OB Exam 2

The nurse should immediately alert the physician when: Select one: a. the infant's blood glucose level is 45 mg/dL. b. the infant is dusky and turns cyanotic when crying. c. acrocyanosis is present at age 1 hour. d. the infant goes into a deep sleep at age 1 hour.

b. the infant is dusky and turns cyanotic when crying.

A neonate weighing 5 lb 6 oz (2438 g) is born in a cesarean birth and admitted to the newborn nursery. What range of resting respiratory rate should the nurse anticipate? 1 20 to 40 breaths/min 2 30 to 60 breaths/min 3 60 to 80 breaths/min 4 70 to 90 breaths/min

2 30 to 60 breaths/min

A mother is breastfeeding her newborn. She asks when she may switch the baby to a cup. The nurse concludes that the mother understands the teaching about feeding when she says she will start to introduce a cup after the baby reaches what age? 1 3 months 2 6 months 3 12 months 4 16 months

2 6 months

In assisting the breastfeeding mother position the baby, nurses should keep in mind that: Select one: a. while supporting the head, the mother should push gently on the occiput. b. the cradle position usually is preferred by mothers who had a cesarean birth. c. whatever the position used, the infant is "belly to belly" with the mother. d. women with perineal pain and swelling prefer the modified cradle position.

c. whatever the position used, the infant is "belly to belly" with the mother.

What statement by a breast-feeding mother indicates that the nurse's teaching regarding stimulating the let-down reflex has been successful? 1 "I will take a cool shower before each feeding." 2 "I will drink a couple of quarts of fat-free milk a day." 3 "I will wear a snug-fitting breast binder day and night." 4 "I will apply warm packs and massage my breasts before each feeding."

4 "I will apply warm packs and massage my breasts before each feeding."

A client seeking family planning information asks the nurse during which phase of the menstrual cycle an intrauterine device (IUD) should be inserted. Before responding the nurse recalls that the insertion is usually performed when? 1 Between the first and fourth days of the cycle 2 Between the 5th and 11th days 3 Between the 14th and 16th days 4 Between the 25th and 28th days

1 Between the first and fourth days of the cycle An IUD should be inserted during menstruation because the cervical os is slightly dilated at this time; also, there is little chance of the woman's being pregnant.

What should be included in a plan of care to limit the development of hyperbilirubinemia in the breastfed neonate? 1 Encouraging more frequent breastfeeding during the first 2 days 2 Instituting phototherapy for 30 minutes every 6 hours for 3 days 3 Substituting formula feeding for breastfeeding on the second day 4 Supplementing breastfeeding with glucose water during the first day

1 Encouraging more frequent breastfeeding during the first 2 days

A client asks the nurse about the use of an intrauterine device (IUD) for contraception. Which information should the nurse include in the response? Select all that apply. 1 Expulsion of the device 2 Occasional dyspareunia 3 Delay of return to fertility 4 Risk for perforation of the uterus 5 Increased number of vaginal infections

1 Expulsion of the device 2 Occasional dyspareunia 4 Risk for perforation of the uterus The presence of the IUD thread should be verified before coitus, because the device may be expelled during menses; if the IUD has been expelled, pregnancy can occur. Although dyspareunia is not common, if it does occur, it should be reported. Perforation may occur during insertion of the IUD.

Neonates have difficulty maintaining their body temperature; however, their bodies have several mechanisms to help them do so. Which ones should a nurse remember when caring for the newborn? Select all that apply. 1 Flexed fetal position 2 Hepatic insulin stores 3 Brown fat metabolism 4 Peripheral vasoconstriction 5 Parasympathetic nervous system

1 Flexed fetal position 3 Brown fat metabolism 4 Peripheral vasoconstriction

The parent of a newborn asks, "Why do I have to scrub my baby's formula bottles?" Which information regarding the normal newborn should the nurse consider before replying in language that the parent will understand? 1 Gastric acidity is low and does not provide bacteriostatic protection 2 Absence of hydrochloric acid renders the stomach vulnerable to infection 3 Infants are almost completely lacking in immunity and require sterile fluids 4 Escherichia coli, a bacterium that is found in the stomach, does not act on milk

1 Gastric acidity is low and does not provide bacteriostatic protection

Three days after birth, a breast-feeding newborn becomes jaundiced. The parents bring the infant to the clinic, and blood is drawn for an indirect serum bilirubin determination, which reveals a concentration of 12 mg/dL (100 mcmol/L). The nurse explains that the infant has physiologic jaundice. What is the cause of this benign condition? 1 Immature liver function 2 An inability to synthesize bile 3 An increased maternal hemoglobin level 4 A high hemoglobin and low hematocrit level

1 Immature liver function Jaundice occurs because of the expected physiologic breakdown of fetal red blood cells and the inability of the newborn's immature liver to conjugate the resulting bilirubin.

A nurse suspects that a newborn has toxoplasmosis, one of the TORCH infections. How and when may it have been transmitted to the newborn? 1 In utero through the placenta 2 In the postpartum period through breast milk 3 During birth through contact with the maternal vagina 4 After the birth through a blood transfusion given to the mother

1 In utero through the placenta

While reviewing the health history of a newborn with suspected jaundice, the nurse recalls that some risk factors place infants at a higher risk for developing jaundice. Which conditions are risk factors for jaundice? Select all that apply. 1 Infection 2 Female sex 3 Prematurity 4 Breast-feeding 5 Formula feeding 6 Maternal diabetes

1 Infection 3 Prematurity 4 Breast-feeding 6 Maternal diabetes

A client arrives at the fertility clinic for a diagnostic workup and is told by the nurse to prepare for a Papanicolaou (Pap) test. The client states, "I do not want this test. I want to speak to the person in charge." How should the nurse respond to this statement? 1 Inform the primary healthcare provider of the client's request. 2 Encourage the client to comply with clinic procedures. 3 Express some disapproval of the client's lack of cooperation. 4 Remind the client of the importance of early cancer detection.

1 Inform the primary healthcare provider of the client's request.

During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite 5 Long periods of sleep

1 Lethargy 2 Ambivalence 3 Emotional lability Insomnia, rather than long periods of sleep, is also associated with postpartum depression.

One hour postpartum a nurse assesses the amount of vaginal bleeding and determines that a client's uterus has become relaxed and boggy. Which intervention is a priority for the nurse to take in this situation? 1 Massage the uterus until firm. 2 Check the client's blood pressure. 3 Obtain a prescription for oxytocin. 4 Notify the primary healthcare provider immediately.

1 Massage the uterus until firm.

The nurse is caring for the newborn of a mother with diabetes. For which signs of hypoglycemia should the nurse assess the newborn? Select all that apply. 1 Pallor 2 Irritability 3 Hypotonia 4 Ineffective sucking 5 Excessive birth weight

1 Pallor 2 Irritability 3 Hypotonia 4 Ineffective sucking

The nurse is caring for a new mother who has a chlamydial infection. For which complications should the nurse assess the client's neonate? Select all that apply. 1 Pneumonia 2 Preterm birth 3 Microcephaly 4 Conjunctivitis 5 Congenital cataracts

1 Pneumonia 2 Preterm birth 4 Conjunctivitis

A nurse explains to a nursing class that the efficiency of the basal body temperature method of contraception depends on fluctuation of the basal body temperature. Which factor can alter the effectiveness of this method? 1 Stress 2 Length of abstinence 3 Age of those involved 4 Frequency of intercourse

1 Stress

Because preterm infants are at risk for respiratory distress syndrome, immediate nursing intervention is required when a preterm infant exhibits what sign? 1 Supraventricular retractions 2 Tachycardia of 160 beats/min 3 Respirations of 50 to 60 breaths/min 4 Neonatal Infant Pain Scale (NIPS) score of three

1 Supraventricular retractions Supraventricular retractions are a prominent feature of respiratory problems in preterm infants because of their compliant chest walls.

A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What information should the nurse include in the explanation of this procedure? 1 The Pap smear can detect cancer of the cervix. 2 Vaginal bleeding is expected after a Pap smear. 3 Colposcopy will be used to visualize the cervix. 4 Scraping the cervix is the most uncomfortable part.

1 The Pap smear can detect cancer of the cervix.

A client who is visiting the prenatal clinic for the first time has a serology test for toxoplasmosis. What information about the client's activities in the history indicates to the nurse that there is a need for this test? 1 The client cares for a neighbor's cat 2 The client works as a dog trainer 3 The client uses chemical cleaners 4 The client consumes raw vegetables

1 The client cares for a neighbor's cat

A pregnant client is concerned that she may have been infected with human immunodeficiency virus (HIV). Which information should a nurse include when counseling this client regarding HIV testing? Select all that apply. 1 The risks of passing the virus to the fetus 2 What positive or negative test results indicate 3 The risk factors for contracting HIV 4 The need for pregnant women to be tested for HIV 5 The emotional, legal, and medical implications of test results

1 The risks of passing the virus to the fetus 2 What positive or negative test results indicate 5 The emotional, legal, and medical implications of test results

A newborn with acquired herpes simplex virus infection is being discharged. Which facet of development should the nurse instruct the parents to monitor closely? 1 Visual clarity 2 Renal function 3 Long bone growth 4 Responses to sounds

1 Visual clarity

A postpartum client tells the nurse that she wishes to breast-feed. When the nurse brings her newborn to be breast-fed, the client asks whether she may drink a small glass of wine to help her relax. How should the nurse respond? 1 "I think drinking one glass of wine won't be a problem. Go ahead." 2 "You seem a little tense. Tell me how you feel about breast-feeding." 3 "You seem to find it relaxing, but you should try to find another way to relax." 4 "I think drinking one glass of wine is alright, but you had better check with your doctor first."

2 "You seem a little tense. Tell me how you feel about breast-feeding."

While performing a newborn assessment after a vaginal birth, a student nurse observes a swelling on one side of the top of the head that does not cross the suture line. The student nurse has identified what clinical manifestation? 1 A bulging fontanel 2 A cephalhematoma 3 Caput succedaneum 4 Normal molding pattern

2 A cephalhematoma A cephalhematoma is a collection of blood between the skull bone and its periosteum that results from trauma during birth. It resolves spontaneously in 3 to 6 weeks.

During a pelvic examination of a 24-year-old woman, the nurse suspects a vaginal infection because of the presence of a white curdlike vaginal discharge. What other finding supports a fungal vaginal infection? 1 A foul odor 2 An itchy perineum 3 An ischemic cervix 4 A forgotten tampon

2 An itchy perineum An itchy perineum usually occurs with candidiasis, a fungal infection; pruritus is the most common symptom.

A neonate born at 35 weeks' gestation has Apgar scores of 8 and 9. At 4 hours of age the newborn begins to experience respiratory distress, has a below-normal temperature in a warm environment, and has a low blood glucose level. What problem does the nurse suspect? 1 Hypoglycemia 2 Bacterial sepsis 3 Cocaine withdrawal 4 Meconium aspiration

2 Bacterial sepsis Preterm neonates react to infection with respiratory distress and subnormal temperatures. Although hypothermia is one sign of hypoglycemia, the newborn is not exhibiting other signs, such as tremors and lethargy.

A nurse is caring for a preterm neonate with physiologic jaundice who requires phototherapy. What is the physiologic mechanism of this therapy? 1 Stimulates the liver to dispose of the bilirubin 2 Breaks down the bilirubin into a conjugated form 3 Facilitates the excretion of bilirubin by activating vitamin K 4 Dissolves the bilirubin, allowing it to be excreted by the skin

2 Breaks down the bilirubin into a conjugated form Phototherapy changes unconjugated bilirubin in the skin to conjugated bilirubin bound to protein, permitting excretion in the urine and feces.

A nurse practitioner prescribes doxycycline for a sexually active woman with a history of mucopurulent discharge and bleeding associated with cervical dysplasia, dysuria, and dyspareunia. With which sexually transmitted infection are these clinical findings and medication therapy commonly associated? 1 Herpes simplex 2 2 Chlamydial infection 3 Treponema pallidum 4 Neisseria gonorrhoeae

2 Chlamydial infection The signs and symptoms listed and the treatment ordered (doxycycline or azithromycin) indicate that the client has a chlamydial infection.

A client asks the nurse what advantage breast-feeding holds over formula feeding. What major group of substances in human milk are of special importance to the newborn and cannot be reproduced in a bottle formula? 1 Amino acids 2 Gamma globulins 3 Essential electrolytes 4 Complex carbohydrates

2 Gamma globulins

The nurse is reviewing a client's history. Which two predisposing causes of puerperal (postpartum) infection should prompt the nurse to monitor this client closely? 1 Malnutrition and anemia 2 Hemorrhage and trauma during labor 3 Preeclampsia and retention of placental fragments 4 Organisms in the birth canal and trauma during labor

2 Hemorrhage and trauma during labor

When teaching a client about using a diaphragm as a form of contraception, what instructions should the nurse provide about the diaphragm? 1 It may or may not be used with a spermicidal lubricant. 2 It should remain in place for at least 6 hours after intercourse. 3 It must be inserted with the dome facing down to be maximally effective. 4 It often appears puckered but this will not interfere with its effectiveness.

2 It should remain in place for at least 6 hours after intercourse.

A newborn is admitted to the nursery and classified as small for gestational age (SGA). What is the priority nursing intervention for this infant? 1 Testing the infant's stools for occult blood 2 Monitoring the infant's blood glucose level 3 Placing the infant in the Trendelenburg position 4 Comparing the infant's head circumference and chest circumference

2 Monitoring the infant's blood glucose level

The nurse is helping a mother breast-feed her newborn. What is the best indication that the newborn has achieved an effective attachment to the breast? 1 The tongue is securely on top of the nipple. 2 The mouth covers most of the areolar surface. 3 Loud sucking sounds are heard during the 15 minutes spent at each breast. 4 Vigorous suckling occurs for the 5 minutes the infant spends at each breast before falling asleep.

2 The mouth covers most of the areolar surface.

On a 6-week postpartum visit a new mother tells the nurse she wants to feed her baby whole milk after 2 months because she will be returning to work and can no longer breastfeed. The nurse plans to teach the mother that she should switch to formula feeding because whole milk does not meet the infant's nutritional requirements for what? 1 Fat and calcium 2 Vitamin C and iron 3 Thiamine and sodium 4 Protein and carbohydrates

2 Vitamin C and iron

The nurse assures a breast-feeding mother that one way she will know that her infant is getting an adequate supply of breast milk is if the infant gains weight. What behavior does the infant exhibit if an adequate amount of milk is being ingested? 1 Has several firm stools daily 2 Voids six or more times a day 3 Spits out a pacifier when offered 4 Awakens to feed about every 4 hours

2 Voids six or more times a day

A new mother who is learning about infant feedings asks the nurse how anyone who is breast-feeding gets anything done with a baby feeding on demand. What is the best response by the nurse? 1 "Most mothers find that feeding whenever the baby cries works out fine." 2 "Perhaps a schedule would be better because the baby is already accustomed to the hospital routine." 3 "Babies on demand feedings eventually set a schedule, so there should be time for you to do other things." 4 "Most breast-feeding mothers find that their babies do better on demand because the amount of milk ingested varies from feeding to feeding."

3 "Babies on demand feedings eventually set a schedule, so there should be time for you to do other things."

The nurse determines that a young female client who is being treated for a sexually transmitted infection (STI) understands instructions regarding future sexual contacts. Which client statement confirms the nurse's conclusion? 1 "If I have sex, nothing I do will really prevent me from getting another STI." 2 "If I get another STI, I can take any antibiotic, because I'm not allergic to any of them." 3 "I won't have unprotected sex again, and I'll tell my partners to be tested for STIs." 4 "I have to ask my partners if they have an STI, and if they say no I'll know that I can have sex."

3 "I won't have unprotected sex again, and I'll tell my partners to be tested for STIs."

A nurse is teaching a postpartum client the characteristics of lochia and any deviations that should be reported immediately. Which client statement indicates that the teaching was effective? 1 "If I pass any clots, I'll notify the clinic." 2 "I'll call the clinic if my lochia changes from red to pink." 3 "I'll notify the clinic if my lochia starts to smell bad." 4 "If my vaginal discharge continues for 3 weeks, I'll call the clinic."

3 "I'll notify the clinic if my lochia starts to smell bad."

What does a nurse who is assessing a newborn 3 minutes after birth remember is the range of heart rate for a healthy, alert neonate? 1 120 and 180 beats/min 2 130 and 170 beats/min 3 110 and 160 beats/min 4 100 and 130 beats/min

3 110 and 160 beats/min

A nurse is teaching a family planning class about ovulation and conception. The nurse should instruct the class that the ovum is thought to be viable for what period of time after ovulation? 1 1 to 6 hours 2 12 to 18 hours 3 24 to 36 hours 4 48 to 72 hours

3 24 to 36 hours

The nurse is assigned to care for an infant in the newborn nursery who is 24 hours old. During assessment the nurse becomes concerned that the baby is jaundiced. The nurse knows that jaundice first becomes visible in a newborn when serum bilirubin reaches what level? 1 1 to 3 mg/dL (17.1 to 51.3 µmol/L) 2 2 to 4 mg/dL (34.2 to 68.4 µmol/L) 3 5 to 7 mg/dL (85.5 to 119.7 µmol/L) 4 8 to 10 mg/dL (136.8 to 171 µmol/L)

3 5 to 7 mg/dL (85.5 to 119.7 µmol/L) Jaundice in a newborn first becomes visible when the serum bilirubin level reaches 5 to 7 mg/dL (85.5 to 119.7 µmol/L). Jaundice will not be visible at a serum bilirubin level of less than 5 mg/dL (85.5 µmol/L).

Which information in a postpartum client's health history should alert the nurse to monitor the client for signs of infection? 1 Three spontaneous abortions 2 B-negative maternal blood type 3 Blood loss of 850 mL after a vaginal birth 4 Temperature of 99.9° F (37.7° C) during the first postpartum day

3 Blood loss of 850 mL after a vaginal birth Excessive blood loss predisposes the client to infection because of decreased maternal resistance; the expected blood loss is 350 to 500 mL.

A nurse withholds methylergonovine maleate from a postpartum client. What clinical finding supports the withholding of the medication? 1 Urine output of 50 mL/hr 2 Third-degree perineal laceration 3 Blood pressure of 160/90 mm Hg 4 Respiratory rate of 12 breaths/min

3 Blood pressure of 160/90 mm Hg Methylergonovine maleate can cause hypertension and should not be given to a client with an increased blood pressure

The nurse is caring for the newborn of a drug-addicted mother with suspected cytomegalovirus disease. What does the nurse suspect was the cause of the disease? 1 Handling a cat litter box 2 Drinking contaminated water 3 Having sex with many partners 4 Eating inadequately cooked meat

3 Having sex with many partners Cytomegalovirus has been recovered from semen, vaginal secretions, urine, feces, and blood; it is commonly found in clients who have human immunodeficiency virus

The nurse is caring for a preterm neonate who is receiving gastric feedings. Which neonatal clinical finding unique to necrotizing enterocolitis (NEC) leads the nurse to suspect that the neonate is experiencing this complication? 1 Persistent diarrhea 2 Decreased abdominal circumference 3 Increased amount of residual gastric aspirates 4 Small amount of vomitus after each gastric feeding

3 Increased amount of residual gastric aspirates An increasing residual volume from earlier feedings without increasing intake indicates that absorption is decreasing, a sign of NEC

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting human immunodeficiency virus (HIV). Which guidance is most appropriate for the nurse to provide? 1 Ask her partner to withdraw before ejaculating. 2 Make certain their relationship is monogamous. 3 Insist that her partner use a condom when having sex. 4 Seek counseling about various contraceptive methods.

3 Insist that her partner use a condom when having sex.

When obtaining informed consent for sterilization from a developmentally challenged adult client, what must the nurse ensure? 1 That a parent or guardian signs the consent 2 That the client is able to explain what the procedure entails 3 That the client is able to comprehend the outcome of the procedure 4 That a parent or guardian has encouraged the client to make the decision

3 That the client is able to comprehend the outcome of the procedure

The nurse is performing a gestational age assessment using the New Ballard Scale. The infant's total neuromuscular score is 16, and total physical maturity score is 20. According to the graph, at how many weeks' gestation is the newborn?

38 weeks The fetus is at 38 weeks' gestation. Add the total neuromuscular score of 16 to the total physical maturity score of 20 for a total of 36. Look under the score total score column and you will find that the closest number to the total score of 36 is 35. Staying on the same row, move right to the Gestational Age column, where you will find the gestational age of 38 weeks. highest score of 35 = 38 weeks

A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond? 1 "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes." 2 "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred." 3 "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range." 4 "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."

4 "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."

Which statement helps the nurse determine that a woman with genital herpes (HSV-2) understands her self-care in regards to this infection? 1 "When I have a baby, I don't want a cesarean." 2 "I can have sex as soon as the herpes sores have healed." 3 "When I finish the acyclovir prescription I will be cured." 4 "I must be careful when I have sex because herpes is a lifelong problem."

4 "I must be careful when I have sex because herpes is a lifelong problem."

A postpartum client who was receiving an intravenous infusion of oxytocin to stimulate labor asks the nurse why it is not being discontinued now that the baby is born. How should the nurse respond? 1 "The oxytocin promotes the flow of lochia." 2 "The oxytocin eases the discomfort of involution." 3 "The oxytocin enhances the healing of tissue in the uterus." 4 "The contractions prevent excessive bleeding."

4 "The contractions prevent excessive bleeding." Oxytocin intensifies contractions of the uterus and promotes return of the uterus to its prepregnant state. It is sometimes used after delivery to prevent hemorrhage caused by uterine atony. As the uterus contracts, the flow of lochia decreases. Oxytocin tends to worsen, not ease, discomfort; the client may experience pain as the uterus contracts.

A couple interested in family planning asks the nurse about the cervical mucus method of preventing pregnancy. The nurse explains that with this method the couple must avoid intercourse when and a few days after the cervical mucus is what? 1 White and thick 2 Yellow and thin 3 Cloudy and viscid 4 Clear and stretchable

4 Clear and stretchable The cervical mucus is clear and stretchable (spinnbarkeit) at ovulation because of maximal estrogen stimulation.

A nurse is teaching a group of women about the side effects of different types of contraceptives. What common side effect associated with the use of an intrauterine device (IUD) should the nurse discuss during the teaching session? 1 Tubal pregnancy 2 Rupture of the uterus 3 Expulsion of the device 4 Excessive menstrual flow

4 Excessive menstrual flow After IUD insertion there may be excessive menstrual flow for several cycles. Because the IUD is a foreign body, there is an increase in the blood supply, a result of the inflammatory process

A nurse is caring for four postpartum clients, each with a different medical condition. Which condition will result in the primary healthcare provider advising the new mother not to breast-feed? 1 Mastitis 2 Inverted nipples 3 Herpes genitalis 4 Human immunodeficiency virus (HIV)

4 Human immunodeficiency virus (HIV)

A 23-year-old woman comes to the clinic for a Pap smear. After the examination, the client confides that her mother died of endometrial cancer 1 year ago and says that she is afraid that she will die of the same cancer. Which risk factor stated by the client after an education session on risk factors indicates that further teaching is needed? 1 Obesity 2 High-fat diet 3 Hypertension 4 Late-onset menarche

4 Late-onset menarche

The nurse is caring for preterm infants with respiratory distress in the neonatal intensive care unit. What is the priority nursing action? 1 Limiting caloric intake to decrease metabolic rate 2 Maintaining the prone position to prevent aspiration 3 Limiting oxygen concentration to prevent eye damage 4 Maintaining a high-humidity environment to promote gas exchange

4 Maintaining a high-humidity environment to promote gas exchange

A client asks for and receives instruction regarding birth control methods. She elects to use a diaphragm with a spermicide. Which disadvantage of using a diaphragm should be emphasized to the client? 1 Its failure rate is 50% when it is used alone. 2 It is physically uncomfortable when in place. 3 Thrombus formation and pulmonary emboli may occur. 4 Some women find its insertion and removal inconvenient.

4 Some women find its insertion and removal inconvenient.

The nurse is conducting the admission assessment of a client who is positive for group B streptococcus (GBS). Which finding is of most concern to the nurse? 1 Continued bloody show 2 Cervical dilation of 4 cm 3 Contractions every 4 minutes 4 Spontaneous rupture of membranes 3 hours ago

4 Spontaneous rupture of membranes 3 hours ago

The nurse evaluates a new mother who is breastfeeding. The client asks how to care for her nipples. What should the nurse recommend? 1 Putting lanolin cream on the nipples after breastfeeding 2 Applying vitamin E gel to the nipples before breastfeeding 3 Using soap and water to clean the breasts and nipples at least once a day 4 Spreading breast milk on the nipples after the feeding and allowing them to air dry

4 Spreading breast milk on the nipples after the feeding and allowing them to air dry

The nurse is caring for a preterm infant who is receiving oxygen therapy. What should the nurse do to prevent retinopathy of prematurity (ROP)? 1 Cover the neonate's eyes with a shield 2 Place the neonate in an elevated side-lying position 3 Assess the neonate every hour with a pulse oximeter 4 Support the neonate's oxygen saturation while providing minimal FiO2

4 Support the neonate's oxygen saturation while providing minimal FiO2 ROP is a complex disease of the preterm infant; hyperoxemia is one of the numerous causes implicated. Oxygen therapy is maintained at the lowest level necessary to support respiratory status.

How should the nurse screen the newborn of a diabetic mother for hypoglycemia? 1 Testing for glucose tolerance 2 Drawing blood for a serum glucose determination 3 Arranging for a fasting blood glucose determination 4 Testing heel blood with the use of a glucose-oxidase strip

4 Testing heel blood with the use of a glucose-oxidase strip Glucose-oxidase strips are used by nurses to screen infants for hypoglycemia.

The nurse is teaching a group of new mothers regarding the benefits of breastfeeding. Which factor has a significant influence on the availability of milk in the lactating woman and should be included in the teaching? 1 Age of the woman at the time of delivery 2 Distribution of erectile tissue in the nipples 3 Amount of milk products consumed during pregnancy 4 Viewpoint of the woman's family toward breast-feeding

4 Viewpoint of the woman's family toward breast-feeding If the woman perceives that significant others in her life hold a negative view of breast-feeding, she may be tense, and the let-down reflex may not occur; a positive attitude on the part of significant others toward breastfeeding promotes relaxation and the let-down reflex.

A woman arrives at the women's health clinic complaining of frequency and burning pain when voiding. The diagnosis is a urinary tract infection. What is important for the nurse to encourage the client to do? 1 Void every 2 hours. 2 Record fluid intake and urinary output. 3 Pour warm water over the vulva after voiding. 4 Wash the hands thoroughly after urinating and defecating.

4 Wash the hands thoroughly after urinating and defecating.

A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she: Select one: a. burps her infant during and after the feeding as needed. b. refrigerates any leftover formula for the next feeding. c. warms the bottles using a microwave oven. d. adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.

a. burps her infant during and after the feeding as needed.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is: a. dilation and evacuation (D&E). b. instillation of hypertonic saline into the uterine cavity. c. vacuum aspiration. d. intravenous administration of Pitocin.

a. dilation and evacuation (D&E).

Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who: a. have difficulty remembering to take oral contraceptives daily. b. are homeless or mobile and rarely receive health care. c. want menstrual regularity and predictability. d. have a history of thrombotic problems or breast cancer.

a. have difficulty remembering to take oral contraceptives daily.

The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as: Select one: a. unconjugation of bilirubin. b. enterohepatic circuit. c. albumin binding. d. conjugation of bilirubin.

d. conjugation of bilirubin.

Absence or weakness of which reflexes tested during the newborn assessment should the nurse report to the health care provider? 1 Gag 2 Moro 3 Babinski 4 Tonic neck

1 Gag Absence or diminution of the gag reflex could be life threatening. The infant might aspirate mucus or a feeding.

One minute after birth a nurse notes that a newborn is crying, has a heart rate of 140 beats/min, is acrocyanotic, resists the suction catheter, and keeps the arms extended. What Apgar score should the nurse assign to the newborn?

The Apgar score is 8. A perfect score is 10; 1 point is deducted for lessened muscle tone (the baby's arms do not flex) and 1 point for acrocyanosis, which is manifested by bluish hands and feet.

Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct? Select one: a. Frequent feedings during predictable growth spurts stimulate increased milk production. b. The milk of preterm mothers is the same as the milk of mothers who gave birth at term. c. The milk at the beginning of the feeding is the same as the milk at the end of the feeding. d. Colostrum is an early, less concentrated, less rich version of mature milk.

a. Frequent feedings during predictable growth spurts stimulate increased milk production.

The nurse caring for the after birth woman understands that breast engorgement is caused by: a. congestion of veins and lymphatics. b. hyperplasia of mammary tissue. c. overproduction of colostrum. d. accumulation of milk in the lactiferous ducts.

a. congestion of veins and lymphatics.

Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection.

b. Barrier methods

Which statement is true about the term contraceptive failure rate? a. It increases over time as couples become more careless. b. It varies from couple to couple, depending on the method and the users. c. It refers to the minimum level that must be achieved to receive a government license. d. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span.

b. It varies from couple to couple, depending on the method and the users.

In the classification of newborns by gestational age and birth weight, the appropriate for gestational age (AGA) weight would: Select one: a. be modified to consider intrauterine growth restriction (IUGR). b. fall between the 10th and 90th percentiles for the infant's age. c. depend on the infant's length and the size of the head. d. fall between the 25th and 75th percentiles for the infant's age.

b. fall between the 10th and 90th percentiles for the infant's age.

A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2.5 to 3 hours when she: Select one: a. waves her arms in the air. b. makes sucking motions. c. stretches her legs out straight. d. has hiccups.

b. makes sucking motions.

A couple comes to the family practice clinic and asks about sterilization procedures. Which question by the nurse should determine whether this method of family planning would be most appropriate? a. "Do either of you have diabetes mellitus?" b. " Do either of you have a problem with high blood pressure?" c. "Do you plan to have other children?" d. "Have you ever had surgery?"

c. "Do you plan to have other children?"

During the complete physical examination 24 hours after birth: Select one: a. once often neglected, blood pressure is now routinely checked. b. the parents are excused to reduce their normal anxiety. c. the nurse can gauge the neonate's maturity level by assessing the infant's general appearance. d. when the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second.

c. the nurse can gauge the neonate's maturity level by assessing the infant's general appearance.

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurse's most appropriate reply is: a. "They're not very effective, and it's very likely you'll get pregnant." b. "These methods have a few advantages and several health risks." c. "You would be much safer going on the pill and not having to worry." d. "They can be effective for many couples, but they require motivation."

d. "They can be effective for many couples, but they require motivation."

Which of the following statements about the various forms of hepatitis is accurate? Select one: a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis B is less contagious than human immunodeficiency virus (HIV). c. The incidence of hepatitis C is decreasing. d. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

d. Hepatitis A is acquired by eating contaminated food or drinking polluted water.

Informed consent concerning contraceptive use is important because some of the methods: a. may not be reliable. b. are invasive procedures that require hospitalization. c. require a surgical procedure to insert. d. have potentially dangerous side effects.

d. have potentially dangerous side effects.

The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. This intervention: Select one: a. helps infants with motor and central nervous system impairment. b. is adopted from classical British nursing traditions. c. gets infants ready for breastfeeding. d. helps infants to interact directly with their parents and enhances their temperature regulation.

d. helps infants to interact directly with their parents and enhances their temperature regulation.

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g (9 lbs, 6 ounces). The nurse's most appropriate action is to: Select one: a. leave the infant in the room with the mother. b. take the infant immediately to the nursery. c. perform a gestational age assessment to determine whether the infant is large for gestational age. d. monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

d. monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

What important instruction should a nurse include when teaching about the correct use of a female condom? 1 "Remove the condom before standing up." 2 "Insert the condom within 1 hour before intercourse." 3 "Have your partner wear a male condom at the same time." 4 "Cleanse the condom with warm water when preparing it for future use."

1 "Remove the condom before standing up."

A man and a woman want to use the calendar (rhythm) method of contraception but do not understand how it works. Based on an average 28-day cycle, during what time frame does the nurse explain that they should refrain from intercourse? 1 Days 10 to 17 of the menstrual cycle 2 7 days before the end of the menstrual cycle 3 7 days after completion of the menstrual period 4 14 days after completion of the menstrual period

1 Days 10 to 17 of the menstrual cycle Ovulation is anticipated approximately 14 days before menstruation; however, it is more reliable to avoid using a specific number of days and instead base calculations on the individual's cycle rather than the average 28-day cycle. Before relying on this method, a woman records the number of days in each menstrual cycle for at least 6 months. The first day of monthly bleeding is always counted as day 1. The woman subtracts 18 from the length of her shortest recorded cycle. This tells her the estimated first day of her fertile time. Then she subtracts 11 days from the length of her longest recorded cycle. This tells her the estimated last day of her fertile time. The couple avoids vaginal sex, or uses condoms or a diaphragm, during the fertile time. They can also use withdrawal or spermicides, but these are less effective. She updates these calculations each month, always using the 6 most recent cycles.

What is the priority nursing intervention for the postpartum client whose fundus is three fingerbreadths above the umbilicus, boggy, and midline? 1 Massaging the uterine fundus 2 Helping the client to the bathroom 3 Assessing the peripad for the amount of lochia 4 Administering intramuscular methylergonovine (Methergine) 0.2 mg

1 Massaging the uterine fundus A uterus that is displaced and above the fundus indicates relaxation of the uterine muscle. Fundal massage is necessary to stimulate uterine contractions.

A primigravida at 39 weeks' gestation is admitted to the high-risk unit with an acute infection and is to have labor induced. In what sequence should the nurse implement the primary healthcare provider's prescriptions? 1. Initiate monitoring with an electronic fetal/maternal monitor. 2. Start oxytocin 30 units in 1000 mL of D5W per protocol. 3. Give the client a 2-g loading dose of ampicillin, followed by 1 g every 4 hours. 4. Call the anesthesia department to evaluate the client for an epidural.

1, 3, 2, 4

A nurse determines that a newborn is suffering from respiratory distress. Which visible signs confirm this assessment? Select all that apply. 1 Crackles 2 Cyanosis 3 Wheezing 4 Tachypnea 5 Retractions

2 Cyanosis 4 Tachypnea 5 Retractions Cyanosis occurs because of inadequate oxygenation. Tachypnea is a compensatory mechanism necessary to increase oxygenation. Retractions occur in an effort to increase lung capacity. Crackles occur in the healthy newborn. Wheezing in the newborn is benign.

A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor? 1 "I will go, but it is against my beliefs and values." 2 "I won't do it, because I do not believe in birth control at all." 3 "I would prefer another assignment that is not contrary to my beliefs." 4 "I will have to stress that the rhythm method is the method of choice."

3 "I would prefer another assignment that is not contrary to my beliefs." Expressing a preference for another assignment that is not contrary to the nurse's beliefs is a positive negotiation to be reassigned to an area where the nurse's personal values will not pose a problem.

The nurse teaches a high school sex education class that herpes genitalis infection cannot be cured, but the disease is marked by remissions and exacerbations. What else should the students be taught about this infection? 1 A healthy lifestyle will prevent exacerbations. 2 Once the infection is effectively treated, exacerbations are rare. 3 Although exacerbations occur, they are not as severe as the initial episode. 4 The most effective way to prevent exacerbations is to abstain from sexual activity.

3 Although exacerbations occur, they are not as severe as the initial episode.

A nurse is assessing a newborn for signs of hyperbilirubinemia (pathologic jaundice). Which clinical finding confirms this complication? 1 Muscle irritability within 1 hour of birth 2 Neurologic signs during the first 24 hours 3 Jaundice that develops in the first 12 to 24 hours 4 Jaundice that develops between 48 and 72 hours after birth

3 Jaundice that develops in the first 12 to 24 hours

One minute after birth a nurse assesses a newborn and auscultates a heart rate of 90 beats/min. The newborn has a strong, loud cry, moves all extremities well, and has acrocyanosis but is otherwise pink. What is this neonate's Apgar score? A. 9 B. 8 C. 7 D. 6

B. 8 A heart rate slower than 100 beats/min receives 1 point, and color (acrocyanosis—body pink, extremities blue) receives 1 point; the respiratory rate (strong, loud cry), muscle tone, and reflex irritability each get a score of 2, for a total of 8. A score of 9 is too high. An Apgar score of 7 is too low, as is a score of 6.

Postpartal overdistention of the bladder and urinary retention can lead to which complications? a. After birth hemorrhage and urinary tract infection b. Urinary tract infection and uterine rupture c. Fever and increased blood pressure d. After birth hemorrhage and eclampsia

a. After birth hemorrhage and urinary tract infection

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: a. uterine atony. b. vaginal hematoma. c. uterine inversion. d. vaginal laceration.

a. uterine atony.

The two primary areas of risk for sexually transmitted infections (STIs) are: Select one: a. large number of sexual partners and race. b. sexual orientation and socioeconomic status. c. age and educational level. d. risky sexual behaviors and inadequate preventive health behaviors.

d. risky sexual behaviors and inadequate preventive health behaviors.

A woman in active labor arrives at the birthing unit. She tells the nurse that she was told that she had a chlamydial infection the last time she visited the clinic; however, she stopped taking the antibiotic after 3 days because she "felt better." In light of this history what would the nurse anticipate as part of the plan of care? 1 Administration of antibiotics before delivery 2 Oxytocin infusion to augment labor 3 Epidural anesthesia to relieve difficult labor discomfort 4 Magnesium sulfate infusion to prevent a precipitous birth

1 Administration of antibiotics before delivery

The nurse is caring for four clients on the postpartum unit. Which client will most likely state that she is having difficulty sleeping due to afterbirth pains? 1 Multipara who has vaginally delivered three children 2 Primipara whose newborn weighed 7 lb 3 Multipara with effectively controlled diabetes 4 Multipara whose second child was small for gestational age

1 Multipara who has vaginally delivered three children A multipara's uterus tends to contract and relax spasmodically, even if uterine tone is effective, resulting in pain that may require an analgesic for relief. A primipara's uterus usually remains in the contracted state unless the newborn is large for gestational age. However, she is less likely to have afterbirth pains requiring an analgesic than a multipara is

When calculating the Apgar score for a newborn, what does the nurse assess in addition to the heart rate? 1 Muscle tone 2 Amount of mucus 3 Degree of head lag 4 Depth of respirations

1 Muscle tone The five areas that are assessed when the Apgar score is calculated are heart rate, respiratory effort, muscle tone, reflex irritability, and color. The rate of respirations, not the depth, is assessed for an Apgar score. Amount of mucus, degree of head lag, and depth of respirations are not tested for an Apgar score.

A community health nurse visits an infant who was born at home 24 hours ago. While assessing the infant the nurse identifies slight jaundice of the face and trunk. What should the nurse do next? 1 Obtain a stat order for a bilirubin level. 2 Plan for immediate admission to the hospital. 3 Document this expected finding in the infant's record. 4 Arrange for the infant to have phototherapy in the home.

1 Obtain a stat order for a bilirubin level. Jaundice that appears within 24 hours of birth may be indicative of a pathological process; if the bilirubin level is high, intervention is required. Physiologic jaundice does not appear until 72 hours after birth; this observation in the 24 hours after birth indicates pathologic hyperbilirubinemia.

A female client asks a nurse about using an intrauterine device (IUD) for contraception. When explaining this method, what common problem should the nurse include in the discussion? 1 The device can be expelled. 2 The uterus may be perforated. 3 Discomfort during intercourse may occur. 4 Vaginal infections are frequent consequences.

1 The device can be expelled.

The nurse is preparing to discharge a 3-day-old infant who weighed 7 lb (3175 g) at birth. Which finding should be reported immediately to the healthcare provider? 1 Weight of 6 lb 4 oz (2835 g) 2 Hemoglobin of 16.2 g/dL (162 mmol/L) 3 Three wet diapers over the last 12 hours 4 Total serum bilirubin of 10 mg/dL (171 µmol/L)

1 Weight of 6 lb 4 oz (2835 g) A loss of 12 oz (340 g) since birth, or more than 10%, is higher than the acceptable figure of 5% to 6%

A couple interested in delaying the start of a family discuss the various methods of family planning. Together they decide to use the basal body temperature method. The nurse explains that the fertile period surrounding ovulation lasts from when to when? 1 12 hours before to 24 hours after ovulation 2 72 hours before to 24 hours after ovulation 3 72 to 80 hours before to 72 hours after ovulation 4 24 to 48 hours before to 48 hours after ovulation

2 72 hours before to 24 hours after ovulation

A client asks a nurse about the most common problem associated with the use of an intrauterine device (IUD). What answer should the nurse provide? 1 Perforation of the uterus 2 Spontaneous device expulsion 3 Discomfort associated with coitus 4 Development of vaginal infections

2 Spontaneous device expulsion The IUD may cause irritability of the myometrium, inducing contraction of the uterus and expulsion of the device.

Jaundice develops in a newborn 72 hours after birth. How should the nurse best explain the probable cause of this jaundice to the parents? 1 An allergic response to the feedings 2 The physiologic destruction of fetal red blood cells 3 A temporary bile duct obstruction commonly found in newborns 4 The seepage of maternal Rh-negative blood into the neonate's bloodstream

2 The physiologic destruction of fetal red blood cells After birth, fetal erythrocytes hemolyze, releasing bilirubin into the circulation; the immature liver cannot metabolize the bilirubin as rapidly as it is produced, resulting in physiologic jaundice.

A female client who has been sexually active for 5 years is diagnosed with gonorrhea. The client is upset and asks the nurse, "What can I do to keep from getting another infection in the future?" Which statement by the client indicates that the teaching by the nurse was effective? 1 "I'll douche after each time I have sex." 2 "Having sex is a thing of the past for me." 3 "My partner has to use a condom all the time." 4 "I'll be using a spermicidal cream from now on."

3 "My partner has to use a condom all the time."

A client asks the nurse at the family planning clinic whether contraception is needed while she is breastfeeding. How should the nurse reply? 1 "As long as you aren't having periods, you won't need a contraceptive." 2 "It would be best to delay sexual relations until you have your first period." 3 "You should use contraceptives, because ovulation may occur at any time without a period." 4 "Breastfeeding suppresses ovulation, so you don't need to worry about pregnancy."

3 "You should use contraceptives, because ovulation may occur at any time without a period."

A 25-year-old woman comes to the clinic complaining of increased vaginal discharge, milky gray in color with a "fishy" odor that both she and her husband have noticed. A wet smear is performed and the presence of "clue cells" confirmed. Which type of infection does the nurse suspect? 1 Candidiasis 2 Trichomoniasis 3 Bacterial vaginosis 4 Group B Streptococcus

3 Bacterial vaginosis

Which nursing assessment is most important for a large-for-gestational-age (LGA) infant of a diabetic mother (IDM)? 1 Temperature less than 98° F (36.6° C) 2 Heart rate of 110 beats/min 3 Blood glucose level less than 40 mg/dL (2.2 mmol/L) 4 Increasing bilirubin during the first 24 hours

3 Blood glucose level less than 40 mg/dL (2.2 mmol/L) At birth, circulating maternal glucose is removed; however, the IDM still has a high level of insulin, and rebound hypoglycemia may develop.

A client had a rubella infection (German measles) during the fourth month of pregnancy. At the time of the infant's birth, the nurse places the newborn in the isolation nursery. Which type of infection control precautions should the nurse institute? 1 Enteric 2 Contact 3 Droplet 4 Standard

3 Droplet

A 24-year-old woman wants to use her basal body temperature (BBT) in natural family planning but is unsure when to take her temperature. When should the nurse explain is the best time for accurate BBT assessment? 1 Each night right before bed 2 On the first day of her next menstrual cycle 3 Each morning before getting out of bed or increasing her activity 4 At bedtime beginning on day 14 of her menstrual cycle and continuing until her next period

3 Each morning before getting out of bed or increasing her activity The most accurate BBT is taken before a woman gets out of bed and begins any type of activity that could increase the body's temperature even slightly.

A nurse in the newborn nursery is monitoring an infant for jaundice related to ABO incompatibility. What blood type does the mother usually have to cause this incompatibility? 1 A 2 B 3 O 4 AB

3 O Mothers with type O blood have anti-A and anti-B antibodies that are transferred across the placenta. This is the most common incompatibility, because the mother is type O in 20% of all pregnancies.

A nurse is assessing a client for the potential for osteoporosis. Which factor in the client's history increases the risk for this disorder? 1 Estrogen therapy 2 Hypoparathyroidism 3 Prolonged immobility 4 Excessive calcium intake

3 Prolonged immobility

The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine? 1 Blood acidity 2 Glucose tolerance 3 Serum glucose level 4 Glycosylated hemoglobin level

3 Serum glucose level

A pregnant client has a positive group B Streptococcus (GBS) test at 36 weeks' gestation. What is the priority instruction that the nurse will include in the client's teaching plan? 1 "Go straight to the outpatient area of the maternity unit for a nonstress test." 2 "You'll need to schedule visits twice a week with your healthcare provider until you deliver." 3 "Your baby will have to spend at least 3 days in the neonatal intensive care unit because of this infection." 4 "This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding."

4 "This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding."

A new mother wishes to breast-feed her infant and asks the nurse whether she needs to alter her diet. How should the nurse respond? 1 "Eat as you have been during your pregnancy." 2 "Drink a lot of milk—the added calcium will help you make milk." 3 "Your body produces the milk your baby needs as a result of the vigorous suckling." 4 "You'll need greater amounts of the same foods you've been eating and more fluids."

4 "You'll need greater amounts of the same foods you've been eating and more fluids."

A 26-year-old woman whose sister recently had a lumpectomy for breast cancer calls the local women's health center for an appointment for a mammogram. What guidance should the nurse provide the client in preparation for the test? 1 Do not eat for 6 hours before the test. 2 The room will be darkened throughout the procedure. 3 The first mammogram is usually performed at 50 years of age. 4 During the procedure, each breast will be compressed firmly between two plates.

4 During the procedure, each breast will be compressed firmly between two plates.

Which finding in a newborn whose temperature over the last 4 hours has fluctuated between 98.0 °F (36.7 °C) and 97.4 °F (36.3 °C) would be considered critical? 1 Respiratory rate of 60 breaths/min 2 White blood count greater than 15,000 mm3 3 Serum calcium level of 8 mg/dL (2 mmol/L) 4 Blood glucose level of 26 mg/dL (1.4 mmol/L)

4 Blood glucose level of 26 mg/dL (1.4 mmol/L) Instability of the newborn's temperature is an indication of hypoglycemia

A client expresses a desire to breast-feed her preterm neonate, who is in the neonatal intensive care unit (NICU). The client states that she will pump her breasts until her baby is ready to breast-feed. The infant has been sucking on a pacifier for 1 week in accordance with protocol. How should the nurse respond to the mother's request? 1 By telling the client that this is unnecessary because the infant is being fed by gavage 2 By discouraging the client because of the time and effort it will take to pump her breasts 3 By instructing the client that breast milk is inadequate because it does not contain the necessary nutrients 4 By supporting the client's decision and explaining that the infant may lie close to her breast for nippling as desired

4 By supporting the client's decision and explaining that the infant may lie close to her breast for nippling as desired

When changing her newborn's diaper a new mother notes a reddened area on the infant's buttock and reports it to the nurse. How should the nurse best address this mother's concern? 1 Have nursery staff members change the infant's diaper. 2 Use both lotion and powder to protect the involved area. 3 Request that the health care provider prescribe a topical ointment. 4 Encourage the mother to cleanse the area and change the diaper more often.

4 Encourage the mother to cleanse the area and change the diaper more often. Frequent cleansing and diaper changes will limit the presence of irritating substances.

A newborn has just begun to breast-feed for the first time. Although the neonate has latched on to the mother's nipple, soon after beginning to suck the infant begins to choke, has an excessive quantity of frothy secretions, and exhibits unexplained episodes of cyanosis. How should the nurse best intervene at this time? 1 Tell the client to use the other breast and continue breast-feeding 2 Delay the feeding to allow more time for the infant to recover from the birthing process 3 Contact the lactation consultant to help the client learn a more successful breast-feeding technique 4 Halt the feeding and notify the healthcare provider to evaluate the infant for a tracheoesophageal fistula

4 Halt the feeding and notify the healthcare provider to evaluate the infant for a tracheoesophageal fistula

A client at term is admitted in active labor. She has tested positive for human immunodeficiency virus (HIV). Which intervention in the standard prescriptions should the nurse question? 1 Sonogram 2 Nonstress test 3 Sterile vaginal examination 4 Internal fetal scalp electrode

4 Internal fetal scalp electrode The electrode used for internal fetal monitoring pierces the fetal scalp; fetal exposure to maternal blood increases the risk of the fetus contracting HIV.

Which drug is administered to women after delivery to prevent postpartum uterine atony and hemorrhage but is not given to augment labor? 1 Dinopristone 2 Mifepristone 3 Indomethacine 4 Methylergonovine

4 Methylergonovine

A client asks about the difference between cow's milk and breast milk. The nurse should respond that cow's milk differs from human milk in that it contains what? 1 Less protein, less calcium, and more carbohydrates 2 More protein, less calcium, and fewer carbohydrates 3 Less protein, more calcium, and more carbohydrates 4 More protein, more calcium, and fewer carbohydrates

4 More protein, more calcium, and fewer carbohydrates

A newborn is experiencing cold stress while being admitted to the nursery. Which nursing goal has the highest immediate priority? 1 Minimize shivering 2 Prevent hyperglycemia 3 Limit oxygen consumption 4 Prevent metabolism of fat stores

4 Prevent metabolism of fat stores Newborns do not shiver. If the newborn is cold, there is increased brown fat metabolism (nonshivering thermogenesis), which increases fatty acid blood levels and predisposes the infant to acidosis. Hypoglycemia and not hyperglycemia will occur because the newborn's glycogen reserves deplete rapidly while under cold stress.

While assessing a newborn the nurse notes the following findings: arms and legs slightly flexed; smooth, transparent skin; abundant lanugo on the back; slow recoil of the pinnae; and few sole creases. What complication does the nurse anticipate in light of these findings? 1 Polycythemia 2 Hyperglycemia 3 Postmaturity syndrome 4 Respiratory distress syndrome

4 Respiratory distress syndrome The assessment findings are indicative of a preterm infant; therefore the nurse should monitor the infant for signs of respiratory distress syndrome.

On the third postpartum day a woman who is breastfeeding calls the nurse at the clinic and asks why her breasts are tight and swollen. What should the nurse consider before explaining engorgement to the client? 1 There is an overabundance of milk. 2 Breastfeeding is probably ineffective. 3 The breasts have been inadequately supported. 4 The lymphatic system in the breasts is congested.

4 The lymphatic system in the breasts is congested. An exaggeration of venous and lymphatic circulation caused by prolactin occurs before lactation. Engorgement occurs before lactation or milk production.

A male newborn has been exposed to human immunodeficiency virus (HIV) in utero. Which assessment supports the diagnosis of HIV infection in the newborn? 1 Delay in temperature regulation 2 Continued bleeding after circumcision 3 Hypoglycemia within the first day of birth 4 Thrush that does not respond readily to treatment

4 Thrush that does not respond readily to treatment

A woman who is 28 weeks pregnant calls the clinic to report that she is frightened because she has begun leaking breast milk. What is the best response? 1 She needs to come in for a calcium level. 2 She needs to come in for a nonstress test. 3 She needs to get off her feet and rest more. 4 This can be a normal occurrence during pregnancy.

4 This can be a normal occurrence during pregnancy.

After her baby's birth a client wishes to begin breast-feeding as soon as possible. How can the nurse best assist the client at this time? 1 Giving the infant a bottle first to evaluate the sucking reflex 2 Positioning the infant to grasp the nipple to express colostrum 3 Leaving the infant and parents alone to promote attachment behaviors 4 Touching the infant's cheek adjacent to the nipple to elicit the rooting reflex

4 Touching the infant's cheek adjacent to the nipple to elicit the rooting reflex

While preparing a client for her first routine Papanicolaou (Pap) smear, a nurse determines that she appears anxious. What should the nurse include as part of the teaching plan? 1 Past statistics on the incidence of cervical cancer 2 Description of the early symptoms of cervical cancer 3 Explanation of why there is a small risk for cervical cancer 4 Verbal instructions that a Papanicolaou smear is effective in detecting precancerous and cancerous cells within the cervix

4 Verbal instructions that a Papanicolaou smear is effective in detecting precancerous and cancerous cells within the cervix

A newborn of 30 weeks' gestation has a heart rate of 86 beats/min and slow, irregular respirations. The infant grimaces in response to suctioning, is cyanotic, and has flaccid muscle tone. What Apgar score should the nurse assign to this neonate?

This infant's Apgar score is 3. A heart rate of less than 100 beats/min receives 1 point; slow and irregular respirations receive 1 point; grimaces in response to suctioning receive 1 point; flaccid muscle tone receives 0 points; and cyanosis receives 0 points. A score of 2 is too low. A score of 4 is too high, as is a score of 5.

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The patient asks, "What is that? Can you get rid of it?" Your best response is: Select one: a. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer. There is no known cure but symptoms are treated." b. "You probably caught this from your current boyfriend. He should get tested for this." c. "It's just a little lump on your cervix. We can freeze it off." d. "HPV is a type of early human immunodeficiency virus (HIV). You will die from this."

a. "HPV stands for 'human papillomavirus.' It is a sexually transmitted infection (STI) that may lead to cervical cancer. There is no known cure but symptoms are treated."

The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching? Select one: a. "I can store my breast milk in the freezer for 3 months." b. "I can store my breast milk in the refrigerator for 3 to 5 days." c. "I can store my breast milk at room temperature for 8 hours." d. "I can store my breast milk in the refrigerator for 3 months."

a. "I can store my breast milk in the freezer for 3 months."

The nurse providing care in a women's health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? Select one: a. Chlamydia b. Venereal warts c. Acquired immunodeficiency syndrome (AIDS) d. Herpes

a. Chlamydia

A woman gave birth to a healthy infant boy 5 days ago. What type of lochia would the nurse expect to find when assessing this woman? a. Lochia serosa b. Lochia sangra c. Lochia alba d. Lochia rubra

a. Lochia serosa

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive: Select one: a. Moro reflex. b. Babinski reflex. c. glabellar (Myerson) reflex. d. tonic neck reflex.

a. Moro reflex.

The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: Select one: a. zidovudine. b. ofloxacin. c. podophyllin. d. acyclovir.

a. zidovudine.

To prevent nipple trauma, the nurse should instruct the new mother to: Select one: a. wash the nipples daily with mild soap and water. b. position the infant so the nipple is far back in the mouth. c. assess the nipples before each feeding. d. limit the feeding time to less than 5 minutes.

b. position the infant so the nipple is far back in the mouth.

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, "What is this black, sticky stuff in her diaper?" The nurse's best response is: Select one: a. "Oh, don't worry about that. It's okay." b. "That means your baby is bleeding internally." c. "That's meconium, which is your baby's first stool. It's normal." d. "That's transitional stool."

c. "That's meconium, which is your baby's first stool. It's normal."

Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot? Select one: a. Plantar grasp b. Tonic neck c. Babinski d. Stepping

c. Babinski

What marks on a baby's skin may indicate an underlying problem that requires notification of a physician? Select one: a. Erythema toxicum anywhere on the body b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infant's body d. Mongolian spots on the back

c. Petechiae scattered over the infant's body

A nurse is caring for a preterm infant with necrotizing enterocolitis (NEC). Which nursing intervention is most important for this infant? 1 Measuring abdominal girth frequently 2 Diluting the formula mixture as prescribed 3 Administering oxygen before the gastric feeding 4 Using half-strength formula for gavage feeding

1 Measuring abdominal girth frequently NEC is marked by prolonged gastric emptying; an increase in abdominal girth of more than 1 cm in 4 hours is significant and requires immediate intervention. Formula feeding is stopped and parenteral fluids, usually total parenteral nutrition (TPN), are started instead

A nurse is teaching breast-feeding to a newly delivered client. Which statement by the client indicates the need for further instruction? 1 "I'll try to empty my breasts at each feeding." 2 "I'll alternate between breasts to start feedings." 3 "I need to wash my breasts with soapy water before I breast-feed." 4 "I need to stroke my baby's cheek gently when I'm ready to breast-feed."

3 "I need to wash my breasts with soapy water before I breast-feed." Soap irritates, cracks, and dries breasts and nipples, making it painful for the mother when the baby sucks; it also increases the risk for mastitis. The client should empty the breasts at each feeding to keep milk flowing.

A nursing student is learning about expected postpartum anatomic and physiologic changes. Which statement made by the nursing student indicates a need for further learning? 1 "The capacity of the bladder increases postpartum." 2 "The uterus involutes to approximately 350 g by two weeks after birth." 3 "The cervical dilation decreases to 2 to 3 cm by the second or third postpartum day." 4 "After birth, the vagina gradually decreases in size and returns to its pre-pregnancy state."

4 "After birth, the vagina gradually decreases in size and returns to its pre-pregnancy state." After a birth, the vagina gradually decreases in size; however, does not return to its pre-pregnancy state.

A client seeking advice regarding contraception asks a nurse to explain how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond? 1 "It covers the entrance to the cervical os." 2 "The openings to the fallopian tubes are blocked." 3 "The sperm are kept from reaching the vagina." 4 "It produces a spermicidal intrauterine environment."

4 "It produces a spermicidal intrauterine environment."

The drug of choice for treatment of gonorrhea is: Select one: a. tetracycline. b. ceftriaxone. c. acyclovir. d. penicillin G.

b. ceftriaxone.

As part of the physical assessment, a nurse inspects a newborn for the presence of an umbilical hernia. Which infant behavior will assist the nurse in identifying this problem? 1 Crying 2 Inhaling 3 Suckling 4 Sleeping

1 Crying Increased intraabdominal pressure associated with crying, coughing, or straining will cause protrusion of the hernia.

For clinical purposes, preterm and postterm infants are defined as: Select one: a. Preterm before 37 weeks, and postterm beyond 42 weeks, no matter the size for gestational age at birth. b. Preterm, SGA before 38 to 40 weeks, and postterm, LGA beyond 40 to 42 weeks. c. preterm before 34 weeks if appropriate for gestational age (AGA) and before 37 weeks if small for gestational age (SGA). d. Postterm after 40 weeks if large for gestational age (LGA) and beyond 42 weeks if AGA.

a. Preterm before 37 weeks, and postterm beyond 42 weeks, no matter the size for gestational age at birth.

A male patient asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: a. "The additional lubrication improves sex." b. "It has also been linked to an increase in the transmission of human immunodeficiency virus." c. "The lubricant prevents vaginal irritation." d. "Nonoxynol-9 improves penile sensitivity."

b. "It has also been linked to an increase in the transmission of human immunodeficiency virus."

A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy? Select one: a. Heroin b. Alcohol c. Cocaine d. Marijuana

b. Alcohol

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? Select one: a. Cytomegalovirus (CMV) b. Herpes simplex virus (HSV)-2 c. Human immunodeficiency virus (HIV) d. Human papillomavirus (HPV)

b. Herpes simplex virus (HSV)-2

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? Select one: a. Intraventricular hemorrhage (IVH) b. Retinopathy of prematurity (ROP) c. Necrotizing enterocolitis (NEC) d. Bronchopulmonary dysplasia (BPD)

b. Retinopathy of prematurity (ROP)

An infant was born 2 hours ago at 37 weeks of gestation and weighing 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of: Select one: a. hypocalcemia. b. hypoglycemia. c. birth injury. d. seizures.

b. hypoglycemia.

When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: Select one: a. gonorrhea. b. candidiasis. c. chlamydia. d. syphilis.

c. chlamydia.

An Apgar score of 10 at 1 minute after birth would indicate a(n): Select one: a. prediction of a future free of neurologic problems. b. infant having no difficulty adjusting to extrauterine life and needing no further testing. c. infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth. d. infant in severe distress who needs resuscitation.

c. infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.

In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is: Select one: a. important in the production of red blood cells. b. responsible for the breakdown of bilirubin and prevention of jaundice. c. not initially synthesized because of a sterile bowel at birth. d. necessary in the production of platelets.

c. not initially synthesized because of a sterile bowel at birth.

The first and most important nursing intervention when a nurse observes profuse after birth bleeding is to: a. assess maternal blood pressure and pulse for signs of hypovolemic shock. b. administer the standing order for an oxytocic. c. palpate the uterus and massage it if it is boggy. d. call the woman's primary health care provider.

c. palpate the uterus and massage it if it is boggy.

The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient? Select one: a. Breastfeeding may enhance after birth weight loss. b. Women who breastfeed have a decreased risk of breast cancer. c. Breastfeeding increases bone density. d. Breastfeeding is an effective method of birth control.

d. Breastfeeding is an effective method of birth control.

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? Select one: a. This condition is also known as "breast milk jaundice." b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types. c. Physiologic jaundice occurs during the first 24 hours of life. d. The bilirubin levels of physiologic jaundice peak between 72 to 96 hours of life.

d. The bilirubin levels of physiologic jaundice peak between 72 to 96 hours of life.

Part of the health assessment of a newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly: Select one: a. chest breathing with nasal flaring. b. diaphragmatic with chest retraction. c. deep with a regular rhythm. d. abdominal with synchronous chest movements.

d. abdominal with synchronous chest movements.

The nurse is teaching participants in a prenatal class regarding breastfeeding versus formula feeding. A client asks, "What is the primary advantage of breastfeeding?" Which response is most appropriate? 1 "Breastfed infants have fewer infections." 2 "Breastfeeding inhibits ovulation in the mother." 3 "Breastfed infants adhere more easily to a feeding schedule." 4 "Breastfeeding provides more protein than cow's milk formula does."

1 "Breastfed infants have fewer infections."

A pregnant client asks the nurse for information regarding toxoplasmosis exposure during pregnancy. What information should the nurse teach this client? 1 "Pork and beef should be cooked thoroughly." 2 "Toxoplasmosis is a disease that is most prevalent in foreign countries." 3 "Cooked shellfish are intermediary hosts and should be avoided during pregnancy" 4 "Salad dressings made with mayonnaise should be avoided during the summer months."

1 "Pork and beef should be cooked thoroughly."

A nurse in a family planning clinic determines that a client understands the discussion regarding use of a cervical cap with a spermicide when the client states that after intercourse, a cervical cap must be left in place for at least how long? 1 6 hours 2 5 hours 3 3 hours 4 2 hours

1 6 hours The cervical cap, used in conjunction with a spermicide that remains active for 6 hours, provides the most effective contraceptive result.

The nurse is caring for a postpartum client who has chosen formula feeding. What should the nurse teach her regarding minimizing breast discomfort? 1 Apply covered ice packs to the breasts. 2 Gently apply cocoa butter to the nipples. 3 Place warm, wet washcloths on the nipples. 4 Manually express colostrum from the breasts.

1 Apply covered ice packs to the breasts.

The nurse is testing newborns' heel blood for the level of glucose. Which newborn does the nurse anticipate will experience hypoglycemia? Select all that apply. 1 Preterm infant 2 Infant with Down syndrome 3 Small-for-gestational-age infant 4 Large-for-gestational-age infant 5 Appropriate-for-gestational-age infant

1 Preterm infant 3 Small-for-gestational-age infant 4 Large-for-gestational-age infant

A patient arrives at the clinic seeking emergency contraception 24 hours after she had unprotected intercourse. The nurse correctly responds by saying: a. " the pills must be started the morning after unprotected intercourse." b. " Come right in so we can get you started." c. "You need to wait until you miss your period" d. "you must wait 72 hours before the pill will work"

b. " Come right in so we can get you started."

With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), nurses should be aware that: a. the effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. b. COCs increase the risk of endometrial and ovarian cancer. c. hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week. d. COCs can cause toxic shock syndrome if the prescription is wrong.

a. the effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

A woman has a thick, white, lumpy, cottage cheese-like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? Select one: a. Miconazole b. Tetracycline c. Acyclovir d. Clindamycin

a. Miconazole

Which finding 12 hours after birth requires further assessment? a. The fundus is palpable two fingerbreadths above the umbilicus. b. The fundus is palpable at the level of the umbilicus. c. The fundus is palpable one fingerbreadth below the umbilicus. d. The fundus is palpable two fingerbreadths below the umbilicus.

a. The fundus is palpable two fingerbreadths above the umbilicus.

A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called: Select one: a. acrocyanosis. b. harlequin color. c. vernix caseosa. d. erythema neonatorum.

a. acrocyanosis.

A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant's body temperature every hour. Maintaining the newborn's body temperature is important for preventing: Select one: a. cold stress. b. respiratory depression. c. tachycardia. d. vasoconstriction.

a. cold stress.

A client has delivered her infant by cesarean birth. The nurse monitors the newborn's respiration closely, because infants born via the cesarean method are prone to atelectasis. Why does this occur? 1 The ribcage is not compressed and released during birth. 2 The sudden temperature change at birth causes aspiration. 3 There is usually oxygen deprivation after a cesarean birth. 4 There is no gravity during the birth to promote drainage from the lungs.

1 The ribcage is not compressed and released during birth.

After a difficult vaginal birth, assessment of a full-term newborn reveals an unequal Moro reflex on one side and a flaccid arm in adduction. Which problem does the nurse suspect? 1 Brachial palsy 2 Supratentorial tear 3 Fracture of the clavicle 4 Developmental dysplasia of the hip

1 Brachial palsy Brachial palsy results from excessive stretching of the nerve fibers that run from the neck, through the shoulder, and down toward the arm; the muscles of the upper arm are involved, and the infant holds the arm at the side with the elbow extended and the hand rotated inward.

The nurse is differentiating between cephalhematoma and caput succedaneum. What finding is unique to caput succedaneum? 1 Edema that crosses the suture line 2 Scalp tenderness over the affected area 3 Edema that increases during the first day 4 Scalp over the area becomes ecchymosed

1 Edema that crosses the suture line

Which hypothalamic hormone helps to treat postpartum uterine atony and hemorrhage? 1 Oxytocin 2 Indomethacin 3 Dinoprostone 4 Methylergonovine

1 Oxytocin **key word HORMONE**

Which interventions are included in the care plan of a postpartum client with a fourth-degree laceration? Select all that apply. 1 Pain management with oral analgesics 2 Continuous application of a warm pack 3 Assessment of the site every 15 minutes 4 Gentle cleansing with antibacterial cleanser 5 Application of an ice pack for 20-minute intervals 6 Instructing the client in how to promote normal bowel function

1 Pain management with oral analgesics 3 Assessment of the site every 15 minutes 5 Application of an ice pack for 20-minute intervals Providing pain management will prevent the client's pain from reaching an unmanageable level. Assessment of the site will identify any abnormal changes. Application of ice will decrease pain and edema. Warmth applied to newly traumatized tissue will increase pain and edema. Antibacterial cleanser would be caustic and painful to the laceration. Teaching regarding bowel function would be more appropriately presented after the client has completed the fourth stage and resumed normal intake.

While changing a newborn girl's diaper a nurse observes a brick-red stain on the diaper. How does the nurse interpret this clinical finding? 1 A sign of low iron excretion 2 An uncommon benign occurrence 3 An expected occurrence in female newborns 4 The result of a medication administered during labor

2 An uncommon benign occurrence The brick-red color in the urine is caused by albumin and urates that are found in the first week of life. Iron is eliminated by way of the gastrointestinal tract. The finding is unrelated to the sex of the infant; it is not hormonally based. No medication administered during labor will cause this discoloration.

A nurse teaches a woman who is planning to breastfeed how to relieve breast engorgement. The nurse determines that further teaching is necessary when the woman states that she will do what? 1 Manually express breast milk 2 Breastfeed the infant less frequently 3 Apply warm compresses to both breasts 4 Place cold compresses on the breasts just after breastfeeding

2 Breastfeed the infant less frequently

A mother is inspecting her newborn girl for the first time. The infant's breasts are edematous, and she has a pink vaginal discharge. How should the nurse respond when the mother asks what is wrong? 1 "You seem very concerned. I don't see anything unusual." 2 "Your baby appears to have a problem. I'll notify the pediatrician." 3 "The swelling and discharge will go away. It's nothing to worry about." 4 "The swelling and discharge are expected. They're a response to your hormones."

4 "The swelling and discharge are expected. They're a response to your hormones."

After a spontaneous vaginal delivery, the client expresses concern when the newborn is brought to her. Although the newborn was just cleaned and examined, the mother notes a red rash consisting of small papules on the face, chest, and back of the newborn. What condition does the nurse recognize? 1 Harlequin sign 2 Vernix caseosa 3 Nevus flammeus 4 Erythema toxicum

4 Erythema toxicum Erythema toxicum is a benign, generalized, transient rash that is a reaction to the new environment in which a neonate finds itself. It disappears a short time after birth.

The nurse is assessing the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located? 1 At the level of the umbilicus 2 One fingerbreadth above the umbilicus 3 Above and to the right of the umbilicus 4 One or two fingerbreadths below the umbilicus

4 One or two fingerbreadths below the umbilicus

The viral sexually transmitted infection (STI) that affects most people in the United States today is: Select one: a. human papillomavirus (HPV). b. cytomegalovirus (CMV). c. herpes simplex virus type 2 (HSV-2). d. human immunodeficiency virus (HIV).

a. human papillomavirus (HPV).

The cheese-like, whitish substance that fuses with the epidermis and serves as a protective coating is called: Select one: a. vernix caseosa. b. acrocyanosis. c. caput succedaneum. d. surfactant.

a. vernix caseosa.

Where should the fundus be 1 day after birth in a client whose bladder is not distended?

One day after birth, the fundus is expected to be at the level of the umbilicus. In the first 12 hours after birth, the uterus is expected to be one fingerbreadth above the umbilicus. It is then expected to descend by approximately one fingerbreadth per day until it descends under the pubic bone, usually around day 10.

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should: Select one: a. document the finding as erythema toxicum. b. notify the physician immediately. c. move the newborn to an isolation nursery. d. take the newborn's temperature and obtain a culture of one of the vesicles.

a. document the finding as erythema toxicum.

The goal of treatment of the infant with phenylketonuria (PKU) is to: Select one: a. prevent gastrointestinal symptoms. b. prevent central nervous system (CNS) damage, which leads to mental retardation. c. cure the urinary tract infection. d. cure mental retardation.

b. prevent central nervous system (CNS) damage, which leads to mental retardation.

An African-American woman noticed some bruises on her newborn girl's buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called: Select one: a. vascular nevi. b. nevus flammeus. c. Mongolian spots. d. lanugo.

c. Mongolian spots.

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Which statement is incorrect? Select one: a. Prevent exposure to people with upper respiratory tract infections. b. Avoid loose bedding, water beds, and beanbag chairs. c. Keep the infant away from secondhand smoke. d. Place the infant on his or her abdomen to sleep.

d. Place the infant on his or her abdomen to sleep.

A woman gave birth vaginally to a 9-lb, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders? a. The woman is a gravida 2, para 2. b. The woman received epidural anesthesia. c. The woman had a vacuum-assisted birth. d. The woman has an episiotomy.

d. The woman has an episiotomy.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include: Select one: a. scaphoid abdomen, no residual with feedings, and increased urinary output. b. hypertension, absence of apnea, and ruddy skin color. c. hypertonia, tachycardia, and metabolic alkalosis. d. abdominal distention, temperature instability, and grossly bloody stools.

d. abdominal distention, temperature instability, and grossly bloody stools.

To prevent the abduction of newborns from the hospital, the nurse should: Select one: a. instruct the mother not to give her infant to anyone except the one nurse assigned to her that day. b. carry the infant when transporting him or her in the halls. c. restrict the amount of time infants are out of the nursery. d. apply an electronic and identification bracelet to mother and infant.

d. apply an electronic and identification bracelet to mother and infant.

When teaching parents about mandatory newborn screening, it is important for the nurse to explain that the main purpose is to: Select one: a. keep the state records updated. b. allow accurate statistical information. c. document the number of births. d. recognize and treat newborn disorders early.

d. recognize and treat newborn disorders early.

As related to the normal functioning of the renal system in newborns, nurses should be aware that: Select one: a. breastfed infants likely will void more often during the first days after birth. b. "Brick dust" or blood on a diaper is always a cause to notify the physician. c. weight loss from fluid loss and other normal factors should be made up in 4 to 7 days. d. the pediatrician should be notified if the newborn has not voided in 24 hours.

d. the pediatrician should be notified if the newborn has not voided in 24 hours.

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot." The most likely cause of after birth hemorrhage in this woman is: a. unrepaired vaginal lacerations. b. puerperal infection. c. retained placental fragments. d. uterine atony.

d. uterine atony.

What type of lochia should the visiting nurse expect to observe on a client's pad on the fourth day after a vaginal delivery? 1 Scant alba 2 Scant rubra 3 Moderate rubra 4 Moderate serosa

4 Moderate serosa The uterus sloughs off the blood, tissue, and mucus of the endometrium post-delivery. This happens in three stages that will vary in length and represent the normal healing of the endometrium. Lochia rubra is the first and heaviest stage of lochia. The blood that's expelled during lochia rubra will be bright red and may contain blood clots. The lochia rubra phase typically lasts for the first three days following delivery. Lochia serosa is the second stage of postpartum bleeding and is thinner in consistency and brownish or pink in color. Lochia serosa typically lasts from day four through day 10, following delivery. Lochia alba is the final stage of lochia. Rather than blood, there will be a white or yellowish discharge that's generated during the healing process and the initial reconstruction of the endometrium. Expect this discharge to continue for around six weeks after birth, but keep in mind that it may extend beyond that if the second phase of lochia lasted longer than ten days.

A postpartum client is being prepared for discharge. The laboratory report indicates that she has a white blood cell (WBC) count of 16,000/mm3. (16 X 109/L) What is the next nursing action? 1 Checking with the nurse manager to see whether the client may go home 2 Reassessing the client for signs of infection by taking her vital signs 3 Delaying the client's discharge until the practitioner has conducted a complete examination 4 Placing the report in the client's record because this is an expected postpartum finding

4 Placing the report in the client's record because this is an expected postpartum finding

While assessing a newborn, the nurse notes that the infant's skin is mottled. What should the nurse's primary intervention be? 1 Administer oxygen 2 Offer an oral feeding 3 Notify the practitioner 4 Warm the environment

4 Warm the environment Mottling results from hypothermia; the newborn should be wrapped, placed under a radiant warmer, or given to the mother for skin-to-skin contact. Mottling is a phenomenon that usually indicates a decreasing temperature; the newborn requires warming, not oxygenation or medical attention.

The nurse is reevaluating a newborn who had an axillary temperature of 97° F (36.1° C) and was placed skin to skin with the mother. The newborn's axillary temperature is still 97° F (36.1° C) after 1 hour of skin-to-skin contact. Which intervention should the nurse implement next? 1 Placing the newborn under a radiant warmer in the nursery 2 Checking the newborn for a wet diaper and then continue the skin-to-skin contact 3 Leaving the newborn in skin-to-skin contact and rechecking the temperature in 1 hour 4 Double-wrapping the newborn in warm blankets and returning the newborn to a crib by the mother's bedside

1 Placing the newborn under a radiant warmer in the nursery The newborn's temperature should be kept in the normal range of 97.7° F to 99.5° F (36.5° C to 37.5° C). A hypothermic temperature that has not improved in 1 hour with the use of skin-to-skin contact requires additional measures. The infant should be placed under a radiant warmer for a short time until the temperature returns to the normal range.

After an uneventful pregnancy a client gives birth to an infant with a meningocele. The neonate has 1-minute and 5-minute Apgar scores of 9 and 10, respectively. What is the priority nursing care for this newborn? 1 Protecting the sac with moist sterile gauze 2 Removing buccal mucus and administering oxygen 3 Placing name bracelets on both the mother and infant 4 Transferring the newborn to the neonatal intensive care unit

1 Protecting the sac with moist sterile gauze Preventing infection and trauma is the priority; rupture of the sac may lead to meningitis. The Apgar scores are 9 and 10 at 1 and 5 minutes, respectively; oxygen is not needed. Removing buccal mucus is not the priority. Placement of name bracelets on both mother and infant may be done before the infant leaves the birthing room; the priority is care of the infant's sac. The infant's sac must be protected before the infant is transferred to the neonatal intensive care unit.

When a nurse brings a newborn to the new mother, the mother comments about the milia on her infant's face. What information should the nurse include when responding? 1 They are common and will disappear in 2 to 3 days. 2 Avoid squeezing them and don't try to wash them off. 3 They are birthmarks that will disappear in 3 to 4 months. 4 Proper handwashing technique is important because milia are infectious.

2 Avoid squeezing them and don't try to wash them off. Attempts to remove milia will irritate the infant's skin, and such attempts are not needed because the milia will disappear during the first month of life. Although milia are common, they do not disappear for several weeks after birth. Milia are not birthmarks; the tiny plugged sebaceous glands are the result of maternal hormonal influence. The white material is not purulent and is not infectious.

The nurse is caring for a newborn with caput succedaneum. The nurse is able to differentiate caput succedaneum from cephalhematoma because of what characteristic of the scalp edema in caput succedaneum? 1 Becomes ecchymotic 2 Crosses the suture line 3 Increases after several hours 4 Is tender in the surrounding area

2 Crosses the suture line Scalp edema that crosses the suture line is the clinical finding that differentiates between these two conditions. With caput succedaneum the swelling crosses the suture line, whereas in cephalhematoma it does not.

The nurse plans to assess a postpartum client's uterine fundus. What should the nurse ask the client to do before this assessment? 1 Drink fluids 2 Empty her bladder 3 Perform the Valsalva maneuver 4 Assume the semi-Fowler position

2 Empty her bladder Having the client empty her bladder will help ensure accurate assessment of fundal height. A full bladder may promote a boggy uterus and may elevate the uterus upward and toward the client's right side.

What step should a nurse take when preparing to administer Rho(D) immune globulin to a postpartum client? 1 Start a primary intravenous (IV) line so that the drug may be administered via IV piggyback. 2 Ensure that the client is Rh negative and the neonate is Rh positive. 3 Obtain a syringe and needle appropriate for the subcutaneous injection. 4 Determine that the client has not eaten since midnight of the previous night.

2 Ensure that the client is Rh negative and the neonate is Rh positive. Rho(D) immune globulin is given to Rh-negative mothers not previously sensitized who have Rh-positive neonates; it prevents Rh incompatibility in the next pregnancy.

The nurse is assessing a new mother at a healthcare facility. Which symptom does the nurse identify as a risk factor for postpartum blues? 1 Frantic energy 2 Mild irritability 3 Hallucinations 4 Unwillingness to sleep

2 Mild irritability Postpartum blues are transient symptoms that a client may experience after childbirth. About 85% of women experience postpartum blues with symptoms of mild irritability, tearfulness, rapid mood fluctuations, and anxiety.

A client arrives at the clinic with swollen, tender breasts and flulike symptoms. A diagnosis of mastitis is made. What does the nurse plan to do? 1 Help her wean the infant gradually. 2 Teach her to empty her breasts frequently. 3 Review breastfeeding techniques with her. 4 Send a sample of her milk to the laboratory for testing.

2 Teach her to empty her breasts frequently. Emptying the breasts limits engorgement because engorgement causes pressure and tenderness in an already tender area. Breastfeeding should be continued; it is not only unnecessary but also unwise to remove the infant from breastfeeding. Suckling keeps the breasts empty, limits engorgement, and reduces pain. The milk culture may be negative because the infection may be limited to the connective tissue of the breast.

The nurse teaches a postpartum client how to care for her episiotomy in order to prevent infection. Which behavior indicates that the teaching has been effective? 1 The perineal pad is changed twice daily. 2 The client washes her hands before and after she changes a perineal pad. 3 The client rinses her perineum with water after using an analgesic spray. 4 The client cleanses the perineum from the anus toward the symphysis pubis.

2 The client washes her hands before and after she changes a perineal pad.

A nurse who is observing a sleeping newborn at 2 hours of age identifies periods of irregular breathing and occasional twitching movements of the arms and legs. The neonate's heart rate is 150 beats/min; the respiratory rate is 50 breaths/min; and the glucose strip reading is 60 mg/dL (3.3 mmol/L). What does the nurse conclude that these findings indicate? 1 Hypoglycemia 2 Seizure activity 3 Expected adaptations 4 Respiratory distress syndrome

3 Expected adaptations During periods of active or irregular sleep, healthy newborns have some twitching movements and irregular respirations; the heart rate, respirations, and blood glucose level are within expected limits. Hypoglycemia in newborns is characterized by a blood glucose level below 30 mg/dL The newborn respiratory rate ranges between 30 and 60 breaths/min; irregular breathing is expected.

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is: Select one: a. the residue of a milk curd. b. passed in the first 12 hours of life. c. seen at age 3 days. d. lighter in color and looser in consistency.

b. passed in the first 12 hours of life.

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver would then: Select one: a. alert the physician that the infant has a dislocated hip. b. tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. c. suggest that, if the condition does not change, surgery to correct vision problems may be needed. d. inform the parents and physician that molding has not taken place.

a. alert the physician that the infant has a dislocated hip.

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed: Select one: a. at least twice, 1 minute and 5 minutes after birth. b. only if the newborn is in obvious distress. c. every 15 minutes during the newborn's first hour after birth. d. once by the obstetrician, just after the birth.

a. at least twice, 1 minute and 5 minutes after birth.

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is: Select one: a. 80 to 100 beats/min. b. 120 to 160 beats/min. c. 100 to 120 beats/min. d. 150 to 180 beats/min.

b. 120 to 160 beats/min.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: a. begin an intravenous (IV) infusion of Ringer's lactate solution. b. massage the woman's fundus. c. assess the woman's vital signs. d. call the woman's primary health care provider.

b. massage the woman's fundus.

A patient is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on "high." The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse's best response is: Select one: a. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." b. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." c. "Your baby will get cold stressed easily and needs to be bundled up at all times." d. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him."

d. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him."