1232 EAQ 2 Clinical Skills questions
A patient with chronic hypertension is hospitalized for a 24-hour observation for preterm labor. The patient's BP is 164/100 mm Hg. Antihypertensive medication has not been needed before this admission. The practitioner orders methyldopa 500 mg to be administered orally. For which condition(s) should the nurse assess the patient's history before safely administering the medication? A. Liver or kidney disease B. Seizure disorder C. Asthma D. Coagulation disorder
A
For a medically induced abortion, the FDA-approved mifepristone-misoprostol combination can be used up to how many weeks of gestation? A. 10 weeks B. 9 weeks C. 6 weeks D. 8 weeks
A
The nurse is instructing a patient at 34 weeks' gestation who has GDM to eat at the best time after taking the dose of regular insulin. When should the patient eat? A. Within 30 minutes B. Within 45 minutes C. Within 60 minutes D. Within 90 minutes
A
What is the medication classification of hydralazine? A. Vasodilator B. Calcium-channel blocker C. Combined alpha and beta blocker D. Angiotensin-converting enzyme inhibitor
A
When does gonococcal infection typically manifest in newborns? A. 2 to 5 days after birth B. 5 to 8 days after birth C. 8 to 11 days after birth D. 11 to 14 days after birth
A
A 37-year-old multipara at 38 weeks' gestation is admitted to the labor unit for induction of labor because of preeclampsia. The practitioner orders a 4 gm loading dose of magnesium sulfate and then 2 gm/hr. Before implementing this order, the nurse also must obtain an order for what? A. Indwelling urinary catheter B. Pain medication C. Antiemetic medication D. Mainline IV fluid and infusion rate
D
Why is erythromycin ophthalmic ointment given to newborns? A. To prevent blindness B. To prevent fungal infection C. To prevent a corneal tear D. To prevent corneal hemorrhage
A
A mother has tested positive for HBsAg. Which action should the nurse take regarding immunoprophylaxis of this mother's newborn? A. Administer the hepatitis B vaccine and HBIG 12 hours apart. B. Remove maternal blood from the newborn's injection sites before giving the injections. C. Give the newborn only the hepatitis B vaccine; HBIG is not needed when the mother is HBsAg positive. D. Give the hepatitis B vaccine within 12 hours but wait to see if the newborn has hepatitis B before giving the HBIG.
B
A new nurse is preparing to administer eye ointment to a newborn and asks how to safely expose the conjunctival sac. What should the experienced nurse explain is the best way to expose the conjunctival sac? A. "Pull the upper lid so the eye stays open." B. "Use the nondominant hand to gently press downward on the newborn's cheekbone below the lower eyelid to expose the lower conjunctival sac." C. "Pinch the skin below the eye and gently pull out." D. "Using two fingers, pull up the upper lid and place downward pressure on the lower eyelid."
B
The mother asks the nurse why her newborn is being given both the hepatitis B vaccine and HBIG. What is the nurse's best response to the mother? A. "The CDC recommends that all newborns receive both vaccines." B. "Because you had ruptured membranes for longer than 24 hours, we give both vaccines to protect your baby." C. "Immature clotting mechanisms put your baby at risk for bleeding; these vaccines will prevent that." D. "Because your blood tested positive for the hepatitis B antigen, we give both vaccines to protect your baby."
D
What is an unexpected outcome of eye prophylaxis? A. The newborn passes meconium. B. The newborn voids yellow urine. C. The newborn's skin is yellow. D. The newborn has mildly red eyes.
D
Which condition is a contraindication to misoprostol administration? A. Intrauterine growth restriction B. Preeclampsia C. Gestational diabetes D. Previous uterine surgery
D
Which preprandial maternal capillary glucose level does the American Diabetes Association recommend for patients with GDM? A. 85 mg/dl or less B. 90 mg/dl or less C. 100 mg/dl or less D. 95 mg/dl or less
D
A patient is concerned about feeling weak and drowsy while on magnesium sulfate for preeclampsia. Which is an appropriate response by the nurse? A. Explain that the symptoms are the normal effects of magnesium sulfate. B. Explain that the patient may need calcium gluconate because the patient's magnesium sulfate level may be too high. C. Explain that the practitioner will be notified. D. Explain that the patient should focus on getting better and not worry about the symptoms.
B
Which strategy should be employed for pain management before administration of a hepatitis B vaccine via the IM route? A. Inject the vaccine into the dorsogluteal muscle; this site is less painful. B. Provide nonnutritive sucking or breastfeeding. C. Newborns do not feel pain, so there is no need for pain management. D. Require the mother to lay her newborn in the crib.
B
A patient at 30 weeks' gestation is receiving magnesium sulfate for fetal neuroprotection. The nurse notes that the patient has a history of renal failure. Why should magnesium sulfate be used with caution in this patient? A. Magnesium sulfate is excreted primarily by the liver. B. Magnesium sulfate can cause kidney damage. C. Magnesium sulfate causes uremia in a patient with renal failure. D. Magnesium sulfate is excreted primarily by the kidneys.
D
A patient in labor at 40 weeks' gestation requires a dose of ephedrine for postepidural hypotension. After administering ephedrine 10 mg IV, the nurse can expect which effect? A. A decrease in FHR B. No change in FHR C. Bradycardia D. An increase in FHR
D
A laboring patient at 39 weeks' gestation just received an epidural bolus for breakthrough pain, and the bolus resulted in severe hypotension. The patient received ephedrine 5 minutes ago. When the nurse completes an initial assessment, the patient's blood pressure is 120/72 mm Hg, and the FHR is Category I (normal). The patient is reporting heart palpitations, dizziness, and nausea. How should the nurse respond? A. Continue to monitor the patient closely and explain that these symptoms are possible adverse reactions to ephedrine. B. Notify the practitioner that the patient may be having an allergic reaction to the medication. C. Reassure the patient that the symptoms are from the epidural bolus. D. Explain that the patient is just experiencing a normal progression of labor symptoms.
A
A multigravida patient at 39 weeks' gestation is being induced for type 2 diabetes. The nurse is explaining to a new nurse about the impact diabetes can have on the newborn. Newborns of patients with diabetes have a higher risk of which complications? A. Malformations, macrosomia, shoulder dystocia, birth injury, hypocalcemia, hypoglycemia, and respiratory distress syndrome B. Malformations, macrosomia, shoulder dystocia, birth injury, hyperglycemia, and respiratory distress syndrome C. Malformations, intrauterine growth restriction, shoulder dystocia, birth injury, hypoglycemia, and respiratory distress syndrome D. Malformations, macrosomia, shoulder dystocia, birth injury, hypoglycemia, and diabetes at birth
A
A multipara with preeclampsia is hospitalized for a 23-hour observation period. The practitioner orders IV hydralazine. The order says to administer an initial dose of 50 mg IV for BP over 160/110 mm Hg. Based on this order, what should the nurse do? A. Clarify the practitioner's order. B. Administer the hydralazine as soon as possible. C. Assume that the practitioner meant to order labetalol 50 mg. D. Assume that the practitioner intended to order oral hydralazine 50 mg.
A
A nurse who is training a new nurse on the labor and delivery unit explains the different uses for magnesium sulfate in labor and delivery. What should the nurse tell the new nurse? A. Magnesium sulfate can be used to treat preeclampsia, eclampsia, and preterm labor and to provide fetal neuroprotection. B. Magnesium sulfate can be used to treat preeclampsia, eclampsia, preterm labor, and anemia. C. Magnesium sulfate can be used to treat preeclampsia, eclampsia, preterm labor, and anemia and to provide fetal neuroprotection. D. Magnesium sulfate can be used to treat preeclampsia, eclampsia, and preterm labor and to provide electrolyte replacement.
A
A patient at 23 weeks' gestation presents to the triage unit with contractions every 3 minutes. During evaluation, the patient is found to have a spontaneous rupture of the membranes, and the cervix is 3 cm dilated. The student nurse asks the nurse if this patient is a candidate for betamethasone. How should the nurse respond? A. Yes, antenatal corticosteroids may be considered for patients who are at 23 weeks' gestation and who are at risk for preterm delivery within 7 days even if the membranes are ruptured. B. Yes, antenatal corticosteroids may be considered for patients who are at 23 weeks' gestation and who are at risk for preterm delivery within 3 days even if the membranes are ruptured. C. No, antenatal corticosteroids should not be considered for patients at 23 weeks' gestation. D. No, antenatal corticosteroids may be considered for patients who are at 23 weeks' gestation and who are at risk for preterm delivery within 7 days only if the membranes are not ruptured.
A
A patient at 28 weeks' gestation is admitted to the antepartum unit in preterm labor, and the practitioner starts magnesium sulfate therapy for neuroprotection of the fetus. Four hours after the magnesium sulfate infusion is initiated, the nurse obtains a specimen for a serum magnesium level. The laboratory calls to report a "critical magnesium value" of 6.2 mEq/L. What is the most appropriate intervention by the nurse? A. Notify the practitioner that a therapeutic level of magnesium has been achieved. B. Notify the practitioner of a critical level of magnesium. C. Stop the magnesium infusion because the patient has a toxic level of magnesium. D. Continue the magnesium infusion but reduce the rate by half.
A
A patient at 30 weeks' gestation has been receiving magnesium sulfate therapy for tocolysis. The patient received betamethasone 24 hours ago and is due for a second injection. Following the initial assessment, the patient reports a sensation of heaviness in the chest. What should the nurse do first? A. Notify the practitioner because this symptom may indicate pulmonary edema. B. Administer the betamethasone before the patient goes into active labor. C. Reassure the patient that this symptom is caused by the baby pushing on the ribs. D. Reassure the patient that this symptom is a normal adverse effect of the patient's medications.
A
A patient at 31 weeks' gestation is receiving a magnesium sulfate infusion for preterm labor. The laboratory calls the nurses' station to report a serum magnesium level of 7.5 mEq/L. The nurse completes an assessment and finds that the patient's blood pressure is 110/66 mm Hg, respirations are 14 breaths/minute, and deep tendon reflexes are 1+ bilaterally. The patient reports mild generalized muscle weakness. The FHR is within normal limits. How should the nurse respond? A. Continue to monitor the patient closely, because she is experiencing adverse reactions to magnesium sulfate therapy. B. Notify the practitioner that the patient is experiencing magnesium toxicity. C. Administer calcium gluconate for magnesium toxicity. D. Decrease the rate of magnesium sulfate administration to prevent magnesium toxicity.
A
A patient at 33 weeks' gestation has presented with preterm premature rupture of the membranes. On examination, the nurse determines the FHR is 100 bpm and the umbilical cord has prolapsed. What is the next action by the nurse? A. Notify the practitioner and prepare for an emergency cesarean birth. B. Quickly administer a dose of betamethasone and prepare for an emergency cesarean birth. C. Administer a dose of betamethasone and recheck the FHR. D. Administer a dose of betamethasone and notify the practitioner.
A
A patient at 35 weeks' gestation with a history of gestational diabetes is admitted to the labor and delivery unit for preterm labor and corticosteroid administration. The nurse provides the patient with instructions on the medication. Which statement related to corticosteroid administration is the most appropriate? A. "You will need to monitor your blood sugar levels more frequently after administration." B. "This medication will be administered intravenously over the course of an hour." C. "A decrease in your white blood cell count is normal." D. "This medication will be administered on a weekly basis until delivery."
A
A patient at 40 weeks' gestation has just started receiving magnesium sulfate for preeclampsia. Which medical condition can affect the metabolism and excretion of the medication and cause signs and symptoms of toxicity? A. Renal disease B. Respiratory disease C. Anemia D. Asthma
A
A patient is hospitalized for induction of labor at 39 weeks' gestation. The patient has GDM that requires subcutaneous insulin injections. On admission, the patient's blood glucose level is 140 mg/dl. What would be the most likely treatment? A. Continuous IV insulin infusion B. Blood glucose monitoring every hour and subcutaneous injections of regular insulin C. No administration of insulin unless blood glucose levels increase because 140 mg/dl is not in the sliding scale range for administering regular insulin D. No administration of insulin because the intrapartum patient typically is not given anything to eat during labor; therefore, the need for insulin should decrease
A
A primigravida at 38 weeks' gestation has received two doses of IV hydralazine 20 minutes apart for a BP greater than 160/110 mm Hg. However, the patient's BP remains above 160/110 mm Hg. Which medication and dose should the patient receive next? A. Labetalol 20 mg IV administered over more than 2 minutes B. Hydralazine 20 mg IV C. Hydralazine 10 mg IV D. Labetalol 10 mg IV administered over more than 2 minutes
A
A primigravida at 40 weeks' gestation with preeclampsia is having labor induced. The patient has received magnesium sulfate for the past 2 days. In the past 2 hours, the patient has been showing signs of magnesium toxicity, with a magnesium level that is now at 10 mEq/L. Which antidote to magnesium sulfate should the practitioner order? A. One gram of calcium gluconate (10 ml of 10% solution) intravenously over several minutes B. One gram of calcium gluconate (10 ml of 20% solution) intravenously over several minutes C. One gram of calcium gluconate (10 ml of 10% solution) intravenously over 1 minute D. Two grams of calcium gluconate (10 ml of 10% solution) intravenously over several minutes
A
A primipara at 39 weeks' gestation presents to the labor and delivery unit for cervical ripening to be followed by labor induction. The practitioner orders misoprostol to be administered vaginally every 6 hours as needed to achieve a Bishop score of 8 or greater or until labor begins. A nursing student on the unit asks the nurse why misoprostol is being given first instead of oxytocin. What is the nurse's most accurate response? A. "Misoprostol is used first to soften and thin the cervix, which may reduce the amount of oxytocin needed to induce labor." B. "Misoprostol is more effective at labor induction; without it, higher levels of oxytocin may be required." C. "If misoprostol is used first, oxytocin most likely won't be necessary." D. "Misoprostol works better than oxytocin for labor induction in term gestations."
A
A student nurse asks the nurse which routes are safe for calcium gluconate administration. How should the nurse respond? A. Calcium gluconate is for IV use only. B. The subcutaneous and IV routes are safe for calcium gluconate administration. C. Calcium gluconate can be given by the IV or intramuscular route. D. Calcium gluconate can be given by the IV, intramuscular, or subcutaneous route.
A
How long should the nurse expect ephedrine's vasopressor effects to last? A. 1 hour B. 2 hours C. 30 minutes D. 45 minutes
A
How should the nurse administer eye ointment? A. Hold the applicator above the lower lid margin and evenly apply a thin ribbon of ointment 1 cm (0.4 in) long along the inner edge of the lower eyelid starting at the inner canthus. B. Hold the applicator down until it touches the eye and apply a small amount of ointment over the iris. C. Hold the applicator tip as close to the eye as possible without touching the eye and apply the correct number of drops into the conjunctival sac by squeezing gently. D. Apply the ointment over the lashes of the newborn's closed eyes if unable to expose the conjunctival sac.
A
The nurse assesses the mother's knowledge related to her newborn's hepatitis B immunization schedule. Which statement indicates that the mother understands the instructions provided? A. "My baby needs a second dose at 1 month after the first dose and the third dose 6 months after the first dose." B. "My baby needs a second dose at 6 weeks after the first dose and the third dose at 9 weeks after the first dose." C. "My baby needs a second dose at 6 weeks after the first dose and the third dose at 3 months after the first dose." D. "My baby needs a second dose at 1 month after the first dose and the third dose at 5 months after the first dose."
A
The nurse has just administered ephedrine 5 mg IV to a patient who is at 38 weeks' gestation following the administration of an epidural. Which effects on the patient should the nurse expect? A. Increased cardiac output and peripheral vasoconstriction B. Decreased cardiac output and peripheral vasoconstriction C. Increased cardiac output and peripheral vasodilation D. Decreased cardiac output and peripheral vasodilation
A
The nurse prepares to document the implementation of a magnesium sulfate infusion in the patient's record, but the space for documentation is limited. How should the nurse refer to the drug? A. Magnesium sulfate B. MgSO4, which is the medical abbreviation for magnesium sulfate C. Mag, which is recognized as an abbreviation for magnesium sulfate D. Mg++, the chemical abbreviation for magnesium sulfate
A
The practitioner orders misoprostol 50 mcg intravaginally for a nulliparous patient being induced at 39 weeks' gestation. With which increased risks is this higher dose of misoprostol associated? A. Uterine tachysystole and FHR decelerations B. Nausea, vomiting, constipation, fever, and uterine tachysystole C. Nausea, vomiting, diarrhea, fever, and postpartum hemorrhage D. Uterine tachysystole and postpartum hemorrhage
A
The student nurse asks the nurse how methyldopa is excreted in the body. How should the nurse respond? A. "Methyldopa is primarily excreted by the kidneys." B. "Methyldopa is primarily excreted by the liver." C. "Methyldopa is primarily excreted after being absorbed in the stool through the colon." D. "Methyldopa is equally excreted by the liver and the kidneys."
A
What should the nurse confirm before giving the hepatitis B vaccine and HBIG to a newborn whose mother is HBsAg positive? A. Informed consent was obtained. B. The newborn weighs more than 2000 gm. C. The newborn's body surface area is documented. D. The newborn's length is documented.
A
What supplies does the nurse know to collect before administering Engerix-B® to a newborn? A. A prefilled syringe with 10 mcg of medication and a ⅝-in needle B. A prefilled syringe with 20 mcg of medication and a ⅝-in needle C. A newborn dropper and medication concentration of 20 mcg/ml D. A newborn dropper and medication concentration of 10 mcg/ml
A
A nurse is caring for a low-risk multipara patient who has an epidural catheter in place. The patient's cervix is dilated 8 cm and preepidural blood pressure was 130/78 mm Hg. Ten minutes after epidural placement and an epidural bolus, the patient reports nausea and is restless. When the nurse assesses vital signs and the FHR pattern, the patient's blood pressure is 100/42 mm Hg and the FHR has minimal variability and a new onset of recurrent late decelerations. Administration of an IV fluid bolus is started, the patient is repositioned in the left lateral position, and oxygen is administered; however, the patient's blood pressure decreases to 96/40 mm Hg. Ephedrine is ordered. What is the most likely cause of the change in the FHR tracing, indicating a disruption of oxygenation? A. Imminent delivery because the patient's cervix is at 8 cm dilation B. Decreased uteroplacental perfusion caused by rapid reduction in blood pressure C. Decreased uteroplacental perfusion caused by cord compression D. Contracted intravascular volume
B
A patient admitted to the postanesthesia care unit 1 hour after cesarean delivery reports nausea and has a blood pressure of 90/52 mm Hg and diaphoresis. After reporting the symptomatic hypotension to the practitioner, which intervention should the nurse anticipate? A. Administration of IV ephedrine B. Administration of an IV fluid bolus C. Administration of an antiemetic D. Reassessment of blood pressure in 5 minutes
B
A patient at 26 weeks' gestation received a course of betamethasone 7 days ago. This patient will have a cesarean delivery because of preeclampsia with severe features. What effects should the antenatal corticosteroid therapy have on the newborn? A. Decreased risk of neonatal intraventricular hemorrhage, RDS, and cerebral palsy B. Decreased risk of neonatal intraventricular hemorrhage, RDS, and necrotizing enterocolitis C. Decreased risk of neonatal intraventricular hemorrhage, RDS, and neonatal infection D. Decreased risk of RDS, necrotizing enterocolitis, and neonatal infection
B
A patient at 35 weeks' gestation with chronic hypertension is concerned about the effect on the fetus of the methyldopa being taken. How should the nurse respond to the patient's concerns? A. "Don't worry, your doctor would not prescribe methyldopa if it could harm your baby." B. "Tell me more about your concerns regarding methyldopa." C. "I will request that your doctor speak with you about methyldopa." D. "Methyldopa has not been shown to have any effects on the baby."
B
A patient at 39 weeks' gestation is admitted for induction of labor after receiving a cervical ripening medication throughout the night. The patient received a scheduled dose of methyldopa 4 hours ago for elevated BP related to chronic hypertension. The nurse completes an hourly assessment, and the patient's BP is 158/90 mm Hg, the FHR is Category I (normal), and the patient is reporting headache, nausea, and drowsiness. Which nursing action is appropriate? A. Notify the practitioner that the patient is having a possible allergic reaction to the medication. B. Continue to monitor the patient closely and emphasize that these are common adverse reactions to methyldopa. C. Reassure the patient that the symptoms are from anxiety related to the induction of labor. D. Explain that the patient is experiencing normal signs and symptoms of pregnancy.
B
A patient at 39 weeks' gestation presents to the labor and delivery unit with severe preeclampsia. The mother's blood pressure is 210/110 mm Hg. The initial fetal tracing shows a baseline FHR of 140 beats per minute, moderate variability, accelerations, and no decelerations. When the cervix is dilated to 6 cm, an epidural infusion is started to manage the patient's pain. Fifteen minutes after the bolus dose of the anesthesia medication, the patient's blood pressure is 130/68 mm Hg. The patient reports dizziness and feeling light-headed, and the FHR assessment shows a baseline FHR of 160 beats per minute, minimal variability, no accelerations, and recurrent late decelerations. The anesthesia provider orders ephedrine 5 mg IV. Why should the nurse clarify this order? A. The usual dose of ephedrine during labor is 20 mg. B. Ephedrine is contraindicated in a pregnant patient with hypertension during labor. C. Administering ephedrine is inappropriate for a normotensive blood pressure reading. D. The patient's blood pressure is normal.
B
A patient is receiving subcutaneous insulin therapy for GDM. After an injection is prepared, what should the nurse do before administering it? A. Call the patient by name and compare the patient record number on the patient's identification band with the number on the MAR. B. Ask the patient's name and compare the patient record number on the patient's identification band with the number on the MAR. C. Check the patient's name on the identification band with the name on the MAR. D. Check the patient's name and room number with the information on the MAR.
B
A patient received a combination of mifepristone and oral misoprostol for medically induced abortion. On discharge, the nurse is explaining which symptoms to report to the practitioner immediately. What should the list include? A. No menstrual period after 3 weeks B. Severe abdominal tenderness C. Menstrual-like cramping and bleeding D. Nausea and vomiting
B
A patient receiving magnesium sulfate for preeclampsia has just delivered a term newborn. After the delivery, magnesium sulfate is usually continued for how long to prevent seizures? A. 48 hours B. 24 hours C. 36 hours D. 12 hours
B
A patient who was receiving a magnesium sulfate infusion to treat eclampsia experienced magnesium toxicity and has just received an IV dose of calcium gluconate. The nurse should monitor this patient for which potentially life-threatening adverse reactions to calcium gluconate? A. Respiratory depression, hypotension, and absence of deep tendon reflexes B. Bradycardia, cardiac arrhythmias, and cardiac arrest C. Severe hypertension and seizures D. Renal failure and disseminated intravascular coagulation
B
A patient with preeclampsia has been receiving magnesium sulfate at a rate of 2 gm/hr for the past 4 hours. On the last assessment, the nurse found that the patient was drowsy, patellar DTRs were 2+ bilaterally, BP was 118/66 mm Hg, pulse was 96 bpm, and respirations were 16 breaths/min. Now the patient is reporting difficulty catching a breath; DTRs are absent; BP is 106/58 mm Hg, pulse is 112 bpm; and respirations are 10 breaths/min. What is the most appropriate nursing intervention? A. Stop the magnesium sulfate infusion and administer a bolus of mainline fluid. B. Stop the magnesium sulfate infusion and notify the practitioner. C. Continue the infusion but notify the practitioner. D. Continue the infusion and reassure the patient that these are normal adverse effects of the medicine.
B
A patient with type 1 diabetes who has just learned of being 8 weeks pregnant continues with the normal insulin dosage, administering subcutaneous short-acting insulin before meals and long-acting insulin at a 10 PM bedtime. The patient is admitted to the hospital with severe hypoglycemia at 9:30 AM and reports several days of low blood glucose levels in the mornings. What should the practitioner be expected to do? A. Take the patient off the subcutaneous insulin. B. Reduce the patient's bedtime dose of insulin. C. Nothing because this is a normal occasional occurrence for patients with type 1 diabetes using insulin. D. Begin the patient on IV insulin.
B
A postpartum mother who was on methyldopa during the last trimester of pregnancy is currently receiving methyldopa 250 mg three times daily. During the current nursing shift, the mother's BP has been greater than 160/105 mm Hg three times. The practitioner has ordered an increase in methyldopa to 500 mg three times daily. Which nursing action is appropriate? A. Clarify the order with the practitioner because the maximum daily dose is 1000 mg. B. Confirm the order for postpartum methyldopa with the practitioner. C. Recheck the mother's BP to determine if an increase in medication is still needed. D. Advise the mother to change from breastfeeding to formula feeding.
B
A pregnant patient presents to the labor and delivery unit with severe preeclampsia, and a magnesium sulfate infusion is started. While completing an assessment after the initial bolus, the nurse realizes that the patient cannot answer questions. The nurse determines that the patient has slowed respirations, hypotension, and absent deep tendon reflexes, and that Category III (abnormal) characteristics are on the fetal monitor tracing. What should the nurse do immediately? A. Administer calcium gluconate and then contact the practitioner. B. Stop the magnesium sulfate infusion, administer oxygen, administer calcium gluconate as ordered, and contact the practitioner. C. Stop the magnesium sulfate infusion, administer oxygen, and contact the practitioner for further orders. D. Continue to monitor the patient for a worsening condition.
B
A pregnant patient with type 2 diabetes is being discharged from the antepartum unit after stabilization of blood glucose levels. When providing instructions regarding hypoglycemia, the nurse should include which signs and symptoms? A. Rapid, deep respirations, odor of acetone on the breath, and flushing B. Dizziness, headache, nervousness, and pallor with clammy skin C. Nausea, vomiting, and diarrhea D. Headache and visual disturbances
B
A primigravida at 39 weeks' gestation is laboring and receiving magnesium sulfate therapy for severe preeclampsia. The patient received IV hydralazine 10 minutes ago for an elevated BP of 201/116 mm Hg. The nurse completes an initial assessment. The patient's BP is now 172/96 mm Hg, the FHR is Category I (normal), and the patient is reporting new-onset headache, loss of appetite, and nausea. What should the nurse do? A. Notify the practitioner that the patient may be having an allergic reaction to the medication. B. Continue to monitor the patient closely because these are common adverse reactions to hydralazine. C. Reassure the patient that magnesium sulfate is causing these symptoms. D. Tell the patient that these symptoms are normal during labor.
B
A primigravida with a BP of 180/110 mm Hg needs a dose of IV hydralazine. The patient does not want the hydralazine administered. What should the nurse do? A. State that the medication is best for both mother and baby and that the mother should take it. B. Explore the patient's concerns about the medication. C. Respect the patient's wishes and do not give the medication. D. Tell the patient that the medication is necessary, and administer it against the patient's wishes.
B
An orientee asks about IM injections in newborns because her only practice experiences have been with adults. What is the correct injection site for an IM injection in the newborn? A. Vastus lateralis muscle or the gluteal muscle B. Vastus lateralis muscle C. Vastus deltoid muscle D. Vastus deltoid muscle or gluteal muscle
B
During labor, a multipara being treated with magnesium sulfate for preeclampsia receives a dose of IV hydralazine because her BP is 180/114 mm Hg. The combination of magnesium sulfate and hydralazine places the patient at an increased risk of which complication? A. Hypertension B. Hypotension C. Hyperreflexia D. Hyporeflexia
B
The nurse has administered a dose of betamethasone by deep IM injection to a multipara at 30 weeks' gestation who is in preterm labor. What is the nurse's next action regarding injection site care? A. Gently massage the injection site. B. Apply gentle pressure to the injection site. C. Vigorously massage the injection site. D. Apply firm pressure to the injection site.
B
The nurse is reviewing the health history of a patient who is pregnant and for whom the practitioner has ordered IV hydralazine for elevated BP. Which condition in the patient's health history is a contraindication to hydralazine administration? A. Thyroid disease B. Mitral valve rheumatic disease C. Asthma D. Allergy to penicillin
B
The nurse who is preparing to administer calcium gluconate to treat magnesium toxicity knows that the medication should not be given to which patients? A. Digitalized patients or those with hypocalcemia or ventricular fibrillation B. Digitalized patients or those with hypercalcemia or ventricular fibrillation C. Digitalized patients or those with hypermagnesemia or ventricular fibrillation D. Digitalized patients or those with hypercalcemia or bradycardia
B
Two days ago, a patient with Type 1 diabetes delivered a term newborn. The mother is breastfeeding the infant, and the infant is feeding every 3 hours for 30 minutes. The practitioner restarts the mother's sliding scale regular insulin orders. This patient has a risk of which complication? A. Hyperglycemia B. Hypoglycemia C. Diabetic ketoacidosis D. Dehydration
B
When assessing a patient at 34 weeks' gestation with a history of preeclampsia, the nurse finds that the patient's BP is currently 220/110 mm Hg. The nurse calls the practitioner for orders to treat the patient's severe hypertension. What would be an appropriate medication order at this time? A. Methyldopa or labetalol B. Labetalol or hydralazine C. Hydrochlorothiazide or hydralazine D. Spironolactone or methyldopa
B
1. A patient at 30 weeks' gestation presents to the obstetric triage unit "for a steroid shot." What should be the nurse's first intervention? A. Tell the patient that steroids are not appropriate for pregnant patients. B. Draw betamethasone into a syringe and administer it to the patient. C. Review the practitioner's order. D. Monitor the FHR pattern and uterine activity
C
2. A patient at 35 weeks' gestation presents to the labor unit reporting rupture of the membranes and contractions every 5 to 8 minutes. Electronic fetal monitoring displays a Category I (normal) FHR pattern and contractions every 5 minutes. The patient rates the contraction pain as 6 on a scale of 0 to 10. A vaginal examination reveals that the cervix is 2 cm dilated and 60% effaced and the fetal presenting part is at -1 station. The patient's temperature is elevated and the amniotic fluid has a foul odor. Why would corticosteroid administration not be appropriate for this patient? A. Delivery of the newborn is imminent. B. The recommended gestational age range for antenatal corticosteroids is 24 to 32 weeks. C. The patient may have chorioamnionitis. D. The patient has gestational hypertension.
C
A mother who is positive for Group B Streptococcus gave birth to a newborn before she could receive antibiotics. Several hours after birth, the newborn is tachypneic with periodic apneic spells, and the complete blood count results are suspicious for infection. The hepatitis B vaccine is on the regular newborn nursery orders. What is the best response? A. Administer the HBIG only. B. Administer the hepatitis B vaccine. C. Delay administration of the hepatitis B vaccine. D. Delay the administration of the HBIG only.
C
A multipara at 40 weeks' gestation received misoprostol for cervical ripening; the last dose was 2 hours ago. The practitioner orders oxytocin to be given now. How should the nurse handle this order? A. Delay starting the oxytocin for another 2 hours. B. Follow the practitioner's order. C. Advise the practitioner that the oxytocin should not be given this soon after the misoprostol dose. D. Call the charge nurse or manager.
C
A newborn needs both hepatitis B vaccine and HBIG. How should the nurse administer the injections? A. Mix the medications in one syringe and give both at once. B. Use the same injection site for both medications, but in separate syringes. C. Give the medications at the same time, but use separate injection sites. D. Give the medications 12 hours apart, but use the same injection site.
C
A nurse is about to administer erythromycin ointment to a newborn and notices that the newborn's right eye is draining yellow discharge. What should the nurse do first? A. Swab the eye and wait for culture and sensitivity test results. B. Proceed with medication administration without removing the exudate and obtain a specimen for culture if drainage continues. C. Obtain a specimen for culture and sensitivity testing and cleanse the eye before administration. D. Check the mother's record for a documented gonorrhea infection.
C
A patient at 38 weeks' gestation is admitted to the labor and delivery unit with preeclampsia. The patient's BP is 198/122 mm Hg. The practitioner orders methyldopa 250 mg to be given orally every 8 hours for BP over 160/100 mm Hg. Which nursing intervention is appropriate? A. Clarify the order with the practitioner because methyldopa's recommended dosage is 500 mg, not 250 mg. B. Clarify the order with the practitioner because methyldopa should be given only every 12 hours. C. Clarify the order with the practitioner because methyldopa's effect on BP is delayed 4 to 6 hours. D. Administer the medication as ordered because 250 mg of methyldopa every 8 hours is the recommended dosage.
C
A patient at 38 weeks' gestation is receiving magnesium sulfate for preeclampsia with severe features. The practitioner has ordered serum magnesium levels every 8 hours. What is the therapeutic target range for serum magnesium levels? A. 5 to 6 mEq/L B. 5 to 9 mEq/L C. 5 to 8 mEq/L D. 6 to 10 mEq/L
C
A patient is receiving calcium gluconate IV for magnesium toxicity. A nurse enters the room to assist with the emergency and notices that the primary nurse is injecting the calcium gluconate rapidly. The assisting nurse should advise the primary nurse to administer the calcium gluconate at which rate? A. 10 mg/10 min B. 1 g/min C. 1 g/3 min D. 1 mg/min
C
A primigravida at 40 weeks' gestation is admitted for induction of labor. The patient has been diagnosed with GDM and is receiving insulin injections at home. Besides setting up for a vaginal delivery, what should the nurse do? A. Notify the radiology department to perform an ultrasound to check for macrosomia. B. Explain to the patient and support person that the patient may not be able to have an epidural anesthetic. C. Notify the perinatal team and be prepared for cesarean delivery. D. Do nothing differently because a vaginal delivery is expected.
C
A primigravida receiving hydralazine for hypertension is concerned about the drug's effects on the baby. The patient asks the nurse, "Will this medicine harm my baby?" How should the nurse respond? A. State that the doctor will speak with the patient about it. B. Tell the patient that a risk of harm to the baby exists but that the benefits outweigh the risk. C. Tell the patient that the amount of drug that crosses the placenta is very small. D. State that everything should be fine and that the patient should not worry.
C
A primipara at 42 weeks' gestation has received two doses of misoprostol vaginally; the last dose was 6 hours ago. The nurse completes an assessment to determine the need for additional doses of misoprostol. Performing a sterile vaginal examination, the nurse determines that the patient's cervix is 6 cm dilated, 100% effaced, soft, and at midposition and that the fetus is at -2 station. The patient's membranes are intact, and contractions are occurring every 2 to 3 minutes. Based on these findings, what is the nurse's next appropriate action? A. Start oxytocin administration as ordered. B. Notify the pharmacist to prepare another dose of misoprostol. C. Notify the practitioner that labor has begun. D. Determine whether the patient wants visitors at the bedside.
C
The nurse has just received an order to administer magnesium sulfate to a patient in preterm labor at 31 weeks' gestation. Which condition would prompt the nurse to notify the practitioner because magnesium sulfate is contraindicated? A. Diabetes B. Preeclampsia C. Myasthenia gravis D. Anemia
C
The nurse is about to administer eye ointment to a newborn. Which action takes priority over the other three actions? A. Gently wipe each of the newborn's eyelids with sterile cotton or gauze. B. Explain the procedure to the family and ensure that they agree to treatment. C. Perform hand hygiene and don gloves. D. Instill the ointment as prescribed using the correct technique.
C
The nurse notes that a patient who is at 41 weeks' gestation and was admitted for labor at 5 cm has a pulse pressure of 35 mm Hg. What effect will this finding have on the nurse's preparation of the patient for an epidural? A. The nurse will administer less IV fluid during the preepidural fluid bolus. B. The nurse will have ephedrine available at the bedside. C. The nurse will administer more IV fluid during the preepidural fluid bolus. D. The nurse will not change patient preparation because the patient's pulse pressure is normal.
C
The nurse receives an order to administer magnesium sulfate to a patient with preterm labor to delay delivery and thus provide time for fetal lung maturity. Before initiating the infusion, the nurse should instruct the patient to report which sign or symptom? A. High fever B. Leg cramps C. Shortness of breath D. Decreased fetal movement
C
What are some of the common adverse effects of misoprostol when given for postpartum hemorrhage? A. Nausea, vomiting, constipation, hypertension, fever, and chills B. Headache, nausea, vomiting, fever, chills, and hypertension C. Headache, nausea, vomiting, diarrhea, fever, and chills D. Nausea, vomiting, constipation, headache, and hypotension
C
Which action is part of the proper injection technique for the hepatitis B vaccine? A. Massaging the site after the injection B. Aspirating after the needle is inserted C. Inserting the needle at a 90-degree angle D. Administering the medication into the subcutaneous tissue
C
Which education should the nurse provide to the family before administration of eye prophylaxis? A. Instruct the family that they can refuse eye prophylaxis. B. Instruct the family on how to instill the eye ointment. C. Instruct the family regarding potential side effects and adverse reactions to the medication. D. Instruct the family to irrigate the newborn's eyes if they seem irritated.
C
Which medication is an alternative to erythromycin 0.5% ophthalmic ointment for newborns at risk of exposure to N. gonorrhoeae? A. Neomycin, polymyxin, and bacitracin ophthalmic eye ointment B. Chloramphenicol eye ointment C. Ceftriaxone 25 to 50 mg/kg intravenously or intramuscularly D. Ampicillin 12.5 mg/kg intravenously or intramuscularly
C
A mother of a newborn asks the nurse if breastfeeding while taking methyldopa is permitted. How should the nurse respond? A. "You should not breastfeed when you're taking methyldopa." B. "Methyldopa can cause diarrhea in your baby." C. "Methyldopa has been shown to be unsafe for use during breastfeeding." D. "Another antihypertensive may be safer to use in the postpartum period."
D
A mother who received oral methyldopa during the last 5 months of pregnancy has delivered, and the newborn has successfully completed the transition period with no complications. Later, the nurse notices that the newborn's blood work shows a positive direct antiglobulin test (DAT) result. Why should the nurse report this to the practitioner? A. The newborn may become jaundiced. B. Based on the maternal history, the practitioner will want to treat hemolytic anemia in the newborn. C. The newborn will need phototherapy treatment. D. Based on the maternal history, the practitioner will probably want to rule out hemolytic anemia in the newborn.
D
A multipara at 35 weeks' gestation has been admitted for preterm labor. The practitioner has ordered a course of corticosteroids. What benefit do corticosteroids have in late preterm pregnancies? A. They reduce the risk of intraventricular hemorrhage. B. They reduce the risk of necrotizing enterocolitis. C. They reduce the risk of cerebral palsy. D. They reduce the risk of TTN.
D
A multipara with severe preeclampsia has an elevated BP of 198/112 mm Hg. The patient is receiving magnesium sulfate and oxytocin IV. The practitioner orders 10 mg of IV hydralazine. Fifteen minutes after the hydralazine is administered, the nurse observes a maternal BP of 120/72 mm Hg and minimal FHR variability with a new onset of late decelerations. Based on the diagnosis of severe preeclampsia and the current medications being administered, what is the most likely cause of the change in the FHR pattern? A. An adverse reaction to the hydralazine B. Imminent delivery C. Severe preeclampsia D. Decreased uteroplacental perfusion
D
A nurse just administered misoprostol vaginally to a patient being induced at 40 weeks' gestation. After misoprostol placement, in which position should the patient be placed? A. Semi-Fowler position with no lateral tilt for 30 minutes B. Recumbent position with no lateral tilt for 30 minutes C. High-Fowler position with a lateral tilt for 30 minutes D. Side-lying or recumbent position with a lateral tilt for 30 minutes
D
A nurse receives an order for IV calcium gluconate for a patient experiencing magnesium toxicity from magnesium sulfate therapy. The nurse prepares the injection and enters the patient's room. What should the nurse's initial steps be? A. Check the patient's name and room number with the corresponding information on the MAR. B. Check the patency of the IV line and administer the medication slowly. C. Discontinue the magnesium sulfate infusion and notify the practitioner. D. Identify the patient using two identifiers and compare the patient record number on the identification band with the number on the MAR.
D
A patient admitted for labor induction at 40 weeks' gestation received a second vaginal dose of misoprostol 30 minutes ago. The nurse completes an assessment and observes that for the past 30 minutes, each of the patient's contractions has lasted 90 seconds and there are six contractions in every 10-minute period. The FHR baseline is 170 beats per minute with minimal variability, no accelerations, and no decelerations; this is a change from the patient's admission tracing, which showed an FHR of 145 beats per minute and moderate variability. Based on the assessment, how should the nurse proceed? A. Do nothing because this is an expected effect of misoprostol. B. Administer terbutaline as ordered, notify the practitioner, and continue to monitor the situation. C. Continue to monitor the patient closely because labor induction has probably occurred. D. Remove the misoprostol tablet (if possible), notify the practitioner, and administer terbutaline as ordered.
D
A patient at 28 weeks' gestation is admitted for 23-hour observation. The patient is pregnant with twins and reports irregular contractions that are increasing in frequency. The practitioner has ordered betamethasone 6 mg IM every 12 hours. What should be the first nursing intervention? A. Assess the patient for diabetes and assess fetal status before administering betamethasone. B. Assume the practitioner intended to order dexamethasone because the ordered dosage is appropriate for dexamethasone. C. Administer the betamethasone as soon as possible so it will take effect before the patient delivers. D. Clarify the practitioner's order because the usual dosage for betamethasone is 12 mg every 24 hours for a total of two doses.
D
A patient at 37 weeks' gestation has just received a dose of methyldopa. The nurse knows the potential maternal adverse reactions to methyldopa are similar to those of other antihypertensives. What are some of the adverse reactions that the patient may experience? A. Drowsiness, muscle cramps, muscle weakness, nausea, vomiting, dry mouth, rash, and orthostatic hypotension B. Drowsiness, headache, muscle weakness, nausea, vomiting, dry mouth, rash, and tinnitus C. Drowsiness, blurred vision, headache, muscle weakness, nausea, vomiting, dry mouth, rash, and orthostatic hypotension D. Drowsiness, headache, muscle weakness, nausea, vomiting, dry mouth, rash, and orthostatic hypotension
D
A patient is to receive IV ephedrine for hypotension after epidural placement. The order reads "ephedrine 50 mg IV every 10 minutes as needed." Based on this order, what should the nurse do? A. Continue with other methods to treat hypotension (e.g., administering an IV fluid bolus) and decline to administer ephedrine. B. Administer the ephedrine as soon as possible so it will take effect before the patient experiences adverse reactions of hypotension. C. Assume the practitioner meant to order hydralazine because 50 mg of hydralazine is a recommended dose. D. Clarify the order because the usual dose for IV ephedrine is 5 to 10 mg.
D
A patient with newly diagnosed GDM presents to the labor and delivery unit at 28 weeks' gestation for instruction on insulin self-administration. The practitioner has ordered intermediate-acting insulin to be administered on a schedule and a short-acting insulin to be administered as needed. The patient begins to prepare the first injection of intermediate insulin and starts to shake the bottle to "mix the cloudy solution." Which patient instruction is appropriate? A. "You should use the clear insulin in place of the cloudy insulin." B. "You are preparing the insulin correctly; it should be well shaken before administration." C. "You don't need to mix the insulin; it is supposed to be cloudy." D. "Cloudy insulin should be gently rolled to mix; it should not be shaken."
D
A primigravida presents to the labor and delivery unit with severe preeclampsia. BP is 210/110 mm Hg. The practitioner orders hydralazine by IV push administration. Which is the primary advantage of administering hydralazine? A. It is available for oral administration. B. It causes hypotension, which is desirable in a patient with an elevated BP. C. It causes uteroplacental insufficiency. D. It increases cardiac output.
D
The family refuses prophylactic eye ointment for their newborn. Which is the best nursing action? A. Have them sign a refusal of treatment form. B. Tell them that legally they have no choice. C. Assure them that the ointment has no side effects. D. Explain the risk of not giving treatment and notify the practitioner if they still refuse.
D
