UW: 4 Maternal and Newborn Health

A pregnant client has chosen labor induction to have a vaginal birth after cesarean. During labor, which is the most concerning assessment finding?

Change in uterine shape and maternal tachycardia

The nurse is reviewing the chart of a pregnant client at 10 weeks gestation during the first prenatal appointment. Which finding indicates that client teaching is needed?

Client has a pet dog and cat at home

The nurse in a women's health clinic is returning client phone calls. Which client would be the priority to call first?

Client who gave birth vaginally a few days ago who states, "They want to hurt my baby."

The nurse is caring for 4 hospitalized clients. Which client should the nurse see first?

Client with suspected ectopic pregnancy who has abdominal and shoulder pain

Exhibit The nurse is observing a pregnant client receiving an oxytocin infusion for induction of labor. The baseline fetal heart rate is 140/min; the strip is shown in the exhibit. What is the nurse's best course of action? Click on the exhibit button for additional information.

Continue to monitor the client

The nurse is monitoring a client who is in active labor with a cervical dilation of 6 cm. Which uterine assessment finding requires an intervention by the nurse?

Contraction duration of 95 seconds

The practical nurse is collecting data on several clients waiting to be seen in the prenatal clinic. Which client situation is most important to report to the registered nurse?

32 weeks gestation client taking ibuprofen for moderate back pain

The nurse is reinforcing discharge instructions to a postpartum client. Which instruction should the nurse include to promote newborn safety?

Remove pillows and loose blankets from the infant's crib

While collecting data from pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first?

Third-trimester client with right upper quadrant pain and nausea

The nurse is assisting with a vaginal delivery of a full-term infant. Which assessment finding of the newborn is most important for the nurse to follow-up?

Tuft of hair at the base of the spine

Which vaccine can safely be given in the second or third trimester of pregnancy?

Tetanus-diphtheria-pertussis vaccine

The nurse is evaluating a parent's understanding of post-circumcision care for a newborn. Circumcision was performed using the clamp method. Which statement by the parent demonstrates a need for further teaching?

"Yellow exudate on the glans penis indicates infection."

A client is at 20 weeks gestation. The client reports having to "run to the bathroom all the time," "it hurts to pee," and my urine "smells bad." Which statement by the nurse is the most appropriate?

"You may need to be checked for a urinary tract infection."

A nurse is reinforcing information on formula preparation for a client with a newborn. Which statements by the client indicate proper understanding? Select all that apply.

- "I must wash the top of the concentrated formula can before opening it." - "Prepared formula should be kept in the refrigerator and discarded after 48 hours."

A 28-year-old client is admitted to the labor and delivery unit for severe preeclampsia. She is started on IV magnesium sulfate. Which signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply.

- 0/4 patellar reflex - Respirations are 10/min

A client is at 24 weeks gestation and preeclampsia-eclampsia syndrome is suspected. Which of the following are significant signs/symptoms criteria related to this syndrome? Select all that apply.

- 300 mg/24 hr (0.3 g/day) protein in urine - Headache, blurry vision

A male infant is born at 28 weeks gestation. What assessment findings would the nurse expect the newborn to exhibit? Select all that apply.

- Abundant lanugo on the shoulders and back - Eyelids that are fully open - Smooth, pink skin with visible veins

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period was September 7. Today is December 7. Which are true statements for this client? Select all that apply.

- According to Naegele's rule, the expected date of delivery is June 14 - Detection of the fetal heart rate via Doppler is possible - Urinary frequency is a common symptom

Exhibit A practical nurse is evaluating the external fetal monitoring strip of a laboring primigravida who is at 36 weeks gestation. Which nursing interventions should the practical nurse anticipate? Click on the exhibit button for additional information. Select all that apply.

- Administer supplemental oxygen by mask - Increase the IV fluid rate - Stop the client's oxytocin infusion

A laboring client weighing 187 lb is 5 cm dilated and having contractions every 2-3 minutes. The client rates the pain at 7 out of 10. Nalbuphine hydrochloride 10 mg/70 kg IV push × 1 is prescribed by the health care provider. Nalbuphine hydrochloride 10 mg/1 mL is available. How many milliliters does the nurse administer? Record your answer using one decimal place. Answer: (mL)

1.2

A nurse is admitting a post-date client at 43 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction?

A Bishop score of 10

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of nonimmune. What will the nurse anticipate as the plan of care for this client?

Administer MMR vaccine immediately postpartum

A nurse is caring for a postpartum client who has breast engorgement following breastfeeding. Which instructions should the nurse reinforce regarding relief of breast engorgement?

Allow newborn to nurse for at least 10-15 minutes on each breast

The nurse preceptor should intervene if the graduate practical nurse performs which action when caring for a jaundiced newborn being treated with phototherapy?

Applying a shirt while the newborn is exposed to phototherapy

Exhibit A nurse auscultates a loud cardiac murmur on a newborn with suspected trisomy 21 (Down syndrome). A genetic screen and an echocardiogram are scheduled that day. The neonate's vital signs are shown in the exhibit. What would be an appropriate action for the nurse to complete next? Click on the exhibit button for additional information.

Document the finding

A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)?

Hemoglobin and hematocrit levels

The practical nurse is monitoring a client 12 hours after the prolonged vaginal delivery of a term infant. Which finding should be reported to the registered nurse?

Foul-smelling lochia

A pregnant client provides the following obstetric history to the nurse at the first prenatal visit: Elective abortion at age 17; a 5-year-old daughter born at 40 weeks gestation; and 3-year-old twin boys born at 34 weeks gestation. Using the GTPAL system, which option is correct?

G4, T1, P1, A1, L3

After giving birth to a full-term neonate, the client tells the practical nurse, "I have been taking hydrocodone on a regular basis for several years." The practical nurse collaborates with the registered nurse to include which intervention in the neonate's plan of care?

Feed newborn while swaddled

A full-term newborn of a mother with gestational diabetes is slightly jittery with a blood glucose level of 45 mg/dL. The practical nurse (PN) is assisting the registered nurse to implement the appropriate intervention. Which action does the PN anticipate first?

Feed the newborn

A pregnant client comes in for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client?

Just above the symphysis pubis

A woman delivers her baby immediately on arrival at the emergency department and 5 minutes later delivers the placenta. The nurse's assessment is that the woman's uterus is boggy and midline. What action should the nurse take first?

Massage the fundus

A neonate is born with exstrophy of the bladder. Which intervention would be appropriate for the nurse to complete first?

Place a protective film over the bladder

The nurse monitoring a newborn after birth observes a bluish discoloration of the hands and feet. The trunk has a pink color. What is the nurse's initial action?

Place infant skin-to-skin with mother

A pregnant client comes to the labor and delivery unit stating the water just broke at home. On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina. Which nursing intervention would be appropriate?

Position the client on hands and knees

Exhibit A client at 38 weeks gestation is in labor and receiving an oxytocin infusion. The continuous fetal heart rate (FHR) monitor displays the strip shown in the exhibit. Which action by the nurse is most appropriate? Click on the exhibit button for additional information.

Review medication administration record

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg, 2+ proteinuria, and moderate peripheral edema. Immediately after hospital admission, she develops seizures and uterine contractions. Magnesium sulfate is prescribed. Which finding indicates that the drug has achieved the desired therapeutic effect?

Seizure activity stops

A pregnant client has labor induced with oxytocin infusion. The practical nurse notes that the fetal heart rate (FHR) tracing shows a change in the baseline rate from 145/min to 170/min and minimal variability. What is the nurse's first action?

Stop oxytocin infusion

A client postpartum 3 days scheduled for discharge today was given education about diaper changes yesterday. The client says to the nurse, "I'm so glad you are here. I think my baby has a dirty diaper. I can't change it as well as you can. Will you change my baby's diaper for me?" What is the nurse's best response?

Suggest that the mother change the diaper as the nurse watches

The nurse is preparing to assess a client visiting the women's health clinic. The client's obstetric history is documented as G5T1P2A1L2. Which interpretation of this notation is correct?

The client had 1 birth at 37 wk 0 d gestation or beyond

The nurse is reinforcing teaching to a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain in pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which of the following statements made by the client indicates an understanding about weight gain?

"I should gain about 30 lb (13.6 kg) during pregnancy."

The nurse is reinforcing instructions to a parent about how to care for a newly circumcised newborn. Which statement by the parent indicates a need for further teaching?

"I will clean the area with alcohol-based wipes or soap water."

The nurse is reinforcing instructions to a postpartum client about cord care for the newborn. Which statement by the client indicates a need for further teaching?

"I will secure the diaper over the cord to protect it."

A nurse is reinforcing teaching about breastfeeding. Which statement by the client indicates correct understanding of the teaching?

"If I need to reposition the baby's latch, I will use my finger to break the suction first."

A couple is excited about finding out the sex of their baby during ultrasound at 14 weeks gestation. What is the nurse's best response?

"If the baby is in the right position, the genitalia may be visualized."

The nurse is caring for a full-term newborn following vaginal delivery. Which nursing interventions should be implemented? Select all that apply.

- Always wear gloves when handling the newborn before bathing - Cover the newborn to maintain a body temperature of 97.5-99 F (36.4-37.2 C) - Give a single dose of vitamin K intramuscularly - Suction the pharynx first, then the nasal passages

A client indicates to the nurse a desire to become pregnant. The client drinks 1-2 glasses of wine on weekends. BMI is 32 kg/m2. Which teachings should the nurse reinforce as part of proper preconception health care for this client? Select all that apply.

- Avoid eating undercooked hamburgers - Receive a rubella vaccine at least 3 months before attempting pregnancy - Take 0.4 mg folic acid supplementation daily

A nurse is caring for a client following delivery of a stillborn infant. Which actions should the nurse plan to take? Select all that apply.

- Bathe the infant and apply lotion and powder - Encourage the parents to hold the infant - Perform handprints and footprints

A primigravid client in early labor is admitted and reports intense back pain with contractions. The fetal position is determined to be right occiput posterior. Which action by the nurse would be most helpful for alleviating the client's back pain during early labor?

Applying counterpressure to the client's sacrum during contractions

The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most concerning and warrants priority intervention?

Client is taking lisinopril to control hypertension

During the first prenatal assessment, the client reports the last normal menstrual period starting on March 1 and ending on March 5, but also slight spotting on March 23. The client had unprotected intercourse on March 15. Using Naegele's rule, what is the estimated date of birth (EDB)?

December 8

The nurse providing culturally sensitive care to a group of new mothers should reinforce information concerning breastfeeding to which client?

Mother of Hispanic descent who refuses to offer colostrum to the newborn

A nurse is measuring the uterine fundal height of a client who is at 36 weeks gestation in supine position. The client suddenly reports dizziness and the nurse observes pallor and damp, cool skin. What should the nurse do first?

Reposition client into a lateral position

A client in the postpartum unit has a temperature of 100.9 F (38.3 C) and tachycardia on the second day following a cesarean delivery. Examination shows uterine tenderness, fundus +2 above the umbilicus, moderate lochia rubra with a foul smell, and chills. Which prescription should the nurse implement first?

Serum laboratory draws for blood culture and sensitivity

A nurse is caring for a client following a forceps-assisted vaginal birth. The client reports severe vaginal pain and fullness. On assessment the nurse notices a firm, midline uterine fundus. Lochia rubra is light. Which diagnosis should the nurse anticipate?

Vaginal hematoma

The nurse is performing an assessment on a 39-week neonate an hour after a spontaneous vaginal delivery. What are common expected newborn findings? Select all that apply.

- Plantar creases up the entire sole - Toes fan outward when the lateral sole surface is stroked - White pearl-like cysts on gum margins

A nurse is caring for a pregnant client who has hyperemesis gravidarum. Which assessment findings should the nurse anticipate? Select all that apply.

- Positive urine ketones (moderate) - Pulse 106/min

The practical nurse is collecting data on several clients in the antepartum unit. Which client should the practical nurse report to the registered nurse for further assessment?

25 weeks gestation, hemoglobin is 9 g/dL

The nurse is reinforcing teaching about infant safety to a class of expectant parents. Which statement by a participant indicates a need for further instruction?

"I will tie bumper pads to the sides of the crib to protect my baby's head."

A pregnant client at 35 weeks gestation has brisk, painless vaginal bleeding. The health care provider suspects placenta previa. The nurse should prepare for which procedures? Select all that apply.

- Blood draw for hemoglobin - Electronic fetal monitoring - Pelvic ultrasound

A practical nurse (PN) is assisting the registered nurse in caring for a client on oxytocin to induce labor. Which assessments does the PN anticipate during the infusion? Select all that apply

- Blood pressure - Fetal heart rate tracings - Intake and output - Uterine contraction pattern - Vaginal examination

A client who reports sudden-onset severe right lower abdominal pain and dizziness is being evaluated for suspected ectopic pregnancy. Which assessment findings should the nurse anticipate? Select all that apply.

- Blood pressure 82/64 mm Hg - Pulse 120/min - Shoulder pain

The nurse is reinforcing information about the prevention of sudden infant death syndrome to a client with a newborn. Which recommendations should the nurse include? Select all that apply.

- Breastfeeding - Pacifier use at bedtime - Smoking cessation by parents

The nurse is reinforcing teaching to the mother of a newborn about gastroesophageal reflux. What does the nurse suggest to help prevent reflux? Select all that apply.

- Burp infant during and after feeds - Offer infant smaller but more frequent feeds - Place infant on tummy after feeding

An infant is born with a cleft palate. Which actions will promote oral intake until the defect can be repaired? Select all that apply.

- Burping the infant often - Feeding in an upright position - Using a specialty bottle or nipple

The nurse is monitoring a neonate 1 hour after spontaneous vaginal delivery. Which of the following are expected findings? Select all that apply.

- Capillary glucose of 60 mg/dL (3.3 mmol/L) - Respirations of 56 breaths per minute - White papules on bridge of the nose

A 36-year-old multigravida is admitted with a diagnosis of severe preeclampsia. IV magnesium sulfate is prescribed. Which nursing measures does the practical nurse anticipate in this client's plan of care? Select all that apply

- Check deep tendon reflex frequently - Ensure calcium gluconate is available - Have suction equipment ready to use - Monitor for right upper quadrant pain

When assessing neonates in the nursery, the practical nurse should report which findings to the registered nurse? Select all that apply.

- Chest wall retractions - Head circumference of 30 cm - Jaundice of the head and sclera - No voiding in 24 hours

Which findings in a newborn are considered abnormal and should be reported to the registered nurse? Select all that apply.

- Decreased muscle tone - Sacral dimple - Single artery in the umbilical cord

The nurse is returning the results of a urine pregnancy test to a client currently taking several medications. Which of the following prescriptions are contraindicated in pregnancy? Select all that apply.

- Doxycycline - Isotretinoin - Lisinopril

A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not had prenatal care. Which topics are most important and priorities for the nurse to discuss with the client in anticipation of referral for prenatal care? Select all that apply.

- Family and social support - Nutrition and prenatal vitamins - Sexual abuse

A pregnant client in the third trimester completes an intake form for a clinic visit. Which signs and symptoms are priority problems for the nurse to evaluate? Select all that apply.

- Frequent urination with dysuria and nocturia - Headache and blurred vision - Nonmalodorous, copious, clear vaginal discharge

The nurse checks the chart of a client who gave birth 4 hours ago. Which contributing factor indicates that the client has a high risk of early postpartum hemorrhage? Select all that apply.

- Grand multiparity - Infant birth weight of 9 lb, 2 oz (4139 g) - Third stage of labor lasting 1 hour

A client at 21 weeks gestation has intense heartburn (pyrosis). What should the nurse recommend? Select all that apply.

- High-protein, low-fat diet - Six small meals a day

A client at 34 weeks gestation has constipation. The client has been taking 325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks ago. Which instructions should the nurse reinforce for this client? Select all that apply.

- Increase intake of fruits and vegetables - Moderate-intensity regular exercise

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? Select all that apply.

- Influenza injection - Tetanus, diphtheria, and pertussis

A client denies illicit drug use but has some suspicious behaviors. The client's neonate has a low birth weight. What other signs would lead the nurse to suspect neonatal abstinence syndrome? Select all that apply.

- Irritability and restlessness - Poor feeding and loose stools - Stuffy nose and frequent sneezing

A practical nurse is collaborating with the registered nurse to form a care plan for a client diagnosed with placenta previa at 33 weeks gestation. What does the nurse anticipate being included in the plan of care? Select all that apply.

- Nonstress test 1 or 2 times a week - Prepare for cesarean birth at any time - Type and screen blood Explain: In placenta previa, the placenta is implanted over or very near the cervix. As a result, placental blood vessels may be disrupted during dilation and effacement. Because of the increased risk of hemorrhage, the client should have a type and screen on file at the selected hospital. A nonstress test or biophysical profile should be performed once or twice a week to ensure fetal well-being. With asymptomatic clients, a cesarean birth is planned after 36 weeks gestation and prior to the onset of labor to prevent blood loss of mother and fetus. However, if the client is bleeding profusely or constantly or goes into active labor, a cesarean birth is typically performed immediately. (Option 1) The recommended activity for a client at less than 36 weeks gestation with diagnosed placenta previa is bed rest with bathroom privileges. A stable client may be released to continue bed rest at home, but the client must be closely monitored and return to the hospital immediately if bleeding occurs.

Which meal should the nurse recommend for a pregnant client at 13 weeks gestation?

Baked chicken, turnip greens, peanut butter cookie, and grape juice

Exhibit Of the abdominal lines shown in the exhibit, where would the nurse expect the fundal height of a 20-week gestation client to be felt? Click on the exhibit button for additional information.

C

Exhibit The nurse is monitoring a newborn in the well-baby nursery. The nurse observes skin discoloration as shown in the exhibit. What would be an appropriate action for the nurse to complete? Click on the exhibit button for additional information.

Measure and document the size and location of the markings

A woman who had a cesarean delivery 5 hours ago now appears anxious and reports shortness of breath. The practical nurse should assess for which priority problem before notifying the registered nurse?

Calf warmth and redness

A neonate requires respiratory resuscitation. Which is the proper head position of the neonate for rescue breathing?

Explain: The neonate should be placed on the back with the neck slightly extended. This is a neutral or "sniffing" position. A blanket or towel roll can be placed under the shoulders, elevating them 0.75-1.0 in (19-25.4 mm) off the mattress. This is particularly useful if the infant has a large occiput from molding or edema. The nurse must watch that the infant's head does not shift to an improper position during caregiving activities.

An obviously pregnant client walks into the emergency department screaming, "I am about to give birth!" What questions are essential to ask in preparation for and performance of possible neonatal resuscitation? Select all that apply.

Fetal distress and cesarean birth

The registered nurse is preparing to administer oxytocin to induce labor in a client. The practical nurse assists the registered nurse and recognizes that the oxytocin infusion can lead to which of the following conditions?

Fetal distress and cesarean birth