4040 Exam 3 Practice Questions

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Which disorders fall into the category of collagen vascular disease? (Select all that apply.)

b c d e

When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?

Dyspnea, crackles, and an irregular, weak pulse

Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole?

Fundal height of 18 cm (large uterus with this disorder)

If the nurse suspects a uterine infection in the postpartum client, the nurse should make which priority assessment?

Odor of the lochia

The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades. Causes include the increase in sexually transmitted infections (STIs) accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms? (Select all that apply.) a. Pelvic pain b.Abdominal pain c.Unanticipated heavy bleeding d.Vaginal spotting or light bleeding e.Missed period

a b d e

With regard to dysfunctional labor, nurses should be aware that: a. Women who are underweight are more at risk. b. Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. c. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. Incorrect d. Abnormal labor patterns are most common in older women.

b. Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years.

Which order should the nurse expect for a client admitted with a threatened abortion?

bedrest

A woman arrives for evaluation of signs and symptoms that include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nurse notices an ecchymotic blueness around the woman's umbilicus. What does this finding indicate? a.Normal integumentary changes associated with pregnancy b.Turner sign associated with appendicitis c.Cullen sign associated with a ruptured ectopic pregnancy d.Chadwick sign associated with early pregnancy

c

On the client's third postpartum day, the nurse enters the room and finds the client crying. The client states that she does not know why she is crying and she cannot stop. What is the most appropriate reply by the nurse? A. "There is no need to cry, you have a healthy baby." B. "Are you dissatisfied with your care? I will see that any issues are addressed." C. "Many new mothers have shared with us their same confusion of feelings, would you like to talk about them?" D. "This happens to lots of mothers, and be reassured that it will pass with time."

c

Which statement most accurately describes the HELLP syndrome? a.Mild form of preeclampsia b.Diagnosed by a nurse alert to its symptoms c.Characterized by hemolysis, elevated liver enzymes, and low platelets d.Associated with preterm labor but not perinatal mortality

c

The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication? a.Complete hydatidiform mole b.Missed abortion c.Unruptured ectopic pregnancy d.Abruptio placentae

c Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and measures less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform mole, for a missed abortion, or for abruptio placentae.

A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client? a.Placenta previa b.Abruptio placentae c.Spontaneous abortion d.Cord insertion

c (before 20 weeks)

Which maternal condition always necessitates delivery by cesarean birth?

complete placenta previa

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? a. Fetal heart rate of 116 beats/min b, Cervix dilated 2 cm and 50% effaced c. Score of 8 on the biophysical profile d. One fetal movement noted in 1 hour of assessment by the mother

d

The infant's heat loss immediately at birth is predominantly from: a. radiation. b. conduction. c. convection. d. evaporation.

d (Dry the infant)

Because postpartum depression occurs in 3 to 30% of postpartal women, the prenatal nurse assesses clients for risk factors for postpartum depression during the prenatal period. Which clients would the nurse consider to be at risk for postpartum depression? SELECT ALL THAT APPLY. A. A client who is an unmarried primipara with family support. B. A client who has previously had postpartum blues. C. A client who is a primipara with documented ambivalence about her pregnancy in the first trimester. D. A client who is a primipara with a history of depression and lack of a supportive relationship. E. A client who is primipara living alone and was consistently ambivalent about pregancy.

d e

In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder?

dic

What condition indicates concealed hemorrhage when the client experiences abruptio placentae?

hard, boardlike abdomen Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. Abdominal pain may increase. The client will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height increases.

A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma?

hemabate

In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae?

intense abdominal pain

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?

missed abortion

What is the correct definition of a spontaneous termination of a pregnancy (abortion)?

pregnancy less than 20 weeks

Four babies are in the newborn nursery. The nurse pages the neonatalogist to see the baby who exhibits which of the following? 1. Intracostal retractions. 2. Erythema toxicum. 3. Pseudostrabismus. 4. Vernix caseosa.

1

Which newborn is at higher risk for developing hypoglycemia? (Select all that apply.) a. Post-term newborn b. 38 weeks' gestation newborn c. Small-for-gestational-age newborn d. Large-for-gestational-age newborn e. Term newborn born by cesarean birth

a Post term c SGA d LGA

Which infant has the lowest risk of developing high levels of bilirubin? a. The infant who developed a cephalohematoma b. The infant who was bruised during a difficult birth c. The infant who uses brown fat to maintain temperature d. The infant who is breastfed during the first hour of life

d ANS: D The infant who is fed early will be less likely to retain meconium and resorb bilirubin from the intestines back into the circulation. Cephalohematomas will release bilirubin into the system as the red blood cells die off. Bruising will release more bilirubin into the system. Brown fat is normally used to produce heat in the newborn.

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to:

perform fundal massage

Which condition is a transient, self-limiting mood disorder that affects new mothers after childbirth?

postpartum blues

With regard to systemic analgesics administered during labor, nurses should be aware that:

the effects on the fetus are decreased alertness and delayed sucking

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. A gush of dark red blood comes from her vagina. The nurse concludes that:

the placenta has separated

One of the first symptoms of puerperal infection to assess for in the postpartum woman is:

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

A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? a.Blood pressure (BP) increase to 138/86 mm Hg b.Weight gain of 0.5 kg during the past 2 weeks c.Dipstick value of 3+ for protein in her urine d.Pitting pedal edema at the end of the day

c Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ alerts the nurse that additional testing or assessment should be performed. A 24-hour urine collection is preferred over dipstick testing attributable to accuracy. Generally, hypertension is defined as a BP of 140/90 mm Hg or an increase in systolic pressure of 30 mm Hg or diastolic pressure of 15 mm Hg. Preeclampsia may be demonstrated as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies, as well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

A 42-week-gestation baby, 2400 grams, whose mother had no prenatal care, is ad mitted into the NICU. The neonatalogist orders blood work. Which of the follow ing laboratory findings would the nurse expect to see? 1. Blood glucose 30 mg/dL. 2. Leukocyte count 1000 cells/mm3. 3. Hematocrit 30%. 4. Serum pH 7.8.

1

A baby is in the NICU whose mother was addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? 1. Tightly swaddle the baby. 2. Place the baby prone in the crib. 3. Provide needed stimulation to the baby. 4. Feed the baby half-strength formula.

1

A baby was just born to a mother who had positive vaginal cultures for group B streptococcus. The mother was admitted to the labor room 2 hours before the birth. For which of the following should the nursery nurse closely observe this baby? 1. Hypothermia. 2. Mottling. 3. Omphalocele. 4. Stomatitis.

1

The nurse should suspect puerperal infection when a client exhibits which of the following? 1. Temperature of 100.2ºF. 2. White blood cell count of 14,500 cells/mm3. 3. Diaphoresis during the night. 4. Malodorous lochial discharge.

4

Which statement best describes chronic hypertension?

Chronic hypertension can occur independently of or simultaneously with preeclampsia.

A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? Select all that apply. 1. Hyperphagia. 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry.

1 5

The nurse should expect to observe which behavior in a 3-week multigravid postpartum client with postpartum depression? 1. Feelings of infanticide. 2. Difficulty with breastfeeding latch. 3. Feelings of failure as a mother. 4. Concerns about sibling jealousy.

3

Which neonatal complications are associated with hypertension in the mother?

a.Intrauterine growth restriction (IUGR) and prematurity

A multiparous patient arrives to the labor unit and urgently states, "The baby is coming RIGHT NOW!" The nurse assists the patient into a comfortable position and delivers the infant. To prevent infant heat loss from conduction, what is the priority nursing action? a. Dry the baby off. b. Turn up the temperature in the patient's room. c. Pour warmed water over the baby immediately after birth. d. Place the baby on the patient's abdomen after the cord is cut.

d

A postpartum client develops a temperature during her postpartum course. Which temperature measurement indicates to the nurse the presence of postpartum infection? A. 99.0 F at 12 hours postdelivery that decreases after 18 hours B. 100.2 F at 24 hours postdelivery that decreases the second postpartum day C. 100.4 F at 24 hours postdelivery that remains until the second postpartum day D. 100.6 at 48 hours post delivery that continues into the third postpartum day

d

Which action by the nurse can cause hyperthermia in the newborn? a. Placing a cap on the newborn b. Wrapping the newborn in a warm blanket c. Placing the newborn in a skin to skin position with the mother d. Placing the newborn in the radiant warmer without attaching the skin probe

d

A woman arrives at the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

threatened

When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of gestation)?

12 - 14 weeks

There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? 1. Morphine. 2. Opium. 3. Narcan. 4. Phenobarbital.

3

Which laboratory marker is indicative of DIC? a.Bleeding time of 10 minutes b.Presence of fibrin split products c.Thrombocytopenia d.Hypofibrinogenemia

b

Which outcome is expected in a breast-fed newborn? 1. Voids spontaneously within 12 hours of life. 2. Loses 10% of body weight in the first 5 days. 3. Regains birth weight by the 10th day of life. 4. Awakens spontaneously for all feedings.

3

The neonatalogist has ordered 12.5 micrograms of digoxin po for a neonate in congestive heart failure. The medication is available in the following elixir— 0.05 mg/mL. How many milliliters (mL) should the nurse administer? _____________ mL.

0.25 ml

. The nurse working in the newborn nursery has to draw a heel-stick blood sample before an infant's discharge. What can the nurse do to decrease the pain the infant feels from this procedure? Select all that apply. 1. Wrap the heel in a warm, damp cloth. 2. Use EMLA before doing the stick. 3. Swaddling the infant. 4. Have the infant do non-nutritive sucking. 5. Do the stick while the infant is asleep.

1, 3, 4.

A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive.

1. ABO incompatibility can arise when the mother is type O and the baby is either type A or type B.

A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia.

2

A client is 3-days post-cesarean delivery for eclampsia. The client is receiving hydralazine (Apresoline) 10 mg 4 times a day by mouth. Which of the following findings would indicate that the medication is effective? 1. The client has had no seizures since delivery. 2. The client's blood pressure has dropped from 160/120 to 130/90. 3. The client's postoperative weight has dropped from 154 to 144 lb. 4. The client states that her headache is gone.

2

The nurse is performing a postpartum assessment on a client who delivered 4 hours ago. The nurse notes a firm uterus at the umbilicus with heavy lochial flow. Which of the following nursing actions is appropriate? 1. Massage the uterus. 2. Notify the obstetrician. 3. Administer an oxytocic as ordered. 4. Assist the client to the bathroom.

2 The uterus is contracted. Massaging the uterus will not remedy the problem of heavy lochial flow. It is important for the nurse to notify the physician. The client is bleeding more than she should after

While assessing a newborn with respiratory distress, the nurse auscultates a machinelike heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased PaCO2, and decreased PO2. The nurse suspects that the newborn has: 1. Pulmonary hypertension. 2. A PDA. 3. A VSD. 4. Bronchopulmonary dysplasia.

2. PDA

A 2-day-old baby is being readied for discharge but looks jaundiced. This is the mother's first baby. The nurse reviews the baby's birth records and notes that the baby has A+ blood type, and the mother has O+ blood type The nurse should check which blood test?

2. This baby has an ABO blood incompatability, with the mother being O and the baby being A. The total bilirubin is a value that combines the unconjugated and the conjugated bilirubin levels. The newborn would have an increase in the unconjugated bilirubin (lipid-soluble) as a result of the presence of antibodies to the mother's blood type.

A Roman Catholic couple has just delivered a baby with an Apgar of 1 at 1 minute, 2 at 5 minutes, and 2 at 10 minutes. Which of the following interventions is appro priate at this time? 1. Advise the parents that they should pray very hard so that everything turns out well. 2. Ask the parents whether they would like the nurse to baptize the baby. 3. Leave the parents alone to work through their thoughts and feelings. 4. Inform the parents that a priest will listen to their confessions whenever they are ready.

2. This baby's Apgar is very low. There is a chance that the baby will not survive. It is appropriate to ask the parents, since they are known to be Roman Catholic, if they would like their baby baptized.

A 42-week gravida is delivering her baby. A nurse and pediatrician are present at the bith. The amniotic fluid is green and thick. The baby fails to breathe sponta neously. Which of the following actions should the nurse take next? 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Assist with intubation. 4. Place the baby in the prone position.

3

A 6-month-old child developed kernicterus immediately after birth. Which of the following tests should be done to determine whether or not this child has developed any *sequelae* to the illness? 1. Blood urea nitrogen and serum creatinine. 2. Alkaline phosphotase and bilirubin. 3. Hearing and vision assessments. 4. Peak expiratory flow and blood gas assessments

3

breastfeeding woman calls the pediatric nurse with the following complaint: "I woke up this morning with a terrible cold. I don't want my baby to get sick. Which kind of formula should I give the baby until I get better?" Which of the following replies by the nurse is appropriate at this time? 1. "Any formula brand is satisfactory, but it is essential that it be mixed with water that has been boiled for at least 5 minutes." 2. "Don't forget to pump your breasts every 3 hours while you are feeding the baby the prescribed formula." 3. "The best way to keep your baby from getting sick is for you to keep breastfeeding him rather than switching him to formula." 4. "In addition to feeding the baby formula, you should wear a surgical face mask when you are around him."

3

A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? Select all that apply. 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.

3, 4, 5

The nurse is instructing a new breastfeeding mother in the need to provide her premature infant with an adequate source of iron in her diet. Which one of the following statements reflects a need for further education of the new mother? 1. "I will use only breast milk or an iron-fortified formula as a source of milk for my baby until she is at least 12 months old." 2. "My baby will need to have iron supplements introduced when she is 4 months old." 3. "I will need to add iron supplements to my baby's diet when she is 9 months old." 4. "When my baby begins to eat solid foods, I should introduce iron-fortified cereals to her diet."

3. Premature infants have iron stores from the mother that last approximately 2 months, so it is important to introduce an iron supplement by 2 months. Full-term infants have iron stores that l

1. A 1-day-old neonate, 32 weeks' gestation, is in an overhead warmer. The nurse as sesses the morning axillary temperature as 96.9ºF. Which of the following could ex plain this assessment finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.

3. Preterm babies are born with an in sufficient supply of brown adipose tis sue that is needed for thermogenesis, or heat generation.

A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.

4

Which of the following would be the priority intervention for the newborn of a mother positive for hepatitis antigen? 1. The newborn should be given the first dose of hepatitis B vaccine by 2 months of age. 2. The newborn should receive the hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth. 3. The newborn should receive the hepatitis B vaccine and hepatitis B immune globulin within 24 hours of birth. 4. The newborn should receive hepatitis B immune globulin only within 12 hours of birth.

4

baby is grunting in the neonatal nursery. Which of the following actions by the nurse is appropriate? 1. Place a pacifier in the baby's mouth. 2. Check the baby's diaper. 3. Have the mother feed the baby. 4. Assess the respiratory rate.

4

A neonatalogist prescribes Garamycin (gentamicin) for a 2-day-old, septic preterm infant who weighs 1653 grams and is 38 centimeters long. The drug reference states: Neonatal dosage of Garamycin for babies less than 1 week of age is 2.5 mg/kg q 12-24 hours. Calculate the safe daily dosage of this medication. _____________ mg q 24 hours.

4.13 mg q 24 hours

Which of the newborns listed are at high risk for hypoglycemia? (Select all that apply). a. Preterm b. Small-for-gestational age c. Postterm d. Large-for-gestational age e. Average-for-gestational age f. Infants with infections g. Infants with cold stress

A B C D F G

In caring for a pregnant woman with sickle cell anemia, the nurse must be aware of the signs and symptoms of a sickle cell crisis. What do these include? (Select all that apply.) a. Fever b. Endometritis c. Abdominal pain d. Joint pain e. Urinary tract infection (UTI)

A C D

Which intervention is most important when planning care for a client with severe gestational hypertension?

Induction of labor is likely, as near term as possible. By 34 weeks of gestation, the risk of continuing the pregnancy may be considered greater than the risks of a preterm birth.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features:

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

In which situations would the use of Methergine or prostaglandin be contraindicated even if the patient was experiencing a postpartum significant bleed?

Patient's blood pressure postpartum is 180/90. Correct Patient has a history of asthma. Correct Patient has a mitral valve prolapse. Correct.

Medications used to manage postpartum hemorrhage (PPH) include (Select all that apply):

Pitocin. Methergine. Hemabate

A nurse is monitoring a patient's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern?

Positive clonus response elicited unilaterally Positive clonus response elicited unilaterally is a cause for concern as it suggests a hyperactive response.

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:

Urinary output of at least 30 ml/hr

A client delivered a 9 pound, 10 ounce infant assisted by forceps. When the nurse performs the second 15-minute assessment, the client reports increasing perineal pain and a lot of pressure. What action should the nurse take? A. Apply ice to the client's perineum, reassuring the client that this is normal. B. Call for assistance from another nurse. C. Assess the fundus for firmness. D. Check the perineum for a hematoma.

a

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: a. Uterine contractions occurring every 8 to 10 minutes. b. A fetal heart rate (FHR) of 180 with absence of variability. c. The client needing to void. d. Rupture of the client's amniotic membranes.

b

The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern? a.Sleepy, sedated affect b.Respiratory rate of 10 breaths per minute c.DTRs of 2 d.Absent ankle clonus

b

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1, is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, which diagnostic procedure will the client most likely have performed? a.Amniocentesis for fetal lung maturity b.Transvaginal ultrasound for placental location c.Contraction stress test (CST) d.Internal fetal monitoring

b (looking for placenta previa)

The birth of a baby, weight 4500 grams, was complicated by shoulder dystocia. Which of the following neonatal complications should the nursery nurse observe for? 1. Leg deformities. 2. Brachial palsy. 3. Fractured radius. 4. Buccal abrasions.

2

A jaundice neonate must have a heel stick to assess bilirubin levels. Which of the following actions should the nurse make during the procedure? 1. Cover the foot with an iced wrap for one minute prior to the procedure. 2. Avoid puncturing the lateral heel to prevent damaging sensitive structures. 3. Blot the site with a dry gauze after rubbing it with an alcohol swab. 4. Grasp the calf of the baby during the procedure to prevent injury.

3

A neonate has intrauterine growth restriction secondary to placental insufficiency. Which of the following signs/symptoms should the nurse expect to observe at delivery? 1. Thrombocytopenia. 2. Neutropenia. 3. Polycythemia. 4. Hyperglycemia.

3

A nurse has administered Methergine (methylergonovine) 0.2 mg po to a grand multipara who delivered vaginally 30 minutes earlier. Which of the following outcomes indicates that the medication is effective? 1. Blood pressure 120/80. 2. Pulse rate 80 bpm and regular. 3. Fundus firm at umbilicus. 4. Increase in prothrombin time.

3

A woman has just had a low forceps delivery. For which of the following should the nurse assess the woman during the immediate postpartum period? 1. Infection. 2. Bloody urine. 3. Heavy lochia. 4. Rectal abrasions.

3

Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Postdates neonate. 4. Down syndrome neonate.

3

Which of the following would lead the nurse to suspect cold stress syndrome in a newborn with a temperature of 96.5ºF? 1. Blood glucose of 50 mg/dL. 2. Acrocyanosis. 3. Tachypnea. 4. Oxygen saturation of 96%

3

The nurse is caring for a newborn male with hypospadias. His parents ask if circumcision is an option. Which is the nurse's best response? 1. "Circumcision is a fading practice and is now contraindicated in most children." 2. "Circumcision in children with hypospadias is recommended because it helps prevent infection." 3. "Circumcision is an option, but it cannot be done at this time." 4. "Circumcision can never be performed in a child with hypospadias."

3. "Circumcision is an option, but it cannot be done at this time."

A newborn admitted to the nursery has a positive direct Coombs' test. Which of the following is an appropriate action by the nurse? 1. Monitor the baby for jitters. 2. Assess the blood glucose level. 3. Assess the rectal temperature. 4. Monitor the baby for jaundice.

4

Which woman is at greatest risk for early postpartum hemorrhage (PPH)?

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

A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill, high-pitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? 1. Urine drug toxicology test. 2. Biophysical profile test. 3. Chest and abdominal ultrasound evaluations. 4. Oxygen saturation and blood gas assessments.

1

Which intervention should the nurse implement for a newborn diagnosed with galactosemia? 1. Eliminate all milk and lactose-containing foods. 2. Encourage breastfeeding as long as possible. 3. Encourage lactose-containing formulas. 4. Avoid feeding soy-protein formula to the newborn.

1

A baby, admitted to the nursery, was diagnosed with galactosemia from an amnio centesis. Which of the following actions must the nurse take? 1. Feed the baby a specialty formula. 2. Monitor the baby for central cyanosis. 3. Do hemoccult testing on every stool. 4. Monitor baby for signs of abdominal pain.

1. Galactosemia is one of the few dis eases that is a contraindication for the intake of breast milk or any milk based formula.

A newborn nursery nurse notes that a baby's body is jaundiced at 36 hours of life. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.

2

A nurse makes the following observations when admitting a full-term, breastfeeding baby into the neonatal nursery: 9 lbs 2 oz, 21 inches long, TPR: 96.6ºF, 158, 62, jittery, pink body with bluish hands and feet, crying. Which of the following actions should the nurse perform first? 1. Swaddle the baby to provide warmth. 2. Assess the glucose level of the baby. 3. Take the baby to the mother for feeding. 4. Administer the neonatal medications.

2

During a health maintenance visit at the pediatrician's office, the nurse notes that a breastfeeding baby has thrush. Which of the following actions should the nurse take? 1. Nothing because thrush is a benign problem. 2. Advise the mother to bottlefeed until the thrush is cured. 3. Obtain an order for antifungals for both mother and baby. 4. Assess for other evidence of immunosuppression.

3

The nurse is caring for a couple who are in the labor/delivery room immediately after the delivery of a dead baby with visible defects. Which of the following actions by the nurse is appropriate? 1. Discourage the parents from naming the baby. 2. Advise the parents that the baby's defects would be too upsetting for them to see. 3. Transport the baby to the morgue as soon as possible. 4. Give the parents a lock of the baby's hair and a copy of the footprint sheet.

4

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage? (Select all that apply.) a.Chromosomal abnormalities b.Infections c.Endocrine imbalance d.Systemic disorders e.Varicella

A C D E nfections are not a common cause of early miscarriage. At least 50% of pregnancy losses result from chromosomal abnormalities. Endocrine imbalances such as hypothyroidism or diabetes are also possible causes for early pregnancy loss. Other systemic disorders that may contribute to pregnancy loss include lupus and genetic conditions. Although infections are not a common cause of early miscarriage, varicella infection in the first trimester has been associated with pregnancy loss.

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? a.Eclampsia b.Disseminated intravascular coagulation (DIC) syndrome c.Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome d.Idiopathic thrombocytopenia

ANS: C

The nurse is explaining the risk of hypothermia in the newborn to a group of nursing students. Which should the nurse include as an explanation of hypothermia in the newborn? a. Newborns shiver to generate heat. b. Newborns have decreased oxygen demands. c. Newborns have increased glucose demands. d. Newborns have a decreased metabolic rate.

ANS: C In hypothermia, the basal metabolic rate (BMR) is increased in an attempt to compensate, thus requiring more glucose. Shivering is not an effective method of heat production for newborns. Oxygen demands increase with hypothermia. The metabolic rate increases with hypothermia.

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?

Assess the fundus for firmness

Which of the following factors lead to the production of excessive amounts of bilirubin during the first week of life? (Select all that apply). a. Longer red blood cell life b. Liver immaturity c. Sterile intestines d. Trauma during birth

B C D

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication?

Hydralazine is an antihypertensive medication commonly used to treat hypertension in severe preeclampsia. Typically, it is administered for a systolic BP higher than 160 mm Hg or a diastolic BP higher than 110 mm Hg.

By 34 weeks of gestation, the risk of continuing the pregnancy may be considered greater than the risks of a preterm birth.

Prevent convulsions

A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman's stools are dark (greenish-black). What should the nurse's initial action be?

Recognize the finding as a normal result of iron therapy.

Which factors would lead to an increased likelihood of uterine rupture?

Short interval between pregnancies Correct Patient receiving a trial of labor (TOL) following a VBAC delivery Correct Patient who had a primary caesarean section with a classic incision

When doing a newborn assessment on a 2-day-old infant, the nurse notices facial jaundice. The bilirubin level was assessed and found to be 6 mg/dL. The nurse understands that this jaundice will be classified as: a. Physiologic jaundice. b. Pathologic jaundice. c. Breastfeeding jaundice. d. True breast mild jaundice.

a With physiologic jaundice, the jaundice is not present during the first 24 hours of life. It appears on the second or third day and is considered a normal phenomenon. When jaundice is noted in the face only, the jaundice level can be estimated to be from 5 to 7 mg/dL.

The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, "Why is this taking so long?" What is the nurse's most appropriate response?

a."The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate? a.Eclamptic seizure b.Rupture of the uterus c.Placenta previa d.Abruptio placentae

d

The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client? a.Absence of uterine bleeding in the postpartum period b.Fundus firm below the level of the umbilicus c.Scant lochia flow d.Boggy uterus with heavy lochia flow

d High serum levels of magnesium can cause a relaxation of smooth muscle such as the uterus. Because of this tocolytic effect, the client will most likely have a boggy uterus with increased amounts of bleeding. All women experience uterine bleeding in the postpartum period, especially those who have received magnesium therapy. Rather than scant lochial flow, however, this client will most likely have a heavy flow attributable to the relaxation of the uterine wall caused by magnesium administration.

If a nurse desires to promote infant-parent attachment, the best time to have the parents spend time with the infant is when the infant is going through which stage? a. Period of sleep b. Second period of reactivity c. Quiet sleep state d. Active sleep state

B During the second period of reactivity, the infant is alert and interested in feeding. It is a good time for the parents to get to know the infant. During the period of sleep, the quiet sleep state, and active sleep state, the infant is asleep and will not interact with the parents.

Transitional periods for neonates

First Period of Reactivity *From birth to 30 minutes* Alert and active; VS unstable; resp estab Sleep/ Inactive Period Next 60-100 minutes Sleepy and /or decreased activity Second Period of Reactivity 4-8 hours after birth Again alert & active; tachy, tone, mucous (best time for bonding)

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include? a.Dilation and curettage (D&C) b.Dilation and evacuation (D&E) c.Misoprostol (cytotec) d.Ergot products

C Outpatient management of a first-trimester loss is safely accomplished by the intravaginal use of misoprostol for up to 2 days. If the bleeding is uncontrollable, vital signs are unstable, or signs of infection are present, then a surgical evacuation should be performed. D&C is a surgical procedure that requires dilation of the cervix and scraping of the uterine walls to remove the contents of pregnancy. This procedure is commonly performed to treat inevitable or incomplete abortion and should be performed in a hospital. D&E is usually performed after 16 weeks of pregnancy. The cervix is widely dilated, followed by removal of the contents of the uterus. Ergot products such as Methergine or Hemabate may be administered for excessive bleeding after miscarriage.

A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse? a."If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." b."The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, then it would make the diagnosis of this cancer more difficult." c."If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, not getting pregnant at this time is best." d."Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy."

b

A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching? a.Any vaginal discharge should be immediately reported to her health care provider. b.The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported. c.The client will need to make arrangements for care at home, because her activity level will be restricted. d.The client will be scheduled for a cesarean birth.

b

A mother, G4P4004, is 15 minutes postpartum. Her baby weighed 4595 grams at birth. For which of the following complications should the nurse monitor this client? 1. Seizures. 2. Hemorrhage. 3. Infection. 4. Thrombosis.

2

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is: a. seen at 3 days of age. b. the residue of a milk curd. c. passed in the first 24 hours of life. d. lighter in color and looser in consistency.

c

A new mother expresses concern that her 18-hour-old son has only voided once since birth. The nurse's best response is: a. "We are aware of that and have notified the pediatrician." b. "How is he eating?" c. "Newborns don't void frequently for the first 2 days, but by the fourth day it will be about six times a day." d. "This may be a concern, so we will continue to monitor his voidings for the next 12 hours."

c

The nurse assesses a newborn as follows: heart rate: 70 respirations: weak and irregular tone: flaccid color: pale baby grimaces when a pediatrician attempts to insert an endotracheal tube What should the nurse calculate the baby's Apgar score to be? ____________

3

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:

uterine atony

A client, 38 weeks' gestation, is being induced with IV oxytocin (Pitocin) for hypertension and oligohydramnios. She is contracting q 3 min × 60 to 90 seconds. She suddenly complains of abdominal pain accompanied by significant fetal heart bradycardia. Which of the following interventions should the nurse perform first?

1

A nurse massages the atonic uterus of a woman who delivered 1 hour earlier. The nurse identifies the nursing diagnosis: Risk for injury related to uterine atony. Which of the following outcomes indicates that the client's condition has improved? 1. Moderate lochia flow. 2. Decreased pain level. 3. Stable blood pressure. 4. Fundus above the umbilicus.

1

A woman in active labor receives an opioid agonist analgesic. Which medication relieves severe, persistent, or recurrent pain, creates a sense of well-being, overcomes inhibitory factors, and may even relax the cervix but should be used cautiously in women with cardiac disease

Meperidine (Demerol)

Which infant is at greater risk to develop cold stress? a. Full-term infant delivered vaginally without complications b. 36-week infant with an Apgar score of 7 to 9 c. 38-week female infant delivered via cesarean section because of cephalopelvic disproportion d. Term infant delivered vaginally with epidural anesthesia

b

How can nurses prevent evaporative heat loss in the newborn? a. Placing the baby away from the outside wall and the windows b. Keeping the baby out of drafts and away from air conditioners c. Drying the baby after birth and wrapping the baby in a dry blanket d. Warming the stethoscope and nurse's hands before touching the baby

c

Vitamin K is given to the newborn to: a. Reduce bilirubin levels. b. Increase the production or red blood cells. c. Enhance ability of blood to clot. d. Stimulate the formation of surfactant.

c

With regard to afterbirth pains, nurses should be aware that these pains are: A. Caused by mild, continual contractions for the duration of the postpartum period. B. More common in first-time mothers. C. More noticeable in births in which the uterus was overdistended. D. Alleviated somewhat when the mother breastfeeds.

c

A pregnant teen is to have prenatal genetic testing. She is afraid of needles and wants to know the least invasive way she can get the genetic testing done. The nurse should suggest which testing procedure? 1. Triple marker screen. 2. Ultrasound examination. 3. Amniocentesis. 4. Chorionic villus sampling.

2

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? a. Place the woman in the knee-chest position. b. Cover the cord in a sterile towel saturated with warm normal saline. c. Prepare the woman for a cesarean birth. d. Start oxygen by face mask.

a

During fetal circulation the pressure is greatest in the: a. left atrium. b. right atrium. c. hepatic system. d. pulmonary veins

b

A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform? 1. Cover the baby's eyes with eye pads. 2. Turn the lights on for ten minutes every hour. 3. Clothe the baby in a shirt and diaper only. 4. Tightly swaddle the baby in a baby blanket.

1

A client has just received Hemabate (carboprost) because of uterine atony not controlled by IV oxytocin. For which of the following side effects of the medication will the nurse monitor this patient? 1. Hyperthermia, vomiting, and diarrhea. 2. Hypotension and respiratory collapse. 3. Anasarca and fluid volume overload. 4. Palpitations, anxiety, and insomnia.

1

A neonate that is admitted to the neonatal nursery is noted to have a 2-vessel cord. The nurse notifies the neonatalogist to get an order for which of the following assessments? 1. Renal function tests. 2. Echocardiogram. 3. Glucose tolerance test. 4. Electroencephalogram.

1

During neonatal cardiopulmonary resuscitation, which of the following actions should be performed? 1. Provide assisted ventilation at 40 to 60 breaths per minute. 2. Begin chest compressions when heart rate is 0 to 20 beats per minute. 3. Compress the chest using the three-finger technique. 4. Administer compressions and breaths in a 5 to 1 ratio.

1

Four 38-week-gestation gravidas have just delivered. Which of the babies should be monitored closely by the nurse for respiratory distress? 1. The baby whose mother has diabetes mellitus. 2. The baby whose mother has lung cancer. 3. The baby whose mother has hypothyroidism. 4. The baby whose mother has asthma.

1

Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? 1. The baby whose mother cultured positive for group B strep during her third trimester. 2. The baby whose mother had gestational diabetes. 3. The baby whose mother was hospitalized for 3 months with complete placenta previa. 4. The baby whose mother previously had a stillbirth.

1

Which approach gives the most support to parents grieving over a terminally ill newborn? 1. State "You are both still young and will be able to have more children." 2. Avoid the parents; let them ask you questions. 3. Offer rationalizations for the child's terminal illness. 4. State "You are still feeling all the pain of your child's illness."

1

An 18-hour-old baby is placed under the bili-lights with an elevated bilirubin level. Which of the following is an expected nursing action in these circumstances? 1. Give the baby oral rehydration therapy after all feedings. 2. Rotate the baby from side to back to side to front every two hours. 3. Tightly swaddle in baby blankets to maintain normal temperature. 4. Administer intravenous fluids via pump per doctor orders.

2

The parent of a newborn wants to know what the newborn screening test does. What is the nurse's best response? 1. "Not all states do newborn screening." 2. "All states test for phenylketonuria and hypothyroidism." 3. "Babies are screened at 48 hours of age." 4. "The baby who is taken home within 24 hours is not screened."

2

Select the following situations that could accelerate fetal lung maturation. (Select all that apply). a. Intrauterine growth restriction b. Maternal hypertension c. Prolonged rupture of membranes d. Maternal diabetes e. Maternal administration of steroids

A B C E

A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition? a.Placenta previa b.Vasa previa c.Severe abruptio placentae d.Disseminated intravascular coagulation (DIC)

ANS: B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood vessels thus are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the FHR without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and is considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. This woman did not have any prior risk factors.

Placental adherence problems

Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient's risk for painless vaginal bleeding during the pregnancy and/or delivery process. Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Placenta increta leads to deep penetration of the myometrium.

One reason that preterm infants are at higher risk for cold stress is the fact that they: a. Have a smaller surface area. b. Have a decreased amount of brown fat. c. Cannot nurse as effectively. d. Cannot buffer the acids in the body as well.

b

When caring for a newborn the nurse must be alert for signs of cold stress, which would include which of the following? a. Decreased activity level b. Increased respiratory rate c. Hyperglycemia d. Shivering

b

A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this patient as having:

superimposed preeclampsia Because this patient already has a medical history of hypertension and is now exhibiting hypertension after to the 20th week of gestation, she would be considered to have superimposed preeclampsia. Preeclampsia would be the classification in a patient without a history of hypertension who was hypertensive following the 20th week of pregnancy. Gestational hypertension occurs after the 20th week of pregnancy in a patient who was previously normotensive. Even though the patient has chronic hypertension, the fact that she is now pregnant determines that she would be classified as having superimposed preeclampsia.

The nurse is circulating on a cesarean delivery of a G5P4004. All of the client's previous children were delivered via cesarean section. The physician declares after delivering the placenta that it appears that the client has a placenta accreta. Which of the following maternal complications would be consistent with this diagnosis? 1. Blood loss of 2000 mL. 2. Blood pressure of 160/110. 3. Jaundice skin color. 4. Shortened prothrombin time.

1

A client, who is 2 weeks postpartum, calls her obstetrician's nurse and states that she has had a whitish discharge for 1 week but today she is, "Bleeding and saturating a pad about every 1⁄2 hour." Which of the following is an appropriate response by the nurse? 1. "That is normal. You are starting to menstruate again." 2. "You should stay on complete bed rest until the bleeding subsides." 3. "Pushing during a bowel movement may have loosened your stitches." 4. "The physician should see you. Please come in whenever you are ready."

4

Which statement by the parent of a newborn male diagnosed with galactosemia demonstrates successful teaching? 1. "This is a rare disorder that usually does not affect future children." 2. "Our newborn looks normal; he may not have galactosemia." 3. "Our newborn may need to take penicillin and other medications to prevent infection." 4. "Penicillin and other drugs that contain lactose as fillers need to be avoided."

4

A 42-week-gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.

4 (Meconium aspiration)

Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.) a.Placental abruption b.Placenta previa c.Renal failure d.Cirrhosis e.Maternal and fetal death

a c e