RN Maternal Newborn Online Practice 2019 A with NGN

A nurse is performing a physical assessment of a newborn upon admission to the nursery. Which of the following manifestations should the nurse expect? Select all that apply.

- Acrocyanosis - Positive Babinski reflex - Two umbilical arteries visible

A nurse is caring for a client who is pregnant.

- Administer a bolus of IV fluids -Reposition the client to their side -Apply oxygen at 10-12 L/min by nonrebreather mask -Elevate the client's legs Assess cervical dilation is incorrect. The nurse should plan to assess the client's cervical dilation based on the client's contraction pattern or the client's report of an urge to bear down; however, there are other actions that the nurse should take first. Administer a bolus of IV fluids is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the client's hypotension and fetal bradycardia and minimal variability. The nurse should plan to administer a bolus of IV fluids to increase the client's blood volume and improve uterine and intervillous space blood flow. Insert an indwelling urinary catheter is incorrect. The nurse should plan to insert an indwelling urinary catheter if the client is unable to empty their bladder. A full bladder can impede fetal descent through the pelvis; however, there are other actions that the nurse should take first. Reposition the client to their side is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the fetal bradycardia and minimal variability caused by decreased uteroplacental perfusion. The nurse should plan to turn the client to their side to increase cardiac output and improve uterine and intervillous space blood flow. Apply oxygen at 10 to 12 L/min by nonrebreather mask is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the fetal bradycardia and minimal variability caused by decreased uteroplacental perfusion. The nurse should plan to administer oxygen via nonrebreather mask to increase maternal circulating oxygen levels and improve oxygen transfer through the intervillous spaces to the fetus. Elevate the client's legs is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the client's hypotension and fetal bradycardia and minimal variability. Elevating the client's legs will promote blood return to the heart and increase cardiac output. This action will improve uterine and intervillous space blood flow. Evaluate the client's pain level is incorrect. The nurse should plan to assess the client's pain level; however, there are other actions that the nurse should take first.

A nurse is caring for a newborn who is 72 hr old. (SATA)

- Administer scheduled oral morphine -Maintain a low stimulus environment -Initiate neonatal abstinence syndrome (NAS) scoring Instruct the mother to discontinue breastfeeding is incorrect. The nurse should encourage the mother to continue to breastfeed on demand. Breastfeeding will assist to decrease manifestations of NAS in the newborn. Administer scheduled doses of oral morphine is correct. The nurse should administer scheduled doses of oral morphine to the newborn to decrease manifestations of withdrawal. The dosage of the medication is adjusted based on the NAS score of the newborn. Give a one-time dose of naloxone IM is incorrect. The nurse should not administer naloxone to a newborn who has NAS. It is contraindicated in newborns who are born with opioid dependence because it can increase the severity of withdrawal manifestations and result in seizures. Maintain a low-stimulus environment is correct. Supportive care for a newborn who has NAS includes maintaining a low-stimulus environment to help prevent exacerbation of withdrawal manifestations. Initiate neonatal abstinence syndrome (NAS) scoring is correct. The nurse should initiate NAS scoring to evaluate the severity of the newborn's withdrawal manifestations. The score obtained will be used to evaluate the need to titrate the prescription for the morphine dosage.

The nurse is reviewing laboratory results in the adolescent's medical record. (drag and drop)

- Doxycycline - Ceftriaxone Ceftriaxone and doxycycline are correct. Ceftriaxone is an anti-infective used to treat a variety of infections, including gonorrheal infection. Ceftriaxone is administered as a one-time IM injection for the treatment of gonorrhea. The adolescent is exhibiting manifestations of a gonorrheal infection. Therefore, the nurse should anticipate a provider's prescription for ceftriaxone. Doxycycline is an anti-infective used to treat a variety of infections. Doxycycline and ceftriaxone are anti-infectives used in the treatment of mild to moderate PID. The adolescent is exhibiting manifestations of a gonorrheal infection and PID. Therefore, the nurse should anticipate a provider's prescription for doxycycline. Acyclovir, fluconazole, and imiquimod are incorrect. Acyclovir is an antiviral used to treat herpes infections by interfering with the virus' DNA synthesis. The adolescent has no manifestations of genital herpes. Therefore, the nurse should not anticipate a provider's prescription for acyclovir. Fluconazole is an antifungal used to treat various fungal infections, including candidiasis. The adolescent has no manifestations of candidiasis or any fungal infection. Therefore, the nurse should not anticipate a provider's prescription for fluconazole Imiquimod is a topical anti-tumor medication used to treat keratoses, tumors of the skin, and genital warts. The adolescent does not have manifestations of genital warts. Therefore, the nurse should not anticipate a provider's prescription for imiquimod.

The nurse is reviewing laboratory results in the adolescent's medical record. (drop down)

- Pelvic inflammatory disease - C reactive protein Box 1 Pelvic inflammatory disease is correct. Pelvic inflammatory disease (PID) is an infection that involves the pelvic reproductive organs. There are several causative agents that lead to infection, including Neisseria gonorrhoeae and C. trachomatis. PID occurs as a result from untreated infections ascending from the vagina.. Manifestations include fever, increased C-reactive protein, nausea, and vomiting; therefore, the nurse should suspect the adolescent is developing PID Ectopic pregnancy is incorrect. Ectopic pregnancy is characterized by lower abdominal pain on one side, vaginal spotting or bleeding, and a delayed menstrual period. The adolescent reports having a normal menstrual period 3 weeks ago. The beta hCG test was negative and there are no other indications that the adolescent has an ectopic pregnancy; therefore, there is another condition the adolescent is most likely developing. Pyelonephritis is incorrect. Pyelonephritis is an inflammation of the upper urinary tract and kidneys and usually develops following a bladder infection. It is characterized by fever, flank pain, dysuria, and urgency. The adolescent's urinalysis has a negative leukocyte esterase and an absence of white blood cells and bacteria. These findings do not indicate the presence of a bladder infection; therefore, there is another condition the adolescent is most likely developing Box 2 C-reactive protein is correct. The adolescent's C-reactive protein is elevated, which is a manifestation of PID. Beta hCG level is incorrect. The beta hCG test was negative and there are no other indications the adolescent has an ectopic pregnancy; therefore, there is another condition the adolescent is most likely developing Urinalysis is incorrect. The adolescent's urinalysis has a negative leukocyte esterase and an absence of white blood cells and nitrites. These findings do not indicate the presence of a bladder infection; therefore, there is another condition the adolescent is most likely developing.

The nurse is reviewing laboratory results in the adolescent's medical record. (drop down)

- Providing education on medication -ceftriaxone Providing education on medications is correct. The nurse should first educate the adolescent regarding medications because clients have the right to know the purpose and potential adverse reactions of all prescribed medications before receiving them. An understanding of the prescribed medications will increase the likelihood that the adolescent will adhere to the prescribed therapy. Scheduling follow-up appointments and administering doxycycline is incorrect. The nurse should schedule the adolescent for a follow-up appointment; however, there is another action that the nurse should take first. The nurse should not administer doxycycline because it is a prescription for the adolescent to begin once discharged, and the prescription will be provided to the adolescent upon discharge; therefore, there is another action that the nurse should take. Dropdown 2 Administering ceftriaxone is correct. Ceftriaxone is designated as a NOW prescription, which means it should be given within 90 min of the provider writing the prescription. The nurse should administer ceftriaxone after educating the adolescent about the purpose and potential adverse reactions of the medication. Administering metronidazole and educating on condom use is incorrect. The nurse should not administer metronidazole because it is a prescription for the adolescent to begin once discharged, and the prescription will be provided to the adolescent upon discharge; therefore, there is another action that the nurse should take. The nurse should educate the adolescent regarding condom use; however, there is another action that the nurse should take first.

A nurse is caring for a prenatal client who has parvovirus B19 (fifth disease). Which of the following actions should the nurse take?

Schedule an ultrasound Administer antiviral medication.Currently, there are no antiviral medications available to treat fifth disease. Schedule an ultrasound examination.MY ANSWERThe nurse should schedule serial ultrasound examinations to monitor the fetus during the pregnancy to detect the possible development of fetal hydrops. Also, the virus can cause miscarriage, intrauterine growth restriction, fetal anemia, or stillbirth. Administer Haemophilus influenzae type b vaccine.The Haemophilus influenzae type b vaccine is given during infancy and childhood to protect against multiple infections caused by Haemophilus influenzae type b, not fifth disease. Currently, there are no vaccines to protect against fifth disease. Schedule an indirect Coombs' test.An indirect Coombs' test determines whether the client has antibodies to the Rh antigen. The titer determines the prenatal client's sensitization and if there is Rh incompatibility.

A nurse is reviewing the prenatal laboratory results for a client who is at 12 weeks of gestation following an initial prenatal visit. Which of the following laboratory findings should the nurse to the provider? Hemoglobin 10 g/dL WBC count 10,000/mm3 Platelets 250,000/mm3 Fasting blood glucose 90 mg/dL

Hemoglobin 10g/dL A hemoglobin of 10 g/dL is below the expected reference range of greater than 11 g/dL for a client who is pregnant. The nurse should report this finding to the provider to obtain a prescription for ferrous iron supplementation because of anemia.

A nurse is caring for a client who is to receive oxytocin to augment her labor. Which of the following findings contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

Late decelerations Late decelerations MY ANSWER Late decelerations are indicative of uteroplacental insufficiency. Therefore, this is a contraindication for the administration of oxytocin and should be reported to the provider.

A nurse is caring for a client who is at 15 weeks of gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure? Check the client's temperature. Observe for uterine contractions. Administer Rho(D) immune globulin. Monitor the FHR.

Monitor the FHR The greatest risk to this client and her fetus is fetal death. Therefore, the priority nursing intervention is to monitor the FHR following an amniocentesis.

A nurse is caring for a client who is at 38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring? Determine progression of dilatation and effacement. Perform Leopold maneuvers. Complete a sterile speculum exam. Prepare a Nitrazine paper test.

Perform Leopold manevuers The nurse should perform Leopold maneuvers to assess the position of the fetus to best determine the optimal placement for the external fetal monitoring transducer.

A nurse is assessing a newborn who was delivered vaginally and experienced a tight nuchal cord. Which of the following findings should the nurse expect?

Petechiae over the head Petechiae over the head MY ANSWER Nuchal cord, or the umbilical cord being wrapped tightly around the neck, can cause bruising and petechiae over the face, head, and neck.

A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn? Apply a cool pack for 10 min to the heel prior to the puncture. Request a prescription for IM analgesic. Use a manual lance blade to pierce the skin. Place the newborn skin to skin on the mother's chest.

Place the newborn skin to skin on the mother's chest

A nurse in a provider's office is reviewing the medical record of a client who is in the first trimester of pregnancy. Which of the following findings should the nurse identify as a risk factor for the development of preeclampsia? Singleton pregnancy BMI of 20 Maternal age 32 years Pregestational diabetes mellitus

Pregestational diabetes mellitus

A nurse in an antepartal clinic is providing care for a client who is at 26 weeks of gestation. Upon reviewing the client's medical record, which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Progress NotesFundal height 30 cmGood fetal movementNot experiencing headache, dizziness, blurred vision, or vaginal bleedingFetal heart rate 110/minA fundal height measurement of 30 cm should be reported to the provider. Fundal height should be measured in centimeters and is the same as the number of gestational weeks plus or minus 2 weeks from 18 to 32 weeks gestation. Therefore, the nurse should report this finding to the provider.

A nurse is creating a plan of care for a client who is postpartum and adheres to traditional Hispanic cultural beliefs. Which of the following cultural practices should the nurse include in the plan of care? Protect the client's head and feet from cold air. Bathe the client within 12 hr following birth. Ambulate the client within 24 hr following birth. Offer the client a glass of cold milk with her first meal.

Protect the client's head and feet from cold air.

A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan? Feed the newborn 1 oz of water every 4 hr. Apply lotion to the newborn's skin three times per day. Remove all clothing from the newborn except the diaper. Discontinue therapy if the newborn develops a rash.

Remove all clothing from the newborn expert the diaper

A nurse is assessing a client who has gestational diabetes mellitus and is experiencing hyperglycemia. Which of the following findings should he nurse expect?

Reports increased urinary output Increased urinary output, nausea and vomiting, reports of thirst, abdominal pain, constipation, drowsiness, and headaches are manifestations of hyperglycemia. Other manifestations include weak rapid pulse, fruity breath odor, urine positive for sugar and acetone, and a blood glucose level greater than 200 mg/dL.

A nurse is assessing a late preterm newborn. Which of the following manifestation is an indication of hypoglycemia? Hypertonia Increased feeding Hyperthermia Respiratory distress

Respiration distress

A nurse is assessing a newborn 12 hr after birth. Which of the following manifestations should the nurse report to the provider? Acrocyanosis Transient strabismus Jaundice Caput succedaneum

Jaundice

A nurse in a clinic is caring for a 16 year old adolescent. (Matrix)

Abdominal pain - gonorrhea Greenish discharge - trichomoniasis and gonorrhea Diabetes - candidiasis Pain on urination - trichomoniasis , gonorrhea and candidiasis Absence of condom - trichomoniasis and gonorrhea

A nurse is admitting a client who is in labor. The client admits to recent cocaine use. For which of the following complications should the nurse assess?

Abruptio placenta Abruptio placentaMY ANSWERCocaine use increases the risk for vasoconstriction and possible abruptio placenta.

A nurse is caring for a client who is experience preeclampsia and has a new prescription for IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if the client develops magnesium toxicity?

Calcium gluconate The nurse should anticipate administering calcium gluconate if the client develops magnesium toxicity. Calcium gluconate is the antidote.

A nurse is assessing a client who received carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication? Hypertension Hypothermia Constipation Muscle weakness

Hypertension The nurse should recognize that carboprost is a vasoconstrictor that can cause hypertension.

A nurse is assessing a client who is 1 day postpartum and has vaginal hematoma. Which of the following manifestations should the nurse expect?

Vaginal pressure Vaginal pressure MY ANSWER The nurse should expect a client who has a vaginal hematoma to report pressure in the vagina due to the blood that leaked into the tissues.

A nurse in a clinic is caring for a 16 year old adolescent. (SATA)

- Abdominal assessment - Vaginal discharge -Temperature -Dyspareunia - Condom usage Abdominal assessment is correct. Abdominal tenderness with palpation is not an expected finding with an abdominal assessment; therefore, the nurse should report this finding to the provider. Vaginal discharge is correct. Greenish vaginal discharge indicates that the adolescent has an infection, which is not an expected finding; therefore, the nurse should report this finding to the provider. Heart rate is incorrect. The adolescent's heart rate of 100/min is within the expected reference range; therefore, the nurse does not need to report this finding to the provider. Temperature is correct. The client's temperature of 38.3° C (101° F) is above the expected reference range. An elevated temperature could signal infection or inflammation; therefore, the nurse should report this finding to the provider. Dyspareunia is correct. Dyspareunia is painful intercourse, which can be associated with STIs; therefore, the nurse should report this finding to the provider. Condom usage is correct. Sexual activity without the use of condoms increases the risk of contracting STIs; therefore, the nurse should report this finding to the provider.

A nurse is caring for a client who is pregnant in an antepartum clinic.

- Uterine contractions - Gestational age - Vaginal examination Uterine contractions is correct. The client is experiencing regular uterine contractions and cervical change, which are indicators of preterm labor; therefore, the nurse should notify the provider about this finding. Gestational age is correct. The client is at 32 weeks of gestation and is experiencing regular uterine contractions and cervical dilation, which indicates that the client is in preterm labor; therefore, the nurse should notify the provider about this finding. Vaginal examination is correct. The client's cervix is dilated to 2 cm and is 50% effaced, which indicate the client is in preterm labor; therefore, the nurse should notify the provider about this finding.

How to bathe their newborn.

- Wipe the NB eyes from the inner canthus outward -Wash the NB neck by lifting the NB chin -Cleanse the skin around the NB umbilical cord stump - Wash the NB legs and feet - Clean the NB diaper area

A nurse is preparing to administer magnesium sulfate 2g/hr IV to a client who is in preterm labor. Available is 20g magnesium sulfate in 500mL of dextrose 5% in water (D5W). The nurse should set the IV infusion pump to administer how many mL/hr?

50 mL/hr

A nurse in a prenatal is assessing a group of clients. Which of the following clients should the nurse see first? A client who is at 11 weeks of gestation and reports abdominal cramping A client who is at 15 weeks of gestation and reports tingling and numbness in right hand A client who is at 20 weeks of gestation and reports constipation for the past 4 days A client who is at 8 weeks of gestation and reports having three bloody noses in the past week

A client who is at 11 weeks of gestation and reports abdominal cramping A client who is at 11 weeks of gestation and reports abdominal cramping MY ANSWER When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority finding is a client who is at 11 weeks of gestation and reports abdominal cramping. Abdominal cramping can indicate an ectopic pregnancy or manifestations of spontaneous abortion. The nurse should request that the provider see this client first.

A nurse is assessing four newborns. Which of the following findings should the nurse report to the provider ?

A newborn who is 18 hr old and has axillary temp of 37.7 C (99.9 F) A newborn who is 18 hr old and has an axillary temperature of 37.7° C (99.9° F) An axillary temperature greater than 37.5° C (99.5° F) is above the expected reference range for a newborn and can be an indication of sepsis. Therefore, the nurse should report this finding to the provider.

A nurse is caring for a client who is anemic at 32 weeks gestation and is in preterm labor. The provider prescribed betamethasone 12 mg IM . Which of the following outcomes should the nurse expect?

A reduction in respiratory distress in the newborn A reduction in respiratory distress in the newborn Betamethasone is a glucocorticoid that is given to stimulate fetal lung maturity and prevent respiratory distress.

A nurse is caring for a client who is 3 days postpartum.

Action to take 1 - Plan to administer IV antibiotics Action to take 2 - Obtain a culture of vaginal fluid using a sterile swab Potential Complication - Endometritis Parameter to monitor 1 - Temperature Parameter to monitor 2 - Lochia amount and odor The nurse should plan to obtain a culture of vaginal fluid and to administer IV antibiotics because the client is most likely experiencing endometritis as evidenced by increased pelvic pain, pressure and tenderness, fever, and foul-smelling vaginal discharge. The client had an increased risk of developing endometritis due to the history of anemia, gestational diabetes, operative vaginal birth, and prolonged rupture of membranes. The nurse should plan to monitor the client's temperature and the amount and odor of the lochia. Clients who have endometritis have an increased risk of hemorrhage. A decrease of foul-smelling lochia and fever indicate progression toward resolution of the infection.

A nurse is caring for a client who is at 26 weeks of gestation and has epilepsy. The nurse enters the room and observes the client having a seizure. After turning the clients head to one side, which of the following actions should the nurse take immediately after the seizure?

Administer oxygen via a nonrebreather mask Monitor the FHR.The nurse should monitor the FHR to assess fetal well-being. However, this is not the action the nurse should take next. Assess uterine activity.The nurse should assess uterine activity for potential complications of the seizure. However, this is not the action the nurse should take next. Administer oxygen via a nonrebreather mask.MY ANSWERWhen using the airway, breathing, and circulation approach to client care, the nurse should place the priority on administering oxygen to the client via a nonrebreather mask at 10 L/min to ensure adequate oxygenation to the fetus. Start a bolus of IV fluids.The nurse should start IV fluids following the seizure to ensure adequate hydration. However, this is not the action the nurse should take next.

A nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. Which of the following findings should the nurse report to the provider?

BUN 25 mg/dL BUN 25 mg/dL MY ANSWER The nurse should report an elevated BUN to the provider since it can indicate dehydration.

A nurse is admitting a client to the labor and delivery unit when the client states, "My water just broke." Which of the following interventions is the nurse's priority?

Begin FHR monitoring

A nurse is caring for a client who is 36 weeks of gestation and has a positive contraction stress test. The nurse should plan to prepare the client for which of the following diagnostic tests?

Biophysical profile A positive contraction stress test indicates that further evaluation of the fetus is necessary. A biophysical profile will provide further evaluation with a real-time ultrasound.

A nurse is caring for a newborn who is 70 hr old. Newborn is inconsolable with a high-pitched cry. Newborn sucks vigorously on pacifier but breastfeeds poorly. Respirations unlabored. Lungs sound clear on auscultation. Increased muscle tone with moderate to severe tremors when disturbed. Hyperactive Moro reflex noted. Several loose stools today. Respiratory findings Temperature Oxygen saturation Central nervous system findings Gastrointestinal findings

Central nervous system findings Gastrointestinal findings Central nervous system findings is correct. The newborn is displaying inconsolability, high-pitched cry, increased muscle tone, tremors, hyperactive Moro reflex, and excessive sucking. These findings are manifestations of NAS and should be reported to the provider. Gastrointestinal findings is correct. The newborn is displaying poor feeding and loose stools. These findings are manifestations of NAS and should be reported to the provider. Respiratory findings is incorrect. The newborn's respiratory rate is within the expected reference range of 30 to 60/min. There is no indication the newborn has an alteration in respiratory status; therefore, this finding does not need to be reported to the provider. Temperature is incorrect. The newborn's temperature is within the expected reference range of 36.5° to 37.5° C (97.7° to 99.5° F). Therefore, this finding does not need to be reported to the provider. Oxygen saturation is incorrect. The newborn's oxygen saturation is within the expected reference range of greater than 94%; therefore, this finding does not need to be reported to the provider.

A nurse is providing teaching about nonpharmacological pain management to client who is breastfeeding and has engorgement. The nurse should recommend the application of which of the following items?

Cold cabbage leaves Cold cabbage leaves MY ANSWER The application of fresh, raw cabbage leaves that have been chilled is an effective nonpharmacological method to relieve the pain associated with engorgement. The nurse should instruct the client to place the cabbage leaves on the breasts for 15 to 20 min, repeating the application for two to three sessions as needed. More frequent applications could decrease the client's milk supply.

A nurse is providing teaching for a client who has a new prescription for combined oral contraceptives. Which of the following findings should the nurse include as an adverse effect of this medication?

Depression Depression MY ANSWER The nurse should instruct the client that depression is a common adverse effect of combined oral contraceptives. Other common adverse effects of the medication include amenorrhea, weight gain, headache, nausea, breakthrough bleeding, and breast tenderness.

A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. Which of the following statements should the nurse include in the teaching? "Obtain an informed consent prior to obtaining the specimen." "Collect at least 1 milliliter of urine for the test." "Ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen." "Premature newborns may have false negative tests due to immature development of liver enzymes."

Ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen. The nurse should ensure that the newborn has been receiving regular feedings for at least 24 hr prior to testing.

A nurse is performing a routine assessment on a client who is at 18 weeks of gestation. Which of the following findings should the nurse expect?

FHR 152 FHR 152/min MY ANSWER The expected range for the FHR is 110/min to 160/min. The FHR is higher earlier in gestation with an average of approximately 160/min at 20 weeks of gestation. Therefore, this is an expected finding by the nurse.

A nurse in an antepartum clinic is providing care for a client who is at 26 weeks of gestation. Upon reviewing the client's medical record, which of the following findings the nurse report to the provider?

Fundal height measurement

A nurse is providing teaching to a client who is at 40 weeks of gestation and has a new prescription for misoprostol. Which of the following instructions should the nurse include in the teaching?

I can administer oxytocin 4 hours after the insertion of the medication "I can administer oxytocin 4 hours after the insertion of the medication." The nurse can administer oxytocin no sooner than 4 hr after the last dose of misoprostol. Oxytocin can be administered following misoprostol for clients who have cervical ripening and have not begun labor..

A nurse is teaching a client who is at 10 weeks of gestation about nutrition during pregnancy. Which of the following statements by the client indicates an understanding of the teaching?

I should take 600 micrograms of folic acid each day "I should take 600 micrograms of folic acid each day." MY ANSWER A client who is pregnant should increase folic acid intake to 600 mcg daily. Folic acid assists with preventing neural tube birth defects.

A nurse is providing teaching to a client about the physiological changes that occur during the pregnancy. The client is at 10 weeks of gestation and has a BMI within the expected reference range. Which of the following client statements indicates an understanding of the teaching? "I will not gain more than 15 to 20 pounds during my pregnancy." "I will likely need to use alternative positions for sexual intercourse." "I'm glad I had a breast reduction years ago, so they will not enlarge with my pregnancy." "I'm glad I have a light complexion and will not get any stretch marks."

I will likely need to use alternative positions for sexual intercourse. "I will likely need to use alternative positions for sexual intercourse." MY ANSWER The weight gain of pregnancy will likely require alternative positions for sexual intercourse. This client statement indicates that she understands the nurse's teaching about the physiological changes that occur during pregnancy.

A nurse is caring for a newborn. (Matrix)

Indicated: - ROM on affected arm after 1 week - Assess grasp reflex - Immobilize the arm Contraindicated: - Limit physical handling for 2 weeks Educate the parents to begin range of motion exercises on the affected arm after 1 week is indicated. Passive ROM exercises of the arm are indicated to restore function of the extremity. The initiation of these exercises is delayed for approximately 1 week to prevent additional injury to the brachial plexus. Assess for grasp reflex in the affected extremity is indicated. With Erb-Duchenne paralysis, only the upper arm is affected. The function of the wrists and fingers should be unaffected; the nurse should assess for a palmar grasp reflex. Immobilize the arm across the abdomen by pinning the newborn's sleeve to their shirt is indicated. Intermittent immobilization of the affected arm across the newborn's abdomen can be achieved by pinning the sleeve to the shirt. Instruct parents to limit physical handling for 2 weeks is contraindicated. Parents and guardians should participate in the physical care of their newborn to increase parental-infant attachment. Providing education and practice opportunities for the parents will decrease their fears of injuring the newborn and increase confidence and bonding.

The nurse is reviewing laboratory results in the adolescent's medical record. (Matrix)

Indicates understanding: "continue taking meds even with no symptoms" "Continue to get this type of infection can affect the ability to have kids in the future" "More likely to get sunburns while taking these medications" Requires further education: "go to the ER if urine is dark" "as long as i keep the IUD, I done need condoms"

A nurse is performing a vaginal examination on a client who is in a labor and observes the umbilical cord protruding from the vagina. After calling for assistance, which of the following actions should the nurse take? Insert two gloved fingers into the vagina and apply upward pressure to the presenting part. Wrap the visible cord tightly with sterile, dry gauze. Apply oxygen to the client at 2 L/min via nasal cannula. Place the client in the lithotomy position and apply fundal pressure.

Insert two gloved fingers into the vagina and apply upward pressure to the presenting part.

A nurse is caring for a client who is at 24 weeks of gestation and has a suspected placental abruption.Which of the following laboratory tests should the nurse expect the provider to prescribe? Kleihauer-Betke test Progesterone serum level Lecithin/sphingomyelin (L/S) ratio Maternal Alpha-fetoprotein (AFP)

Kleihauer-Betke test The nurse should expect the provider to prescribe a Kleihauer-Betke test for a client who has suspected placental abruption to determine if fetal blood is in maternal circulation. This test is useful to determine if Rho-(D) immune globulin therapy should be administered to a client who is Rh-negative.

A nurse is observing a new parent caring for their crying newborn who is bottle feeding. Which of the following actions by the parent should the nurse recognize as a positive parenting behavior? Lays the newborn across their lap and gently sways Places the newborn in the crib in a prone position Offers the newborn a pacifier dipped in formula Prepares a bottle of formula mixed with rice cereal

Lays the newborn across their lap and gently sways Lays the newborn across their lap and gently swaysMY ANSWERThis is a correct technique for quieting a newborn. This tactile stimulation promotes a sense of security for the newborn. Places the newborn in the crib in a prone positionThe parent should place the infant in the supine position, not a prone position, in the bassinet or crib because of the risk of sudden infant death syndrome. Offers the newborn a pacifier dipped in formulaPacifiers may be used for a newborn who needs extra sucking for self-soothing. However, formula should not be placed on the tip of the pacifier because the newborn might become accustomed to it and refuse to take the pacifier in the future without added supplement. Prepares a bottle of formula mixed with rice cerealRice cereal should not be added to the bottle of a newborn because solids should not be introduced until 4 to 6 months of age.

A nurse is assessing a newborn who was born 26 weeks of gestation using the New Ballard Score. Which of the following findings should the nurse expect? Minimal arm recoil Popliteal angle of 90° Creases over the entire foot sole Raised areolas with 3 to 4 mm buds

Minimal arm recoil

A nurse is assessing a client who is receiving morphine IV bolus for pain following a cesarean birth. The nurse notes a respiratory rate of 8/min. Which of the following medications should the nurse administer?

Naloxone Naloxone MY ANSWER Morphine is a common opioid analgesic used for postoperative pain management that can cause central nervous system depression and can cause respiratory depression. The nurse should administer naloxone, an opioid antagonist, to reverse the opioid-induced respiratory depression in the client.

A charge nurse on a labor and delivery unit is teaching a newly licensed nburse how to perform Leopold Maneuvers. Which of the following images indicates the first step of Leopold Maneuvers?

Nurse palpates the clients abdomen with the palms to determine which fetal part is in the uterine fundus. Evidence-based practice indicates the nurse should perform this step first when performing Leopold maneuvers. During this step, the nurse palpates the client's abdomen with the palms to determine which fetal part is in the uterine fundus. This step also identifies the lie (transverse or longitudinal) and presentation (cephalic or breech) of the fetus.

A nurse is providing education about family bonding to parents who recently adopted a newborn. The nurse should make which of the following suggestions to aid the family's 7 year old child in accepting the new family member?

Obtain a gift from the newborn to present to the sibling. Perform Nitrazine testing.The nurse should perform a Nitrazine test to determine the pH of the fluid. An alkaline pH can indicate rupture of membranes. However, this is not the first action the nurse should take. Assess the fluid.The nurse should observe the characteristics of the fluid to document color, odor, and amount. However, this is not the first action the nurse should take. Check cervical dilation.The nurse should check the client's cervical dilation to assess progress of labor. However, this is not the first action the nurse should take. Begin FHR monitoring.MY ANSWERThe greatest risk to the client and her fetus following a rupture of membranes is umbilical cord prolapse. The nurse should monitor the fetus closely to ensure well-being. Therefore, this is the priority action the nurse should take.

A nurse is caring for a client who is at 30 weeks of gestation and has a prescription for magnesium sulfate IV to treat preterm labor. The nurse should notify the provider of which of the following adverse effects?

Respiratory rate 10/min The nurse should report a respiratory rate of less than 12/min to the provider, because this is a manifestation of magnesium toxicity. The nurse should ensure that the antidote, calcium gluconate, is readily available.

A nurse is providing teaching for a client who gave birth 2 hr ago about the facility policy for newborn safety. Which of the following client statements indicates an understanding of the teaching?

The person who comes to take my baby's pictures will be wearing a photo identification badge.

A nurse is caring for a client who is at 36 weeks gestation and has a prescription for an amniocentesis. For which of the following reasons should the nurse prepare the client for the ultrasound?

To locate a pocket of fluid To locate a pocket of fluid An ultrasound is done to locate a pocket of amniotic fluid and the placenta prior to an amniocentesis. This decreases the risk of injury to the fetus.

A nurse is transporting a newborn back to the parent's room following a procedure. Which of the following actions should the nurse take? Verify that the parent's identification band matches the newborn's identification band. Scan the newborn's identification band to verify their identity. Check the newborn's security tag number to ensure it matches the newborn's medical record. Match the newborn's date and time of birth to the information in the parent's medical record.

Verify that the parent's identification band matches the newborn's identification band.

A nurse is assessing a client who is at 38 weeks of gestation during a weekly prenatal visit. Which of the following findings should the nurse report to the provider? Blood pressure 136/88 mm Hg Report of insomnia Weight gain of 2.2 kg (4.8 lb) Report of Braxton Hicks contractions

Weight gain of 2.2kg (4.8 lb) A weight gain of 2.2 kg (4.8 lb) in a week is above the expected reference range and could indicate complications. Therefore, this finding should be reported to the provider.

A nurse is providing discharge teaching to a client who had a cesarean birth 3 days ago. Which of the following instructions should the nurse include?

You can still become pregnant if you are breastfeeding. "You can still become pregnant if you are breastfeeding." The nurse should instruct the client that breastfeeding does not prevent ovulation. Therefore, the client can become pregnant. The nurse should discuss contraception that is safe to use while breastfeeding.