MATERNAL NEWBORN EX 2 PT 2

The nursing staff in a labor and delivery unit has noticed an increase in the number of patients experiencing placental abruption. The nurses begin to review demographics for the patients involved. Which risk factors will the nurses expect? Select all that apply. 1. Hypertensive disorders 2. Uterine fibroids 3. Cigarette smoking 4. Methamphetamine use 5. Abdominal trauma

Hypertensive disorders Uterine fibroids Cigarette smoking Methamphetamine use Abdominal trauma

The nurse is providing care for a patient in the second phase of labor. After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the greatest risk related to the nurse's suspected complication? 1. Neonatal asphyxia related to prolonged labor 2. Fetal injury confirmed by the presence of bruising 3. Greater risk for maternal lacerations 4. Increased consideration for a cesarean delivery

Neonatal asphyxia related to prolonged labor

A patient who is at 30 weeks gestation is involved in a car crash. The nurse recognizes that which initial testing will be used to assess fetal well-being? 1. Ultrasonography 2. Non-stress testing 3. Contraction stress test 4. Fetal movement counting

Non-stress testing

When a patient is diagnosed with preeclampsia, one sign that the fetus is at risk for hypoxia is a change in amniotic fluid called ________________.

OLIGOHYDRAMNIOS

When performing a physical assessment on a patient during the initial prenatal visit, the nurse notes spongy gums prone to bleeding during the oral exam. Which comment by the nurse is appropriate? 1. "Oral bleeding can contribute to anemia." 2. "Dental problems can interfere with nutrition." 3. "Periodontal disease is a risk factor for preterm labor" 4. "You need dental care because pregnancy causes dental problems."

"Oral bleeding can contribute to anemia."

A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety? 1. "Multiple screening tests are ordered for every pregnancy." 2. "It is better to identify problems before birth than afterward." 3. "Screening tests are primarily to identify those without disease or abnormality." 4. "Diagnostic testing is a reason for worry because they indicate fetal problems."

"Screening tests are primarily to identify those without disease or abnormality."

The nurse is performing an NST along with a biophysical profile scoring (BPP) on a patient at 39 weeks gestation. The nurse determines the fetus has a nonreactive NST. The fetus has trunk or limb movement two times; is noted to be opening and closing hands; has a 45-second breathing episode; and has two 2-cm pockets of amniotic fluid. The nurse should assign a BPP score of _____/10.

6

A patient at 30 weeks gestation is exhibiting signs of preterm labor and delivery. The health care provider (HCP) informs the patient that nothing can be done to disrupt this process. The patient is in distress and states, "Why can't something be done to save my baby?" The nurse understands the HCP's decision is likely based on which finding? 1. Ruptured membranes caused an infection. 2. The patient is unstable due to hemorrhage. 3. Fetal age is incompatible with survival. 4. A fetal heartbeat could not be obtained.

A fetal heartbeat could not be obtained.

The ______________ in conjunction with NST is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia.

AMNIOTIC FLUID INDEX

The nurse is providing care to a patient who is diagnosed with dystocia related to hypertonic uterine dysfunction. Which medical intervention does the nurse implement for this patient? 1. Explain to the family that the patient needs rest before labor continues. 2. Assist the patient to relax by providing back and neck massage. 3. Administer morphine to decrease contractions and promote uterine rest. 4. Discuss how the patient's fear is interfering with the progression of labor.

Administer morphine to decrease contractions and promote uterine rest.

The nurse is providing care for a 45-year-old patient who has just learned she is in the second trimester of pregnancy. The patient thought she was experiencing manifestations of menopause until she recognized fetal movement. Which diagnostic test does the nurse expect to be prescribed for this patient? 1. Amniocentesis 2. Ultrasonography 3. Daily fetal movement count 4. Chorionic villi sampling

Amniocentesis

A patient is scheduled for transvaginal ultrasound testing. Which preparation by the nurse is appropriate? 1. Place the patient supine with a pillow beneath her head. 2. Explain that pain at 4 or less on a 0 to10 scale is expected. 3. Ascertain whether the patient has a latex or banana allergy. 4. Request that the patient's partner leave the testing room.

Ascertain whether the patient has a latex or banana allergy.

A patient is threatening spontaneous abortion at 18 weeks gestation. The patient's two previous pregnancies aborted in the same time frame. The patient states, "They want to sew my cervix shut." The nurse shares the terminology for surgical treatment of incompetent cervix, which is ____________________.

CERCLAGE

Premature rupture of membranes is defined as rupture of the _________________ membranes before the onset of labor but at term.

CHORIOAMNIOTIC

The nurse is providing care to a patient who is at 41 weeks gestation. Which factor about the patient does the nurse consider as an indication of late-term or post-term pregnancy? 1. Fetus is identified as a male 2. Patient's multiparity status 3. Delivered two babies at 38 weeks 4. History of regular menstruation

Fetus is identified as a male

A patient with pregestational diabetes mellitus delivers a neonate who is diagnosed with macrosomia. The nurse is aware that the neonate is at risk for additional long-term conditions related to maternal diabetes mellitus. Which long-term effects may occur? Select all that apply. 1. Shoulder injury related to birth size 2. Development of metabolic syndrome 3. Impaired intellectual development 4. Changes in genetic expression 5. Increased risk for chronic illnesses

Development of metabolic syndrome Impaired intellectual development Changes in genetic expression Increased risk for chronic illnesses

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor? 1. Fear promotes feelings of exhaustion. 2. Mothers cannot enjoy the actual birth. 3. Dystocia is associated with extreme fear. 4. Fear during labor causes postpartum depression.

Dystocia is associated with extreme fear.

A patient in the third trimester of pregnancy is instructed on how to perform daily fetal movement count. The nurse needs to inform the patient what to do if fetal movement is decreased. Which patient actions are appropriately recommended by the nurse? Select all that apply. 1. Eat something. 2. Recount movements the next morning. 3. Arrange for a period of rest. 4. Focus on movement for 1 hour. 5. Exercise or take a walk.

Eat something. Arrange for a period of rest. Focus on movement for 1 hour.

An adolescent patient who is 15 weeks pregnant refuses to have an alpha-fetoprotein test performed because, "I don't like needles." Which initial approach does the nurse take to achieve the testing? 1. Insist that testing will be done with or without her cooperation. 2. Explain the testing is important in detecting serious birth defects. 3. Ask an accompanying parent to help persuade the patient. 4. Notify the health care provider of the patient's refusal.

Explain the testing is important in detecting serious birth defects.

A patient in the second trimester of pregnancy is scheduled for a Doppler flow study because the health care provider (HCP) is concerned about an assessment finding during a routine prenatal visit. Which finding of concern does the nurse suspect? 1. Fetal movement count is less than 8 per hour. 2. Patient shows no weight gain in 2 weeks. 3. Patient exhibits mild lower extremity edema. 4. Fetal growth is below expectation for gestational age.

Fetal growth is below expectation for gestational age.

A patient is in her first trimester of her second pregnancy. The patient's first child was born with a trisomy 21 defect. The patient is requesting testing to determine whether the current fetus has the same defect. Which initial testing does the nurse expect the HCP to prescribe? 1. Fetal ultrasound 2. Magnetic resonance imaging 3. Chorionic villa sampling 4. Amniocentesis

Fetal ultrasound

A patient just learns that her unborn fetus has a life-threatening condition and is not expected to survive long term. Which does the nurse include in a plan of care to meet psychological needs of the patient and her partner? Select all that apply. 1. Provide time for the patient to talk about her feelings. 2. Encourage the patient's partner to be emotionally strong. 3. Facilitate referrals related to the fetal condition. 4. Monitor patient's condition and adjust visitors accordingly. 5. Ascertain if the patient and partner have previous crisis skills.

Provide time for the patient to talk about her feelings. Facilitate referrals related to the fetal condition. Ascertain if the patient and partner have previous crisis skills.

The nurse is aware that some___________ tests, such as multiple marker screening and ultrasound, are offered to all pregnant women.

SCREENING

A patient at 35 weeks gestation arrives at the prenatal clinic in physical distress. Assessment reveals hypotension, thready pulse, shallow respirations, pallor, cold and clammy skin, and anxiety. The nurse does not find evidence of vaginal bleeding but suspects placental abruption. For which reason does the nurse call for emergency transport to the hospital? Select all that apply. 1. The patient has all the symptoms of hypovolemia. 2. The patient reports a recent bout with nausea and vomiting. 3. The absence of blood can indicate a concealed hemorrhage. 4. The patient and fetus are at risk of death from hypovolemic shock. 5. The patient states a sudden onset of severe symptoms

The patient has all the symptoms of hypovolemia. The absence of blood can indicate a concealed hemorrhage. The patient and fetus are at risk of death from hypovolemic shock. The patient states a sudden onset of severe symptoms

______________ stimulation may be effective in eliciting a change in fetal behavior, fetal startle movements, and increased FHR variability.

VIBROACOUSTIC

A patient is scheduled for a contraction stress test (CST) at 36 weeks gestation. The nurse is aware that a successful testing is dependent on which factor? 1. Whether Braxton-Hicks contractions are occurring 2. Whether uterine contractions can be stimulated 3. If the mother is not overly tired or anxious 4. If the fetus is in an awake cycle and active

Whether uterine contractions can be stimulated

A patient who is in the third trimester of pregnancy is informed that she will need a cesarean hysterectomy and bladder reconstruction due to a placenta defect. Which medical condition does the nurse explain to the patient? 1. Placenta accreta 2. Placenta increta 3. Placenta percreta 4. Placenta previa

Placenta percreta

The nurse is providing care for a primip patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next? 1. Rupture of uterine membranes by the nurse 2. Preparation for a cesarean delivery due to signs of fetal distress 3. Augmentation of labor with oxytocin per health care provider's order 4. Medicating the patient with pain medication to promote uterine rest

Augmentation of labor with oxytocin per health care provider's order

The nurse in a prenatal unit is providing care for a patient who experienced PPROM at 32 weeks gestation. Which assessment does the nurse consider unnecessary? 1. Check for cervical dilation 2. Monitor for signs of infection 3. Assess for vaginal bleeding 4. Watch for fetal compromise

Check for cervical dilation

A patient at 36 weeks gestation reports a constant dull backache, regular frequent contractions that are painless, and lower abdominal pressure. Physical examination reveals intact membranes and cervical dilation of 3 cm. Which order by the health care provider is unexpected by the nurse? 1. Administer antenatal steroids 2. Obtain fetal fibronectin levels 3. Beta-adrenergic agonist therapy 4. Monitor blood glucose levels

Obtain fetal fibronectin levels

A patient who is at 20 weeks gestation is being prepared for an MRI after a nonconclusive ultrasound testing for suspected brain abnormality related to possible zika virus exposure. Which nursing actions are appropriate for this patient? Select all that apply. 1. Provide information regarding the test. 2. Allow patient to express feelings about her high-risk pregnancy. 3. Promote open communication with her primary health care providers. 4. Encourage patient to think about resolutions for negative testing. 5. Provide psychological support to the patient and her partner.

Provide information regarding the test. Allow patient to express feelings about her high-risk pregnancy. Promote open communication with her primary health care providers. Provide psychological support to the patient and her partner.

The nurse in a prenatal clinic is assessing a patient who is at 37 weeks gestation for twins. The patient reports increased discomfort and increased lower pelvic pressure. Which action does the nurse take with this patient? 1. After examination, assures the patient of the absence of contractions 2. Explains to the patient that increased discomfort is expected with twins 3. Performs a digital cervical examination to determine if dilation is occurring 4. Sends the patient to the hospital to be checked for possible signs of labor

Sends the patient to the hospital to be checked for possible signs of labor

The nurse is providing care to a postpartum patient after an emergency cesarean due to eclampsia. The patient received spinal anesthesia prior to delivery. Magnesium sulfate is infusing 2 g/hr in 100 mL of IV fluid. Which assessment finding will cause the nurse to administer calcium gluconate to the patient via IV push? 1. Serum magnesium level is 10 mg/dL. 2. Patella reflexes are rated at zero. 3. Respiratory rate is 18 breaths/min. 4. Urinary output remains at 30 mL/hr.

Serum magnesium level is 10 mg/dL.

The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening? 1. This method is quicker than hormonal ripening. 2. The patient has a history of cesarean childbirth. 3. The method may be indicative of fetal demise. 4. This patient is being treated for active herpes.

The method may be indicative of fetal demise.

The nurse is assisting a patient who is pregnant to prepare for an MRI scheduled to assess fetal brain development. Which situation causes the nurse to notify the radiology department personnel? 1. The patient had breakfast before the test. 2. The patient reports having an iodine allergy. 3. The patient expresses concern about pain. 4. The patient has a permanent body piercing.

The patient has a permanent body piercing.

The nurse is assessing a patient who just received confirmation of pregnancy. While collecting information about the patient's medical history, which information alerts the nurse to biophysical risk factors? Select all that apply. 1. The patient is primip who is 38 years of age. 2. The patient smokes two packs of cigarettes weekly. 3. The patient has been a strict vegetarian for 25 years. 4. The patient works as a nuclear medicine technician. 5. The patient is medically treated for rheumatoid arthritis.

The patient has been a strict vegetarian for 25 years. The patient is medically treated for rheumatoid arthritis.

The nurse in a prenatal clinic is reviewing the files of four patients scheduled for visits. Which patient does the nurse identify as having the highest-risk pregnancy? 1. The patient who is 16 years of age just diagnosed with gestational diabetes 2. The patient with preexisting hypertension who is currently pregnant with twins 3. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension 4. The patient who is 28 years of age who delivered a premature neonate 3 years prior

The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension

A patient arrives at labor and delivery for the induction labor for her first child. The patient tells the nurse, "I can't believe how easy this is just to pick a day, sign a paper, and have a baby." Which action does the nurse take before the induction process? 1. Call the health care provider to validate patient understanding. 2. Check the patient's chart for an informed consent. 3. Explain the possible complications of induction to the patient. 4. Report an incidence of probable malpractice by the health care provider.

Call the health care provider to validate patient understanding.

A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (CVAC) screening. The nurse is aware that which patient information will likely disqualify the patient for CVAC? 1. A low transverse uterine scar 2. Cesarean due to pelvic abnormalities 3. First labor needed to be induced 4. Patient asks multiple questions

Cesarean due to pelvic abnormalities

The nurse educator is preparing a presentation on preterm labor (PTL) and birth (PTB). Which information does the nurse recognize as being inaccurate? 1. PTB is the leading cause of neonatal mortality and for antenatal hospitalization. 2. PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks gestation. 3. PTBs result in increased numbers of neonatal and infant deaths and long-term neurological impairment. 4. Average costs for premature/low birthweight infants are more than 10 times as high than for other newborns.

PTL is defined as regular uterine contractions resulting in cervical changes before 40 weeks gestation.

The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug? 1. Hypothalamus stimulation increases circulating oxytocin. 2. Synthetic oxytocin is identical to endogenous oxytocin. 3. The half-life of oxytocin is 1 hour, supporting close monitoring. 4. Action from IV oxytocin administration is less than 1 minute.

Synthetic oxytocin is identical to endogenous oxytocin.

The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met? 1. Extension of the episiotomy is performed. 2. Signs of fetal compromise have resolved. 3. Patient is under full anesthesia status. 4. The "three-pull rule" has been achieved.

The "three-pull rule" has been achieved.

The nurse is reviewing the purpose of a modified BPP for a patient at 38 weeks gestation. The nurse recognizes which determinations can be made through a modified BPP regarding fetal well-being? Select all that apply. 1. The NST is an indicator of short-term fetal well-being. 2. The test is normal if NST is considered to be nonreactive. 3. The test is considered most predictive for perinatal outcomes. 4. The AFI is an indicator of long-term placental function. 5. An AFI of 5 cm is indicative of fetal asphyxia.

The NST is an indicator of short-term fetal well-being. The test is considered most predictive for perinatal outcomes. The AFI is an indicator of long-term placental function. An AFI of 5 cm is indicative of fetal asphyxia.

A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure? 1. Ultrasound indicates the umbilical cord is away from the cervix. 2. The nurse must have certification to perform the procedure. 3. The fetal head is currently engaged in the maternal pelvis. 4. Prior amniotic fluid leakage must be validated before the procedure.

The fetal head is currently engaged in the maternal pelvis.

A patient undergoes chorionic villa sampling to rule out the presence of a genetic disorder. Following the procedure, the patient experiences iatrogenic PPROM. Which explanation does the nurse provide to promote patient understanding? 1. The rupture of the membranes is from a bacterial infection. 2. The membranes ruptured because the test caused fetal death. 3. The premature rupture of the membranes is a known risk to the test. 4. The membranes ruptured due to the presence of a genetic disorder.

The premature rupture of the membranes is a known risk to the test.

An Eastern European Jewish couple had two children who died from Tay-Sachs disease. The couple is currently pregnant and have asked for genetic confirmation about this fetus with the intention of early termination if the fetus tests positively. For which reason does the nurse expect chorionic villa sampling to be prescribed? 1. The test is performed as early as 10 weeks gestation. 2. Risks to the fetus and mother are less than other tests. 3. A positive result allows termination during the test. 4. This is the only testing that is disease specific.

The test is performed as early as 10 weeks gestation.

The nurse is conducting a staff education session about preeclampsia and eclampsia complications. Which statements by the nurse are accurate about HELLP syndrome? Select all that apply. 1. This syndrome destroys red blood cells. 2. This syndrome impacts the amount of platelets. 3. This syndrome decreases a patient's white blood cell (WBC) count. 4. This syndrome decreases a patient's blood urea nitrogen (BUN). 5. This syndrome increases liver enzymes.

This syndrome destroys red blood cells. This syndrome impacts the amount of platelets. This syndrome increases liver enzymes.

A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule? 1. Doppler flow studies 2. Nonstress testing 3. Magnetic resonance imaging 4. Ultrasonography studies

Ultrasonography studies

The nurse is providing pre-amniocentesis teaching for a patient who is at 18 weeks gestation. Which information does the nurse provide? Select all that apply. 1. Positioning on the left side will avoid injury to the fetus. 2. A full bladder will assist in ultrasound visualization. 3. Discomfort will be minimized with a local anesthetic. 4. Avoid lifting heavy objects for a period of 2 weeks. 5. Abdominal cramping and bleeding is normal for 24 hours.

A full bladder will assist in ultrasound visualization. Discomfort will be minimized with a local anesthetic.

The nurse is interviewing a new patient who is in the first trimester of her second pregnancy. The patient shares that her first child was born at 36 weeks gestation. Which information does the patient share that places the patient at risk for a second premature birth? 1. The first labor was induced due to unresponsive management of hypertension. 2. The health care provider induced labor at the patient's request to avoid holiday interruptions. 3. Labor was induced when the fetus moved from a posterior to an anterior position. 4. The premature labor and birth was unexpected and followed a normal pregnancy.

The premature labor and birth was unexpected and followed a normal pregnancy.

The nurse is assessing a patient at 26 weeks gestation. The patient has chronic hypertension and exhibited hypertension and proteinuria prior to 20 weeks gestation. Previous blood pressure (BP) readings have been in the range of 130 to 140/88 to 90 mm Hg. Due to superimposed preeclampsia, for which additional manifestations will the nurse immediately contact the health care provider? Select all that apply. 1. Laboratory report that shows an elevation of liver enzymes 2. Current blood pressure reading of 162/102 mm Hg 3. Evident pulmonary edema noted with auscultation. 4. Subjective report of severe headache and photophobia 5. Lack of response to verbal and tactile stimulation

Current blood pressure reading of 162/102 mm Hg Evident pulmonary edema noted with auscultation. Subjective report of severe headache and photophobia Lack of response to verbal and tactile stimulation