uworld maternal & newborn

how much weight gain should occurr in 2nd trimester

1lb(0.5)kg per week if pre preggo BMI is normal

when does screening for diabetes gestational begin

24 - 28 weeks gestation If serum BG is ≥140 mg/dL (7.8 mmol/L), the client requires a 2- or 3-hour glucose tolerance test (GTT) to diagnose GDM.

list 5 sources of fortified

leafy green veggies, beans, rice, peanut butter, and fortified cereals.

The postpartum nurse is documenting client care at the unit's front desk. During that time, several clients request assistance from the nurse. Which client need should the nurse address first? 1. Client reports that a suspicious visitor is walking up and down the hallway 2. Client reports that her newborn is uncontrollably crying and having difficulty breastfeeding 3. Client who had a cesarean birth 8 hours ago is requesting to ambulate for the first time 4. Client who is receiving IV antibiotics for postpartum endometritis reports that the IV pump is beeping

1. Newborns are a vulnerable client population, and nurses play an important role in establishing a culture of safety and preventing infant abduction. Security measures may include matching mother/newborn identification bracelets; newborn security sensors; locked perinatal units; specific uniforms for nursing staff; unit-specific badges; and hospitalwide, overhead emergency alerts (eg, code pink for infant or child abduction).

a newly circumcised infant should have diapers changed every

4 hrs or when soiled

The labor and delivery charge nurse receives report on several clients. Which task is appropriate for the nurse to delegate to the unlicensed assistive personnel? 1. Assist a client to the restroom 1 hour after a vaginal birth with regional anesthesia 2. Check the perineal pad of a client who is in triage with possible rupture of membranes 3. Obtain vital signs on a newborn who is skin-to-skin with the mother 1 hour after birth 4. Reposition an unmedicated client who is in active labor onto a birthing ball

4. Nurses must implement the five rights of delegation and understand the delegatee's scope of practice to ensure that tasks are appropriately delegated. Unlicensed assistive personnel (UAP) participate in client care by performing basic tasks (eg, hygiene, activities of daily living) for stable clients; tasks should have a predictable outcome and not require clinical judgment or assessment. Repositioning an unmedicated, laboring client onto a birth ball is a low-risk, routine task that is appropriate to delegate to a UAP who has received proper training (Option 4). In addition, the nurse should provide specific instructions to the UAP (eg, type of position, problems to report) and ensure appropriate completion of the task. (Option 1) After a client gives birth with regional anesthesia (eg, epidural), the nurse must evaluate readiness for ambulation (eg, assess sensory and motor function) and observe early attempts to ambulate to ensure client safety. (Option 2) The nurse is responsible for ongoing assessments of a client's health status in the triage setting. Therefore, the nurse should not delegate checking a perineal pad to the UAP if doing so may require assessment for leaking amniotic fluid. (Option 3) Newborns require frequent monitoring (ie, vital signs) by nurses during the first several hours after birth, which is a vulnerable and potentially unstable time of transition to extrauterine life. Educational objective:

temperature after giving birth that may indicate infection

over 100.4

2 complications of oligohydramnios

pulmonary hypoplasia umbilical cord compression

meckels diverticulum

rectal bleeding due to a remnant of umbilical cord that should have disingratterm-15ed at 8 weeks in utero but became pouch on small intestine

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G5T1P2A1L2. Which interpretation of this notation is correct? 1. The client had 1 birth at 37 wk 0 d gestation or beyond 2. The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation 3. The client has 3 currently living children 4. The client is currently not pregnant

1. This client (G5T1P2A1L2) has been pregnant 5 times (G5); had 1 term birth (T1), 2 preterm births (P2), and 1 abortion (A1); and has 2 currently living children (L2). The client's term birth is indicated by the T1 portion of the GTPAL notation (Option 1). (Option 2) The client had 2 preterm births, indicated by the P2 portion of the GTPAL notation. (Option 3) The client has 2 currently living children, as indicated by the L2 portion of the GTPAL notation. If a child born full- or preterm is not living (due to stillbirth from 20 wk 0 d and beyond or infant/child death after birth), that birth and subsequent death is counted toward T or P (term or preterm) but is not notated under L (currently living children); T and P record total number of births without regard to current living status. This client has 2 currently living children (L2), which is 1 less than the client's total notation for term + preterm (T1 + P2 = 3). Therefore, the client has experienced the death of 1 child who had been born at 20 wk 0 d gestation or beyond. (Option 4) If a client is currently pregnant, the number of pregnancies (gravida) will be greater than the number of births (term, preterm, and abortions combined). This client is a G5, and T1 + P2 + A1 = 4. Therefore, the client is currently pregnant. Educational objective: The GTPAL system notational components are G - gravida (number of pregnancies, regardless of outcome and including current pregnancies), T - term (37 wk 0 d gestation and beyond), P - preterm (20 wk 0 d through 36 wk 6 d gestation), A - abortions (before 20 wk 0 d gestation; spontaneous or induced), and L - currently living children. Copyright © UWorld. All rights reserved.

The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion. The nurse notes persistent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply. 1. Administer oxygen via a nonrebreather face mask 2. Change maternal position to the left side 3. Discontinue the oxytocin infusion 4. Notify the health care provider 5. Perform a nitrazine test

1,2,3,4 The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FHR) changes noted on monitor tracings. A late deceleration is a decrease in FHR that begins after a contraction, reaches its lowest point (nadir) after the contraction peak, and then gradually returns to baseline. Late decelerations indicate impaired fetal oxygenation associated with decreased uteroplacental perfusion (eg, due to maternal hypotension after epidural placement or uterine tachysystole). Chronic uteroplacental insufficiency (eg, intrauterine growth restriction, preeclampsia, diabetes) may also cause late decelerations. Nursing actions to improve fetal perfusion and oxygenation include: Discontinuing uterotonics (eg, oxytocin [Pitocin]) to reduce uterine activity (Option 3) Changing maternal position to the left side to relieve compression of the inferior vena cava. If the FHR tracing does not improve, a right-side position may be attempted (Option 2) Administering oxygen at 8-10 L/min via nonrebreather face mask to promote fetal oxygenation (Option 1) Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve placental perfusion, especially during maternal hypotension Notifying the health care provider (Option 4) (Option 5) Nitrazine pH tests are used to detect leaking amniotic fluid, most often if premature (prelabor) rupture of membranes is suspected. This client is at term and in active labor.

The nurse is planning education for clients in group prenatal care who are entering the second trimester of pregnancy. Which of the following are appropriate for the nurse to include in second-trimester teaching? Select all that apply. 1. Anticipate light fetal movements around 16-20 weeks gestation 2. Expect to have an abdominal ultrasound for fetal anatomy evaluation 3. Gain about 1 lb (0.5 kg) per week if pre-pregnancy BMI was normal 4. Increase consumption of iron-rich foods like meat and dried fruit 5. Plan for gestational diabetes screening near the end of the second trimester

1,2,3,4,5 The second trimester (14 wk 0 d to 27 wk 6 d) is a time of positive changes for many pregnant clients (eg, improved nausea) and when physical evidence of the pregnancy is noted (eg, increased fundal height). The nurse should prepare clients for expected physical changes and discuss prevention of potential complications. Quickening, or a client's first perception of light fetal movement, is expected around 16-20 weeks gestation, depending on parity (Option 1). Weight gain increases by approximately 1 lb (0.5 kg) per week if pre-pregnancy BMI has been normal (Option 3). Increasing intake of iron-rich foods (eg, meat, dried fruit) and continuing prenatal vitamins both help to prevent anemia caused by increased fetal iron requirements after 20 weeks gestation (Option 4). Preterm labor warnings and signs of preeclampsia should be reviewed beginning at 20 weeks gestation. The nurse should also discuss routine screening/diagnostic tests performed during the second trimester. An ultrasound is performed around 18-20 weeks gestation to evaluate fetal anatomy and the placenta (Option 2). Screening for gestational diabetes mellitus (GDM) occurs between 24-28 weeks gestation (ie, 1-hour glucose challenge test) (Option 5). GDM is a complication of pregnancy caused by hormonally related maternal insulin resistance.

The nurse is reinforcing education to a group of clients that are pregnant or planning pregnancy. Which of the following client statements about alcohol use in pregnancy should concern the nurse? Select all that apply. 1. "As long as I don't binge drink, an occasional glass of wine is fine." 2. "I drank alcohol heavily before realizing I was pregnant, so there is no benefit to quitting now." 3. "If I drink alcohol, my baby may have withdrawal after birth but no permanent damage." 4. "It is important to stop drinking while I am trying to conceive." 5. "Third-trimester alcohol use is less harmful because the baby is fully developed."

1,2,3,5 Alcohol consumption during pregnancy is concerning and is reported by 1 in 9 women according to research surveys. Nurses play a significant role in educating clients about the teratogenic risks of alcohol consumption, which include miscarriage, preterm birth, low birth weight, and fetal alcohol spectrum disorders (eg, fetal alcohol syndrome). Fetal alcohol spectrum disorders may not be diagnosed immediately, but a range of permanent neurodevelopmental abnormalities or dysmorphic facial features may occur (Option 3). During pregnancy, the nurse should screen for substance abuse to identify clients who consume alcohol. The nurse should educate clients that alcohol freely crosses the placenta into the fetal bloodstream, affecting the growth and development of the fetus at any gestational age. Therefore, no amount of alcohol intake during pregnancy is safe (Options 1 and 5). The nurse should also inform clients that discontinuing alcohol intake at any time during pregnancy can improve future outcomes for the child (Option 2). (Option 4) The nurse should encourage clients who are planning pregnancy to abstain from alcohol to avoid potential exposure of the embryo during a highly critical period of development.

The nurse is teaching the mother of a newborn about gastroesophageal reflux. What does the nurse suggest to help prevent reflux? Select all that apply. The nurse is teaching the mother of a newborn about gastroesophageal reflux. What does the nurse suggest to help prevent reflux? Select all that apply. 1. Burp during and after feeds 2. Engage baby in active play after the feeding 3. Feed baby in side-lying position 4. Hold baby upright 20-30 minutes after each feeding 5. Offer smaller but more frequent feeds 6. Place baby on tummy after feeding

1,4,5 Gastroesophageal reflux (GER) is attributed to an immature lower esophageal sphincter. It is common in infants age ≤3 months and results in spitting up after feeds. If an infant is gaining weight and meeting developmental milestones, treatment is aimed at controlling the symptoms. Because infants with GER are at risk for aspiration and apnea, caregivers should be instructed in cardiopulmonary resuscitation. Burping the baby frequently helps expel trapped air before milk builds up over it. If there is milk over an air pocket, the milk will come up with the burp (Option 1). Holding the baby upright for 20-30 minutes after feedings allows gravity to assist in keeping the food in the stomach while the stomach settles (Option 4).

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios. Considering the client's indication for induction, what should the nurse anticipate? 1. Additional neonatal personnel present for birth 2. Intermittent fetal monitoring during labor 3. Need for forceps-assisted vaginal birth 4. Need for uterotonic drugs for postpartum hemorrhage

1. Amniotic fluid is produced by the fetal kidney and serves 2 major purposes - to prevent cord compression and promote lung development. Oligohydramnios is a condition characterized by low amniotic fluid volume. This can occur due to fetal kidney anomalies (eg, renal agenesis or urine flow obstruction) or fluid leaking through the vagina (eg, undiagnosed ruptured membranes). Fluid volume also declines gradually after 41 weeks. Small uterine size for gestational age or a fetal outline that is easily palpated through the maternal abdomen should raise suspicion for oligohydramnios. Ultrasound confirms the diagnosis. Major complications of oligohydramnios are: Pulmonary hypoplasia - due to the lack of normal alveolar distension by aspirated amniotic fluid. Therefore, additional neonatal personnel should attend the birth in anticipation of possible resuscitation (Option 1). Umbilical cord compression - continuous (not intermittent) fetal monitoring should be applied to monitor for variable decelerations (Option 2).

A primigravid client in early labor is admitted and reports intense back pain with contractions. The fetal position is determined to be right occiput posterior. Which action by the nurse would be most helpful for alleviating the client's back pain during early labor? 1. Applying counterpressure to the client's sacrum during contractions 2. Encouraging the client to remain in bed during early labor 3. Positioning the client on the left side with pillows for support 4. Requesting that the nurse anesthetist administer epidural anesthesia

1. Fetal occiput posterior (OP) position is a common fetal malposition that occurs when the fetal occiput rotates and faces the mother's posterior or sacrum. OP fetal position can cause increased back pain or "back labor." Many fetuses in OP position during early labor spontaneously rotate to occiput anterior position (occiput facing the mother's anterior or pubis). The nurse or labor support person can apply counterpressure to the client's sacrum during contractions to help alleviate back pain associated with OP fetal positioning. Firm, continuous pressure is applied with a closed fist, heel of the hand, or other firm object (eg, tennis ball, back massager) (Option 1). (Option 2) Clients should be encouraged to change positions frequently (every 30-60 minutes) during labor to promote fetal rotation/descent and increase maternal comfort. Remaining in bed during early labor increases the risk for persistent fetal malposition and slows labor progression. (Option 3) Left lateral positioning is better for uteroplacental blood flow and fetal oxygenation than supine positioning when the client is resting in bed. However, it may not alleviate the client's back pain. (Option 4) Although epidural anesthesia can provide effective pain relief, it can limit client mobility and contribute to persistent fetal malposition. This client is also still in early labor and has not requested an epidural at this time.

A laboring client at 35 weeks gestation comes to the labor and delivery unit with preterm rupture of membranes "about 18 hours ago." The client's group B Streptococcus status is unknown. What intervention is a priority for this client? 1. Administration of prophylactic antibiotics 2. Assessment of uterine contraction frequency 3. Collection of a clean-catch urine specimen 4. Vaginal examination to assess cervical dilation

1. Group B Streptococcus (GBS) may be present as part of normal vaginal flora in up to 30% of pregnant clients. Although colonization with GBS rarely poses harm to the client, it can be transmitted to the newborn during labor and birth, resulting in serious complications (eg, neonatal GBS sepsis, pneumonia). Pregnant clients are tested for GBS colonization at 35-37 weeks gestation and receive prophylactic antibiotics during labor if results are positive. If GBS status is unknown, antibiotics are typically indicated when membranes have been ruptured for ≥18 hours, maternal temperature is ≥100.4 F (38 C), or gestation is <37 weeks (Option 1). (Option 2) Part of the client's assessment includes evaluation of the uterine contraction pattern. However, the client and newborn are at risk for infection due to prolonged rupture of membranes and unknown GBS status, so antibiotic administration is the priority. (Option 3) A urine specimen is often collected to evaluate for proteinuria in clients with elevated blood pressure or to assess for urinary tract infection in symptomatic clients. Urine specimen collection is not the priority for this client. (Option 4) Vaginal examinations should be limited in the presence of ruptured membranes. Multiple vaginal examinations in such a client correlate with an increased risk for infection (eg, chorioamnionitis). Educational objective: Group B Streptococcus (GBS) infection can be transmitted to the newborn during labor and birth and cause serious complications. Indications for prophylactic antibiotics during labor include maternal GBS-positive status or unknown GBS status with fever ≥100.4 F (38 C), preterm gestation, and/or prolonged rupture of membranes. Copyright © UWorld. All rights reserved.

The nurse assesses a client at term gestation who reports having contractions for the last 2 hours. The client states, "I'm not sure, but I think my water broke." The nurse performs a nitrazine pH test, which turns blue. When documenting the results of the test, which client statement is most concerning to the nurse? 1. "I did have sexual intercourse with my partner 1 hour before coming in today." 2. "I have noticed constant wetness in my panties since I thought my water broke." 3. "It is difficult for me to tell if my water broke or if I just peed on myself a little bit." 4. "With my last three pregnancies, my water never broke on its own."

1. Testing vaginal secretions with a nitrazine pH test strip can help differentiate between amniotic fluid, which is alkaline, and normal vaginal fluids or urine, which are acidic. A yellow, olive, or green color suggests that amniotic membranes are intact. A bluish color suggests probable rupture of membranes (ROM). However, the presence of blood or semen may result in a false positive, as serum and prostatic fluid are alkaline. A client history of recent sexual intercourse should alert the nurse to notify the health care provider that nitrazine results may be falsely positive due to the presence of semen in the vagina (Option 1). (Option 2) Constant wetness of undergarments may indicate leaking amniotic fluid. This statement is not concerning and substantiates the positive nitrazine results and the client's history. (Option 3) Occasional involuntary urine leakage is common late in the third trimester as the gravid uterus presses on the bladder. Urine is generally acidic and should not inhibit nitrazine testing or cause a false positive. (Option 4) Many clients have never experienced spontaneous ROM, especially if previous labors were induced. This statement does not inhibit the nurse's ability to judge the accuracy of nitrazine results.

The nurse is providing teaching to a prenatal client about the 1-hour glucose challenge test that will be performed at the next visit. Which client statement indicates a need for further teaching? 1. "Fasting is required before the 1-hour glucose challenge test." 2. "One blood sample is obtained at the end of the test." 3. "The test includes drinking a 50-g glucose solution." 4. "The test's purpose is to screen for gestational diabetes, not diagnose it."

1. Gestational diabetes mellitus (GDM) is diagnosed in clients who have impaired blood glucose (BG) regulation due to physiologic pregnancy changes (eg, rising BG levels, insulin resistance). GDM screening occurs at 24-28 weeks gestation. If GDM is diagnosed, management includes nutritional counseling and, if needed, pharmacologic therapy. Two-step GDM testing begins with a screening test: the 1-hour glucose challenge test (GCT). The 1-hour GCT can be performed any time of day and does not require fasting (Option 1). If the client's serum BG is <140 mg/dL (7.8 mmol/L), GDM is unlikely, and the client requires no further testing. If serum BG is ≥140 mg/dL (7.8 mmol/L), the client requires a 2- or 3-hour glucose tolerance test (GTT) to diagnose GDM. (Options 2 and 3) For the 1-hour GCT, the nurse draws one blood sample an hour after ingestion of a 50-g glucose solution (eg, glucola). In contrast, a 2- or 3-hour GTT requires the nurse to obtain fasting and hourly blood samples. (Option 4) The 1-hour GCT is a screening test only.

The nurse is participating in an obstetrical emergency simulation in which a client is hemorrhaging after birth due to uterine inversion. When describing interventions, which statement by the nurse indicates a need for further education? 1. "I will administer a rapid infusion of IV oxytocin before the inverted uterus is corrected." 2. "I will establish a second IV line with an 18-gauge catheter." 3. "I will initiate serial blood pressure monitoring every 3-5 minutes." 4. "I will notify anesthesia and operating room staff of the client's condition immediately."

1. Uterine inversion is a rare, obstetrical emergency that occurs after birth when the uterine fundus collapses (partially or completely) into the uterine cavity, causing sudden hemorrhage, severe pelvic pain, and hypovolemic shock. Successful manual replacement of the inverted uterus through the vaginal canal by the health care provider (HCP) is the first step in resolving the inversion and requires a soft, uncontracted uterus. Tocolytics (eg, terbutaline) or inhaled anesthetics may be needed to assist with uterine relaxation. Uterotonic medications (eg, oxytocin, carboprost) must be delayed or discontinued until after the HCP has corrected the inversion (ie, manual uterine replacement) (Option 1). After uterine replacement, uterotonics are administered to reinforce its location in the pelvis and control further bleeding. (Option 2) Initiating a second, large-bore (eg, 18-gauge) IV line is an important intervention that allows for adequate volume resuscitation (eg, fluids, blood products) as needed for hemorrhage. (Option 3) Serial blood pressure monitoring (eg, every 3-5 min) helps the nurse assess for worsening hypovolemic shock. (Option 4) If manual uterine replacement through the vagina is unsuccessful, emergency laparotomy (ie, replacement via abdominal incision) may be necessary; it is appropriate to notify surgical staff members who will be involved.

A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not had prenatal care. Which topics are most important and priorities for the nurse to discuss with the client in anticipation of referral for prenatal care? Select all that apply. 1. Adoption planning 2. Family and social support 3. Future education plans 4. Nutrition and prenatal vitamins 5. Sexual abuse

2,4,5 The nurse should ascertain potential risks to the client and her baby due to teenage pregnancy. Lack of family/social support or fear of social discrimination may prevent the client from obtaining prenatal care (Option 2). Poverty, dangerous living conditions, and exposure to teratogens (eg, tobacco, alcohol, illicit drugs) may place the client at risk for complications. Adolescents are at risk for poor nutritional status and poor pregnancy weight gain, which can have deleterious effects on the baby (eg, small for gestational age, low birth weight) (Option 4). They are also less likely to take prenatal vitamins with folic acid. Adolescents who are pregnant should be evaluated for sexual abuse; girls age 11-14 do not usually seek sexual relationships, and the pregnancy may be evidence of abuse (Option 5). (Option 1) Adoption planning is not necessary at this first assessment, although the topic may be addressed later in collaboration with a social worker. (Option 3) The younger adolescent (age <16) is emotionally and developmentally immature and may be resistant to planning for the future. Education planning may be approached at subsequent encounters, but it is not a priority for the client and the baby's health at this time

The nurse is performing a postpartum assessment 12 hours after the prolonged vaginal delivery of a term infant. Which assessment findings should be reported to the health care provider? 1. Complaints of discomfort during fundal palpation [6%] 2. Foul-smelling lochia [56%] 3. Oral temperature 100.1 F (37.8 C) [3%] 4. White blood cell (WBC) count 24,000/mm3 (24.0 x 109/L) [33%]

2. A foul odor of lochia suggests endometrial infection. This client has an increased risk of infection due to her prolonged labor, which involved multiple cervical examinations. The odor of lochia is usually described as "fleshy" or "musty." A foul smell warrants further evaluation. Other signs of endometrial infection are maternal fever, tachycardia, and uterine pain/tenderness. (Option 1) Palpation of the postpartum uterine fundus is commonly uncomfortable for the client. If the client complains of increasing pain, further evaluation is needed. (Option 3) Major signs and symptoms of endometrial infection include temperature above 100.4 F (38.0 C); chills; malaise; excessive uterine tenderness; and purulent, foul-smelling lochia. During the first 24 hours postpartum, the temperature is normally elevated; temperature above 100.4 F (38 C) requires further evaluation. (Option 4) The WBC count is normally elevated during the first 24 hours postpartum (up to 30,000/mm3 [30.0 x 109/L]). Leukocyte levels that are not decreasing require further evaluation.

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which statement by the client indicates an appropriate understanding about weight gain? The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain during pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which statement by the client indicates an appropriate understanding about weight gain? 1. "I should gain 10-15 lb (4.5-6.8 kg) during the first trimester." [14%] 2. "I should gain a total of about 30 lb (13.6 kg) during my pregnancy." [65%] 3. "I should gain no more than 0.5 lb (0.2 kg) per week during the third trimester." [17%] 4. "If I gain <20 lb (9.1 kg) during pregnancy, it will be easier to lose weight postpartum." [2%]

2. Appropriate weight gain during pregnancy decreases risks to the client and fetus. Expected weight gain is determined by prepregnancy BMI. Underweight clients need to gain more weight (1 lb [0.5 kg] per week) during the second and third trimesters of pregnancy than obese clients (0.5 lb [0.2 kg] per week). However, weight gain in the first trimester should be 1.1-4.4 lb (0.5-2.0 kg), regardless of BMI. With a prepregnancy BMI of 21 kg/m2, this client has an appropriate weight and should gain 25-35 lb (11.3-15.9 kg) over the course of the pregnancy (Option 2). (Option 1) Weight gain during the first trimester should be approximately 1.1-4.4 lb (0.5-2.0 kg). A 10 lb (4.5 kg) weight gain during the first three months of pregnancy would be excessive for any client. (Option 3) A client of appropriate weight should gain approximately 1 lb (0.5 kg) per week during the second and third trimesters of pregnancy. A weight gain of only 0.5 lb (0.2 kg) per week is recommended for obese clients. (Option 4) A weight gain of <20 lb (9.1 kg) during pregnancy is inadequate for a client of appropriate weight. Restricting weight gain increases the fetus' risk for low birth weight (<5.5 lb [2500 g]) and preterm birth.

The nurse is assessing a client at 36 weeks gestation during a routine prenatal visit. Which statement by the client should the nurse investigate first? 1. "I am not sleeping as well due to cramps in my calves at night." 2. "I have noticed less kicking movements as the baby grows bigger." 3. "Over the last few weeks, I have not been able to wear any of my shoes." 4. "Sometimes I feel short of breath after walking up a flight of stairs."

2. Fetal movement is a sign of fetal health and indicates an intact fetal central nervous system. Fetal movement may occur numerous times per hour during the last trimester of pregnancy, although the client may not perceive every movement. Multiple factors (eg, maternal substance abuse, medications, fasting, fetal sleep) can affect fetal movement. However, fetal movements should not decrease as the fetus increases in size. Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired oxygenation), which may precede fetal death (Option 2). The nurse prioritizes assessment of client reports of decreased fetal movement to evaluate fetal well-being (eg, nonstress test). (Option 1) Leg cramps commonly occur in the third trimester, especially at night, due to the weight of the gravid uterus applying pressure to nerves affecting calf muscles. Home interventions include stretching legs, massaging calves, and increasing fluid intake. (Option 3) Dependent edema in the lower extremities is common in the third trimester due to decreased venous return (gravid uterus pressure on vena cava), especially with prolonged sitting/standing. This is not a priority over decreased fetal movement. (Option 4) As the uterus rises in the third trimester, the diaphragm is prevented from allowing full lung expansion, causing dyspnea, especially with exertion.

The precepting nurse is supervising a new obstetric nurse performing a labor admission assessment on a client with suspected spontaneous rupture of membranes. Which action by the new nurse would cause the precepting nurse to intervene? 1. Documenting a positive nitrazine test result when the test strip turns blue 2. Donning nonsterile gloves and using soluble gel for vaginal examination 3. Palpating the client's abdomen before applying external fetal monitors 4. Providing the client with a variety of clear liquids to drink

2. The nurse should use a sterile glove during vaginal examination in the presence of ruptured membranes to prevent infection. Use of nonsterile gloves and instruments during vaginal examinations increases the risk of infection in the laboring client or fetus (eg, chorioamnionitis). (Option 1) A nitrazine pH test strip inserted into the vagina can differentiate between amniotic fluid, which is alkaline, and vaginal fluid, which is acidic. A blue-green, blue-gray, or deep blue color indicates a positive result and probable rupture of membranes. A yellow, olive-yellow, or olive green color indicates a negative result and suggests that membranes are intact. (Option 3) Leopold maneuvers help determine fetal presentation and involve systematic palpation of the client's abdomen. These maneuvers assist the nurse in locating the fetal back for optimal placement of the ultrasound transducer for external fetal heart monitoring. (Option 4) Hospital policy, provider preference, and the client risk profile will dictate appropriate oral intake during labor. However, there is no evidence to support NPO status of low-risk laboring clients, and most clients benefit from hydration provided by oral clear liquids during labor. Educational objective: Vaginal examinations of the laboring client with ruptured membranes should be performed using a sterile glove to decrease the risk of infection (eg, chorioamnionitis) to the client and fetus. Other labor admission interventions include application of external fetal monitoring and performance of a nitrazine pH test to determine if membranes have ruptured.

The nurse reviews the external fetal monitoring tracing of a client receiving an oxytocin infusion for augmentation of labor. The obstetric provider asks to increase the infusion rate. Which action by the nurse is most appropriate at this time? Click on the exhibit button for additional information. 1. Increase the rate of oxytocin infusion as requested by the provider 2. Inform the provider that the oxytocin rate should not be increased at this time 3. Request that the charge nurse speak with the obstetric provider 4. Request to leave the rate unchanged, as the contraction pattern is adequate

2. Uterotonic drugs (eg, oxytocin [Pitocin]) are used to induce or augment labor and to stop postpartum hemorrhage by promoting uterine contractions. Oxytocin must be administered via infusion pump and requires continuous electronic fetal monitoring as it is a high-alert medication. The nurse assesses and documents the fetal heart rate and contraction pattern every 15 minutes during the first stage of labor with oxytocin. Most oxytocin protocols dictate gradual titration to achieve contractions every 2-3 minutes. Tachysystole (ie, ≥5 contractions in 10 minutes) is a potential adverse effect of oxytocin. Excessive uterine contractions can decrease placental blood flow and compromise fetal oxygenation. Treatment of tachysystole may include decreasing or stopping oxytocin infusion and administering IV fluid bolus and/or tocolytic drugs (eg, terbutaline) (Option 2).

umbilical cord compression

variable decelerations

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects? Select all that apply. 1. Black beans and rice 2. Fortified breakfast cereal and milk 3. Medium baked sweet potato 4. Peanut butter on whole wheat toast 5. Raw carrots with cheese dip

1,2,4, Folic acid, or folate, is a water-soluble, B-complex vitamin necessary for red blood cell production. Pregnant women and those attempting pregnancy need a minimum of 400 mcg of folic acid per day to decrease the chance of fetal neural tube defects (eg, spina bifida, anencephaly). Most prenatal vitamins contain 400-800 mcg of folic acid; additional folic acid can come from the diet. Leafy green vegetables are the best dietary sources of folic acid. However, other appropriate food choices include cooked beans, rice, fortified cereals, and peanut butter, which provide at least 40 mcg folic acid per serving (Options 1, 2, and 4). (Option 3) Sweet potatoes provide vitamin A, vitamin C, and minerals to the diet but no folic acid. (Option 5) Raw carrots are a dietary source of vitamin A, vitamin C, and minerals, but not of folic acid.

The nurse is performing an assessment on a neonate shortly after delivery. The nurse is most concerned about which assessment finding? 1. Bilateral rales found on lung auscultation [37%] 2. Dullness over bladder found on percussion [4%] 3. Ptosis of right eyelid found on facial inspection [29%] 4. Single testicle found on genital palpation [28%]

3 Eyelids should sit above the pupils symmetrically with irises showing. Ptosis (drooping of the eyelid below the level of the pupil) could indicate paralysis of the oculomotor nerve. This finding warrants further investigation. At the time of birth, there should be no cranial nerve abnormalities. (Option 1) Crackles (rales) indicate fluid in the lungs and are expected immediately after birth. Rales will clear as the neonate transitions to extrauterine life. However, wheezes, stridor, or persistence of crackles after the first few hours of birth are abnormal and should be reported. (Option 2) Percussing dullness in the hypogastric area is a normal finding when the bladder is full. The neonate should void spontaneously within a few hours after birth. (Option 4) An undescended testicle (cryptorchidism) at birth is not concerning. Most undescended testes descend spontaneously by age 6 months.

Prior to hospital discharge, the nurse discusses sexuality after childbirth with a client who had an uncomplicated vaginal birth with no perineal lacerations. Which client statement requires further teaching? 1. "I should avoid resuming sexual intercourse until after my vaginal bleeding has stopped." 2. "I should expect vaginal dryness and use water-soluble lubricants, especially if I'm breastfeeding." 3. "I will begin using condoms to prevent pregnancy once menses returns." 4. "I will try to feed my baby before my partner and I engage in sexual activity."

3. Initiating an open discussion about sexual activity after childbirth allows the nurse to provide anticipatory guidance and recognize individual client concerns (eg, discomfort, fatigue, fear, body image). The nurse should plan to reinforce the use of contraception because many clients resume sexual activity before their postpartum checkup (4-6 weeks after birth), when contraception methods are usually prescribed. Ovulation may occur as early as 4 weeks after birth and before resumption of menses, especially in clients who formula feed. Clients should be encouraged to use a barrier contraceptive such as condoms to prevent pregnancy until another form of birth control can be prescribed (Option 3). (Option 1) Sexual activity may be resumed once lacerations/episiotomy are healed, and vaginal bleeding has stopped. For clients with no birth complications, risk of infection or bleeding is low at ≥2 weeks postpartum. (Option 2) Sexual arousal takes more time for most postpartum clients due to hormonal changes. Lactating clients may especially experience symptoms of estrogen deficiency (eg, vaginal dryness). Vaginal lubrication is recommended to increase comfort. (Option 4) Sexual activity may be inhibited by the couple's sense of responsibility for newborn needs. In addition, sexual arousal may stimulate leakage of breast milk. Feeding the newborn before sexual activity helps alleviate these concerns/distractions.

the nurse is performing an assessment on a 2-day-old infant with suspected Hirschsprung disease. Which findings should the nurse anticipate? Select all that apply. 1. Bright red bleeding from anus 2. Distended abdomen 3. Has not passed stool (meconium) 4. Nonbilious vomiting 5. Refusal to feed

2,3,5 Hirschsprung disease is caused by a lack of specialized nerve cells in portions of the distal large intestine; this renders the internal sphincter unable to relax. Infants with Hirschsprung disease will not pass meconium but will have distended abdomens and bilious emesis. Additional Information Physiological Adaptation NCSBN Client Need

A nurse is teaching the parent how to care for a newly circumcised newborn. Which statement by the parent indicates that further teaching is needed? 1. "Discharge and odor indicate infection of the circumcision site." 2. "I will clean the area with alcohol-based wipes or soap water." 3. "Infant crying during petrolatum gauze changes is expected." 4. "The diaper should be changed at least every 4 hours."

2. Common complications of circumcision include hemorrhage, infection, and voiding difficulty. Parents should clean the area with warm water (without soap) to remove urine and feces and prevent infection. Prepackaged alcohol-based wipes delay healing and cause discomfort; they should be avoided until the circumcision site has healed (usually takes 5-6 days).

The nurse is performing assessments of several clients during routine prenatal visits. Which client should the nurse discuss with the health care provider first? 1. Client at 30 weeks gestation with darkened patches of skin on the face 2. Client at 32 weeks gestation with painless, flesh-colored bumps on the perianal area 3. Client at 34 weeks gestation with intense itching on the hands and feet that worsens at night but no rash 4. Client at 38 weeks gestation with stretch marks on the abdomen that have become reddened and pruritic

3 Intrahepatic cholestasis of pregnancy is a liver disorder exclusive to pregnancy that manifests with intense, generalized itching but no rash. Itching often involves the hands and feet and worsens at night. This condition increases the risk of intrauterine fetal demise and requires priority assessment by the health care provider (Option 3). Management includes laboratory testing (eg, elevated bile acids), fetal surveillance (eg, biophysical profile, nonstress test), medication (ie, ursodeoxycholic acid), and labor induction around 37 weeks gestation. Intrahepatic cholestasis of pregnancy begins to resolve after birth. (Option 1) Chloasma (ie, melasma, mask of pregnancy) is a hormonally stimulated increase in pigmentation over the bridge of the nose and cheeks that usually appears in the second trimester; it is benign and fades postpartum. (Option 2) Fleshy, nontender bumps on genital/anal areas are characteristic of condylomata acuminata (ie, anogenital warts) caused by human papillomavirus. Treatments (eg, trichloroacetic acid) are available for removal of warts in pregnancy, but it is not a priority. (Option 4) Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a dermatologic complication that causes discomfort but is not harmful to the client. Pruritic, raised lesions form within abdominal striae, spare the umbilicus, and may spread to the thighs, arms, legs, and back.

The graduate nurse (GN) receives report on a postpartum client with an Rh-negative blood type. Which statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide further teaching? 1. "Additional doses of Rh immune globulin may be required if excessive fetomaternal hemorrhage is suspected." 2. "I should administer Rh immune globulin to the client within 72 hours after birth." 3. "If the maternal antibody screen is negative, I will hold Rh immune globulin and contact the health care provider." 4. "Rh immune globulin is not required if the newborn's blood type is Rh negative."

3. Rh alloimmunization (ie, isoimmunization) occurs when a pregnant client with an Rh-negative blood type is exposed to Rh-positive fetal RBCs during pregnancy and birth. After exposure, the maternal immune system produces antibodies to the Rh antigen that can cause serious complications for an Rh-positive fetus during future pregnancies (eg, hemolytic anemia). Rh immune globulin (RhoGAM) prevents antibody formation by suppressing the maternal immune response and is effective only if the client has never developed antibodies to the Rh antigen (ie, Rh sensitization). The nurse should verify that the client is not Rh sensitized by checking for a negative antibody screen (eg, indirect Coombs test) and then proceeding with administration of Rh immune globulin (Option 3). A positive maternal antibody screen would require further clarification from the health care provider (HCP). (Option 1) If the HCP suspects excessive fetomaternal hemorrhage, a Kleihauer-Betke stain is performed to quantify the fetal RBCs in maternal circulation. Depending on the quantity of fetal RBCs, >1 dose of Rh immune globulin may be required. (Option 2) Rh immune globulin should be administered within 72 hours of birth to ensure effectiveness. (Option 4) If the newborn is Rh negative, Rh immune globulin is not necessary postpartum.

A pregnant client in the first trimester tells the clinic nurse she will be traveling to an area with a known Zika virus outbreak and expresses concern regarding disease transmission. Which statement by the nurse is most appropriate? 1. "If you experience Zika symptoms, notify your health care provider." [1%] 2. "Take precautions against mosquito bites throughout the trip." [33%] 3. "You are not far enough along for the Zika virus to affect your baby." [0%] 4. "You should consider postponing your trip until after you have the baby." [64%]

4. Zika virus is transmitted via mosquitoes, sexual contact, and infected bodily fluids. Zika causes viral symptoms (eg, low-grade fever, arthralgias) and has been shown to cause microcephaly, developmental dysfunction, and encephalitis in babies born to Zika-infected women. Women who are attempting to conceive and those who are pregnant are encouraged to avoid travel to areas affected by Zika until after birth (Option 4). For clients currently living in a Zika-affected area, proper mosquito precautions (eg, insect repellant containing DEET) and safe sex practices (eg, barrier methods) should be utilized, and routine Zika testing may be provided. (Option 1) Although this statement is true, it does not provide education on avoiding Zika infection. Waiting until symptoms are present does not address preventing fetal exposure and possible birth defects. (Option 2) Current guidelines recommend that pregnant women avoid travel to Zika-affected areas completely. In addition, mosquitoes are not the only mode of tra