MICA EDGE 3

The nurse is teaching the parents of a preterm infant about necrotizing enterocolitis (NEC). What statement indicates to the nurse that teaching has been successful?

"Breastfeeding will help protect my baby's gut from NEC."

A perinatal nurse is educating a patient with preeclampsia about potential complications during delivery. What important information should the nurse include in the teaching?

"Maternal mortality is the death of a woman from complications of pregnancy and childbirth occurring up to 1 year postpartum."

A G4P4 patient who is 6 hours post-delivery is complaining of severe cramp-like uterine pains. What is a therapeutic nursing response?

"The pains are caused by your uterus contracting and should get better in a few days."

The nurse performs a newborn assessment and finds a heart rate of 180 beats per minute. What data by the nurse is necessary to determine if the heart rate is a sign of distress?

Time of birth

The nurse is assigned four newborns in the nursery. Which newborn should the nurse report to the physician?

2-day-old neonate with irregular respirations at 70 per minute

The labor nurse is preparing oxytocin for the prevention of postpartum hemorrhage (PPH) during the third stage of labor. Which dosage and route for oxytocin is correct for the prevention of PPH?

20 milliunits IV infusion

The nurse places the newborn on the mother skin-to-skin immediately after birth. What is the most appropriate teaching for the mother at this time?

Encourage the mother to initiate breastfeeding and provide support.

A postpartum nurse is caring for multiple patients on the mother-baby unit. Which task can the nurse delegate to the Licensed Practical Nurse (LPN)?

A G2P1 who gave birth yesterday and has moderate lochia rubra

The charge nurse on a mother-baby unit is preparing assignments. Which assignment is most appropriate for the Licensed Practical Nurse (LPN)?

A G3P2 4 hours post-vaginal delivery with a white blood cell count of 28,000/mm

A postpartum nurse is caring for multiple patients on the mother-baby unit. Which patient should the nurse evaluate first?

A G6P5 who gave birth 6 hours ago and reports passing a basketball-sized blood clot

Abrupt discontinuation of intrauterine exposure to various substances, including heroin, nicotine, alcohol, cannabis, opiates, cocaine, and methamphetamines puts the neonate at risk for signs and symptoms of neonatal abstinence syndrome (NAS). The withdrawal of what substance can cause symptoms of NAS to start within 4 hours?

ALCOHOL

A nurse is caring for a patient 2 hours post-vaginal delivery of a term neonate. The patient suddenly complains of heavy bleeding, nausea, and dizziness. Vital signs are BP 85/49, HR 110, RR 18, O2 saturation 90%, temp 98.3 F. Based on these assessment findings, what is the priority nursing intervention?

Administer oxygen per nasal cannula.

The postpartum nurse is preparing to ambulate a patient who received an epidural. What is the priority nursing intervention for this patient?

Assess for decreased nerve sensation.

During routine assessment, a nurse caring for a postpartum patient notes the uterus is shifted to the side. What is the priority nursing action?

Assist the woman to the bathroom.

The nurse is assessing a neonate 1 hour after birth. Which assessment data by the nurse will require further evaluation?

Axillary temperature at 97 oF

A client calls the nurse to her room and states, "The baby is really sleepy and hasn't been feeding well." The nurse notes the infant is jittery. What additional assessment should the nurse perform?

Blood glucose

A postpartum patient has an order for methylergonovine (Methergine). Which assessment finding should alert the nurse to withhold the medication?

Blood pressure 168/96 mmHg

The nurse is caring for a patient who has an order for misoprostol (Cytotec) for postpartum hemorrhage. Which part of the order should the nurse question?

Dose is 50 mcg

After the birth of a newborn, what is the priority nursing action to prevent cold stress?

Dry the neonate thoroughly

A premature neonate with severe hyperbilirubinemia is starting phototherapy. What nursing intervention is the most important?

Eye patches in place while under lights

A postpartum patient has uterine atony after a prolonged labor. The nurse receives an order for carboprost (Hemabate). Which route should the nurse anticipate administering this medication?

IM

A nurse is caring for a patient who gave birth 30 minutes ago. Upon fundal assessment, the nurse notes moderate vaginal bleeding and a boggy uterus that does not respond to fundal massage. What is the priority nursing action?

Increase IV Oxytocin rate.

Four newborns have been admitted to the nursery. Which of the newborns should the nurse assess first?

Newborn with Apgar 8/9, weight 4590 grams

A day shift nurse gives a report to the night shift nurse on four newborns. Which newborn should be assessed first?

Newborn with clear breath sounds and grunting

The nurse is assessing a postpartum patient. Her fundus is firm and midline but she is having a steady stream of vaginal bleeding without clots. What is the appropriate nursing intervention based on these assessment findings?

Notify the provider of a suspected laceration

The telehealth care nurse is checking in with postpartum patients. Which patient should be instructed to come in for evaluation?

Patient who is 14 days post-vaginal birth with return of bright red lochia

The nurse is concerned that a newborn may be suffering from neonatal methamphetamine withdrawal. Which assessment finding is indicative of neonatal methamphetamine withdrawal?

Poor weight gain and excoriated skin

A nurse notes a 4-hour-old neonate gagging and cyanotic around the mouth. What is the priority nursing action for this neonate?

Suction the mouth and nose with a bulb syringe.

During labor, the nurse notes the presence of meconium stained fluid. What does the nurse prepare for at the time of delivery?

Suctioning of the infant's mouth and trachea

The nurse is administering oxygen to a 29-week gestation infant. To decrease the risk of retinopathy of prematurity (ROP), what safety measure does the nurse utilize?

Use an oxygen blender to administer oxygen.