribution of air in the lungs

A pregnant woman's last menstrual period began on April 8 2009 and ended on April 13. Using Nägele's rule her estimated date of birth would be: A. January 15 2010. B. January 20 2010. C. December 15 2009. D. November 5 2009.

A. January 15 2010.

The nurse is assessing a neonate born by vacuum extraction. What assessment does the nurse perform to detect possible subgaleal hemorrhage? A. Measure serial head circumference. B. Monitor the neonate for bradycardia. C. Inspect the frontal aspect of the head. D. Look for backward positioning of the ears.

A. Measure serial head circumference.

The nurse is assessing a neonate immediately after birth. How does the nurse document the presence of bluish-black pigmentation on the neonate's buttocks? A. Mongolian spots B. Nevus simplex C. Nevus flammeus D. Erythema toxicum

A. Mongolian spots

The nurse is caring for a full-term neonate born by cesarean. What is the effect of cesarean birth on the respiratory function of the neonate? A. Retention of fluid in the lungs B. Incidence of transient bradypnea C. Exhaustion from the effort of breathing D. Episodes of periodic breathing

A. Retention of fluid in the lungs

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? A. She keeps all prenatal appointments. B. She "eats for two." C. She drives her car slowly. D. She wears only low-heeled shoes.

A. She keeps all prenatal appointments.

The nurse notices that a newborn has difficulty breathing. What infant behavior might have led to the nurse to this conclusion? A. The infant did not cry after birth. B. The infant had improper bowel sounds. C. The infant moved its head from side to side. D. The infant had increased blood pressure (BP).

A. The infant did not cry after birth.

The nurse performs nasal and oral suctioning of a newborn immediately after birth. What is the reason for this nursing intervention? A. To stimulate respiration B. Assist in stimulating cardiac activity C. Removal of fluid from the lungs D. To increase pulmonary blood flow

A. To stimulate respiration

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is what? A. vision. B. hearing. C. smell. D. taste.

A. Vision

A laboring woman is reclining in the supine position. What is the most appropriate nursing action at this time? a.Ask her to turn to one side. b.Elevate her feet and legs. c.Take her blood pressure. d.Determine whether fetal tachycardia is present.

ANS: A

As the United States and Canada continue to become more culturally diverse- recognizing a wide range of varying cultural beliefs and practices is increasingly important for the nursing staff. A client is from which country if she requests to have the baby's father in attendance? a.Mexico b.China c.Iran d.India

ANS: A

In recovery if a woman is asked to either raise her legs (knees extended) off the bed or flex her knees and then place her feet flat on the bed and raise her buttocks well off the bed- the purpose of this exercise is to assess what? a.Recovery from epidural or spinal anesthesia b.Hidden bleeding underneath her c.Flexibility d.Whether the woman is a candidate to go home after 6 hours

ANS: A

The nurse is caring for a client in early labor. Membranes ruptured approximately 2 hours earlier. This client is at increased risk for which complication? a.Intrauterine infection b.Hemorrhage c.Precipitous labor d.Supine hypotension

ANS: A

The nurse should be aware of which information related to a woman's intake and output during labor? a.Traditionally- restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia. b.Intravenous (IV) fluids are usually necessary to ensure that the laboring woman stays hydrated. c.Routine use of an enema empties the rectum and is very helpful for producing a clean clear delivery. d.When a nulliparous woman experiences the urge to defecate it often means birth will quickly follow.

ANS: A

Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position? a.Occiput of the fetus is in a posterior position. b.Fetus is at or above the ischial spines. c.Fetus is in a vertex presentation. d.Membranes have ruptured.

ANS: A

What is the most critical nursing action in caring for the newborn immediately after the birth? a.Keeping the airway clear b.Fostering parent-newborn attachment c.Drying the newborn and wrapping the infant in a blanket d.Administering eye drops and vitamin K

ANS: A

When assessing a multiparous woman who has just given birth to an 8-pound boy the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. What is the nurse's assessment of the situation? a.The placenta has separated. b.A cervical tear occurred during the birth. c.The woman is beginning to hemorrhage. d.Clots have formed in the upper uterine segment.

ANS: A

When assessing a woman in the first stage of labor- which clinical finding will alert the nurse that uterine contractions are effective? a.Dilation of the cervix b.Descent of the fetus to -2 station c.Rupture of the amniotic membranes d.Increase in bloody show

ANS: A

When managing the care of a woman in the second stage of labor the nurse uses various measures to enhance the progress of fetal descent. Which instruction best describes these measures? a.Encouraging the woman to try various upright positions including squatting and standing b.Telling the woman to start pushing as soon as her cervix is fully dilated c.Continuing an epidural anesthetic so pain is reduced and the woman can relax d.Coaching the woman to use sustained 10- to 15-second closed-glottis bearing-down efforts with each contraction

ANS: A

Which component of the physical examination are Leopold's maneuvers unable to determine? a.Gender of the fetus b.Number of fetuses c.Fetal lie and attitude d.Degree of the presenting part's descent into the pelvis

ANS: A

Which information regarding the procedures and criteria for admitting a woman to the hospital labor unit is important for the nurse to understand? a.Client is considered to be in active labor when she arrives at the facility with contractions. b.Client can have only her male partner or predesignated doula with her at assessment. c.Children are not allowed on the labor unit. d.Non-English speaking client must bring someone to translate.

ANS: A

Which technique is an adequate means of controlling the birth of the fetal head during delivery in a vertex presentation? a.Ritgen maneuver b.Fundal pressure c.Lithotomy position d.De Lee apparatus

ANS: A

Women who have participated in childbirth education classes often bring a birth plan with them to the hospital. Which items might this plan include? (Select all that apply.) a.Presence of companions b.Clothing to be worn c.Care and handling of the newborn d.Medical interventions e.Date of delivery

ANS: A, B, C, D

Emergency conditions during labor that would require immediate nursing intervention can arise with startling speed. Which situations are examples of such an emergency? (Select all that apply.) a.Nonreassuring or abnormal FHR pattern b.Inadequate uterine relaxation c.Vaginal bleeding d.Prolonged second stage e.Prolapse of the cord

ANS: A, B, C, E

A client is diagnosed with having a stillborn infant. At first she appears stunned by the news- cries a little- and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing? a.Anticipatory grief b.Acute distress c.Intense grief d.Reorganization

ANS: B

A newborn in the neonatal intensive care unit (NICU) is dying as a result of a massive infection. The parents speak to the neonatologist who informs them of their son's prognosis. When the father sees his son he says "He looks just fine to me. I can't understand what all this is about." What is the most appropriate response or reaction by the nurse at this time? a."Didn't the physician tell you about your son's problems?" b."This must be a difficult time for you. Tell me how you're doing." c.Quietly stand beside the infant's father. d."You'll have to face up to the fact that he is going to die sooner or later."

ANS: B

A woman who has a history of sexual abuse may have a number of traumatic memories triggered during labor. She may fight the labor process and react with pain or anger. The nurse can implement a number of care measures to help her client view the childbirth experience in a positive manner. Which intervention is key for the nurse to use while providing care? a.Tell the client to relax and that it won't hurt much. b.Limit the number of procedures that invade her body. c.Reassure the client that- as the nurse- you know what is best. d.Allow unlimited care providers to be with the client

ANS: B

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. What is the nurse's ideal response? a."Don't worry about it. You'll do fine." b."It's normal to be anxious about labor. Let's discuss what makes you afraid." c."Labor is scary to think about but the actual experience isn't." d."You can have an epidural. You won't feel anything."

ANS: B

A woman who is gravida 3 para 2 arrives on the intrapartum unit. What is the most important nursing assessment at this time? a.Contraction pattern- amount of discomfort- and pregnancy history b.FHR- maternal vital signs- and the woman's nearness to birth c.Identification of ruptured membranes- woman's gravida and para- and her support person d.Last food intake- when labor began- and cultural practices the couple desires

ANS: B

After an emergency birth the nurse encourages the woman to breastfeed her newborn. What is the primary purpose of this activity? a.To facilitate maternal-newborn interaction b.To stimulate the uterus to contract c.To prevent neonatal hypoglycemia d.To initiate the lactation cycle

ANS: B

During a follow-up home visit the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding? a.Guilt particularly in the mother b.Numbness or lack of response c.Bitterness or irritability d.Fear and anxiety especially about getting pregnant again

ANS: B

Parents have asked the nurse about organ donation after that infant's death. Which information regarding organ donation is important for the nurse to understand? a.Federal law requires the medical staff to ask the parents about organ donation and then to contact their state's organ procurement organization (OPO) to handle the procedure if the parents agree. b.Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience. c.Most common donation is the infant's kidneys. d.Corneas can be donated if the infant was either stillborn or alive as long as the pregnancy went full term.

ANS: B

Through a vaginal examination the nurse determines that a woman is 4 cm dilated. The external fetal monitor shows uterine contractions every to 4 minutes. The nurse reports this as what stage of labor? a.First stage/latent phase b.First stage/active phase c.First stage/transition phase d.Second stage/latent phase

ANS: B

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination? a.Admission to the hospital at the start of labor b.When accelerations of the FHR are noted c.On maternal perception of perineal pressure or the urge to bear down d.When membranes rupture

ANS: B

What is the rationale for the administration of an oxytocic (Pitocin or Methergine) after expulsion of the placenta? a.To relieve pain b.To stimulate uterine contraction c.To prevent infection d.To facilitate rest and relaxation

ANS: B

Which description of the phases of the first stage of labor is most accurate? a.Latent: mild regular contractions- no dilation- bloody show b. Active: moderate regular contractions- 4 to 7 cm dilation c.Lull: no contractions- dilation stable d.Transition: very strong but irregular contractions- 8 to 10 cm dilation

ANS: B

Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving? a.The parents say that they "feel no pain." b.The parents are discussing sex and a future pregnancy even if they have not yet sorted out their feelings. c.The parents have abandoned those moments of "bittersweet grief." d.The parents' questions have progressed from "Why?" to "Why us?"

ANS: B

Which statement concerning the third stage of labor is correct? a.The placenta eventually detaches itself from a flaccid uterus. b.An expectant or active approach to managing this stage of labor reduces the risk of complications. c.It is important that the dark roughened maternal surface of the placenta appears before the shiny fetal surface. d.The major risk for women during the third stage is a rapid heart rate.

ANS: B

A 25-year-old gravida 3 para 2 client gave birth to a 9-pound 7-ounce boy 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light and asks for her nurse right away stating "I'm bleeding a lot." What is the most likely cause of postpartum hemorrhaging in this client? a.Retained placental fragments b.Unrepaired vaginal lacerations c.Uterine atony d.Puerperal infection

ANS: C

A nulliparous woman has just begun the latent phase of the second stage of her labor. The nurse should anticipate which behavior? a.A nulliparous woman will experience a strong urge to bear down. b.Perineal bulging will show. c.A nulliparous woman will remain quiet with her eyes closed between contractions. d.The amount of bright red bloody show will increase

ANS: C

During the initial acute distress phase of grieving parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurse's role at this time? a.To take over as much as possible to relieve the pressure b.To encourage the grandparents to take over c.To ensure that the parents- themselves- approve the final decisions d.To leave them alone to work things out

ANS: C

The first 1 to 2 hours after birth is sometimes referred to as what? a.Bonding period b.Third stage of labor c.Fourth stage of labor d.Early postpartum period

ANS: C

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and are moderate to strong. Based on this information- what would a prudent nurse do next? a.Immediately notify the woman's primary health care provider. b.Prepare to administer an oxytocic to stimulate uterine activity. c.Document the findings because they reflect the expected contraction pattern for the active phase of labor. d.Prepare the woman for the onset of the second stage of labor.

ANS: C

What is the primary rationale for the thorough drying of the infant immediately after birth? a.Stimulates crying and lung expansion b.Removes maternal blood from the skin surface c.Reduces heat loss from evaporation d.Increases blood supply to the hands and feet

ANS: C

When assisting the mother/father and other family members to actualize the loss of an infant- which action is most helpful? a.Using the words lost or gone rather than dead or died b.Making sure the family understands that naming the baby is important c.Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby d.Setting a firm time for ending the visit with the baby so that the parents know when to let go

ANS: C

Where is the point of maximal intensity (PMI) of the FHR located? a.Usually directly over the fetal abdomen b.In a vertex position heard above the mother's umbilicus c.Heard lower and closer to the midline of the mother's abdomen as the fetus descends and internally rotates d.In a breech position heard below the mother's umbilicus

ANS: C

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions? a.Placing the hand on the abdomen below the umbilicus and palpating uterine tone with the fingertips b.Determining the frequency by timing from the end of one contraction to the end of the next contraction c.Evaluating the intensity by pressing the fingertips into the uterine fundus d.Assessing uterine contractions every 30 minutes throughout the first stage of labor

ANS: C

Which clinical finding indicates that the client has reached the second stage of labor? a.Amniotic membranes rupture. b.Cervix cannot be felt during a vaginal examination. c.Woman experiences a strong urge to bear down. d.Presenting part of the fetus is below the ischial spines.

ANS: C

Which description of the phases of the second stage of labor is most accurate? a.Latent phase: Feeling sleepy- fetal station 2+ to 4+ duration of 30 to 45 minutes b.Active phase: Overwhelmingly strong contractions- Ferguson reflux activated- duration of 5 to 15 minutes c.Descent phase: Significant increase in contractions- Ferguson reflux activated- average duration varies d.Transitional phase: Woman "laboring down"- fetal station 0 duration of 15 minutes

ANS: C

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a.Fetal head is felt at 0 station during vaginal examination. b.Bloody mucous discharge increases. c.Vulva bulges and encircles the fetal head. d.Membranes rupture during a contraction.

ANS: C

Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? a.The nurse should not discuss any options at this time- plenty of time will be available after the baby is born. b."Would you like a picture taken of your baby after birth?" c."When your baby is born would you like to see and hold her?" d."What funeral home do you want notified after the baby is born?"

ANS: C

Which statement by the client will assist the nurse in determining whether she is in true labor as opposed to false labor? a."I passed some thick pink mucus when I urinated this morning." b."My bag of waters just broke." c."The contractions in my uterus are getting stronger and closer together." d."My baby dropped and I have to urinate more frequently now."

ANS: C

Which statement most accurately describes complicated grief? a.Occurs when- in multiple births- one child dies and the other or others live b.Is a state during which the parents are ambivalent- as with an abortion c.Is an extremely intense grief reaction that persists for a long time d.Is felt by the family of adolescent mothers who lose their babies

ANS: C

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant? a.Refers to the two live infants as twins b.Asks about the dead triplet's current status c.Brings in play clothes for all three infants d.Refers to the dead infant in the past tense

ANS: D

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurse's highest priority in this situation? a.Prepare the woman for imminent birth. b.Notify the woman's primary health care provider. c.Document the characteristics of the fluid. d.Assess the fetal heart rate (FHR) and pattern.

ANS: D

A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt? a.Siblings b.Mother c.Father d.Grandparents

ANS: D

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The FHR has been normal. Contractions are 5 to 9 minutes apart- 20 to 30 seconds in duration- and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. What disposition would the nurse anticipate? a.Admitted and prepared for a cesarean birth b.Admitted for extended observation c.Discharged home with a sedative d.Discharged home to await the onset of true labor

ANS: D

After giving birth to a stillborn infant the woman turns to the nurse and says "I just finished painting the baby's room. Do you think that caused my baby to die?" What is the nurse's most appropriate response? a."That's an old wives' tale- lots of women are around paint during pregnancy and this doesn't happen to them." b."That's not likely. Paint is associated with elevated pediatric lead levels." c.Silence. d."I can understand your need to find an answer to what caused this. What else are you thinking about?"

ANS: D

Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information? a.Autopsies are usually covered by insurance. b.Autopsies must be performed within a few hours after the infant's death. c.In the current litigious society more autopsies are performed than in the past. d.Some religions prohibit autopsy.

ANS: D

The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one's breath with a closed glottis and a tightening of the abdominal muscles. When is it appropriate to instruct the client to use this maneuver? a.During the second stage to enhance the movement of the fetus b.During the third stage to help expel the placenta c.During the fourth stage to expel blood clots d.Not at all

ANS: D

The nurse performs a vaginal examination to assess a client's labor progress. Which action should the nurse take next? a.Perform an examination at least once every hour during the active phase of labor. b.Perform the examination with the woman in the supine position. c.Wear two clean gloves for each examination. d.Discuss the findings with the woman and her partner

ANS: D

When a nulliparous woman telephones the hospital to report that she is in labor- what guidance should the nurse provide or information should the nurse obtain? a.Tell the woman to stay home until her membranes rupture. b.Emphasize that food and fluid intake should stop. c.Arrange for the woman to come to the hospital for labor evaluation. d.Ask the woman to describe why she believes she is in labor.

ANS: D

Which characteristic of a uterine contraction is not routinely documented? a.Frequency: how often contractions occur b.Intensity: strength of the contraction at its peak c.Resting tone: tension in the uterine muscle d.Appearance: shape and height

ANS: D

Which collection of risk factors will most likely result in damaging lacerations- including episiotomies? a.Dark-skinned woman who has had more than one pregnancy- who is going through prolonged second-stage labor- and who is attended by a midwife b.Reddish-haired mother of two who is going through a breech birth c.Dark-skinned first-time mother who is going through a long labor d.First-time mother with reddish hair whose rapid labor was overseen by an obstetrician

ANS: D

Which statement is the most appropriate for the nurse to make when caring for bereaved parents? a."This happened for the best." b."You have an angel in heaven." c."I know how you feel." d."What can I do for you?"

ANS: D

A new mother asks "Why are you doing a gestational age assessment on my baby?" The nurse's best response is: a. "This must be done to meet insurance requirements." b. "It helps us identify infants who are at risk for any problems." c. "The gestational age determines how long the infant will be hospitalized." d. "It was ordered by your physician."

B

A newborn with a congenital defect of the penis should not be circumcised because: a. There is increased risk of infection. b. The foreskin may be needed for future repairs. c. A circumcision will make the defect more visible. d. There is no medical rationale for a circumcision.

B

An infant diagnosed with erythroblastosis fetalis would characteristically exhibit: A. Edema B. Immature red blood cells C. Enlargement of the heart D. Ascites

B

Infants who develop cephalohematoma are at increased risk for: a. Infection. b. Jaundice. c. Caput succedaneum. d. Erythema toxicum.

B

Plantar creases need to be evaluated within a few hours of birth because: a. the newborn has to be footprinted. b. as the skin dries the creases will become more prominent. c. heel sticks may be required. d. creases will be less prominent after 24 hours.

B

The hips of a newborn are examined for developmental dysplasia. Which sign indicates an incomplete development of the acetabulum? a. Negative Ortolani sign b. Thigh and gluteal creases are asymmetric c. Negative Barlow test d. Knee heights are equal

B

The most common cause of pathologic hyperbilirubinemia is: A. Hepatic disease B. Hemolytic disorders in the newborn C. Postmaturity D. Congenital heart defect

B

A nurse is assisting in the resuscitation of a newborn. The nurse would expect to stop resuscitation efforts when the newborn has no heartbeat and respiratory effort after which time frame? A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes

B) 10 minutes

When developing the plan of care for a newborn with an acquired condition which of the following would the nurse include to promote participation by the parents? A) Use verbal instructions primarily for explanations B) Assist with decision making process C) Provide personal views about their decisions D) Encourage them to refrain from showing emotions

B) Assist with decision making process

A newborn has an Apgar score of 6 at 5 minutes. Which of the following is the priority? A) Initiating IV fluid therapy B) Beginning resuscitative measures C) Promoting kangaroo care D) Obtaining a blood culture

B) Beginning resuscitative measures

The nurse is assessing the newborn of a mother who had gestational diabetes. Which of the following would the nurse expect to find? (Select all that apply.) A) Pale skin color B) Buffalo hump C) Distended upper abdomen D) Excessive subcutaneous fat E) Long slender neck

B) Buffalo hump C) Distended upper abdomen D) Excessive subcutaneous fat

Which of the following would not be considered a risk factor for bronchopulmonary dysplasia (chronic lung disease)? A) Preterm birth (less than 32 weeks) B) Female gender C) White race D) Sepsis

B) Female gender

After teaching the parents of a newborn with periventricular hemorrhage about the disorder and treatment which statement by the parents indicates that the teaching was successful? A) Well make sure to cover both of his eyes to protect them. B) Our newborn could develop a learning disability later on. C) Once the bleeding ceases there won't be any more worries. D) We need to get family members to donate blood for transfusion.

B) Our newborn could develop a learning disability later on.

A newborn is diagnosed with meconium aspiration syndrome. When assessing this newborn which of the following would the nurse expect to find? (Select all that apply.) A) Pigeon chest B) Prolonged tachypnea C) Intercostal retractions D) High blood pH level E) Coarse crackles on auscultation

B) Prolonged tachypnea C) High blood pH level E) Coarse crackles on auscultation

A group of nursing students are reviewing the different types of congenital heart disease in infants. The students demonstrate a need for additional review when they identify which of the following as an example of increased pulmonary blood flow (left-to-right shunting)? A) Atrial septal defect B) Tetralogy of Fallot C) Ventricular septal defect D) Patent ductus arteriosus

B) Tetralogy of Fallot

Which of the following would the nurse include in the plan of care for a newborn receiving phototherapy? A)Keeping the newborn in the supine position B)Covering the newborns eyes while under the bililights C) Ensuring that the newborn is covered or clothed D)Reducing the amount of fluid intake to 8 ounces daily

B)Covering the newborns eyes while under the bililights

The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary for which reason? A)Lactase enzymatic activity is not adequate. B)Oxygen demands need to be reduced. C)Renal solute lead must be considered. D)Hyperbilirubinemia is likely to develop.

B)Oxygen demands need to be reduced.

Which of the following would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice? A)Physiologic jaundice results in kernicterus. B)Pathologic jaundice appears within 24 hours after birth. C)Both are treated with exchange transfusions of maternal O- blood. D)Physiologic jaundice requires transfer to the NICU.

B)Pathologic jaundice appears within 24 hours after birth.

When planning the care of a newborn addicted to cocaine who is experiencing withdrawal which of the following would be least appropriate to include? A)Wrapping the newborn snugly in a blanket B)Waking the newborn every hour C)Checking the newborns fontanels D)Offering a pacifier

B)Waking the newborn every hour

Which findings would lead to increased bilirubin levels in the newborn? A. Cord clamped immediately following delivery of newborn B. Meconium passed after 24 hours C. Initiation of newborn feedings were delayed following birth D. Hyperglycemia E. Twin to twin transfusion syndrome

B, C, E

The nurse is caring for an infant with breathing difficulty. Upon auscultating the infant the nurse finds that the infant has a murmur. What suggestion does the nurse give to the parents about infant care? A. "Use formula milk." B. "Additional cardiac testing is necessary." C. "The infant should be wrapped in a thick blanket." D. "Maintain skin-to-skin contact with the mother."

B. "Additional cardiac testing is necessary."

A client tells the nurse "While crying my baby often moves its hand towards its mouth and also gets startled by the sound of the rattle." What statement given by the nurse best explains this behavior? "The baby: A. "Is hungry." B. "Is consoling itself." C. "Wants to interact with you." D. "Is frightened by some noise."

B. "Is consoling itself."

A woman who is 32 weeks' pregnant is informed by the nurse that a danger sign of pregnancy could be: A. Constipation. B. Alteration in the pattern of fetal movement. C. Heart palpitations. D. Edema in the ankles and feet at the end of the day.

B. Alteration in the pattern of fetal movement.

If exhibited by an expectant father what would be a warning sign of ineffective adaptation to his partner's first pregnancy? A. Views pregnancy with pride as a confirmation of his virility B. Consistently changes the subject when the topic of the fetus/newborn is raised C. Expresses concern that he might faint at the birth of his baby D. Experiences nausea and fatigue along with his partner during the first trimester

B. Consistently changes the subject when the topic of the fetus/newborn is raised

The nurse is caring for a neonate immediately after delivery. What does the nurse expect to find while assessing the neonate during the first 30 minutes after birth? A. Heart rate increases from 100 to 120 beats/minute. B. Fine crackles may be present on auscultation. C. Peristaltic waves may benoted over the abdomen. D. Respirations are shallow and may reach up to 60 breaths/minute.

B. Fine crackles may be present on auscultation.

The nurse is caring for an infant experiencing cold stress. Which complication does the nurse suspect in the infant? A. Hyperglycemia B. Hyperbilirubinemia C. Respiratory alkalosis D. Decreased metabolic rate

B. Hyperbilirubinemia

In understanding and guiding a woman through her acceptance of pregnancy a maternity nurse should be aware that: A. Nonacceptance of the pregnancy very often equates to rejection of the child. B. Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes. C. Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers. D. Conflicts that involve not wanting to be pregnant or be involved in childrearing and career-related decisions that relate to being pregnant need not be addressed during pregnancy because they will resolve themselves naturally after birth.

B. Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes.

The nurse notes that when placed on the scale the newborn immediately abducts and extends the arms and the fingers fan out with the thumb and forefinger forming a "C." This response is known as what? A. Tonic neck reflex. B. Moro reflex. C. Cremasteric reflex. D. Babinski reflex.

B. Moro reflex.

What findings might the nurse expect in a neonate within 30 minutes of birth? A. Tremors B. Nasal flaring C. Audible grunting D. Pinkish skin color E. Quick respiration A. Tremors

B. Nasal flaring, C. Audible grunting

What is the basic mechanism for conserving internal heat within infants? A. Shivering B. Vasoconstriction C. Metabolism of brown fat D. Decrease in muscle activity

B. Vasoconstriction

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: A. tells the parents that one leg may be longer than the other but they will equal out by the time the infant is walking. B. alerts the physician that the infant may have a dislocated hip. C. informs the parents and physician that molding has not taken place. D. suggests that if the condition does not change surgery to correct vision problems might be needed.

B. alerts the physician that the infant may have a dislocated hip.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick sticky stool is very dark green almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: A. telling the mother not to worry because breastfed babies have this type of stool. B. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. C. asking the mother what she ate at her last meal. D. suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

B. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements.

When caring for a newborn the nurse must be alert for signs of cold stress- including: A. decreased activity level. B. increased respiratory rate. C. hyperglycemia. D. shivering.

B. increased respiratory rate.

A maculopapular rash with a red base and a small white papule in the center is: a. Milia. b. Mongolian spots. c. Erythema toxicum. d. Café-au-lait spots.

C

A newborn who is large for gestational age (LGA) is: a. below the 90th percentile for weight. b. less than the 10th percentile for weight. c. greater than the 90th percentile for weight. d. between the 10th and 90th percentiles for weight.

C

Which characteristic shows the greatest gestational maturity? a. Few rugae on the scrotum and testes high in the scrotum b. Infant's arms and legs are extended c. Some peeling and cracking of the skin d. The arm can be positioned with the elbow beyond the midline of the chest

C

With regard to congenital abnormalities involving the central nervous system nurses should be aware that: A. Although the death rate from most congenital anomalies has decreased over the past several decades neural tube defects (NTDs) have gone up in the last few years. B. Spina bifida cystica usually is asymptomatic and may not be diagnosed unless associated problems are present. C. A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury. D. Microcephaly can be corrected with timely surgery.

C

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment findings? A) Absent grasp reflex B) Hand weakness C) Absent Moro reflex D) Facial asymmetry

C) Absent Moro reflex

Assessment of newborn reveals a large protruding tongue slow reflexes distended abdomen poor feeding hoarse cry goiter and dry skin. Which of the following would the nurse suspect? A) Phenylketonuria B) Galactosemia C) Congenital hypothyroidism D) Maple syrup urine disease

C) Congenital hypothyroidism

A newborn is suspected of developing persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which of the following to confirm the suspicion? A) Chest x-ray B) Blood cultures C) Echocardiogram D) Stool for occult blood

C) Echocardiogram

Which of the following would the nurse expect to assess in a newborn who develops sepsis? A) Increased urinary output B) Interest in feeding C) Hypothermia D) Wakefulness

C) Hypothermia

A nurse is teaching the mother of a newborn diagnosed with galactosemia about dietary restrictions. The nurse determines that the mother has understood the teaching when she identifies which of the following as needing to be restricted? A) Phenylalanine B) Protein C) Lactose D) Iodine

C) Lactose

A group of students are reviewing information about the effects of substances on the newborn. The students demonstrate understanding of the information when they identify which drug as not being associated with teratogenic effects on the fetus? A) Alcohol B) Nicotine C) Marijuana D) Cocaine

C) Marijuana

A nursing student is preparing a presentation for the class on clubfoot. The student determines that the presentation was successful when the class states which of the following? A) Clubfoot is a common genetic disorder. B) The condition affects girls more often than boys. C) The exact cause of clubfoot is not known. D) The intrinsic form can be manually reduced.

C) The exact cause of clubfoot is not known.

A newborn is suspected of having fetal alcohol syndrome. Which of the following would the nurse expect to assess? A)Bradypnea B)Hydrocephaly C)Flattened maxilla D)Hypoactivity

C)Flattened maxilla

An expectant father confides in the nurse that his pregnant wife 10 weeks of gestation is driving him crazy. "One minute she seems happy and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response would be: A. "This is normal behavior and should begin to subside by the second trimester." B. "She may be having difficulty adjusting to pregnancy I will refer her to a counselor that I know." C. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." D. "You seem impatient with her. Perhaps this is precipitating her behavior."

C. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant."

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: A. "You don't need to modify your exercising any time during your pregnancy." B. "Stop exercising because it will harm the fetus." C. "You may find that you need to modify your exercise to walking later in your pregnancy around the seventh month." D. "Jogging is too hard on your joints switch to walking now."

C. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month."

In most healthy newborns blood glucose levels stabilize at _________ mg/dl during the first hours after birth. A. 30 to 40 B. 40 to 50 C. 50 to 60 D. 60 to 70

C. 50 to 60

Upon assessment the nurse finds that the infant has a sunken abdomen- bowel sounds heard in the chest- nasal flaring- and grunting. What clinical condition does the nurse suspect the infant has based on these findings? A. Epispadias. B. A ruptured viscus. C. A diaphragmatic hernia. D. Hirschsprung's disease.

C. A diaphragmatic hernia.

While assessing a 1-week-old infant the nurse observes that the newborn has apnea- lethargy- jitteriness- and feeding problems. What could be the possible reason for the infant's symptoms? A. Heart rate of 120 beats/min. B. Body temperature of 99.5° F. C. Blood glucose level of 38 mg/dl. D. Blood pressure (BP) of 80/40 mm Hg

C. Blood glucose level of 38 mg/dl.

The nurse observes that the lips/feet and palms of a newborn are pale blue even 48 hours after birth. What can the nurse suspect from this observation about the newborn's clinical condition? A. Acrocyanosis. B. Polycythemia. C. Central cyanosis. D. Transient tachypnea.

C. Central cyanosis.

The nurse is caring for a neonate in the nursery. What behavior in the neonate does the nurse recognize as thermogenesis? A. Starts shivering incessantly B. Assumes position of extension C. Cries and appears restless D. Develops pallor and seizures

C. Cries and appears restless

The nurse is caring for an infant after a forceps-assisted birth. Which feature does the nurse attribute to a forceps-assisted birth? A. Erythematous skin B. Blotchy or mottled skin C. Edema and ecchymosis D. Cyanotic discoloration

C. Edema and ecchymosis

A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: A. Wiggles and points her toes during the cramp. B. Applies cold compresses to the affected leg. C. Extends her leg and dorsiflexes her foot during the cramp. D. Avoids weight bearing on the affected leg during the cramp.

C. Extends her leg and dorsiflexes her foot during the cramp.

During the first trimester the pregnant woman would be most motivated to learn about: A. Fetal development. B. Impact of a new baby on family members. C. Measures to reduce nausea and fatigue so she can feel better. D. Location of childbirth preparation and breastfeeding classes.

C. Measures to reduce nausea and fatigue so she can feel better.

The nurse is caring for a baby who is 4 weeks old. The nurse finds that the newborn is breathing through the mouth. What does the nurse expect to be the most likely clinical condition for this observation? A. Hypoxemia. B. Cardiac disorder. C. Nasal obstruction. D. Laryngeal obstruction.

C. Nasal obstruction.

The nurse clamps the umbilical cord of a preterm infant after 3 minutes of birth. What would be the possible effect in the newborn associated with this action? A. Epispadias B. Polydactyly C. Polycythemia D. Hyperbilirubinemia

C. Polycythemia

The nurse is caring for a healthy caucasian neonate who was born at 37 weeks of gestation. What does the nurse find while performing the skin assessment of the newborn immediately after the birth? A. Bluish-black areas on the body B. Desquamation of the epidermis C. Vernix caseosa covering the body D. Dark red-colored swellings on the body

C. Vernix caseosa covering the body

A ____________ succedaneum may appear over the vertex of the newborn's head as a result of pressure against the mother's cervix while in utero.

Caput

As a home care nurse you are visiting a 5-day-old male infant for a scheduled follow-up appointment to ensure that he is responding to home phototherapy for treatment of jaundice. Based on the diagnosis of hyperbilirubinemia you are aware that the development of acute bilirubin encephalopathy is a risk for this infant. This disease process occurs after the bilirubin level has peaked. After completing a thorough assessment and obtaining a history from the parents you recognize that this infant is in the first phase of encephalopathy when he exhibits: A. A high-pitched cry B. Severe muscle spasms (opisthotonos) C. Fever and seizures D. Hypotonia lethargy and poor suck

D

Hypoglycemia in a newborn can lead to: a. tachycardia. b. hypocarbia. c. hyperthermia. d. brain damage.

D

In order to provide comprehensive newborn care the nurse should understand that kernicterus occurs if: A. The kidney excretes bilirubin. B. Bilirubin collects in the liver. C. Bilirubin deposits are concentrated in the cardiac muscle. D. Bilirubin deposits are in the brain.

D

The priority nursing diagnosis for a newborn diagnosed with a diaphragmatic hernia would be: A. Risk for impaired parent-infant attachment B. Imbalanced nutrition: less than body requirements C. Risk for infection D. Impaired gas exchange

D

What finding supports the diagnosis of pathologic jaundice? A. Serum bilirubin concentrations greater than 2 mg/dl in cord blood B. Serum bilirubin levels increasing more than 1 mg/dl in 24 hours C. Serum bilirubin levels greater than 10 mg/dl in a full-term newborn D. Clinical jaundice evident within 24 hours of birth

D

When attempting to diagnose and treat developmental dysplasia of the hip (DDH) the nurse should: A. Be able to perform the Ortolani and Barlow tests B. Teach double or triple diapering for added support C. Explain to the parents the need for serial casting D. Carefully monitor infants for DDH at follow-up visits

D

With regard to hemolytic diseases of the newborn nurses should be aware that: A. Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother. B. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. C. Exchange transfusions frequently are required in the treatment of hemolytic disorders. D. The indirect Coombs' test is performed on the mother before birth.

D

With smaller families and increased genetic screening many couples have come to expect a perfect baby. Mothers tend to have the greatest and most difficult adjustment to a child with unexpected disabilities. A metaanalysis of families in the United States and Canada has revealed that there are four developmental milestones that the mothers of "differently abled" children need to achieve. At a follow-up office visit the nurse knows that she needs to listen carefully to the mother's cues in order to determine how well she is coping. Which phase has this mother reached when she states "Don't you agree that my daughter has made a lot of progress since her last visit?" A. Becoming the mother of a disabled child B. Learning a new maternal role C. Realizing that daily life will never be the same D. Acceptance/denial

D

Which of the following would alert the nurse to suspect that a newborn has developed NEC? A) Irritability B) Sunken abdomen C) Clay-colored stools D) Bilious vomiting

D) Bilious vomiting

A newborn has been diagnosed with a Group B streptococcal infection shortly after birth. The nurse understands that the newborn most likely acquired this infection from which of the following? A)Improper handwashing B)Contaminated formula C)Nonsterile catheter insertion D)Mothers birth canal

D)Mothers birth canal

The vaginal examination is an essential component of labor assessment. It reveals whether the client is in true labor and enables the examiner to determine whether membranes have ruptured. The vaginal examination is often stressful and uncomfortable for the client and should be performed only when indicated. Match the correct step number from 1 to 7 with each component of a vaginal examination of the laboring woman. a.After obtaining permission gently insert the index and middle fingers into the vagina. b.Explain the findings to the client. c.Position the woman to prevent supine hypotension. d.Use sterile gloves and soluble gel for lubrication. e.Document findings and report to the health care provider. f.Cleanse the perineum and vulva if necessary. g.Determine dilation- presenting part- status of membranes- and characteristics of amniotic fluid.

D,C,F,A,G,B,E

A woman who is 14 weeks' pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: A. "Since you're in your second trimester there's no problem with having one drink with dinner." B. "One drink every night is too much. One drink three times a week should be fine." C. "Since you're in your second trimester you can drink as much as you like." D. "Because no one knows how much or how little alcohol it takes to cause fetal problems the best course is to abstain throughout your pregnancy."

D. "Because no one knows how much or how little alcohol it takes to cause fetal problems the best course is to abstain throughout your pregnancy."

While caring for an infant which method should the nurse adapt to prevent heat loss due to evaporation? A. Wrap the infant in a cloth. B. Place the infant in a warm crib. C. Place the crib away from the windows. D. Dry the infant immediately after the bath.

D. Dry the infant immediately after the bath.

The nurse is examining the external genitalia of a female infant. What finding must the nurse report? A. Slight bloody spotting B. Presence of hymenal tag C. Mucoid vaginal discharge D. Fecal discharge from vagina

D. Fecal discharge from vagina

An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. The nurse should tell the couple that: A. Intercourse should be avoided if any spotting from the vagina occurs afterward. B. Intercourse is safe until the third trimester. C. Safer-sex practices should be used once the membranes rupture. D. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

D. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

A mother reports that her baby's skin always appears flushed. What does the nurse suspect to be the reason for this condition in the infant? A. Loss of water and fluids B. Increased acid production C. Increased heat production D. Loss of heat from the body

D. Loss of heat from the body

The nurse is caring for a patient who is breastfeeding a term newborn. What does the nurse teach the patient about how normal stool should appear on the fourth day after birth? A. Greenish-black stool B. Greenish-brown stool C. Pale yellow to brown stool D. Pasty yellow to golden stool

D. Pasty yellow to golden stool

____________________ is a condition in which the ventricles of the brain are enlarged as a result of an imbalance between the production and absorption of the CSF. An infant with this condition initially has a bulging anterior fontanel and a head circumference that increases at an abnormal rate resulting from the increase in CSF pressure.

Hydrocephalus

____________________ is when the fetus begins to descend and drop into the pelvis.

Lightening

In nonpregnant women blood glucose levels must be 160 to 180 mg/dl before glucose is "spilled" into the urine. During pregnancy glucosuria occurs when maternal glucose levels are lower than 160 mg/dl. Is this statement true or false?

True

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." b. "The drug keeps your baby from requiring too much sedation." c. "Surfactant is used to reduce episodes of periodic apnea." d. "Your baby needs this medication to fight a possible respiratory tract infection."

a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."

Early postpartum hemorrhage is defined as a blood loss greater than: a. 500 mL in the first 24 hours after vaginal delivery. b. 750 mL in the first 24 hours after vaginal delivery. c. 1000 mL in the first 48 hours after cesarean delivery. d. 1500 mL in the first 48 hours after cesarean delivery.

a. 500 mL in the first 24 hours after vaginal delivery.

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely has: a.Amenorrhea b.Positive pregnancy test c.Chadwick sign d.Hegar sign

a. Amenorrhea

When should discharge instruction- or the teaching plan that tells the woman what she needs to know to care for herself and her newborn- officially begin? a. At the time of admission to the nurses unit b. When the infant is presented to the mother at birth c. During the first visit with the physician in the unit d. When the take-home information packet is given to the couple

a. At the time of admission to the nurses unit

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice is inconsistent with what? a. Baby Friendly Hospital Initiative b. Promotion of longer periods of breastfeeding c. Perception of being supportive to both bottle feeding and breastfeeding mothers d. Association with earlier cessation of breastfeeding

a. Baby Friendly Hospital Initiative

In the continuing assessment of a preterm infant the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. The nurse should suspect: a. Hypovolemia and/or shock. b. A nonneutral thermal environment. c. Central nervous system injury. d. Pending renal failure.

a. Hypovolemia and/or shock.

The diagnosis of pregnancy is based on which positive signs of pregnancy? Choose all that apply. a.Identification of fetal heartbeat b.Palpation of fetal outline c.Visualization of the fetus d.Verification of fetal movement e.Positive human chorionic gonadotropin (hCG) test

a. Identification of fetal heartbeat c.Visualization of the fetus d. Verification of fetal movement

What PPH conditions are considered medical emergencies that require immediate treatment? a. Inversion of the uterus and hypovolemic shock b. Hypotonic uterus and coagulopathies c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura d. Uterine atony and disseminated intravascular coagulation

a. Inversion of the uterus and hypovolemic shock

An infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant places him under the radiant warmer and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse's most appropriate action would be to: a. Listen to breath sounds and ensure the patency of the endotracheal tube/increase oxygen and notify a physician. b. Continue to observe and make no changes until the saturations are 75%. c. Continue with the admission process to ensure that a thorough assessment is completed. d. Notify the parents that their infant is not doing well.

a. Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes thick meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate: a. Meconium aspiration hypoglycemia and dry cracked skin. b. Excessive vernix caseosa covering the skin lethargy and respiratory distress syndrome. c. Golden yellow- to green stained-skin and nails absence of scalp hair and an increased amount of subcutaneous fat. d. Hyperglycemia hyperthermia and an alert wide-eyed appearance.

a. Meconium aspiration, hypoglycemia, and dry, cracked skin.

Rho immune globulin will be ordered postpartum if which situation occurs? a. Mother Rh- baby Rh+ b. Mother Rh- baby Rh c. Mother Rh+- baby Rh+ d. Mother Rh+- baby Rh

a. Mother Rh, baby Rh+

Risk factors associated with necrotizing enterocolitis (NEC) include (choose all that apply): a. Polycythemia. b. Anemia. c. Congenital heart disease. d. Bronchopulmonary dysphasia. e. Retinopathy.

a. Polycythemia. b. Anemia. c. Congenital heart disease.

According to Beck's studies- what risk factor for postpartum depression is likely to have the greatest effect on the woman's condition? a. Prenatal depression b. Single-mother status c. Low socioeconomic status d. Unplanned or unwanted pregnancy

a. Prenatal depression

The laboratory results for a postpartum woman are as follows: blood type A- Rh status positive- rubella titer 1:8 (enzyme immunoassay [EIA] 0.8)- hematocrit 30%. How should the nurse best interpret these data? a. Rubella vaccine should be administered. b. Blood transfusion is necessary. c. Rh immune globulin is necessary within 72 hours of childbirth. d. Kleihauer-Betke test should be performed.

a. Rubella vaccine should be administered.

The perinatal nurse caring for the postpartum woman understands that late postpartum hemorrhage (PPH) is most likely caused by: a. Subinvolution of the placental site. b.Defective vascularity of the decidua. c.Cervical lacerations. d.Coagulation disorders.

a. Subinvolution of the placental site.

A primiparous woman is to be discharged from the hospital the following day with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? a. The woman is disinterested in learning about infant care. b. The woman continues to hold and cuddle her infant after she has fed her. c. The woman reads a magazine while her infant sleeps. d. The woman changes her infants diaper and then shows the nurse the contents of the diaper.

a. The woman is disinterested in learning about infant care.

A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that: a.This is a normal respiratory change in pregnancy caused by elevated levels of estrogen b.This is an abnormal cardiovascular change and the nosebleeds are an ominous sign c.The woman is a victim of domestic violence and is being hit in the face by her partner d.The woman has been using cocaine intranasally

a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. What goal is the nurse attempting to achieve by performing this practice? a. To improve the accuracy of blood loss estimation which usually is a subjective assessment b. To determine which pad is best c. To demonstrate that other nurses usually underestimate blood loss d. To reveal to the nurse supervisor that one of them needs some time off

a. To improve the accuracy of blood loss estimation, which usually is a subjective assessment

The perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals that the woman is experiencing profuse bleeding. The most likely etiology for the bleeding is: a. Uterine atony. b. Uterine inversion. c. Vaginal hematoma. d. Vaginal laceration.

a. Uterine atony.

A pregnant woman tells her nurse that she is worried about the blotchy- brownish coloring over her cheeks- nose- and forehead. The nurse can reassure her that this is a normal condition related to hormonal change- commonly called the mask of pregnancy or scientifically: a.Chloasma b.Linea nigra c.Striae gravidarum d.Palmar erythema

a.Chloasma

Appendicitis may be difficult to diagnose in pregnancy because the appendix is: a.Displaced upward and laterally high and to the right b.Displaced upward and laterally- high and to the left c.Deep at McBurney's point d.Displaced downward and laterally- low and to the right

a.Displaced upward and laterally- high and to the right

A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the client that this type of contraction: a.Is painless b.Increases with walking c.Causes cervical dilation d.Impedes oxygen flow to the fetus

a.Is painless

The mucous plug that forms in the endocervical canal is called the a.Operculum b.Leukorrhea c.Funic souffle d.Ballottement

a.Operculum

A woman's obstetric history indicates that she is pregnant for the fourth time and all her children from previous pregnancies are living. One was born at 39 weeks of gestation- twins were born at 34 weeks of gestation- and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a.3-1-1-1-3 b.4-1-2-0-4 c.3-0-3-0-3 d.4-2-1-0-3

b. 4-1-2-0-4

Which woman is at greatest risk for early postpartum hemorrhage (PPH)? a. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor is being induced c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor d. A primigravida in spontaneous labor with preterm twins

b. A woman with severe who is receiving magnesium sulfate and whose labor is being induced

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include: a. Hypertonia tachycardia and metabolic alkalosis. b. Abdominal distention temperature instability and grossly bloody stools. c. Hypertension absence of apnea and ruddy skin color. d. Scaphoid abdomen no residual with feedings and increased urinary output.

b. Abdominal distention, temperature instability, and grossly bloody stools.

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment the nurse notices that both breasts are swollen/warm and tender on palpation. Which guidance should the nurse provide to the client at this time? a. Run warm water on her breasts during a shower. b. Apply ice to the breasts for comfort. c. Express small amounts of milk from the breasts to relieve the pressure. d. Wearing a loose-fitting bra to prevent nipple irritation.

b. Apply ice to the breasts for comfort.

The prevalence of urinary incontinence (UI) increases as women age with more than one third of women in the United States suffering from some form of this disorder. The symptoms of mild to moderate UI can be successfully decreased by a number of strategies. Which of these should the nurse instruct the client to use first? a. Pelvic floor support devices b. Bladder training and pelvic muscle exercises c. Surgery d. Medications

b. Bladder training and pelvic muscle exercises

Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive however there are known interventions that may decrease the risk of NEC. To develop an optimal plan of care for this infant the nurse must understand that which intervention has the greatest effect on lowering the risk of NEC? a. Early enteral feedings b. Breastfeeding c. Exchange transfusion d. Prophylactic probiotics

b. Breastfeeding

In appraising the growth and development potential of a preterm infant nurses should: a. Tell parents their child won't catch up until about age 10 (girls) to 12 (boys). b. Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age. c. Know that the greatest catch-up period is between 9 and 15 months postconceptual age. d. Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.

b. Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age.

A mother in late middle age who is certain she is not pregnant tells the nurse during an office visit that she has urinary problems and sensations of bearing down and of something in her vagina. The nurse would realize that the client most likely is suffering from: a. Pelvic relaxation. b. Cystoceles and/or rectoceles. c. Uterine displacement. d. Genital fistulas.

b. Cystoceles and/or rectoceles.

When caring for a newly delivered woman- what is the best measure to prevent abdominal distention after a cesarean birth? a. Rectal suppositories b. Early and frequent ambulation c. Tightening and relaxing abdominal muscles d. Carbonated beverages

b. Early and frequent ambulation

A newborn was admitted to the neonatal intensive care unit after being delivered at 29 weeks of gestation to a 28-year-old multiparous married Caucasian female whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. The nurse's most appropriate action would be to: a. Wait quietly at the newborn's bedside until the parents come closer. b. Go to the parents introduce himself or herself and gently encourage them to come meet their infant explain the equipment first and then focus on the newborn. c. Leave the parents at the bedside while they are visiting so they can have some privacy. d. Tell the parents only about the newborn's physical condition and caution them to avoid touching their baby.

b. Go to the parents, introduce himself or herself, and gently encourage them to come meet their infant explain the equipment first and then focus on the newborn.

In order to reassure and educate pregnant clients about the functioning of their kidneys in eliminating waste products- maternity nurses should be aware that: a.Increased urinary output makes pregnant women less susceptible to urinary infection b.Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even if the bladder is almost empty c.Renal (kidney) function is more efficient when the woman assumes a supine position d.Using diuretics during pregnancy can help keep kidney function regular

b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even if the bladder is almost empty

With regard to small for gestational age (SGA) infants and intrauterine growth restrictions (IUGR) nurses should be aware that: a. In the first trimester diseases or abnormalities result in asymmetric IUGR. b. Infants with asymmetric IUGR have the potential for normal growth and development. c. In asymmetric IUGR weight will be slightly more than SGA whereas length and head circumference will be somewhat less than SGA. d. Symmetric IUGR occurs in the later stages of pregnancy.

b. Infants with asymmetric IUGR have the potential for normal growth and development.

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests: a. Uterine atony. b. Lacerations of the genital tract. c. Perineal hematoma. d. Infection of the uterus.

b. Lacerations of the genital tract.

For diagnostic and treatment purposes nurses should know the birth weight classifications of high risk infants. For example extremely low birth weight (ELBW) is the designation for an infant whose weight is: a. Less than 1500 g. b. Less than 1000 g. c. Less than 2000 g. d. Dependent on the gestational age.

b. Less than 1000 g.

Which instructions should be included in the discharge teaching plan to assist the patient in recognizing early signs of complications? a. Palpate the fundus daily to ensure that it is soft. b. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding. c. Report any decrease in the amount of brownish red lochia. d. The passage of clots as large as an orange can be expected.

b. Notify the physician of any increase in the amount of lochia or a return to bright red bleeding.

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: a. Establish venous access. b. Perform fundal massage. c. Prepare the woman for surgical intervention. d. Catheterize the bladder.

b. Perform fundal massage.

A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period- the test was positive. During her assessment interview- the nurse inquires about the woman's last menstrual period (LMP) and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result? a.She took the pregnancy test too early. b.She takes anticonvulsants. c.She has a fibroid tumor. d.She has been under considerable stress and has a hormone imbalance.

b. She takes anticonvulsants

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change? a.Her center of gravity will shift backward. b.She will have increased lordosis. c.She will have increased abdominal muscle tone. d.She will notice decreased mobility of her pelvic joints.

b. She will have increased lordosis.

A woman is at 14 weeks of gestation. The nurse expects to palpate the fundus at which level? a.Not palpable above the symphysis at this time b.Slightly above the symphysis pubis c.At the level of the umbilicus d.Slightly above the umbilicus

b. Slightly above the symphysis pubis

The perinatal nurse assisting with establishing lactation is aware that acute mastitis can be minimized by: a. Washing the nipples and breasts with mild soap and water once a day. b. Using proper breastfeeding techniques. c. Wearing a nipple shield for the first few days of breastfeeding. d. Wearing a supportive bra 24 hours a day.

b. Using proper breastfeeding techniques.

The nurse should be aware that a pessary would be most effective in the treatment of what disorder? a. Cystocele b. Uterine prolapse c. Rectocele d. Stress urinary incontinence

b. Uterine prolapse

What information should the nurse understand fully regarding rubella and Rh status? a. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus. b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination. c. Rh immunoglobulin is safely administered intravenously because it cannot harm a nursing infant. d. Rh immunoglobulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for at least 1 month after vaccination.

A woman delivered a 9-lb 10-oz baby 1 hour ago. When you arrive to perform her 15-minute assessment she tells you that she "feels all wet underneath." You discover that both pads are completely saturated and that she is lying in a 6-inch-diameter puddle of blood. What is your first action? a. Call for help. b.Assess the fundus for firmness. c.Take her blood pressure. d. Check the perineum for lacerations.

b.Assess the fundus for firmness.

In order to reassure and educate pregnant clients about changes in their cardiovascular system- maternity nurses should be aware that: a.A pregnant woman experiencing disturbed cardiac rhythm- such as sinus arrhythmia- requires close medical and obstetric observation no matter how healthy she otherwise may appear b.Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term c.Palpitations are twice as likely to occur in twin gestations d.All of the above changes likely will occur

b.Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term

Probable signs of pregnancy are: a.Determined by ultrasound b.Observed by the health care provider c.Reported by the client d.Diagnostic tests

b.Observed by the health care provider

Which time-based description of a stage of development in pregnancy is accurate?a.Viability—22 to 37 weeks since the last menstrual period (assuming a fetal weight greater than 500 g) b.Term—pregnancy from the beginning of week 38 of gestation to the end of week 42 c.Preterm—pregnancy from 20 to 28 weeks d.Postdate—pregnancy that extends beyond 38 weeks

b.Term—pregnancy from the beginning of week 38 of gestation to the end of week 42

In order to reassure and educate pregnant clients about changes in the uterus- nurses should be aware that: a.Lightening occurs near the end of the second trimester as the uterus rises into a different position b.The woman's increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening c.Braxton Hicks contractions become more painful in the third trimester particularly if the woman tries to exercise d.The uterine souffle is the movement of the fetus

b.The woman's increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening

An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity including respiratory distress syndrome mild bronchopulmonary dysplasia and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant's mother asks the nurse if her baby will meet developmental milestones on time as did her son who was born at term. The nurse's most appropriate response is: a. "Your baby will develop exactly like your first child did." b. "Your baby does not appear to have any problems at the present time." c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing." d. "Your baby will need to be followed very closely."

c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing."

Under the Newborns and Mothers Health Protection Act- all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth. What is the correct interpretation of this legislation? a. 24- 72 b. 24- 96 c. 48- 96 d. 48- 120

c. 48 (2 days vaginal)- 96 (4 days c/s)

Some pregnant clients may complain of changes in their voice and impaired hearing. The nurse can tell these clients that these are common reactions to: a.A decreased estrogen level b.Displacement of the diaphragm- resulting in thoracic breathing c.Congestion and swelling- which occur because the upper respiratory tract has become more vascular d.Increased blood volume

c. Congestion and swelling, which occur because the upper respiratory tract has become more vascular

Despite popular belief- there is a rare type of hemophilia that affects women of childbearing age. von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels increase naturally during pregnancy- there is an increased risk for postpartum hemorrhage from birth until 4 weeks after delivery as levels of von Willebrand factor (vWf) and factor VIII decrease. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: a. Cryoprecipitate. b.Factor VIII and vWf. c. Desmopressin d. Hemabate.

c. Desmopressin

When a woman is diagnosed with postpartum depression (PPD) with psychotic features- one of the main concerns is that she may: a. Have outbursts of anger. b. Neglect her hygiene. c. Harm her infant. d. Lose interest in her husband.

c. Harm her infant.

The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. This intervention: a. Is adopted from classical British nursing traditions. b. Helps infants with motor and central nervous system impairment. c. Helps infants to interact directly with their parents and enhances their temperature regulation. d. Gets infants ready for breastfeeding.

c. Helps infants to interact directly with their parents and enhances their temperature regulation.

An infant was born 2 hours ago at 37 weeks of gestation weighing 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of: a. Birth injury. b. Hypocalcemia. c. Hypoglycemia. d. Seizures.

c. Hypoglycemia.

To provide adequate postpartum care- the nurse should be aware that postpartum depression (PPD) without psychotic features: a. Means that the woman is experiencing the baby blues. In addition she has a visit with a counselor or psychologist. b. Is more common among older Caucasian women because they have higher expectations. c. Is distinguished by irritability- severe anxiety- and panic attacks. d. Will disappear on its own without outside help.

c. Is distinguished by irritability, severe anxiety, and panic attacks.

What infection is contracted mostly by first-time mothers who are breastfeeding? a. Endometritis b. Wound infections c. Mastitis d. Urinary tract infections

c. Mastitis

As a result of large body surface in relation to weight the preterm infant is at high risk for heat loss and cold stress. By understanding the four mechanisms of heat transfer (convection conduction radiation and evaporation) the nurse can create an environment for the infant that prevents temperature instability. While evaluating the plan that has been implemented the nurse knows that the infant is experiencing cold stress when he or she exhibits: a. Decreased respiratory rate. b. Bradycardia followed by an increased heart rate. c. Mottled skin with acrocyanosis. d. Increased physical activity.

c. Mottled skin with acrocyanosis.

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths/min with marked substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure. Which arterial oxygen level would indicate hypoxia? a. PaO2 of 67 b. PaO2 of 89 c. PaO2 of 45 d. PaO2 of 73

c. PaO2 of 45

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: a. Call the woman's primary health care provider. b. Administer the standing order for an oxytocic. c. Palpate the uterus and massage it if it is boggy. d. Assess maternal blood pressure and pulse for signs of hypovolemic shock.

c. Palpate the uterus and massage it if it is boggy.

With regard to eventual discharge of the high risk newborn or transfer to a different facility nurses and families should be aware that: a. Infants will stay in the neonatal intensive care unit (NICU) until they are ready to go home. b. Once discharged to home the high risk infant should be treated like any healthy term newborn. c. Parents of high risk infants need special support and detailed contact information. d. If a high risk infant and mother need transfer to a specialized regional center it is better to wait until after birth and the infant is stabilized.

c. Parents of high risk infants need special support and detailed contact information.

Anxiety disorders are the most common mental disorders that affect women. While providing care to the maternity patient the nurse should be aware that one of these disorders is likely to be triggered by the process of labor and birth. This disorder is: a. Phobias. b. Panic disorder. c. Post-traumatic stress disorder (PTSD). d. Obsessive-compulsive disorder (OCD).

c. Post-traumatic stress disorder (PTSD).

Postpartum overdistention of the bladder and urinary retention can lead to which complications? a. Postpartum hemorrhage and eclampsia b. Fever and increased blood pressure c. Postpartum hemorrhage and urinary tract infection d. Urinary tract infection and uterine rupture

c. Postpartum hemorrhage and urinary tract infection

For clinical purposes preterm and postterm infants are defined as: a. Preterm before 34 weeks if appropriate for gestational age (AGA) before 37 weeks if small for gestational age (SGA). b. Postterm after 40 weeks if large for gestational age (LGA) beyond 42 weeks if AGA. c. Preterm before 37 weeks postterm beyond 42 weeks no matter the size for gestational age at birth. d. Preterm SGA before 38 to 40 weeks postterm LGA beyond 40 to 42 weeks.

c. Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.

Infants of mothers with diabetes are at higher risk for developing: a. Anemia. b. Hyponatremia. c. Respiratory distress syndrome. d. Sepsis.

c. Respiratory distress syndrome.

An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating/gastrointestinal reflux into the esophagus/vomiting/respiratory compromise? a. Rapid bolusing of the entire amount in 15 minutes b. Warm cloths to the abdomen for the first 10 minutes c. Slow small warm bolus feedings over 30 minutes d. Cold medium bolus feedings over 20 minutes

c. Slow small warm bolus feedings over 30 minutes

A mother with mastitis is concerned about breastfeeding while she has an active infection. The nurse should explain that: a. The infant is protected from infection by immunoglobulins in the breast milk. b. The infant is not susceptible to the organisms that cause mastitis. c. The organisms that cause mastitis are not passed to the milk. d. The organisms will be inactivated by gastric acid.

c. The organisms that cause mastitis are not passed to the milk.

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. Which response by the client alerts the nurse that psychosocial outcomes have NOT been met? a. The woman excessively discusses her labor and birth experience. b. The woman feels that her baby is more attractive and clever than any others. c. The woman has not given the baby a name. d. The woman has a partner or family members who react very positively about the baby.

c. The woman has not given the baby a name.

A woman who has recently given birth complains of pain and tenderness in her leg. On physical examination the nurse notices warmth and redness over an enlarged hardened area. The nurse should suspect __________ and should confirm the diagnosis by ___________. a. Disseminated intravascular coagulation/ asking for laboratory tests b. von Willebrand disease/ noting whether bleeding times have been extended c. Thrombophlebitis/ using real-time and color Doppler ultrasound d. Coagulopathies/ drawing blood for laboratory analysis

c. Thrombophlebitis/ using real-time and color Doppler ultrasound

In order to reassure and educate pregnant clients about changes in their breasts- nurses should be aware that: a.The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery's tubercles and possibly infection of the tubercles b.The mammary glands do not develop until 2 weeks before labor c.Lactation is inhibited until the estrogen level declines after birth d.Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding

c.Lactation is inhibited until the estrogen level declines after birth

A nurse providing care to a pregnant woman should know that all are normal gastrointestinal changes in pregnancy except: a.Ptyalism b.Pyrosis c.Pica d.Decreased peristalsis

c.Pica

A nurse providing care to preterm infants should understand that nasogastric and orogastric tubes are used to: a) Help maintain body temperature b) Provide oxygen and ventilation c) Replace surfactants d) Feed the infant

d) Feed the infant

On day 3 of life a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they can hold their infant during his next gavage feeding. Given that this newborn is physiologically stable what response would the nurse give? a. "Parents are not allowed to hold infants who depend on oxygen." b. "You may only hold your baby's hand during the feeding." c. "Feedings cause more physiologic stress so the baby must be closely monitored. Therefore I don't think you should hold the baby." d. "You may hold your baby during the feeding."

d. "You may hold your baby during the feeding."

Parents who have not already done so need to make time for newborn follow-up of the discharge. According to the American Academy of Pediatrics (AAP)- when should a breastfeeding infant first need to be seen for a follow-up examination? a. 2 weeks of age b. 7 to 10 days after childbirth c. 4 to 5 days after hospital discharge d. 48 to 72 hours after hospital discharge

d. 48 to 72 hours after hospital discharge

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus? a. Notify the physician of an impending hemorrhage. b. Assess the blood pressure and pulse. c. Evaluate the lochia. d. Assist the client in emptying her bladder.

d. Assist the client in emptying her bladder.

Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are: a. Suffering from sleep or wakeful apnea. b. Experiencing severe swings in blood pressure. c. Trying to maintain a neutral thermal environment. d. Breathing in a respiratory pattern common to premature infants.

d. Breathing in a respiratory pattern common to premature infants.

If nonsurgical treatment for late postpartum hemorrhage is ineffective- which surgical procedure is appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. D&C

d. D&C

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room the husband asks for help with warming the soup so that his wife can eat it. What is the nurses most appropriate response? a. Didn't you like your lunch? b. Does your physician know that you are planning to eat that? c. What is that anyway? d. I'll warm the soup in the microwave for you.

d. I'll warm the soup in the microwave for you.

Because a full bladder prevents the uterus from contracting normally- nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails- what tactic might the nurse use? a. Pouring water from a squeeze bottle over the woman's perineum b. Placing oil of peppermint in a bedpan under the woman c. Asking the physician to prescribe analgesic agents d. Inserting a sterile catheter

d. Inserting a sterile catheter,d.

The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth. Which scenario is not a contributor to this model of care? a. Wellness orientation model of care rather than a sick-care model b. Desire to reduce health care costs c. Consumer demand for fewer medical interventions and more family-focused experiences d. Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

d. Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

On examining a woman who gave birth 5 hours ago the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. What is the nurses highest priority at this time? a. Beginning an intravenous (IV) infusion of Ringers lactate solution b. Assessing the womans vital signs c. Calling the womans primary health care provider d. Massaging the womans fundus

d. Massaging the womans fundus

To provide adequate postpartum care the nurse should be aware that postpartum depression (PPD) with psychotic features: a. Is more likely to occur in women with more than two children. b. Is rarely delusional and then is usually about someone trying to harm her (the mother). c. Although serious- is not likely to need psychiatric hospitalization. d. May include bipolar disorder (formerly called "manic depression").

d. May include bipolar disorder (formerly called "manic depression").

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed and the birth weight is 4550 g (9 pounds 6 ounces). The nurse's most appropriate action is to: a. Leave the infant in the room with the mother. b. Take the infant immediately to the nursery. c. Perform a gestational age assessment to determine whether the infant is large for gestational age. d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

Which condition is a transient self-limiting mood disorder that affects new mothers after childbirth? a. Postpartum depression b.Postpartum psychosis c. Postpartum bipolar disorder d. Postpartum blues

d. Postpartum blues

With shortened hospital stays- new mothers are often discharged before they begin to experience symptoms of the baby blues or postpartum depression. As part of the discharge teaching the nurse can prepare the mother for this adjustment to her new role by instructing her regarding self-care activities to help prevent postpartum depression. The most accurate statement as related to these activities is to: a. Stay home and avoid outside activities to ensure adequate rest. b. Be certain that you are the only caregiver for your baby to facilitate infant attachment. c. Keep feelings of sadness and adjustment to your new role to yourself. d. Realize that this is a common occurrence that affects many women

d. Realize that this is a common occurrence that affects many women

One of the first symptoms of puerperal infection to assess for in the postpartum woman is: a. Fatigue continuing for longer than 1 week. b. Pain with voiding. c. Profuse vaginal bleeding with ambulation. d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.

d. Temperature of 38° C (100.4° F) or higher on 2 successive days starting 24 hours after birth.

When providing an infant with a gavage feeding which of the following should be documented each time? a. The infant's abdominal circumference after the feeding b. The infant's heart rate and respirations c. The infant's suck and swallow coordination d. The infant's response to the feeding

d. The infant's response to the feeding

Nurses need to know the basic definitions and incidence data about postpartum hemorrhage (PPH). For instance: a. PPH is easy to recognize early- after all- the woman is bleeding. b. Traditionally it takes more than 1000 mL of blood after vaginal birth and 2500 mL after cesarean birth to define the condition as PPH. c. If anything- nurses and doctors tend to overestimate the amount of blood loss. d. Traditionally PPH has been classified as early or late with respect to birth.

d. Traditionally PPH has been classified as early or late with respect to birth.

When caring for a postpartum woman experiencing hemorrhagic shock the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: a. Absence of cyanosis in the buccal mucosa. b. Cool dry skin. c. Diminished restlessness. d. Urinary output of at least 30 mL/hr.

d. Urinary output of at least 30 mL/hr.

A woman gave birth vaginally to a 9-pound 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs- use of a sitz bath three times daily- and a stool softener. Which information regarding the clients condition is most closely correlated with these orders? a. Woman is a gravida 2 para 2. b. Woman had a vacuum-assisted birth. c. Woman received epidural anesthesia. d. Woman has an episiotomy.

d. Woman has an episiotomy.

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and therefore the basis for many tests. A maternity nurse should be aware that: a.hCG can be detected as early as 2½ weeks after conception b.The hCG level increases gradually and uniformly throughout pregnancy c.Much lower than normal increases in the level of hCG may indicate a postdate pregnancy d.A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome

d.A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome

In order to reassure and educate pregnant clients about changes in the cervix- vagina- and position of the fetus- nurses should be aware that: a.Because of a number of changes in the cervix- abnormal Papanicolaou (Pap) tests are much easier to evaluate b.Quickening is a technique of palpating the fetus to engage it in passive movement c.The deepening color of the vaginal mucosa and cervix (Chadwick sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor d.Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal- especially in the second trimester

d.Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester

Which statement about a condition of pregnancy is accurate? a.Insufficient salivation (ptyalism) is caused by increases in estrogen. b.Acid indigestion (pyrosis) begins early but declines throughout pregnancy. c.Hyperthyroidism often develops (temporarily) because hormone production increases. d.Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

d.Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

A nurse caring for a pregnant client must understand that the hormone essential for maintaining pregnancy is: a.Estrogen b.Human chorionic gonadotropin (hCG) c.Oxytocin d.Progesteron

d.Progesteron