OB quizzes after midterm

The nurse assessing a newborn for heat loss is aware that nonshivering thermogenesis utilizes the newborn's stores of brown adipose tissue (BAT) to provide heat in the cold-stressed newborn. Select one: True False

True

Lesbian women are at a higher risk for heart disease than heterosexual women. Select one: True False

True The rates of smoking and obesity in lesbians are higher than those of heterosexual women which places them at higher risk for heart disease.

During a routine physical of a 31-year-old non-Hispanic black woman, it was noted that the woman's BMI is 32, her only exercise is taking care of her two children, her last pelvic exam and Pap test were 4 years ago, and her last clinical breast exam was 4years ago. Based on this information the woman (select all that apply): Select one or more: a. Needs to be scheduled for a Pap test b. Needs to be scheduled for a clinical breast exam c. Is at risk for type 2 diabetes d. Is at risk for depression related to lowered physical activity

a, b, c, d Recommended screenings for women ages 19 to 39 are clinical breast exams and Pap test every 3 years. Obesity (a BMI of 30 or greater) places the woman at risk for type 2 diabetes; decreased physical activity places the woman at risk of depression.

The most appropriate time to give prophylactic antibiotics to the women undergoing cesarean section is: Select one: a. One hour before the surgery b. Two hours before the surgery c. Not indicated unless she has an active infection d. At the time the cord is clamped

a. One hour before the surgery Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

Anne is a 17 year old sexually active woman (G0000) who wants an effective birth control method. She denies any medical problems. Which of the following would the nurse not recommend to Anne? Select one: a. essure b. oral contraceptive pills c. intrauterine device d. the implant

a. essure

During an emergency cesarean birth the "time-out" procedure may be omitted based on the obstetrical emergency. Select one: True False

False Joint commission guidelines for patient safety necessitate there always be a time-out to prevent wrong patient, wrong site, wrong procedure, and medical errors.

The clinic nurse recognizes that the longer an infant is formula fed, the greater is the immunity and resistance the infant will develop against bacterial and viral infections. True False

False One of the primary benefits of breastfeeding, not formula feeding, is the decreased incidence of bacterial and viral infections as a result of passive immunity, including the transfer of maternal antibodies.

The perinatal nurse explains to the student nurse that the most frequent fetal risk associated with the use of forceps is cord compression. Select one: True False

False The most frequent fetal risk associated with the use of forceps is superficial scalp or facial marks that will resolve quickly.

Bonding is bidirectional from parent to infant and infant to parent. Select one: True False

False Bonding is unidirectional from parent to infant. Attachment is bidirectional

Eye movements are an example of newborn/infant style of communication. Select one: True False

True Crying, cooing, facial expressions, eye movements, cuddling, and arm and leg movements are all examples of newborn/infant style of communication

The perinatal nurse teaches the postpartum woman that the most critical time to achieve effectiveness from the application of ice packs to the perineum is during the first 24 hours following birth. Select one: True Correct False

True To reduce perineal swelling and pain that result from bruising, ice packs may be applied every 2 to 4 hours. Patients obtain the most relief when ice packs are applied within the first 24 hours after childbirth.

A hematoma is the collection of blood beneath the intact skin layer following an injury to a blood vessel. Select one: True False

True A hematoma is a localized collection of blood in connective or soft tissue under the skin that follows injury of or laceration to a blood vessel without injury to the overlying tissue. At the time of injury, pressure necrosis and inadequate hemostasis occur.

Metritis is an infection that usually starts at the placental site. Select one: True False

True Metritis is an infection of the endometrium that usually starts at the placental site and spreads to encompass the entire endometrium.

Abruptio placenta is a risk factor for amniotic fluid embolism. Select one: True False

True Risk factors for amniotic fluid embolism include induction of labor, maternal age over 35, operative delivery, placenta previa, abruptio placenta, polyhydramnios, eclampsia, and cervical or uterine lacerations.

The nurse is teaching the parents of a healthy newborn about infant safety. Which of the following should be included in the teaching plan? Select one or more: a. Water temperature for the infant's bath should be 100.4 degrees F. b. Do not cook while holding an infant c. Cover electrical outlets d. Remove strings from infant sleepwear, bedding, and pacifiers to prevent strangulation.

a,b,c,d

General skin care for full-term infants includes which of the following? (Select all that apply.) Select one or more: a. Avoid daily bathing with soap. b. Use a cleanser with a neutral pH. c. Avoid fragrant soaps. d. Apply petrolatum-based ointments sparingly to dry skin, but avoid head and face.

a,b,c,d It is not necessary to bathe an infant daily. Daily bathing with soap can cause dry skin in the infant. The cleanser should be of neutral pH and free of additives such as fragrances that could be irritants.

Secondary amenorrhea results from (select all that apply): Select one or more: a. Polycystic ovary syndrome b. Uncontrolled Diabetes c. Secondary amenorrhea is no menses in 6 months in a woman who has had normal menstrual cycles. May result from: lack of ovarian production, pregnancy, polycystic ovary syndrome, nutritional and endocrine disturbances, uncontrolled diabetes, heavy athletic activity, or emotional distress. d. Pregnancy

a,b,c,d Nutritional disturbances such as anoxia and emotional distress can cause secondary amenorrhea.

Jennifer is 3 hours postpartum following the vaginal delivery of a 9lb 15oz baby girl. Estimated blood loss at delivery was 800 ml. The RN is aware that Jennifer experienced an early-postpartum hemorrhage). Select the appropriate nursing actions for the care of this patient. (Select all that apply.) Select one or more: a. Maintain IV site in case fluids/medication for PPH are indicated b. Frequent fundal assessment to prevent uterine atony and further blood lossc. Assess for displaced uterus secondary to overdistended bladder. d. Assess lochia for amount and for clots

a,b,c,d PPH is blood loss greater than 500 ml for vaginal deliveries and 1000 ml for cesarean with a 10% drop in hemoglobin and/or hematocrit. Unfortunately, postpartum women may not show signs/symptoms of PPH until about 1/3 of entire blood volume is lost. RNs must frequently assess uterine tone, location, and position as well as blood loss amount and characteristics (slow, steady, sudden, massive, presence of clots, possible distended bladder). Keeping the IV site intact will allow immediate access to fluids and/or medications should PPH worsen.

The CHOICE Project removed 3 key barriers to contraception for many women. These included which of the following? Select one or more: a. knowledge deficit b. state laws that restrict methods c. lack of access to preferred method d. parental permission e. cost

a,c,e knowledge deficit, cost, lack of access to preferred method

Which of the following women is at highest risk for osteoporosis? Select one: a. A 70-year-old non-Hispanic Caucasian woman who has smoked for 50 years b. A 70-year-old non-Hispanic black woman who is a heavy drinker c. A 60-year-old Asian woman who takes steroids to treat SLE d. A 70-year-old Hispanic woman who has had weight loss surgery

a. A 70-year-old non-Hispanic Caucasian woman who has smoked for 50 years Each of the women has a risk factor for osteoporosis, but answer (a) has the additional risk factor of being a non-Hispanic white woman.

Contraindications for induction of labor include: Select one or more: a. Abnormal fetal position b. Post-term pregnancy c. Pregnancy-induced hypertension d. Placental abnormalities

a. Abnormal fetal position d. Placental abnormalities Contraindications for induction of labor include abnormal fetal position because of the risk of fetal injury and placental abnormalities because of the risk of hemorrhage. Pregnancy-induced hypertension and post-term pregnancy are two of the common indications for induction of labor.

Maddy, a G3 P1 woman, gave birth 12 hours ago to a 9 lb. 13 oz. daughter. She experiences severe cramps with breastfeeding. The perinatal nurse best describes this condition as: Select one: a. Afterpains b. Uterine hypertonia c. Bladder hypertonia d. Rectus abdominis diastasis

a. Afterpains Afterpains (afterbirth pains) are intermittent uterine contractions that occur during the process of involution. Afterpains are more pronounced in patients with decreased uterine tone due to overdistension, which is associated with multiparity and macrosomia. Patients often describe the sensation as a discomfort similar to menstrual cramps. Afterpains are also related to the increase of oxytocin released in response to infant suckling.

The nurse is teaching the parents of a female baby how to change a baby's diapers. Which of the following should be included in the teaching? Select one: a. Always wipe the perineum from front to back. b. Use an antibiotic ointment at the first sign of diaper rash c. Put powder on the buttocks every time the baby stools. d. Weigh every diaper in order to assess for hydration.

a. Always wipe the perineum from front to back. Clean female genitals by washing from front to back to decrease the risk of cystitis

Menorrhagia may result from (select all that apply): Select one or more: a. Anovulatory cycle b. Metritis c. Anorexia d. Emotional distress

a. Anovulatory cycle b. Metritis Menorrhagia is menstrual bleeding excessive in number of days and amount of blood. It may result from an anovulatory cycle, fibroids, inflammatory or infectious disease such as metritis or salpingitis, endometrial issues, or intrauterine device (IUD)

A nurse is completing the initial assessment on a neonate of a mother with type I diabetes. Important assessment areas for this neonate include which of the following? (Select all that apply.) Select one or more: a. Assessment of cardiovascular system. b. Assessment of respiratory system c. Assessment of musculoskeletal system d. Assessment of neurological system.

a. Assessment of cardiovascular system. b. Assessment of respiratory system c. Assessment of musculoskeletal system d. Assessment of neurological system. Complications of high maternal levels of glucose during pregnancy include cardiac anomalies, skeletal defects, risk for RDS, neurological damage and seizures. Assessment findings of the macrosomic infant may include fractured clavicle, brachial nerve damage, hypoglycemia, hypocalcemia and hypomagnesemia, poycythemia, hyperbilirubinemia, low muscle tone, and poor feeding abilities.

The nurse is developing a plan of care for a client who is in the "taking-in" phase after delivering a healthy baby boy. Which of the following should the nurse include in the plan? Select one: a. Assist the woman in selecting a nutritious meal plan. b. Teach baby care skills like diapering. c. Discuss the pros and cons of circumcision. d. Counsel her regarding future sexual encounters.

a. Assist the woman in selecting a nutritious meal plan. The "taking-in" phase is a period of dependent behaviors and occurs during the first 24-48 hours. Assisting her in ordering her meals allows her to focus on her comfort while acknowledging her decreased ability to make decisions. Teaching infant skills is probably more appropriate during the "taking-hold" phase.

The perinatal nurse is caring for a woman in the recovery room immediately following cesarean birth. Which of the following assessment findings would indicate the need for immediate notification of the obstetrical provider? Select one or more: a. Catheter is draining blood-tinged urine. CorrectBlood in the urine occurs when there has been trauma to the bladder. Bladder, ureter, and bowel trauma are surgical complications requiring prompt attention. Itching and nausea are common reactions to anesthesia and are treated with ordered medications. Moderate lochia is an expected finding. b. Woman complains of itching c. Woman complains of nausea d. Lochia is moderate

a. Catheter is draining blood-tinged urine. Blood in the urine occurs when there has been trauma to the bladder. Bladder, ureter, and bowel trauma are surgical complications requiring prompt attention. Itching and nausea are common reactions to anesthesia and are treated with ordered medications. Moderate lochia is an expected finding.

During a health visit, a 23-year-old patient shares with her health-care provider that she has been experiencing a yellowish mucus vaginal discharge, pain during sexual intercourse, and burning on urination. A culture of the cervical epithelial cells is obtained. Based on the patient information, the culture is obtained to assist in the diagnosis of which of the following? (Select all that apply.) Select one or more: a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis

a. Chlamydia b. Gonorrhea These are symptoms that can be related to either chlamydia or gonorrhea. Syphilis is diagnosed via blood test. Genital herpes has symptoms similar to the flu, and the person usually has an itching or burning sensation in the genital or anal area.

25 year old Susan (G0000) is thinking about getting pregnant this next year, but wants an effective method right now. She currently uses condoms. She denies medical problems. Which of the following birth control methods are most appropriate for the nurse to discuss with Susan? (Select all that apply). Select one or more: a. Condoms (continue) b. Oral contraceptive pills c. Copper IUD (Paragard) d. The implant e. The birth control patch

a. Condoms (continue) b. Oral contraceptive pills e. The birth control patch Long-acting contraception is not the best choice for a woman who desires pregnancy within one year. More appropriate methods include birth control pills and the patch, and the vaginal ring as they are not long acting and are reversible once the woman stops using them. Condoms are short acting with no hormones.

Which of the following actions can decrease the risk for a postpartum infection? (Select all that apply.) a. Diet high in protein and vitamin C b. Increased fluid intake c. Ambulating within a few hours after delivery d. Good hand washing techniques by staff and patients

a. Diet high in protein and vitamin C b. Increased fluid intake c. Ambulating within a few hours after delivery d. Good hand washing techniques by staff and patients Protein and vitamin C assist with tissue healing. Rehydrating a woman after delivery can assist with decreasing risk for infections. Early ambulation decreases risk for infection by promoting uterine drainage. Hand washing by staff and patients has been shown to be the number one measure in the transmission of infection.

Which of the following are common assessment findings of postmature neonates? (Select all that apply.) Select one or more: a. Dry and peeling skin b. Abundant vernix caseosa c. Hypoglycemia d. Thin, wasted appearance

a. Dry and peeling skin c. Hypoglycemia d. Thin, wasted appearance A post-mature or post-term neonate is one delivered after the completion of 41 weeks' gestation. Placental insufficiency related to an aging placenta may result in post-maturity syndrome - fetus begins us use its subcutaneous fat and glycemic stores. Common assessment findings include dry, peeling, cracked skin; lack of vernix; profuse hair; long fingernails; thin, wasted appearance; meconium staining; hypoglycemia; poor feeding behaviors.

A woman who is receiving radiation therapy for treatment of stage I cervical cancer is experiencing diarrhea. She contacts the oncology advice nurse. The advice nurse recommends that the woman (select all that apply): Select one or more: a. Eat five or six small meals a day instead of three large meals b. Eat cooked vegetables instead of raw vegetables c. Use baby wipes instead of toilet paper d. Reduce fluid intake to four glasses of water

a. Eat five or six small meals a day instead of three large meals b. Eat cooked vegetables instead of raw vegetables c. Use baby wipes instead of toilet paper Radiation damages the cells of the intestines. Interventions are aimed at decreasing stress on the intestines such as eating small, frequent meals and foods low in fiber. Baby wipes help reduce irritation to the anal area. A person should increase fluid intake to compensate for fluid loss caused by the diarrhea.

Which of the following are primary risk factors for subinvolution of the uterus? (Select all that apply.) Select one or more: a. Fibroids b. Retained placental tissue c. Metritis d. Urinary tract infection

a. Fibroids b. Retained placental tissue c. Metritis Uterine fibroids can interfere with involution. Retained placental tissue does not allow the uterus to remain contracted. Infection in the uterus is a risk factor for subinvolution. UTI does not interfere with involution of the uterus.

Which STD can be prevented by a vaccine and reduce a person's risk for certain types of cancer? Select one: a. Human papilloma virus b. gonorrhea c. Herpes simplex virus d. HIV

a. Human papilloma virus

A woman gave birth to a 3200 g baby girl with an estimated gestational age of 40 weeks. The baby is 1 hour of age. In preparation for administration of Vitamin K to the infant, the nurse will explain to the parents that an injection of this medication: Select one: a. Influences the activation of coagulation factors to prevent delayed clotting and hemorrhagic disease b. Prevents high levels of unconjugated bilirubin in the newborn's blood c. Prevents the excessive loss of RBCs d. Aids the liver in regulation of blood glucose

a. Influences the activation of coagulation factors to prevent delayed clotting and hemorrhagic disease Vitamin K (phytonadione) influences the activation of coagulation factors II, VII, IX, and X. After birth, the neonate experiences a decrease in Vitamin K and is at risk for delayed clotting and for hemorrhage. An injection of Vitamin K is given as a prophylaxis to decreased the risk of bleeding.

The nurse is working with a 36-year-old, married client, G6 P6, who smokes. The woman states, "I don't expect to have any more kids, but I hate the thought of being sterile." Which of the following contraceptive methods would be best for the nurse to recommend to this client? Select one: a. Intrauterine contraceptive device e patch c. Bilateral tubal ligation d. Birth control pills

a. Intrauterine contraceptive device Intrauterine contraception (IUC) is the recommended method for this patient. IUC has a low failure rate and provides long-term contraception for up to 10 years. Bilateral tubal ligation (BTL) is a surgical procedure which results in sterilization. Due to her history of smoking, neither birth control pills nor contraceptive patch is recommended due to the increased risks for blood clots, heart disease, and strokes, also associated with smoking.

Augmentation of labor: Select one: a. Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is elective induction of labor d. Is an operative vaginal delivery that uses vacuum cups

a. Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are ineffective Labor augmentation is the stimulation of ineffective UCs after the onset of spontaneous labor to manage labor dystocia. Lower doses of oxytocin are required but all of the principles pertaining to the use of oxytocin apply to augmentation.

To accurately measure the neonate's head, the nurse places the measuring tape around the head: Select one: a. Just above the ears and eyebrows b. Middle of the ear and over the eyes c. Middle of the ear and over the bridge of the nose d. Just below the ears and over the upper lip

a. Just above the ears and eyebrows

The perinatal nurse is teaching the new mother who has chosen to formula feed her infant. Appropriate instructions to be given to this mother include (select all that apply): Select one or more: a. Mix the formula according to manufacturer's instructions; do not overdilute or underdilute b. Periodically check the nipple for slow flow. c. Prepare only enough formula to last for 24 hours and discard open containers or prepared formula after 24 hours. d. Discard any unused formula that remains in a bottle following use.

a. Mix the formula according to manufacturer's instructions; do not overdilute or underdilute b. Periodically check the nipple for slow flow. d. Discard any unused formula that remains in a bottle following use. Parents should be advised to read and follow the manufacturer's instructions explicitly when preparing the formula, because some require no water and some need to be diluted with water. Cold water should be used to mix the powder, only the amount to be used for each feeding should be prepared, and any unused formula should be discarded. The nipples should be checked periodically during feedings for correct flow and should be replaced regularly. Formula to last 48 hours and then discard

The clinic nurse teaches expectant mothers about the differences between breast milk and commercially prepared infant formulas. When compared to commercially prepared formulas, breast milk has (select all that apply): Select one or more: a. More carbohydrates b. Less protein c. Fewer nutrients d. Less cholesterol

a. More carbohydrates b. Less protein Human breast milk contains more carbohydrates, less protein, and more cholesterol than cow's milk or infant formulas. Commercially prepared infant formulas use vegetable oils which are void of cholesterol.

Which of the following are common symptoms for gonorrhea? Select all that apply. Select one or more: a. none b. chancre on the vulva c. penile discharge d. vaginal discharge with odor

a. none c. penile discharge

The perinatal nurse observed the pediatrician completing the Ballard Maturational Score (BMS). The maturity components used with this assessment are (select all that apply): Select one or more: a. Physical b. Behavioral c. Reflexive d. Neuromuscular

a. Physical d. Neuromuscular With the BMS, the infant examination yields a score of neuromuscular and physical maturity that can be extrapolated onto a corresponding age scale to reveal the infant's gestational age in weeks.

Tanya, a 30-year-old woman, is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions Tanya in a supine position. Tanya's blood pressure drops to 90/52, and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse's best response is to: Select one: a. Place Tanya in a left lateral tilt b. Discontinue Tanya's intravenous administration. c. Have naloxone (Narcan) ready for administration. d. Have epinephrine ready for administration.

a. Place Tanya in a left lateral tilt Reposition the woman after epidural or spinal anesthesia in a supine position with a left lateral tilt to decrease the pressure from the uterus on the inferior vena cava and to maintain placental perfusion.

A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? a. Previous uterine surgery b. Flexed fetal attitude c. Previous low flap uterine incision d. Positive vaginal candidiasis

a. Previous uterine surgery Contraindications for trial of labor after cesarean (TOLAC) leading to VBAC include vertical uterine incision, previous uterine surgery, previous uterine rupture, pelvic abnormalities, complications preventing vaginal delivery, lack of personnel required for operative delivery

The perinatal nurse notes a rapid decrease in the fetal heart rate that does not recover immediately following an amniotomy. The most likely cause of this obstetrical emergency is: Select one: a. Prolapsed umbilical cord b. Vasa previa c. Oligohydramnios d. Placental abruption

a. Prolapsed umbilical cord Amniotomy is the artificial rupture of membranes (AROM) to induce or augment labor. This is a common procedure seen in obstetrics. Risks associated with amniotomy include umbilical cord prolapse when the presenting part is not engaged. Vasa previa or rupture of fetal vessels unsupported by the placenta is a very rare situation and usually results in rapid fetal exsanguination in the presence of bloody fluid seen following AROM.

A woman who gave birth 2 hours ago has a temperature of 100.2 degrees Fahrenheit. Select all of the immediate nursing actions. Select one or more: a. Promote rest and rehydration and recheck in 1 hour b. Explain to the patient that she needs to change her position c. Immediately medicate the patient with 500 mg of acetaminophen d. Call the patient's physician or midwife to report the elevated temperature

a. Promote rest and rehydration and recheck in 1 hour A mild temperature elevation within a few hours of birth can be related to dehydration and exhaustion. Acetaminophen is given if the temperature remains elevated after the woman has been hydrated and rested. The physician or midwife is notified if temperature remains elevated after initial interventions.

An infant admitted to the newborn nursery has a blood glucose level of 55 mg/dL. Which of the following actions should the nurse perform at this time? Select one: a. Provide the baby with routine feedings. b. Assess the baby's blood pressure. c. Place the baby under the infant warmer. d. Monitor the baby's urinary output.

a. Provide the baby with routine feedings. Neonatal hypoglycemia is defined as <40mg/dL; 55mg/dL is a normal glucose value requiring no treatment

Which of the following nursing actions are directed at promoting bonding? (Select all that apply.) Select one or more: a. Providing opportunity for parents to hold their newborn as soon as possible following the birth. b. Providing opportunities for the couple to talk about their birth experience and about becoming parents c. Promoting rest and comfort by keeping the newborn in the nursery at night. d. Providing positive comments to parents regarding their interactions with their newborn.

a. Providing opportunity for parents to hold their newborn as soon as possible following the birth. b. Providing opportunities for the couple to talk about their birth experience and about becoming parents d. Providing positive comments to parents regarding their interactions with their newborn. Parent bonding can be delayed by prolonged periods of separation from their child. The other three actions support parent bonding with their newborn.

The nurse is advising parents of a full-term neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? Select one: a. Put the car seat facing forward only after the baby reaches 20 pounds. b. The infant car seat should be placed facing the rear seat in the front seat of the car. c. Car seats are recommended only when traveling longer distances from home; holding the infant is safe for short trips d. It is safe to leave an infant in a car seat alone as long as the windows are down at least 1 inch.

a. Put the car seat facing forward only after the baby reaches 20 pounds. Infants are safest when secured in the back seat. Rear-facing car seats are used with infants until they are 1 year of age and weigh 20 pounds. It is never safe to leave an infant unattended in a car seat and car seats should be used whenever traveling in a motor vehicle.

Jennifer is a 32 year old lawyer 37 weeks pregnant with her first child. She tells you that she has been on Paroxetine (an SSRI) for anxiety throughout her pregnancy. She asks you if she needs to worry about any side effects for her baby. Your best response would be: Select one: a. SSRIs have been linked to symptoms in the newborn and while they don't usually last too long I will alert your pediatrician and our high-risk nursery so everyone is aware. b. Yes, taking SSRIs in late pregnancy can cause symptoms in the baby but these won't show up for several months so I'll share with you what to look for before you are discharged. c. You probably don't need to worry as the use of SSRIs in pregnancy is not a problem. d. Yes, taking SSRIs in late pregnancy can be dangerous to the baby. You need to stop taking your Paroxetine immediately.

a. SSRIs have been linked to symptoms in the newborn and while they don't usually last too long I will alert your pediatrician and our high-risk nursery so everyone is aware. SSRI are commonly used for the management of depression and anxiety in pregnant women. SSRI use during the last trimester of pregnancy has been associated with symptoms in the baby very similar to clinical signs of Neonatal Abstinence Syndrome (NAS). The onset of clinical signs for infants exposed to SSRIs range from several hours after birth to several days after birth, with symptomatology lasting 1-2 weeks after birth.

The laboratory reported that the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid client with preeclampsia are 2:1. The nurse interprets the result as which of the following? Select one: a. The baby's lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby's kidneys are functioning poorly. d. The mother is high risk for eclampsia.

a. The baby's lung fields are mature.

Which of the following is correct regarding endometriosis? Select one: a. The physical symptoms of endometriosis can affect the woman's mental health. b. The abnormal tissue bleeds into surrounding tissue during the secretory stage of the menstrual cycle. c. Endometriosis causes severe headaches. d. Metronidazole is used to treat endometriosis.

a. The physical symptoms of endometriosis can affect the woman's mental health. The physical symptoms of endometriosis can have an effect on the woman's mental health; she may experience anger and grief related to loss of fertility and the pain related to this condition can interfered with her social activities. Dyspareunia can have an effect of intimate relationships. Abnormal tissue breaks down and bleeds into the surrounding tissues during the menstrual phase. Endometriosis is not associated with headaches and the drugs used in treatment include Danazol, Lupron, oral contraceptives, and progestins.

Nursing actions that decrease the risk of skin breakdown include which of the following? (Select all that apply.) Select one or more: a. Using gelled mattresses b. Using emollients in dry areas c. Using transparent adhesive dressings d. Few diaper changes

a. Using gelled mattresses b. Using emollients in dry areas The skin of the preterm neonate is predisposed to injury related to it being thin and fragile. Recommendations for appropriate skin care include: use of a neutral pH cleanser and sterile water when bathing; bathe only soiled areas; use adhesives sparingly, change diapers frequently, change positions frequently; apply emollients to dry areas, and use water/air/gel mattresses.

During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large quantity of bright red bleeding. Her uterine fundus is firm. The nurse's most appropriate action is to notify the physician/certified nurse midwife and anticipate the need for: Select one: a. Vaginal assessment and possible repair of vaginal and/or cervical lacerations b. An oxytocin infusion c. Further information for the woman/family about forceps d. Bladder assessment and catheterization

a. Vaginal assessment and possible repair of vaginal and/or cervical lacerations Risks as a result of forceps delivery include vaginal/cervical lacerations, extension of episiotomy, hemorrhage related to uterine atony or rupture, perineal hematoma, bladder injury, and perineal wound infection.

Nursing actions focused at reducing a postpartum woman's risk for cystitis include which of the following? (Select all that apply.) Select one or more: a. Voiding within a few hours post-birth b. Oral intake of a minimum of 3000 mL per day c. Changing peri-pads every 3 to 4 hours or more frequently as indicated d. Reminding the woman to void every 3 to 4 hours while awake

a. Voiding within a few hours post-birth b. Oral intake of a minimum of 3000 mL per day c. Changing peri-pads every 3 to 4 hours or more frequently as indicated d. Reminding the woman to void every 3 to 4 hours while awake Early voiding helps flush bacteria from the urethra. Voiding every 3 to 4 hours will decrease the risk of bacterial growth in the bladder. Soiled peri-pads are a media for bacterial growth. It is recommend that a postpartum woman drink a minimum of 3000 mL/day to help dilute urine and promote frequent voiding.

The nurse is about to elicit the rooting reflex on a newborn baby. Which of the following responses should the nurse expect to see? Select one: a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. b. When the lateral aspect of the sole of the baby's foot is stroked, the toes extend and fan outward. c. When the baby is suddenly lowered or startled, the neonate's arms straighten outward and the knees flex. d. When the newborn is supine and the head is turned to one side, the arm on that same side extends.

a. When the cheek of the baby is touched, the newborn turns toward the side that is touched. An infant exhibits Rooting reflex when the neonate turns his head toward the direction of the stimulus and opens his mouth. Choice 2 is the Babinski reflex; Choice 3 is the Startle or Moro reflex; Choice 4 is the Tonic Neck reflex

A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal problems could have resulted in this complication? (Select all that apply.) Select one or more: a. Cholecystitis b. Chronic Hypertension with Preclampsia c. Cigarette smoker d. Candidiasis e. Cerebral palsy

b,c Babies born to women with cholecystitis, cerebral palsy, or candida are not especially high risk for IUGR. Babies born to women with chronic hypertension and/or preeclampsia or who smoke are high risk for IUGR.

Which of the following factors increases the risk of necrotizing enterocolitis (NEC) in very premature neonates? (Select all that apply.) Select one or more: a. Prolonged hyperoxia b. Prolonged use of mechanical ventilation c. Hyperbilirubinemia d. Nasogastic feedings

b,d Necrotizing enterocolitis (NEC) is a GI disease resulting in inflammation and necrosis of the bowel. Risk factors include prematurity, bacterial colonization from contaminate NG feedings of formula, and umbilical catheter placement.

The perinatal nurse is preparing a woman for a scheduled cesarean birth. The woman will be receiving spinal anesthesia for the birth. In order to prevent maternal hypotension, the nurse: Select one: a. Assists the woman to lie down in a supine position. b. Administers an intravenous preload infusion of 500 mL of normal saline. CorrectAn IV fluid preload of 500-1000 mL is given before administration of spinal or epidural anesthesia to increase fluid volume and decrease risk of hypotension related to the effects of anesthetic agents. c. Assesses blood pressure and pulse every 5 minutes, three times, before the spinal insertion. d. Encourages frequent cleansing breaths after the patient has been placed in the correct position for the anesthesia administration.

b. Administers an intravenous preload infusion of 500 mL of normal saline. An IV fluid preload of 500-1000 mL is given before administration of spinal or epidural anesthesia to increase fluid volume and decrease risk of hypotension related to the effects of anesthetic agents.

A 25 year-old woman gave birth to her second child 6 hours ago. She informs the nurse that she is bleeding more than with her previous birth experience. The initial nursing action is to: Select one: a. Explain that this is normal for second-time moms. b. Assess the location and firmness of the fundus. c. Change her pad and return in 1 hour and reassess. d. Give her 10 units of oxytocin as per standing order.

b. Assess the location and firmness of the fundus. Frequent assessment of uterine tone and placement allows for the identification of potential complications such as uterine atony (decreased uterine muscle tone) that may lead to postpartum hemorrhage.

During the assessment of the newborn at 3 hours of age, the perinatal nurse documents the presence on the infant's scalp of a unilateral, well-defined mass which does not cross the suture lines. The mother's chart indicates a prolonged labor with use of a vacuum extractor. The RN identifies this finding as: Select one: a. Caput succedaneum b. Cephalohematoma c. Molding d. Intraventricular hemorrhage

b. Cephalohematoma Cephalohematoma is hematoma formation between the periosteum and skull with unilateral swelling. It appears within a few hours of birth and can increase in size over the next few days. It has a well-defined outline and does not cross suture lines.

The nurse notes that a new father gazes at his baby for prolonged periods of time and comments that his baby is beautiful and he is very happy having a baby. These behaviors are commonly associated with: Select one: a. Bonding b. Engrossment c. Couvade syndrome d. Attachment

b. Engrossment Engrossment is defined as an absorption, preoccupation, and interest shown by fathers with their newborns. New fathers gaze at their newborns for prolonged periods of time as if they are in a hypnotic trance. characteristics of engrossment include a perception that the newborn is perfect.

A full-term neonate who is 30 hours old has a bilirubin level of 10 mg/dL. The neonate has a yellowish tint to the skin of the face. The mother is breastfeeding her newborn. The nurse caring for this neonate would anticipate which of the following interventions? Select one: a. Phototherapy b. Feeding neonate every 2 to 3 hours c. Switch from breastfeeding to bottle feeding d. Assess red blood cell count

b. Feeding neonate every 2 to 3 hours

A full-term neonate who is 30 hours old has a bilirubin level of 10 mg/dL. The neonate has a yellowish tint to the skin of the face. The mother is breastfeeding her newborn. The nurse caring for this neonate would anticipate which of the following interventions? Select one: a. Phototherapy b. Feeding neonate every 2 to 3 hours c. Switch from breastfeeding to bottle feeding d. Assess red blood cell count

b. Feeding neonate every 2 to 3 hours Treatment of jaundice is based on bilirubin levels and the age of the neonate in hours. At 30 hours of age and a bilirubin level of 10 mg/dL, the RN would ensure adequate hydration by feeding the neonate every 2-3 hours to promote excretion of bilirubin in the urine and stool. Phototherapy for this infant would be considered if bilirubin level was 12 mg/dL or higher with treatment most likely initiated at a level of 15 mg/dL or higher.

Your patient is a 28-year-old gravida 2 para 1 in active labor. She has been in labor for 12 hours. Upon further assessment, the nurse determines that she is experiencing a hypotonic labor pattern. Possible maternal and fetal implications from hypotonic uterine dysfunction are: Select one: a. Intrauterine infection and maternal exhaustion with fetal distress usually occurring in the latent phase of labor. b. Intrauterine infection and maternal exhaustion with fetal distress usually occurring in the active phase of labor. c. Intrauterine infection and postpartum hemorrhage with fetal distress early in labor. d. Intrauterine infection, ruptured uterus and fetal death.

b. Intrauterine infection and maternal exhaustion with fetal distress usually occurring in the active phase of labor. With hypotonic uterine dysfunction, normal progress is seen in the latent phase of labor but during the active phase, the UCs become weaker and less effective. The woman is at risk for exhaustion and infection related to the prolonged labor. The fetus is at risk for fetal intolerance of labor and asphyxia.

During a cesarean section, which action by the nurse is done to prevent compression of the descending aorta and vena cava? Select one: a. Right lateral tilt b. Left lateral tilt CorrectPositioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus. c. Elevate head of gurney at 30 degrees d. Administration of IV fluid preload of 500 to 1000 mL

b. Left lateral tilt Positioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus.

Karen, a G2 P2, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. The nurse's most appropriate first action is to: Select one: a. Assess vital signs including blood pressure and pulse. b. Massage the uterine fundus with continual lower segment support. c. Measure and document each perineal pad changed in order to assess blood loss. d. Ensure appropriate lighting for a perineal repair if it is needed.

b. Massage the uterine fundus with continual lower segment support. As the primary caregiver, the registered nurse may be the first person to identify excessive blood loss and initiate immediate actions. The nurse should first locate the uterine fundus and initiate fundal massage. Nursing actions performed after the massage are frequent vital sign measurements, measuring the length of time it takes for blood loss to saturate a pad, and assessing for bladder distention.

Which of the following can be used in cervical cancer screening? (Select all that apply). Select one or more: a. chlamydia b. Pap smear test c. herpes simplex 1 and 2 d. high risk HPV test

b. Pap smear test d. high risk HPV test Pap smear test and high risk HPV tests are used to screen cervical cancer. Other STD testing is not done for cervical cancer screening.

A primigravida woman at 42 weeks gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? Select one: a. Perform Nitrazine analysis of the amniotic fluid b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the provider for an order for oxytocin.

b. Report the lack of progress to the obstetrician. Prepidil is indicated for cervical ripening, the process of physical softening and opening of the cervix. Cervical status is the most important predictor of successful induction of labor. Cervical status is assessed before induction of labor using the Bishop score. A score of 6 or more is considered favorable for successful induction of labor.

The perinatal nurse observes the new mother watching her baby daughter closely, touching her face, and asking many questions about infant feeding. This stage of mothering is best described as: Select one: a. Taking in b. Taking hold c. Taking charge d. Taking time

b. Taking hold As the mother's physical condition improves, she begins to take charge and enters the taking-hold phase where she assumes care for herself and her infant. At this time, the mother eagerly wants information about infant care and shows signs of bonding with her infant. During this phase, the nurse should closely observe mother-infant interactions for signs of poor bonding, and if present, implement actions to facilitate attachment.

Which of the following nursing actions are directed at assisting men in their transition to fatherhood? (Select all that apply.) Select one or more: a. Encourage the woman to take on the major responsibility for infant care. b. Talk to the couple about their expectations of the parenting role. c. Praise the father for his interactions with his infant. d. Provide information on infant care and behavior to both parents.

b. Talk to the couple about their expectations of the parenting role. c. Praise the father for his interactions with his infant. d. Provide information on infant care and behavior to both parents. It is important to first have the couple discuss with each other their expectations of the fathering role. Once this has occurred, then the woman and nurse need to support the man in his role of infant care. Both parents need to receive information about infant care and infant behaviors, and both parents need to be praised for their interactions with their baby.

Combination oral contraceptives, the vaginal ring and the patch contain two hormones. Which of the following is the primary hormone that stops ovulation? Select one: a. testosterone b. progesterone c. estrogen d. hCG

b. progesterone

The NICU nurse recognizes that respiratory distress syndrome results from a developmental lack of: Select one: a. Lecithin b. Calcium c. Surfactant d. Magnesium

c Respiratory distress syndrome (RDS) is a life-threatening lung disorder resulting from underdeveloped and small alveoli and insufficient level of pulmonary surfactant.

The woman's health clinic nurse is providing information to a 21-year-old woman who is being scheduled for a pelvic exam and Pap test. This information should include (select all that apply): Select one or more: a. The Pap test is a diagnostic test for cervical cancer. b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam c. The best time to have a Pap test is 5 days after the menstrual period has ended. d. The woman should have a yearly Pap test.

b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam c. The best time to have a Pap test is 5 days after the menstrual period has ended The Pap test is a screening versus a diagnostic test. Women should not douche; use tampons; use vaginal creams, spermicide foams, creams, or jellies; use vaginal lubricants or moisturizers; use vaginal medications; or have sexual intercourse for 48 hours prior to the exam. The best time to obtain a Pap test is 5 days after the period ends. Women ages 21 to 29 should have a Pap test every 3 years.

The woman's health clinic nurse is providing information to a 21-year-old woman who is being scheduled for a pelvic exam and Pap test. This information should include (select all that apply): Select one or more: a. The Pap test is a diagnostic test for cervical cancer. b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam. c. The best time to have a Pap test is 5 days after the menstrual period has ended. d. The woman should have a yearly Pap test.

b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam. c. The best time to have a Pap test is 5 days after the menstrual period has ended. The Pap test is a screening versus a diagnostic test. Women should not douche; use tampons; use vaginal creams, spermicide foams, creams, or jellies; use vaginal lubricants or moisturizers; use vaginal medications; or have sexual intercourse for 48 hours prior to the exam. The best time to obtain a Pap test is 5 days after the period ends. Women ages 21 to 29 should have a Pap test every 3 years.

The perinatal nurse demonstrates for the student nurse the correct technique of postpartum uterine palpation. Support for the lower uterine segment is critical, as without it, there is an increased risk of: Select one: a. Uterine edema b. Uterine inversion c. Incorrect measurement d. Intensifying the patient's level of pain

b. Uterine inversion During pregnancy there is stretching of the ligaments that hold the uterus in place. Fundal pressure could result in uterine inversion. Supporting the lower uterine segment may prevent uterine inversion during fundal assessment or massage

A baby was born 4 days ago at 34 weeks' gestation. She is receiving phototherapy as ordered by the physician for physiological jaundice. She has symptoms of temperature instability, dry skin, poor feeding, lethargy, and irritability. The nurse's priority nursing action(s) is (are) to (select all that apply): Select one or more: a. Verify laboratory results to check for hypomagnesia. b. Verify laboratory results to check for hypoglycemia. c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake and output to check for dehydration.

c,d There are two priority nursing interventions for hyperbilirubinemia. Hydration status is important if the newborn shows signs of dehydration such as dry skin and mucus membranes, poor intake, concentrated urine or limited urine output, and irritability. The newborn should also be kept warm while receiving phototherapy. When an infant is under phototherapy, the temperature needs to be monitored closely because the lights give off extra heat, but if the newborn is in an open crib and undressed, hypothermia may occur.

A 1-day-old neonate in the well-baby nursery is suspected of suffering from drug withdrawal because he is markedly hyperreflexic and is exhibiting which of the following additional sign or symptom? Select one: a. Prolonged periods of sleep b. Hypovolemic anemia c. Repeated bouts of diarrhea d. Pronounced pustular rash

c. Neonatal abstinence syndrome (neonatal withdrawal) may result from intrauterine exposure to various substances including opioids such as heroin, methadone, oxycodone; alcohol; barbiturates. Signs of neonatal withdrawal include apnea, diarrhea, excessive crying, sleep problems, irritability, and restlessness.

A NICU nurse is caring for a full-term neonate being treated for group B streptococcus (GBS). The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is: Select one: a. "Newborns are more susceptible to infections due to an immature immune system. Would you like additional information on the newborn immune system?" b. "The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?" c. "Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?" d. "I see that this is very upsetting for you. I will come back later and answer your questions."

c. "Approximately 15% to 40% of women have no symptoms but are carriers of group B streptococcus which is found in the vaginal and lower intestinal areas. What other questions do you have regarding your baby's health?"

The perinatal nurse accurately defines postpartum hemorrhage by including a decrease in hematocrit levels from pre- to postbirth by: Select one: a. 5% b. 8% c. 10% d. 15%

c. 10% Historically, practitioners have defined postpartum hemorrhage as a blood loss greater than 500 mL following a vaginal birth and 1000 mL or more following a cesarean birth. Hematocrit levels that decrease 10% from pre- to postbirth measurements are also included in the definition.

A 35-year-old G1 P1 postpartum woman is Rh negative and has given birth to an Rh positive infant. Rh0(D) immune globulin is to be administered. The most appropriate dose that the perinatal nurse would expect to be ordered would be: Select one: a. 120 mcg b. 250 mcg c. 300 mcg d. 350 mcg

c. 300 mcg Nonsensitized women who are Rh negative and have given birth to an Rh positive infant should receive 300 mcg of Rh(D) immune globulin (RhoGAM) within 72 hours after giving birth. RhoGAM should be given whether or not the mother received RhoGAM during the antepartum period. In some situations, depending on the extent of hemorrhage and exchange of maternal-fetal blood, a larger dose of RhoGAM may be indicated.

The nurse completes an initial newborn examination on a baby boy at 90 minutes of age. The baby was born at 40 weeks' gestation with no birth trauma. The nurse's findings include the following parameters: heart rate 136 beats per minute; respiratory rate 64 breaths per minute; temperature 98.2°F (36.8°C); length 49.5 cm; and weight 3500 g. The nurse documents the presence of a heart murmur, absence of bowel sounds, symmetry of ears and eyes, no grunting or nasal flaring, and full range of movement of all extremities. Which assessment would warrant further investigation and require immediate consultation with the baby's health-care provider? Select one: a. Respiratory rate b. Presence of a heart murmur c. Absent bowel sounds d. Weight

c. Absent bowel sounds Bowel sounds are present but may be hypoactive for the first few days.

Which of the following foods is highest in calcium? a. An 8 oz. glass of milk b. A 1.5 oz. piece of cheddar cheese c. An 8 oz. container of plain, low-fat yogurt d. A 3 oz. piece of salmon

c. An 8 oz. container of plain, low-fat yogurt Milk has 293 mg of calcium; cheddar cheese has 307 mg; yogurt has 415; salmon has 181 mg.

A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couple's anxiety levels. Select one: a. Explain the reason for the need for a cesarean section. b. Inform parents that their baby is in distress. c. Ask the couple to share their concerns. d. Reassure the couple that both the woman and baby are in no danger.

c. Ask the couple to share their concerns. Urgent cesarean births, rather than emergent, should allow the RN time to discuss with the family their feelings and concerns. The RN should provide emotional support during the preparation for surgery in an attempt to facilitate communication and decrease fear, anxiety, and distress. Medical management includes the determination of the need for cesarean birth and the explanation of the procedure in order to obtain consent.

The nurse is assessing a baby girl on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist? Select one: a. Intermittent strabismus b. Startling c. Grunting. d. Vaginal bleeding

c. Grunting. Grunting may be a sign of respiratory distress and should be reported immediately. Intermittent strabismus, startling, and vaginal bleeding are normal findings during a newborn assessment.

18 year old Ellen has a positive pregnancy test and cries when she sees the result. Per her LMP, the nurse determines she is approx 7 weeks pregnant. She asks the nurse what should she do. Which of the following is the nurse's best initial response? Select one: a. I think adoption would be your best choice at this time. b. You need to decide what obstetrician you want to see for prenatal care. c. Let's discuss your three options d. Here is a list of clinics that provide abortions. My sister liked this one best.

c. Let's discuss your three options

During labor induction with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability. Contraction frequency is assessed to be every 2 minutes with duration of 60 seconds, of moderate strength to palpation. Based on this assessment, the nurse should take which action? Select one: a. Increase oxytocin infusion rate per provider's protocol. b. Stop oxytocin infusion immediately. c. Maintain present oxytocin infusion rate and continue to assess. d. Decrease oxytocin infusion rate by 2 mU/min and report to provider.

c. Maintain present oxytocin infusion rate and continue to assess. The goal of oxytocin use in labor is to establish uterine contraction patterns that promote cervical dilation of about 1 cm/hr once in active labor. The lowest possible dose should be used to achieve labor progress. Generally, the labor pattern should be 3 UCs in 10 minutes, lasting 40-60 seconds with an intensity of 25-75 mm/HG with IUPC and resting tone <20 mm HG with 1 minute between each UC. The labor pattern described above is appropriate and no increase or decrease in oxytocin infusion rate is indicated.

A new mother notices what appears to be bruising over her newborn's buttocks. She asks the nurse if the baby has been injured in some way. The nurse explains that this is: Select one: a. Erythema Toxicum b. Jaundice c. Mongolian spots d. Milia

c. Mongolian spots Mongolian spots are flat, bluish discolored areas on the lower back and/or buttock which might be mistaken for bruising. Nursing actions include documentation of size and location. Usually resolve by school age.

A primary topic for health promotion for a 25-year-old woman with a history of polycystic ovary syndrome (PCOS or Stein-Leventhal syndrome) is (select the most important topic): Select one: a. The adverse effects of cigarette smoking b. The adverse effects of excessive alcohol consumption c. Nutrition for prevention of obesity and Type 2 Diabetes d. Self-esteem issues

c. Nutrition for prevention of obesity and Type 2 Diabetes Women with PCOS are at higher risk for being obese. Obesity increases the woman's risk for type 2 diabetes. Obesity and type 2 diabetes increase the woman's risk for cardiovascular disease, hypertension, dyslipidemia, and metabolic syndrome. It is also important to talk about self-esteem issues related to hirsutism and the effects of smoking and drinking, but the long-term effects of obesity are a greater risk to a woman with PCOS.

The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: Select one: a. Hypertonic contractions b. Hypotonic contractions c. Precipitous labor

c. Precipitous labor Precipitous labor that lasts fewer than 3 hours from onset to birth. Precipitous labor is more likely to be seen in woman who have previously given birth or have a previous history of rapid labors. As the fetal head descends, the woman may feel rectal pressure indicating delivery is imminent.

A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time? Select one: a. Encourage the parents to pray for the baby's soul. b. Advise the parents that it is better for the baby to have died than to have had to live with a defect. c. Provide opportunities for grieving parents and family members to spend time with the baby d. Advise the parents to refrain from discussing the baby's death with their other children.

c. Provide opportunities for grieving parents and family members to spend time with the baby

One of the following neonates is at highest risk for cold stress: Select one: a. LGA neonate at 38 weeks gestation b. AGA neonate at 32 weeks gestation c. SGA neonate at 33 weeks gestation d. SGA neonate at 40 weeks gestation

c. SGA neonate at 33 weeks gestation Risk factors for cold stress include prematurity, small for gestational age (SGA); hypoglycemia, prolonged resuscitation efforts, sepsis, neurological/endocrine/cardiorespiratory problems

A nurse is performing a postpartum assessment 30 minutes after a vaginal delivery. Which of the following actions indicates that the nurse is performing the assessment correctly? Select one: a. The nurse measures the fundal height in relation to the symphysis pubis. b. The nurse monitors the client's central venous pressure. c. The nurse assesses the client's perineum for edema and ecchymoses. d. The nurse performs a sterile vaginal exam.

c. The nurse assesses the client's perineum for edema and ecchymoses. Fundal height is measured in relation to the umbilicus. Assessment of the perineum for edema and bruising is appropriate. Central venous pressure is not routinely measured nor is SVE indicated.

The nurse is caring for a recently immigrated Chinese woman in the postpartum unit. Based on cultural beliefs and practices of the woman, the nurse would anticipate which of the following? (Select all that apply.) Select one or more: a. The woman prefers cold water for drinking. b. The woman prefers not to shower. c. The woman prefers to have her female relatives care for her baby. d. The woman prefers a wide variety of foods to eat.

c. The woman prefers to have her female relatives care for her baby. In traditional Chinese beliefs and practices, the woman is to rest and female family members take care of the infant. During the first month, the woman is to avoid yin energy by eating specific foods and avoiding drinking or touching cold water.

Polydrug use among some pregnant women makes it difficult to determine a given effect on the neonate. The symptoms of Neonatal Abstinence Syndrome (NAS) can be seen in many of the drug classes described and are often overlapping. The clinical presentation of a newborn with NAS is influenced by many factors including which of the following (select all that apply): Select one: a. Gestational age, weight, heredity factors b. Sex of fetus, length of labor, presence of decelerations during labor c. Type or types of drugs used, timing and amount of the last drug use, metabolism and clearance of the drugs by the newborn. d. Type of drug, prematurity, weight of fetus

c. Type or types of drugs used, timing and amount of the last drug use, metabolism and clearance of the drugs by the newborn.

25 year old Martha tested positive for chlamydia. What medication is most appropriate to treat her and her partner, per CDC? (Neither report drug allergies) Select one: a. ceftriaxone b. metronidazole c. azithromycin d. penicillin

c. azithromycin

The clinic nurse sees Xiao and her infant in the clinic for their 2-week follow-up visit. Xiao appears to be tired, her clothes and hair appear unwashed, and she does not make eye contact with her infant. She is carrying her son in the infant carrier and when asked to put him on the examining table, she holds him away from her body. The clinic nurse's most appropriate question to ask would be: Select one: a. "What has happened to you?" b. "Do you have help at home?" c. "Is there anything wrong with your son?" d. "Would you tell me about the first few days at home?"

d. "Would you tell me about the first few days at home?" The well-baby checkup that generally takes place 1 to 2 weeks following the hospital discharge may offer the first opportunity to assess the mother-baby dyad. In this setting, the nurse needs to be alert for subtle cues from the new mother, such as making negative comments about the baby or herself, ignoring the baby's or other children's needs, as well as the mother's physical appearance. In a private area, the nurse should take time to explore the new mother's feelings. A nonthreatening way to open the dialogue might be to say: "Tell me how the first few days at home have gone." This statement provides the new mother with an opportunity to share both positive and negative impressions.

A client delivered a 2800-gram neonate 4 hours ago by cesarean section with epidural anesthesia. Which of the following interventions should the nurse perform on the mother at this time? Select one: a. Maintain the client flat in bed. b. Assess the client's patellar reflexes. c. Monitor hourly urinary outputs. d. Assess the client's respiratory rate.

d. Assess the client's respiratory rate.

Felicity Chan, a new mother, is accompanied by her mother during her hospital stay on the postpartum unit. Felicity's mother makes specific, various requests of the nurses including bringing warm tea, a cot to sleep on, and that the baby not be bathed at this time. Felicity's mother is also concerned about the amount of work that Felicity may be doing in the provision of infant care. Felicity asks for help with breastfeeding. After Felicity has finished breastfeeding, her mother asks for a bottle so they can warm it and "feed" the baby. How would the perinatal nurse best respond to Felicity's mother in a culturally sensitive way? Select one: a. Ask Felicity's mother to leave for 30 minutes to allow for some private time with Felicity to explore her learning needs privately. b. Ask both Felicity and her mother about the preferred infant feeding method, and assess what they already know. c. Convey to Felicity and her mother an understanding of the concepts of "hot" and "cold" within their belief system. d. Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity's decision.

d. Ask Felicity what she knows about breastfeeding, and provide information to both women to support Felicity's decision. In certain multicultural populations such as India, Thailand, and China, the woman's postpartum confinement lasts for 40 days. During this time, prolonged rest with restricted activity is believed to be essential. The postpartum period is an important time for ensuring future good health, and great emphasis is placed on allowing the mother's body to regain balance after the birth of a child. To provide sensitive, appropriate care, nurses need to adopt a flexible approach when caring for women who embrace non-Western health beliefs and practices. The nurse should advocate for the patient by inquiring about her feeding preferences and by providing information to the mother and her family to support her in her decision.

A nurse is preparing to administer RhoGam to a client who delivered a fetal demise. Which of the following must the nurse check before giving the injection? Select one: a. Verify that the direct Coombs test results are positive. b. Check that the fetus was at least 28 weeks' gestation. c. Make sure that the client is at least 3 days postdelivery. d. Confirm that the woman is Rh negative.

d. Confirm that the woman is Rh negative. RhoGam is given to Rh negative mothers who have given birth to an Rh positive fetus, whether or not the fetus is born alive.

The perinatal nurse listens as Chantal describes her labor and emergency cesarean birth. Providing an opportunity to review this experience may assist Chantal in: Select one: a. Her role development in the "letting go" stage b. Decreasing her ambivalence about her labor and birth c. Understanding her guilt involved in her labor and birth d. Developing more positive feelings about her labor and birth

d. Developing more positive feelings about her labor and birth After a cesarean birth, especially when unplanned, nurses must be aware of the myriad of potential psychological issues that may arise. Research suggests that women may perceive cesarean birth to be a less positive experience than a vaginal birth. Unplanned or emergent cesarean deliveries and the experience of cesarean birth may be associated with more negative perceptions of the birthing experience. Allowing Chantal to talk about the experience can help her develop a more positive attitude about her own experience.

The perinatal nurse teaches the postpartum woman about the normal process of diuresis that she can expect to occur approximately 6 to 8 hours after birth. A decrease in which of the following hormones is primarily responsible for the diuresis? Select one: a. Prolactin b. Progesterone c. Lactogen d. Estrogen

d. Estrogen Maternal diuresis (elimination of excess tissue fluids) occurs within 12 hours after birth. After childbirth, a decrease in the level of estrogen naturally occurs and contributes to the diuresis.

A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Select one: a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. More than 5 contractions in 10 minutes

d. More than 5 contractions in 10 minutes Cervidil should be removed in the presence of tachysystole or Category II/III FHR patterns.

A nurse assesses that a 3-day-old neonate who was born at 34 weeks' gestation has abdominal distention and vomiting. These assessment findings are most likely related to: Select one: a. Respiratory Distress Syndrome (RDS) b. Bronchopulmonary Dysplasia (BPD) c. Periventricular Hemorrhage (PVH) d. Necrotizing Enterocolitis (NEC)

d. Necrotizing Enterocolitis (NEC) Necrotizing enterocolitis (NEC) findings include abdominal distention, bloody stools, abdominal tenderness, vomiting, increased gastric residuals, discoloration of abdomen, and visible bowel loops.

A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following? Select one: a. Hypoglycemia b. Hypercalcemia c. Cold stress d. Neonatal withdrawal

d. Neonatal withdrawal

The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first: Select one: a. Methergine b. Epinephrine c. Carboprost (Hemabate) d. Oxytocin or pitocin

d. Oxytocin or pitocin If the cause of the hemorrhage is uterine atony, continual fundal massage with lower uterine segment support is mandatory. While one member of the team massages the fundus, another nurse establishes intravenous access with a large bore needle and administers oxytocic drugs in the following order: oxytocin (Pitocin), followed by methylergonovine (Methergine), and carboprost (Hemabate).

A nurse is admitting a woman for a scheduled cesarean section. Which of the following assessment data should be immediately reported to the physician? Select one: a. White cell count of 11,000 b. Hemoglobin of 11 g/dL c. Hematocrit of 33% d. Platelet count of 75,000

d. Platelet count of 75,000 Contraindications for epidural or spinal anesthesia include low platelet count, <100,000 due to increased possibility of hemorrhage.

A neonate is admitted to the nursery. The nurse makes the following assessments: weight 2845 grams, overriding sagittal suture, molding, and point of maximal impulse (PMI) at the xiphoid process. Which of the assessments should be reported to the health-care practitioner? Select one: a. Birth weight b. Sagittal suture line c. Closed posterior fontanel d. Point of maximum intensity

d. Point of maximum intensity PMI should be at the 3rd or 4th intercostal space. Displaced PMI occurs with cardiomegaly. Molding and sagital suture overrides are expected findings.

A nurse is caring for a woman 10 hours post-cesarean birth. She received a dose of intrathecal morphine at the time of the birth. Which of the following assessment data would require immediate intervention? Select one: a. Itching of the palms and feet b. Nausea c. Urinary output of 300 mL in the past 4 hours d. Respiratory rate of 8 breaths/minute

d. Respiratory rate of 8 breaths/minute Severe respiratory depression is the most serious complication of intrathecal morphine administration.

Depo provera, or The Shot, contains which of the following hormones? Select one: a. estrogen b. neither estrogen or progesterone c. estrogen and progesterone d. progesterone

d. progesterone

The perinatal nurse is assisting the student nurse with completion of documentation. The laboring woman has just given birth to a 2700 gram infant at 36 weeks' gestation. The most appropriate term for this is: Select one: a. Late premature birth b. Term birth c. Very premature birth d. Large for gestational age infant

a Late premature birth is a neonate born between 34 and 37 weeks' gestation; term is considered 38 - 40 weeks' gestation; very premature is less than 32 weeks' gestation; LGA refers to an infant who is large for gestational age.

Supportive care of the infant with neonatal abstinence syndrome (NAS) include both pharmacologic and nonpharmacologic therapy. Nonpharmacologic therapy would include which of the following (select all that apply): Select one or more: a. Quiet environment with low lighting and use of soft voices Correct b. Use of oral morphine and methadone c. Clonidine for infants who do not respond to a single agent d. Swaddling, clustering care, use of pacifiers to promote "self-soothing"

a, d Nonpharmacologic therapy includes quiet environment, low lighting, soft voices, clustering care, swaddling, pacifier use, frequent small feedings, and vertical rocking.

Postoperative nursing care and education for a woman who had an abdominal hysterectomy includes (select all that apply): Select one or more: a. Administering hormone replacement therapy as per provider orders b. Informing the woman that she will experience small amounts of vaginal bleeding for several days c. Instructing the woman not to use tampons until advised by surgeon d. Instructing the woman to increase her ambulation to facilitate return of normal intestinal peristalsis

a,b,c,d

A nurse is caring for a 2-day-old neonate born at 31 weeks' gestation. The neonate has a diagnosis of respiratory distress syndrome (RDS). Which of the following medical treatments would the nurse anticipate for this neonate? (Select all that apply.) Select one or more: a. Umbilical artery and vein catheters b. Dopamine or dobutamine for treatment of hypotension c. Nasal continuous positive airway pressure (NCPAP) d. Continuous pulse oximetry

a,b,c,d All of the responses would be expected treatment options for the management of a very premature infant The correct answer is: Umbilical artery and vein catheters, Dopamine or dobutamine for treatment of hypotension, Nasal continuous positive airway pressure (NCPAP), Continuous pulse oximetry

A nurse is completing the initial assessment on a neonate of a mother with type I diabetes. Important assessment areas for this neonate include which of the following? (Select all that apply.) Select one or more: a. Assessment of cardiovascular system b. Assessment of respiratory system c. Assessment of musculoskeletal system d. Assessment of neurological system

a,b,c,d Complications of high maternal levels of glucose during pregnancy include cardiac anomalies, skeletal defects, risk for RDS, neurological damage and seizures. Assessment findings of the macrosomic infant may include fractured clavicle, brachial nerve damage, hypoglycemia, hypocalcemia and hypomagnesemia, poycythemia, hyperbilirubinemia, low muscle tone, and poor feeding abilities.

You are working in the ED and assessing a patient who presents with a fractured radius. Which of the following observations might lead you to believe your patient is a victim of intimate partner violence (IPV)? (Select all that apply) a. Her husband refuses to leave the room and answers your questions to his wife b. Presence of bruises on her shoulders and chest at various stages of healing c. Evasive when giving you her health history d. You note chart documentation of 4 previous visits to the Emergency Department over the last 3 months for vague complaints

a,b,c,d Intimate partner violence (IPV), also called domestic violence, is physical, sexual, and/or psychological harm by a current or former intimate partner or casual dating partner. Signs of IPV include: overuse of health care system; hesitancy, embarrassment, or evasiveness in relating history of injury; overly solicitous partner who stays close to the woman and attempts to answer questions directed at her; injuries in areas covered by a one-piece bathing suit or during pregnancy.

A first-time mother informs her nurse that she is concerned about infant abduction. The nurse should explain to the parents which of the following? (Select all that apply.) Select one or more: a. Do not allow a person without proper unit specific hospital ID to take their baby. b. Encourage parents to accompany any person who removes their infant from the hospital room c. Instruct parents not to leave their newborn unattended at any time d. Inform parents that ID bands with matching identification numbers are placed on the parents and infant at birth to ensure identification of the correct infant with the correct parents

a,b,c,d,

Which of the following nursing actions can assist a man in his transition to fatherhood? (Select all that apply.) Select one or more: a. Ask the man to share his ideas of what it means to be a father. b. Demonstrate infant care such as diapering and feeding. c. Engage couple in a discussion regarding each other's expectations of the fathering role. d. Provide the man with information on infant care.

a,b,c,d, a. Ask the man to share his ideas of what it means to be a father. b. Demonstrate infant care such as diapering and feeding. c. Engage couple in a discussion regarding each other's expectations of the fathering role. d. Provide the man with information on infant care Each of these actions can assist the father in his transition. It is important for the man to be able to learn and practice infant care skills in a nonthreatening environment. It is also important for the man to be able to openly talk about his feelings regarding fatherhood and for the couple to identify mutual expectations of the fathering role.

A nurse is caring for a 40 weeks' gestation neonate. The neonate is 12 hours post-birth and has been admitted to the NICU for meconium aspiration. The nurse recalls that the following are potential complications related to meconium aspiration (select all that apply): Select one or more: a. Obstructed airway b. Hyperinflation of the alveoli c. Hypoinflation of the alveoli d. Decreased surfactant proteins

a,b,d Meconium aspiration syndrome (MAS) occurs when meconium is released into the amniotic fluid and aspirated by the fetus. Meconium fluid in the lungs can cause a partial airway obstruction leading to trapped air and hyperinflation of the alveoli. Chemical pneumonitis may lead to decreased surfactant proteins.

Tachysystole, previously referred to as hyperstimulation, is defined as: Select one or more: a. Contractions lasting 2 minutes or longer b. Five or more contractions in 10 minutes over a 30-minute window c. Contractions occurring within 1 minute of each other d. Uterine resting tone below 20 mm/Hg

a., b, c Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for tachysystole. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone.

The nurse assesses that a full-term neonate's temperature is 97.1°F (36.2°C). The first nursing action is to: Select one: a. Turn up the heat in the room. b. Place the neonate on the mother's chest with a warm blanket over the mother and baby. c. Take the neonate to the nursery and place in a radiant warmer. d. Notify the neonate's primary provider.

b. Place the neonate on the mother's chest with a warm blanket over the mother and baby. Preventative nursing actions to prevent cold stress include skin-to-skin contact with the mother withe a warm blanket over both.

The perinatal nurse understands that the purpose of the surgical "Time-out" is to: a. Confirm that the surgeon is ready to begin b. Verify that it is the correct site, procedure, and patient c. Verify that anesthesia is adequate d. Confirm that the neonatal team is present

b. Verify that it is the correct site, procedure, and patient Surgical "time-out" is performed by the entire surgical team and the patient prior to the administration of anesthesia. The purpose is to validate correct patient, site, and procedure.

The perinatal nurse is teaching her new mother about breastfeeding and explains that the most appropriate time to breastfeed is: Select one: a. 3 to 4 hours after the last feeding b. When her infant is in a quiet alert state c. When her infant is in an active alert state d. When her infant exhibits hunger-related crying

b. When her infant is in a quiet alert state The optimal time to breastfeed is when the baby is in a quiet alert state. Crying is usually a late sign of hunger, and achieving satisfactory latch-on at this time is difficult. Latch-on is proper attachment of the infant to the breast for feeding. The neonate is most alert during the first 1 to 2 hours after an unmedicated birth, and this is the ideal time to put the infant to the breast.

Which of the following can provide contraception and protection against sexually transmitted infections? (Select all that apply). Select one or more: a. the vaginal ring b. condoms c. abstinence d. intrauterine devices

b. condoms c. abstinence

Which of the following statements indicates that a new mother needs additional teaching? Select one: a. "I need to supervise my cat when she is in the same room as my baby." b. "I will place my baby on her back when she is sleeping." c. "I will not leave my baby on an elevated flat surface after she is able to turn over on her own." d. "I have asked my husband to install safety latches on the lower cabinets."

c. "I will not leave my baby on an elevated flat surface after she is able to turn over on her own."

A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is: Select one: a. "I understand your concern, but your baby will be okay until your milk comes in." b. "Your baby seems content, so you should not worry about him getting enough to eat." c. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health." d. "You can bottle feed until your milk comes in."

c. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health."

According to the CDC, all women under the age of 26 years old should be tested for which of the following STDs? Select one: a. HIV b. HPV c. chlamydia d. syphilis

c. chlamydia

A nurse is making a home visit on the twelfth postpartum day to assess a 23-year-old primipara woman and her full-term, healthy baby. Breastfeeding is the method of infant nutrition. The woman tells the nurse that she does not think her milk is good because it looks very watery when she expresses a little before each feeding. The nurse's best response is: Select one: a. "This is normal. You only have to be concerned when your baby does not gain weight." b. "What types of foods are you eating? A lack of protein in the diet can cause watery looking breast milk." c. "How much fluid are you drinking while you are nursing your baby? Too much fluid during the feeding session can dilute the breast milk." d. "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance."

d. "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance." There are 3 stages of human milk production: Stage 1 is colostrum, a yellowish fluid present for 2-3 days after birth and rich is protein; Stage 2 is transitional milk and consists of colostrum and milk and is present from day 3-10; Stage 3 is mature milk and consists of foremilk which is produced and stored between feedings and is higher in water content and hind milk which is produced during the feeding session and is higher in fat content.

If the umbilical cord prolapses during labor, the nurse should immediately: Select one: a. Type and cross-match blood for an emergency transfusion. b. Await provider order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part. d. Performing vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord

d. Performing vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord becomes trapped against the presenting part and circulation is occluded; FHR will usually show bradycardia or prolonged decel. An emergency cesarean birth is typically performed. Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner's hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean. There is no attempt to push the cord above the presenting part. Type and screen of blood is generally done on admission for all laboring women; type and cross-match can readily be accomplished using the blood sample already in the lab.

If the umbilical cord prolapses during labor, the nurse should immediately: Select one: a. Type and cross-match blood for an emergency transfusion. b. Await provider order for preparation for an emergency cesarean section. c. Attempt to reposition the cord above the presenting part. d. Performing vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord.

d. Performing vaginal exam and lifting the presenting part off of the cord to relieve pressure on the cord. Prolapse of the umbilical cord is when the cord lies below the presenting part of the fetus. The cord becomes trapped against the presenting part and circulation is occluded; FHR will usually show bradycardia or prolonged decel. An emergency cesarean birth is typically performed. Occlusion of the cord may be partially relieved by lifting the presenting part off the cord with a vaginal exam. The examiner's hand remains in the vagina, lifting the presenting part off the cord until delivery by cesarean. There is no attempt to push the cord above the presenting part. Type and screen of blood is generally done on admission for all laboring women; type and cross-match can readily be accomplished using the blood sample already in the lab.

When intrathecal morphine is used for post-operative pain, the anesthesiologist manages the woman's pain for the first 24 hours. The perinatal RN is aware that the most serious complication of intrathecal morphine in the first 24 hours following surgery is: Select one or more: a. Urinary retention b. Nausea and itching c. Decreased sensation in the legs d. Respiratory depression

d. Respiratory depression Severe respiratory depression is a life-threatening adverse reaction to intrathecal morphine. Naloxone and resuscitative equipment need to be available whenever intrathecal morphine is administered and during the 24 hours post-procedure.

Angie is an ER nurse. Her patient complains of 'sores down there' for the last 3 days. The physician diagnoses herpes simplex virus and asks Angie to look up the medication to treat the patient's symptoms. Angie knows the best resource to find this information is: Select one: a. an STD website b. her current drug book c. the 2001 STD book in the ER d. the CDC's STDs Treatment Guidelines 2015

d. the CDC's STDs Treatment Guidelines 2015