Maternal Child Exam 2

3,4,5

In preparation for a cesarean birth, the nurse expects which medical-based preoperative interventions? Select all that apply. 1. Assessment of the woman's knowledge and educational needs 2. Verification that the woman has been nothing by mouth (NPO) for 6 to 8 hours before surgery 3. Administration of narrow-spectrum prophylactic antibiotics 4. Assessment for risk of venous thromboembolism (VTE) 5. Prescription for sequential compression devices before surgery

1

The most common complication of childbirth for women having cesarean birth is: 1. Hemorrhage requiring a blood transfusion 2. Unplanned hysterectomy 3. Ruptured uterus 4. Retained surgical sponges

4

The mother of a premature infant in the neonatal intensive care unit (NICU) is encouraged by her baby's nurse to bring expressed breast milk for enteral feedings. For which reason does the nurse encourage the mother to do this? 1. The baby will be more likely to breastfeed later. 2. The baby will gain weight faster on breast milk. 3. The mother will feel more involved with her baby. 4. Breast milk helps prevent necrotizing enterocolitis.

1

The neonatal intensive care unit (NICU) nurse is providing care for a premature neonate born at 26 weeks' completed gestation who is experiencing respiratory distress syndrome (RDS). Which assessment finding indicates to the nurse that the neonate's respiratory status is deteriorating? 1. Pronounced audible expiratory grunting is heard .2. PaO2 is 65 and PaCO2 is 45 mm Hg. 3. Respiratory rate is 58 breaths per minute. 4. Heart rate is 162 beats per minute.

4

The nurse continues to monitor a patient after a vaginal delivery with an estimated blood loss of 1,000 mL. Which assessment finding does the nurse recognize as requiring Stage 3 hemorrhage protocol? 1. Increased patient restlessness 2. Manifestations of severe pain 3. Patient requests water for extreme thirst 4. Development of abnormal vital signs

bronchopulmonary dysplasia

._______________is a chronic lung problem that affects neonates who have been treated with prolonged periods of mechanical ventilation and oxygen therapy.

2,4,5

17. The nurse is preparing to teach a class on the benefits of breastfeeding for infants. Which benefits will the nurse include in the presentation? Select all that apply. 1. Immunity to respiratory syncytial virus 2. Fewer cases of necrotizing enterocolitis 3. Less likely to develop cancer as adults 4. Decreased risk for developing otitis media 5. Decreased incidence of sudden unexpected infant death (SUID)

4

A breastfeeding mother is planning to return to work 3 months after her baby is born. The mother is planning to use an electric breast pump and freeze some breast milk for use later. Which information does the nurse need to provide? 1. Breast milk can only be frozen in special plastic freezer bags. 2. Frozen breast milk can be defrosted in a microwave. 3. The freezer door shelf decreases the chance of milk contamination. 4. Breast milk can be kept in a deep freezer for 6 to 12 months

1

A patient arrives to the family practice clinic for her annual examination. The nurse's assessment data includes thin, 35-year-old female, history of weight loss surgery and total hysterectomy, body mass index (BMI) is 19; the patient has been taking corticosteroids for severe asthma. Which of the following is an expected diagnostic screening for a potential health problem? 1. Dual-energy x-ray absorptiometry scan 2. Serum electrolyte levels and vitamin D 3. Serum cholesterol and diabetic screening. 4. Papanicolaou (Pap) smear

3

A patient delivers a term neonate and expresses concern about the reason for giving the neonate an injection. Which information from the nurse is accurate? 1. Neonates will hemorrhage without vitamin K. 2. Mothers are unable to supply vitamin K to the fetus. 3. Vitamin K is needed to activate clotting factors. 4. Mothers on certain medications do not provide enough vitamin K to infants through breastfeeding.

separation

After pregnancy and birth, a mother may notice a condition called diastasis recti abdominis, which is a(n)______________ of the rectus muscle.

3

Adequate output is a good indicator that the baby is getting enough breast milk. Which information is important for the nurse to provide to parents on the number of wet diapers and stools in a 24-hour period? 1. By day 3 the baby should have at least 4 to 5 wet diapers and 2 to 3 stools. 2. By day 2 the baby should have at least 3 to 4 wet diapers and 3 to 4 stools. 3. By day 4 the baby should have at least 3 to 5 wet diapers and 3 to 4 stools. 4. By day 10 the baby should have at least 5 to 6 wet diapers and 5 to 6 stools.

3

An emergency cesarean is being implemented. The patient describes tingling in her ears and a metallic taste with the administration of regional anesthesia. The nurse is aware that which incidence has occurred? 1. Manifestation of maternal respiratory depression related to anesthesia 2. Maternal hypotension is occurring related to administration of anesthesia 3. Inadvertent injection of the anesthetic agent into the maternal bloodstream 4. Expected manifestations related to anesthetic medications are present

2

Levesque, Bisson, Charton, and Fernet (2020) conducted research focused on parenting and relational well-being during the transition to parenthood. Based on the research findings, which of the following is a central challenge identified by the couples? 1. Experiencing fatigue 2. Maintaining couple relationship 3. Maintaining friendships 4. Experiencing discrimination at work

4

Postpartum endometritis is: 1. Associated with precipitous labor and birth 2. Effectively treated with a single dose of ampicillin or cephalosporin 3. Less frequent following cesarean birth due to sterile technique used during surgery 4. Associated with internal monitoring, amnioinfusion, prolonged labor, and prolonged rupture of membranes

4

The leading health problems or issues for females aged 15 to 19 are: 1. Eating disorders 2. Bullying 3. Pregnancy 4. Persistent feelings of sadness

1,2,3

The nurse in a postpartum unit evaluates new parents for risk factors that can indicate problems with bonding or attachment. Which situations does the nurse recognize as a cause for bonding or attachment problems? Select all that apply. 1. The mother experienced eclampsia in the third trimester of pregnancy. 2. The neonate is being treated for meconium aspiration syndrome (MAS). 3. The mother experienced dystocia in the second phase of labor. 4. The father of the neonate is in the military and not yet home on leave. 5. The mother's mother lives next door and is available to help with the baby.

1,3,4,5

The nurse is assessing a 25-year-old female patient. This past year she has been training for the Boston Marathon. She wears a sports bra to provide adequate support when running. The patient is concerned that she might have breast cancer. The patient states that she has thin milky discharge from her nipples and several painful lumps in both breasts that fluctuate in sizes. She has lost over 20 pounds in the past year. She also reports that she experiences mood swings. Besides a negative mammogram, what other symptoms that she is experiencing would correlate with a diagnosis of fibrocystic breast? Select all that apply. 1. Milky discharge from nipples 2. Extensive weight loss 3. Painful lumps 4. Mood swings 5. Multiple lumps

1,2,4,5

The nurse is aware of concern about the increasing numbers of severe maternal morbidity (SMM). It is believed to be related to changes in the overall health of the population of women giving birth. Which reasons does the nurse identify as causes of SMM? Select all that apply. 1. Increases in maternal age 2. Prepregnancy obesity 3. Inability to pay for health care 4. Cesarean deliveries 5. Preexisting chronic medical conditions

2

The nurse is discussing contraception with a breastfeeding woman and her husband before discharge following the birth of a first child. The couple are uncertain about the method but are certain about avoiding pregnancy for at least 2 years. Which method does the nurse recommend? 1. Lactational amenorrhea method 2. Depo-Provera 3. Oral estrogen/progesterone pill 4. Natural family planning

2,3,5

The nurse is educating a 24-year-old female patient who was newly diagnosed with polycystic ovary syndrome (PCOS). The patient was prescribed an antidiabetic medication. Which medication effects should the nurse educate the patient about? Select all that apply. 1. A period of initial weight gain 2. A change in her integumentary system 3. Low blood sugar until her hormones stabilize 4. Decreased likelihood of pregnancy 5. A decrease in abdominal obesity and weight

4,5

The nurse is explaining to the new breastfeeding mother the types of neonatal stools the mother can expect. Which examples does the nurse provide? Select all that apply. 1. Residual meconium is passed as loose watery stool. 2. Sticky, thick, black stools indicate a presence of blood. 3. Stools will eventually become drier and more formed. 4. Stools will be golden yellow, with a "seedy" appearance, and a sour odor is expected. 5. A neonate's first stool is passed within the first 12 to 24 hours.

1,3,4,5

The nurse is making a plan of care for a patient who is in the first 24-hour period past a cesarean delivery. Which interventions will the nurse include in regards to medications? Select all that apply. 1. Continue a daily stool softener. 2. Provide prophylaxis antibiotics. 3. Ensure the availability of naloxone. 4. Manage pain with morphine. 5. Administer RhoGAM if needed.

1

The nurse is monitoring a patient who has been in prolonged labor. Which assessment finding will result in the nurse notifying the health-care provider (HCP) about the development of an emergent situation requiring a cesarean delivery? 1. Recognition of a Category II fetal heart rate (FHR) pattern 2. Maternal exhaustion from prolonged uterine activity 3. Maternal blood pressure indicative of hypotension 4. Increased maternal temperature related to infection

2,5

The nurse is preparing a talk with new parents about immunity and their newborns. Which factual information will the nurse present? Select all that apply. 1. Antigens are produced as part of natural immunity. 2. A vaccination is an example of acquired immunity. 3. Placental transfer is how newborns get natural acquired immunity. 4. Gamma globulin is an example of artificial active immunity. 5. Natural passive immunity protects the baby for a few months after birth.

1

The nurse is preparing a teaching plan for a polycystic ovary syndrome (PCOS) support group. One of the teaching points will include diet and weight loss to decrease hirsutism and acne. What is the reasoning for this rationale? 1. Diet and exercise will promote weight loss, which will decrease hyperandrogenemia. 2. Diet and exercise will decrease the risk of type 2 diabetes and gestational diabetes. 3. Diet and exercise will decrease serum lipid levels and lower the risk for cardiovascular disease. 4. Diet and exercise will increase the frequency of ovulation and menstruation and increase fertility.

3

The nurse is preparing discharge teaching for a postpartum patient who exhibits signs and symptoms of an episiotomy infection and is on oral antibiotic therapy. Which discharge teaching will the nurse provide regarding pain management? 1. Application of hot packs to the perineal area 2. Instructions to improve circulation by ambulating 3. Information applicable to medication therapy 4. Medicating for pain above level 4 on a 0 to 10 scale

1,2,3,4,5

The nurse is providing care for a patient who delivered via cesarean 24 hours ago. Which teaching does the nurse provide for the patient and family? Select all that apply. 1. Signs and symptoms to report to the health-care provider (HCP) 2. Comfortable positions for feeding the newborn 3. Encouragement for early dietary intake of solid foods 4. Encouragement for family to help with infant care and housework 5. Information on nutrition to promote tissue healing

1,4

The nurse is providing care to the 35-year-old female patient at the family practice clinic who is in the office for her annual physical examination. She is 5 feet 7 inches and weighs 135 pounds. She is married and has two children ages 9 and 12. Which tests should the nurse recommend are the most appropriate for this patient? Select all that apply. 1. Papanicolaou test every 5 years 2. Type 2 diabetic screening 3. DEXA screen every 2 years 4. HPV every 5 years 5. HIV testing every 5 years.

1,5

The nurse is providing teaching to a patient who is breastfeeding a newborn. The patient expresses interest in maintaining a healthy nutritional status for both her and her baby. Which information does the nurse present to meet the patient's need? Select all that apply. 1. Increase caloric intake by 500 to 1,000 per day. 2. Avoid the intake of processed foods. 3. Abstain from the intake of alcohol. 4. Eat fresh fruits and vegetables. 5. Drink 2 to 3 liters of fluid each day

2

The nurse is researching for evidence-based practice related to a mother's response during the postpartum period. Based on research by Rubin and Mercer, which finding will the nurse be able to easily implement to change the culture of the unit? 1. Satisfaction questionnaires 2. Alterations in terminology 3. Decrease in nurse/patient ratios 4. Soliciting paternal expectations

1,2,3,4,5

The nurse uses research from Greenberg and Morris (1974) as a guideline for identifying the presence of engrossment in a new baby by the father. Which behaviors exhibit paternal-infant bonding related to engrossment? Select all that apply. 1. Seeing the baby as attractive 2. Perceiving the baby as being perfect 3. Having a desire to touch the baby 4. Indicating an increasing sense of self-esteem 5. Positively commenting about the baby's features

1,4,5

The premature neonate is susceptible to skin breakdown because of thin, immature skin. Which skin care interventions are appropriate for the premature neonate? Select all that apply. 1. Use a neutral pH cleanser and sterile water for bathing. 2. Provide a full bath every day. 3. Use adhesives to secure medical devices. 4. Change the neonate's position at least every 4 hours. 5. Place a hydrocolloid barrier underneath medical devices.

3

What is the common risk factor for hypertension, abnormal menstrual cycles, osteoarthritis, and high-risk pregnancies? 1. Polycystic ovarian syndrome 2. Diabetes mellitus 3. Body mass index (BMI) over 32 4. Sedentary lifestyle

3

a patient in the second trimester of pregnancy is discussing breastfeeding and other options with the nurse. Which question is most important for the nurses to ask? 1. "What are the reasons why you are considering breastfeeding?" 2. "Do you have family members who have breastfed their babies?" 3. "How does your partner feel about you breastfeeding?" 4. "At what point after childbirth do you plan to return to work?"

3

the nurse is aware that the greatest source of bleeding during childbirth occurs following detachment of the placenta. Which physiological change takes place immediately after the expulsion of the placenta to decrease the amount of blood loss? 1. Platelet activity increases before labor and delivery. 2. Factor VIII complex increases during gestation. 3. Contractions of the uterine myometrium occur. 4. Fibrin formation increases before the birth occurs.

2

The nurse in the neonatal intensive care unit (NICU) is assessing a neonate delivered at 28 weeks' gestation. Which of the following findings is the nurse's greatest concern? 1. Presence of a heart murmur 2. Apnea 20 seconds or longer 3. Low hemoglobin laboratory level 4. Absent or weak reflexes

1,2,4

. A college-aged female patient states that she understands the risk of sexual assault with overdrinking. She asks the nurse what health risks are associated with excessive alcohol intake for her age. What diseases or conditions should the nurse include in her response? Select all that apply. 1. Infertility 2. Cancer of the mouth 3. Hypertension 4. Brain shrinkage 5. Osteoporosis

2

. A mother's milk supply is dependent on which two factors? 1. Adequate breast tissue and stimulation of the breast 2. Stimulation of the breast and milk removal 3. Milk removal and adequate let-down reflex 4. Let-down reflex and increased level of estrogen following birth

2

A 48-year-old female patient presents to the OB/GYN clinic for her annual examination. She states that she has had the following symptoms: mood swings, irregular menstrual cycles, forgetfulness, food cravings, and a decrease in libido. Which of the following does the nurse suspect the patient is experiencing? 1. Menopause 2. Perimenopause 3. Postmenopause 4. Pregnancy

2

Dayton et al. (2016) performed qualitative research regarding expectant fathers' beliefs and expectations. The nurse identifies which theme as emerging from this research? 1. Men felt that the role of being a father can be learned. 2. Men described fathering as an extremely difficult task. 3. Men rely on other men to support the fathering role. 4. Men believe that the nurturing role is always the mother's.

sibling rivalry

When providing care to a multiparous mother, the nurse needs to assess for the presence of ___________________between the older children and the new baby

2

The nurse is palpating a patient's uterus 12 hours after a vaginal delivery. For which reason does the nurse place one hand just above the symphysis pubis? 1. To prevent uterine prolapse 2. To prevent uterine inversion 3. To prevent uterine hemorrhage 4. To prevent uterine movement

4

. Findings from analysis of maternal deaths from multiple states' maternal mortality review committees suggest what percentage of maternal deaths are likely preventable? 1. 30% 2. 40% 3. 50% 4. 60%

1

. A patient is being prepared for an unplanned cesarean section. Which pre-procedure information is most important for the nurse to report before the administration of regional anesthesia? 1. Laboratory value indicating a low platelet count 2. Inability of the patient to sit on the bedside and flex forward 3. Hypovolemia corrected with IV fluid administration 4. History of patient experiencing headaches after a spinal

4

. A patient who is 12 hours' postpartum after a vaginal delivery continues to have difficulty in initiating urination. The nurse is aware that an integrative method used when a woman is unable to void is peppermint oil. In which manner will the peppermint oil be used? 1. A thin layer is applied to the urinary meatus. 2. A small amount on toilet paper is added to the toilet bowl. 3. A small amount is added to the water of a vaporizer. 4. A saturated cotton ball is placed in a "hat" on the toilet.

1,3,4,5

. A postpartum patient informs the nurse of a frequent urge and burning when attempting to urinate. The nurse reviews the patient's medical record and associates which risk factors related to a possible urinary tract infection (UTI)? Select all that apply. 1. Neonatal macrosomia 2. Low-grade fever (101.3°F [38.5°C]) 3. Poor oral fluid intake 4. Urinary catheter during labor 5. Use of a vacuum extractor

2

. Postnatal nurses expressed concern about neonatal pain management during painful interventions. Using evidence-based practice from research performed by Thakkar, Arora, Das, Javadekar, and Panigrahi (2016), which method of pain control will be used for heel sticks? 1. An anesthetic gel will be applied 20 minutes before the stick. 2. A combination of stimulated sucking and receiving sucrose orally is used. 3. The stick will be administered while the neonate is breastfeeding. 4. The neonate is stuck while the mother and neonate are en face.

2

. The initial drug of choice for excessive bleeding in the immediate postpartum period is: 1. Methylergonovine maleate (Methergine) IM 2. Oxytocin IV infusion 3. Prostaglandin 15-MF2α suppository 4. Misoprostol

1

. The nurse is assisting the primary care provider (PCP) with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient? 1. Carboprost-tromethamine 2. Fresh frozen plasma 3. Methylergonovine 4. Magnesium sulfate

1

. The nurse on a postpartum unit observes a patient who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The patient states, "I think that my baby is deformed inside and we have to fix him." Which risk factor is most strongly related to possible postpartum psychosis (PPP)? 1. Personal history of bipolar disorder 2. Separation from the baby's father 3. Prolonged labor resulting in cesarean 4. Loss of first child from a heart defect

3

The nurse is assessing a newborn's reflexes. Which response will cause the nurse concern? 1. A positive tonic neck reflex 2. Absence of rooting or sucking reflexes 3. Asymmetrical Moro reflex 4. Strong Babinski reflex

3

The labor and delivery nurse is present for the delivery of a neonate born at 30 weeks' completed gestation. Which action by the nurse is most important? 1. Stabilize and transfer the neonate to the neonatal intensive care unit (NICU). 2. Review the pregnancy history for risk factors. 3. Provide a neutral thermal environment (NTE). 4. Maintain fluid and electrolyte balance

2

Which behavior does the nurse identify as a demonstration of unidirectional bonding between a parent and infant? 1. The parents respond to the baby's cry. 2. The parents call the baby by name. 3. The baby responds to comforting measures. 4. The parents stimulate and entertain the baby.

3

Which milk is released after initial let-down and has a higher fat concentration than the others? 1. Transitional milk 2. Foremilk 3. Hindmilk 4. Colostrum

1,3,4,5

A neonate is born after 37 weeks' gestation, and the nurse is concerned about avoiding cold stress after discharge. Which suggestions does the nurse give the mother to keep the baby safe? Select all that apply. 1. Keep the baby wrapped in a warm blanket. 2. Perform the daily bath in a warm location. 3. Change wet clothing immediately. 4. Place a stocking cap on the neonate's head. 5. Position the baby away from outside walls and windows.

2

A 55-year-old postmenopausal female patient presents to the family practice clinic for her annual examination. The nurse notes that the patient has lost one-half inch in height. Upon further investigation, the nurse discovers that the patient has a slow-healing fracture of the left radius. What screening will most likely be initiated at this time for the patient? 1. Assessment for domestic violence 2. Dual-energy x-ray absorptiometry scan 3. Follicle-stimulating hormone 4. Serum levels of calcium and vitamin D

3

A new mother expresses severe frustration with an infant that is exhibiting symptoms of colic. Which suggestions from the nurse are aimed at infant safety? Select all that apply . 1. Hold the infant and sway from side to side or walk around with the infant. 2. Place the infant in a car seat and take the child for a ride in the car. 3. Place the baby in a safe location and allow the baby to cry for 10 to 15 minutes. 4. Swaddle the infant snugly and provide a pacifier. 5. Place the infant (abdomen down) over the knees and gently rub or pat the back.

3,4

A new mother states, "I don't want anyone around my baby. I need to protect him from getting sick." Which statement by the nurse will help the mother to understand neonatal immunity? Select all that apply. 1. "I agree with you; the baby's sterile environment is gone." 2. "The baby will have acquired immunity soon from vaccinations." 3. "The baby has natural passive immunity from you for a few months." 4. "Babies start to establish gut flora after birth which helps to provide protection against gastrointestinal (GI) infections." 5. "Your baby was exposed to some pretty serious pathogens in your birth canal."

4

A nurse is caring for a client who is 2 days' postpartum, is breastfeeding, and reports cracked nipples and soreness. The nurse identifies the most common cause of the skin breakdown is related to which of the following? 1. Milk let-down caused by oxytocin production in the posterior pituitary gland 2. Nipple confusion due to the use of a pacifier 3. Placing the infant on the breast to feed every 1 to 2 hours 4. Improper latch by the newborn during feedings

1

A nurse is teaching her patient about formula feeding. All of the following statements are correct except which one? 1. Store unmixed powder in the refrigerator. 2. Freezing mixed formula is not recommended. 3. Once you prepare a bottle of formula it must be kept refrigerated and used within 24 hours. 4. Discard unused formula remaining in the bottle at the end of a feeding

postpartum depression

A patient who is 8 months' postpartum arrives for an obstetrics (OB) appointment. The nurse notices that both the patient and the infant appear unkempt. The nurse anticipates a diagnosis of ______________________.

4

Because of the previously mentioned research study, the nurses in a postpartum facility will implement which evidence-based change? 1. Continue to assess the level of fatigue for the mother during the postpartum period. 2. Assist the partner in recognizing and managing stress and depressive symptoms. 3. Encourage the partner to go home and rest while the mother is hospitalized. 4. Promote strategies to decrease fatigue for both parents during postnatal periods.

1

Before discharge from the birthing center, the nurse informs the patient that she will receive vaccines for rubella, hepatitis B, pertussis, and influenza. For which reason does the nurse explain the need for the vaccinations? 1. Vaccinating the mother will protect the neonate from serious illnesses. 2. Discharge with a neonate is discouraged if the mother is not vaccinated. 3. The mother's immune system has been suppressed during pregnancy. 4. Vaccination is more easily accomplished while the mother is under medical care

1,4,5

During the fourth stage of labor, which actions by the nurse will promote parent-newborn attachment? Select all that apply. 1. Delay administration of eye ointment until parents have held the newborn. 2. Stay close with the couple and the neonate in case of an emergency. 3. Space out necessary assessments to prevent prolonged interruptions. 4. Initiate skin-to-skin contact with a warm blanket over the neonate and parent. 5. Explain expected neonatal characteristics such as molding, milia, and lanugo.

3

During the nurse's assessment of a 44-year-old female patient in the family medicine clinic, the patient becomes tearful and states she may be pregnant, as she has some unintentional weight gain, mood swings, and irregular menstrual cycles. The urine human chorionic gonadotropin (hCG) reveals that the patient is not pregnant. What is the possible reason for her symptoms at this time? 1. The patient has a false pregnancy. 2. The patient is menopausal. 3. The patient is perimenopausal. 4. The patient may be pregnant.

1,2,4,5

Following a cesarean birth, intrathecal morphine is administered to the patient for postoperative pain management. Of which fact about intrathecal morphine therapy is the nurse aware? Select all that apply. 1. An anesthesiologist or certified registered nurse anesthetist (CRNA) administers it intrathecally. 2. The nurse needs to closely monitor for common side effects. 3. The recommended dose is 10 to 15 mg. 4. The drug produces generalized central nervous system (CNS) depression. 5. The drug alters perception of and response to painful stimuli.

2,3,4

The American Dental Association (ADA) recommends which of the following should be done to decrease the risk of baby bottle tooth decay? Select all that apply. 1. Begin regular dental appointments by second birthday. 2. Use only fluorinated water for preparing bottles. 3. Only give bottles of sugary fluid in the morning. 4. Clean the infant's gums with clean gauze after each feeding. 5. Begin brushing teeth with toothbrush once the first tooth erupts.

1,3

The nurse in labor and delivery notices an increase in the number of women requesting cesarean births. Which are the parameters and criteria used when making the decision to perform a cesarean delivery on maternal request (CDMR)? Select all that apply . 1. Procedure is performed after 39 weeks' gestation. 2. Patient is willing to defer from legal litigation. 3. Patient is aware of possible neonatal complications. 4. Mother is planning to only have one child. 5. Patient is able to self-pay for the procedure.

1

The nurse in the neonatal nursery notices a neonate, born 35 minutes ago, is unresponsive to external stimuli, and has a respiratory and heart rate slightly below normal range. Which action does the nurse take? 1. Allows the neonate to naturally continue deep sleep. 2. Picks up the neonate and tries to get a response. 3. Asks another nurse to assist with reassessment. 4. Notifies the caregiver of the neonate's condition.

1

The nurse is assessing a 72-year-old female patient in the women's health clinic. The mildly obese patient's history includes seven vaginal births, two of which necessitated forceps deliveries. The patient has type 2 diabetes and hypertension. The patient states that she has become incontinent of urine, has a history of frequent urinary tract infections (UTIs), and has a sense of fullness "down there." What would be an appropriate nursing intervention to help the patient with her symptoms? 1. Instruct the patient to stop urinating midstream at least twice a day. 2. Instruct the patient to eat a high-fiber diet and increase fluid intake. 3. Instruct the patient to add probiotics to their diet while taking antibiotics. 4. Instruct the patient to bear down effectively while having a bowel movement.

1,4,5

The nurse is collecting information during a follow-up obstetrics (OB) appointment with a patient who delivered 3 months ago. The patient reports her partner has become cynical, irritable, and verbally abusive. The nurse will screen for which risks related to paternal postnatal depression (PPND)? Select all that apply. 1. The father exhibited depression during the pregnancy. 2. The mother experienced a prolonged labor and a cesarean birth. 3. The father expresses feeling bored and underappreciated in his job. 4. The father is recently estranged from his parents and siblings. 5. The birth of this fourth child was unexpected and unplanned.

1,2,5

The nurse is preparing to teach the community about risk factors for the second most common cancer of the female reproductive system. Which of the following groups of women are at higher risk for this cancer? Select all that apply. 1. Menopausal women with an intact uterus who receive hormonal therapy 2. Women who have undergone treatment for breast cancer 3. Women who have many pregnancies and nursed their infants 4. Women who smoke and have many sexual partners 5. Women with a long-standing history of polycystic ovarian syndrome (PCOS)

1,2,3,4,5

The nurse is preparing to teach the postpartum mom about newborn feeding cues. Which of the following behaviors of the infant would be appropriate feeding cues to include? Select all that apply. 1. Smacking their lips 2. Extending their tongue 3. Putting their hand to their mouth 4. Entering a quiet alert stage 5. Turning their head to their mother's voice

2

The nurse is present in the delivery room when a mother is told her neonate was stillborn. The mother begins to shout obscenities. Which action does the nurse take? 1. Attempt to calm the mother and prevent self-harm. 2. Provide privacy and allow the mother to express grief in her own way. 3. Ask a family member to comfort the mother. 4. Ask for a sedative to calm the mother's reaction

previous

The nurse understands that logically_______________ cesarean births are an influential factor related to the overall incidence of cesarean births

4

The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room? 1. Ask the patient how many peripads she considered to be "soaked." 2. Rely on the primary health-care provider's (HCP's) estimate of blood loss. 3. Place a basin at the foot of the delivery table to catch any blood. 4. Collect blood in calibrated, under-buttocks drapes for vaginal birth.

1

The nurse works in a postnatal nursery and is required by hospital policy to perform a gestational age assessment on specified neonates. On which neonate is the nurse most likely to perform this assessment? 1. The neonate of a diabetic mother 2. The neonate born at 41 weeks' gestation 3. The neonate born after an 18-hour labor 4. The neonate exposed to oxytocin in utero

4

The priority nursing action when caring for lesbian couples in the postpartum unit is which of the following? 1. Assess the couple's knowledge of infant care. 2. Include both mothers in infant teaching sessions 3. Clarify if both mothers are planning to breastfeed their infants and provide teaching and support to both mothers. 4. Self-assessment of the nurse's attitudes, beliefs, and knowledge of lesbian couples.

2

The telephone triage nurse receives a call from a patient who is 5 days' postoperative total abdominal hysterectomy. The patient states that her pain is not relieved with the medications and that she has noticed blood in her urine. The nurse instructs the patient to report immediately to the emergency department (ED). What does the nurse suspect as the surgical complication? 1. Possible complication related to the anesthesia 2. Possible injury to the ureters or bladder 3. Possible hemorrhage from the internal incision 4. Possible peritoneal venous thromboembolism

1,2,3,4,5

Which actions by the neonatal intensive care unit (NICU) nurse best provide psychosocial support to the parents of a premature neonate? Select all that apply. 1. Assess the parents' readiness to care for their neonate. 2. Ask the parents how they are coping with the experience. 3. Encourage parents to take photos to share with family and friends. 4. Praise parents for their involvement in the care of their baby. 5. Inform parents that they should ask any questions they have.

4

Which information is important for the nurse to provide to mothers of infants of 3 months of age regardless of the method of infant feeding? 1. Why breastfeeding delays the need for solid foods 2. When and what order solid foods are introduced 3. Why the babies are most likely to prefer food over milk 4. When growth spurts and dietary increases are expected

1

Which nursing intervention would best correlate with the nursing diagnosis of At risk for disturbed sleep patterns related to night sweats? 1. Take a cool shower before bedtime. 2. Avoid medications such as fluoxetine. 3. Eat a consistent carbohydrate before bedtime. 4. Avoid liquid intake 2 hours before bedtime.

1

Which of the following is a false statement regarding the contraindications to breastfeeding? 1. Women who are HIV positive should never breastfeed. 2. Women with active herpes simplex lesions on the breast should not breastfeed. 3. Women using cannabis should refrain from breastfeeding. 4. Newborns diagnosed with galactosemia should not breastfeed.

3

. Following a vacuum-assisted delivery, the nurse must understand which of the following regarding subgaleal hemorrhage? 1. Blood is subperiosteal and confined by suture lines. 2. Soft-pitting edema is present, which crosses the suture lines. 3. A fluid wave is often seen due to collection of blood between the scalp and the skull. 4. Firm, fluctuant swelling is present which does not cross the suture lines

3,5

. In an attempt to improve the effectiveness of postpartum teaching, the nurse uses the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) acronym POST BIRTH. Which teaching points require the patient to call for 911 assistance? Select all that apply. 1. Bleeding that soaks a pad per hour 2. A bad headache with vision changes 3. Thoughts of hurting self or baby 4. Signs an incision is not healing 5. Pain in the chest

3

. The nurse is providing support to a mother whose newborn is diagnosed with a life-threatening defect. Which of the following statements by the mother does the nurse recognize to be emotional distancing as a coping mechanism? 1. A mother who has delivered a premature infant is discharged home after 3 days. She states, "I can't go home without my baby." 2. The mother of a 2-week-old infant hospitalized in the neonatal intensive care unit (NICU) states, "I can't visit today because I have to take care of my other three children." 3. A mother who has never visited during the first week of her critically ill infant's life states, "I don't even feel like his mother." 4. The mother of a premature infant states, "I can't get over the fact that I may have caused her to be born too early."

1

A 32-year-old female patient is evaluated for heavy uterine bleeding. The nurse recalls that the normal menstrual cycles occur when the hormone levels and feedback pathways of the hypothalamus-anterior pituitary-ovaries function appropriately. Which hormone is released by the hypothalamus? 1. Gonadotropin-releasing hormone (GnRH) 2. Follicle-stimulating hormone (FSH) 3. Luteinizing hormone (LH) 4. Progesterone

2

A mother of a premature infant in the neonatal intensive care unit (NICU) asks the nurse when her baby will begin oral feedings. The nurse is aware that multiple criteria must first be met. Which criterion is most essential? 1. The infant is able to demonstrate hunger cues. 2. The infant exhibits cardiorespiratory regulation. 3. The infant is able to maintain a quiet alert state. 4. The infant is able to demonstrate a stable suck, swallow, breathe pattern

1

A mother who is 2 weeks' postpartum asks the nurse lactation specialist how she knows if her baby is hungry. Which hunger indicator does the nurse discuss? 1. Opening the mouth in response to tactile stimulation 2. If 2 to 3 hours have passed since feeding 3. When the mother experiences a let-down sensation 4. Crying when all other physical needs are met

1

A mother who is breastfeeding expresses concern about whether her infant is getting enough milk. Which concrete indicator does the nurse provide to the mother? 1. There are at least eight wet diapers and several stools per day. 2. The mother is physically and emotionally comfortable during feedings. 3. The newborn suckles and the mother can hear or see swallowing. 4. The newborn spontaneously releases the grip on the breast when satiated

4

A multiparous patient reports severe uterine cramps the first day after a vaginal delivery. The nurse is aware the patient is breastfeeding and associates the patient's pain primarily with which occurrence? 1. The efforts of the uterus to return to a prepregnancy condition 2. The presence of intense afterbirth pains related to multiparity 3. An expected response to the daily administration of oxytocin 4. An increase in oxytocin release related to the newborn suckling

3

A neonatal intensive care unit (NICU) nurse is providing care for a premature neonate born at 27 weeks' completed gestation in the delivery room. Which intervention would the nurse prepare to do in the delivery room to maintain a neutral thermal environment (NTE) for the neonate? 1. Initiate skin-to-skin immediately after birth. 2. Dry the infant vigorously with prewarmed linen. 3. Place a polyurethane plastic wrap over the neonate's torso and extremities. 4. Place the neonate directly on a chemical warming mattress.

4

A new mother expresses frustration about how to know what her baby wants. The mother states, "I don't know what I expect, but then, the baby doesn't know either." Which situation does the nurse use as an example of neonate communication? 1. The baby is content to lie still on the mother's abdomen. 2. The baby is easily awakened if irritated by loud noises. 3. The baby resists eye contact if bored or disinterested. 4. The baby roots for the breast when the cheek is stroked.

4

A patient in the first stage of pregnancy is discussing the options for feeding her infant, and asks the nurse, "Which is the most important reason I should consider breastfeeding my baby?" Which is the most significant reason the nurse presents? 1. Human milk proteins are easier to digest than protein in prepared formula. 2. The amount of cholesterol in human milk is essential for the baby. 3. Vitamins and minerals are transferred to human milk from the mother. 4. Human milk contains multiple antibodies to protect the newborn from pathogens.

2

A patient who is at 42 weeks' gestation is concerned when the primary care provider (PCP) decides to induce labor. Which reason does the nurse explain as the most important need for this procedure? 1. Risk of hypoglycemia due to macrosomia 2. Fetal hypoxia due to placental insufficiency 3. Likelihood of meconium aspiration 4. Risk of hypothermia due to loss of fetal subcutaneous fat

3

A patient who is expecting her first baby tells the nurse, "I am afraid of the whole birth experience and plan to ask the doctor for a cesarean delivery." Which response by the nurse is most appropriate? 1. "Most women avoid cesarean births unless it is an emergency." 2. "I will get you some material about how labor pain is managed." 3. "Cesarean will cause you issues with additional pregnancies." 4. "I suggest you talk with the physician and get another opinion."

2

A postpartum patient calls the obstetric (OB) office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern? 1. Increased flow noticed with physical activity 2. A description of the lochia as being red in color 3. Discharge that is noted to have a fleshy odor 4. Bleeding that is described as brown in color

1,2,3,4,5

A postpartum patient states, "I am really in pain." For which sources of pain will the nurse specifically assess the patient? Select all that apply. 1. Uterine contractions 2. Perineal trauma 3. Breast engorgement 4. Hemorrhoids 5. General soreness

1,2,3

The aim of the qualitative research by Cox, Lashley, Hansen, and Hans was to describe the experiences of first-time African American teen mothers during their first 2 years of motherhood. Which of the following are positive changes experienced by the women? 1. Becoming more responsible 2. Becoming more mature 3. Being motivated to succeed 4. Being financially independent 5. Developing new friendships

1

The labor and delivery nurse understands that some neonates spontaneously take a breath once the head and chest are delivered. Which understanding does the nurse have for the neonate that requires chemical stimuli to breathe? 1. Mild hypoxia and decreased pH stimulate the brain. 2. Carbon dioxide is administered in small doses. 3. Oxygen is applied immediately to start respirations. 4. Suctioning is used to stimulate breathing efforts.

2

The lactation nurse takes a phone call from a mother who is breastfeeding her 2-month-old infant. The mother reports an area of redness and warmth on the breast and a painful burning sensation when breastfeeding. Which statement by the nurse is correct if mastitis is suspected? 1. "If your nipples are cracked, you will need to stop breastfeeding." 2. "Continuing to breastfeed will help clear up the condition." 3. "The baby gave you an infection and needs to be on antibiotics." 4. "Pump your milk and throw it away until the infection is gone."

3

The lactation nurse visits the room of a patient who is postpartum and being prepared for discharge. The nurse plans to provide breastfeeding information aimed at assisting the patient to continue breastfeeding her newborn. Which statement by the patient indicates a need for additional teaching? 1. "I am nursing about 20 minutes on each side." 2. "My partner will feed the baby my pumped milk once I go back to work in a month." 3. "I can hear my baby making clicking sounds when nursing." 4. "I will slide my finger in the corner of the baby's mouth to break the suction."

1

The mom in Room 8 delivered 2 hours ago. The newborn nursed for 20 minutes after delivery and is now sleeping quietly. She asks when she should feed the baby again. Your best response is: 1. Teach to observe for feeding cues and encourage her to offer her breast at least every 2 to 3 hours or on demand. 2. Teach to observe for feeding cues and encourage her to offer her breast only when the baby initiates a feeding. 3. Encourage her to offer the breast on demand and to supplement with formula if the baby shows feeding cues every hour. 4. Encourage her to offer her breast at least every 4 hours and gently awaken the infant as needed.

1

The nurse at a family practice clinic is providing care to a 47-year-old obese patient. The patient states that she realizes that she has put on extra weight but is reluctant to go to any exercise classes. She states that she often has to cross her legs when she sneezes and cannot do any exercises with her legs crossed. The health-care provider (HCP) has prescribed tolterodine (Detrol). What is the rationale for this medication? 1. Tolterodine is used to treat overactive bladders and to decrease urinary frequency, urgency, and urge incontinence. 2. Tolterodine is used to improve the tone and tissue in the urethral and vaginal areas. 3. Tolterodine is used to facilitate weight loss by acting as an appetite suppressant. 4. Tolterodine is used to improve blood flow to the pelvic muscles to decrease urinary tract infections (UTI).

1

The nurse in a labor and delivery department carefully assesses postpartum patients for signs of complications related to hemorrhage. Which factor makes it most difficult to identify the risk of hemorrhage through vital sign evaluation? 1. Changes in blood pressure may not be an immediate sign. 2. Respirations are increased due to activity of labor. 3. Blood pressure may be elevated from prenatal conditions. 4. Heart rate may increase with intensity of labor

1

The nurse in a postpartum unit frequently teaches patients regarding breast care. Which teaching is most helpful to the breastfeeding patient? 1. Express milk by a breast pump or manually if the infant is unable to nurse. 2. Wear a supportive bra for 24 hours a day. 3. Run warm water over breasts while in the shower. 4. Avoid taking analgesics unless absolutely necessary for comfort

3

The nurse in the post-delivery unit is encouraging skin-to-skin contact for a mother and neonate after cesarean delivery. Which action, if noticed by the nurse, requires immediate intervention by the nurse? 1. The mother is sitting up with the neonate prone on her chest. 2. The neonate is prone on the mother's chest and facing to the side. 3. The mother is supine with the neonate prone on her chest. 4. The neonate is prone with mother resting in semi-Fowler's position.

1,2,5

The nurse is arranging education for the menopausal support group regarding the approaches to treat the symptoms and discomforts. Which of the following would be components of current treatments? Select all that apply. 1. Moderately intense exercises 2. Balanced diet, rich in calcium 3. Use of oil-based lubricants during sexual intercourse 4. Over-the-counter sleep aid 5. Hormone therapy

2

The nurse is assembling data for an education session at the local women's shelter. The majority of the guests at the shelter are 25- to 35-year-old American Indian women with young children. What is the leading cause of death for this population? 1. Situational depression 2. Risk-taking behaviors 3. Poor prenatal care 4. Poor dietary choices

3

The nurse is assessing a 16-year-old sexually active patient in the family practice clinic. The patient's symptoms include breakthrough vaginal bleeding, abdominal pain, nausea, and fever. The health-care provider (HCP) obtains cultures of the cervical epithelial cells during a Papanicolaou (Pap) smear and orders doxycycline 100 mg orally twice a day for 7 days for her and her partner. The nurse understands that this prescription is consistent with the treatment of which medical diagnosis? 1. Herpes 2. Condylomas 3. Chlamydia 4. Gonorrhea

2

The nurse is assessing a 19-year-old female patient in the women's health clinic. She reports that for the past several months she has had lower abdominal pain, elimination issues, and mood swings, and her acne is worse the week before menstruation. The health-care provider (HCP) has prescribed oral contraceptives. The patient asks the nurse for the reason for the prescription. Which response by the nurse is appropriate? 1. "Pregnancy should be avoided because the hormonal shift would place the fetus at risk for birth defects." 2. "The hormones in the oral contraceptives can maintain estrogen-progesterone hormones to alleviate discomfort." 3. "Oral contraceptives may provide an increase in the hormones to help with your possible infertility issues." 4. "Oral contraceptives may balance the chemical changes in your brain to alleviate the depression symptoms."

2

The nurse is assessing a 22-year-old female patient who arrives at the family clinic. The patient has finished her prescription for a urinary tract infection (UTI) and now reports a milky discharge from her vagina, which has a fishy odor. After microscopic examination of the vaginal discharge, the health-care provider (HCP) prescribed metronidazole gel to be inserted vaginally. What is the suspected medical diagnosis for this patient? 1. The patient has gonorrhea due to lowered immunity after antibiotic therapy. 2. The patient has bacterial vaginosis due to recent disruption of normal vaginal flora. 3. The patient has genital condylomas due to the recent UTI treatment. 4. The patient has candida vaginitis due to recent disruption of normal vaginal flora.

1,3,4

The nurse is assessing a 42-year-old patient who presents to the gynecology office with complaints of pelvic pressure, backaches, menorrhagia, and urinary frequency. The health-care provider (HCP) has diagnosed the patient with leiomyoma of the uterus. What are the treatment options for this condition? Select all that apply. 1. Routine pelvic examinations to assess rate of disease process 2. Oral contraceptives to control the bleeding and pain 3. Myomectomy for women who desire pregnancy 4. Hysterectomy for women who do not desire pregnancy 5. Antibiotic therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) for symptom management

3

The nurse is assessing a 64-year-old female patient. The patient states that she is able to reduce the risk of urinary tract infections (UTIs) by drinking a quart of cranberry juice a day. Which health condition, if present in this patient, contraindicates the use of cranberry juice? 1. Hypertension, managed with lisinopril 2. Rheumatoid arthritis 3. Atrial fibrillation, managed with warfarin 4. Chronic obstructive pulmonary disease (COPD), managed with inhaled steroid

2

The nurse is assessing a 70-year-old menopausal female patient in the family practice clinic. The patient states that she has been experiencing intermittent heavy vaginal bleeding the past 3 months. What is the expected diagnosis for this patient? 1. Chronic nongestational abnormal uterine bleeding 2. Acute abnormal uterine bleeding (AUB) 3. Intermenstrual bleeding 4. Dysmenorrhea

1

The nurse is assessing a multiparous woman who is 8 hours' postpartum. Her fundus is located 2 cm above the umbilicus and shifted slightly to the right. What education would the nurse provide to the patient related to this assessment finding? 1. Emptying the bladder frequently will help to reduce displacement of the uterus. 2. The uterus is normally above the fundus on the first postpartum day and will significantly reduce in size within the next 24 hours. 3. Beginning an infusion of oxytocin will help to contract the uterus below the umbilicus. 4. Breastfeeding can cause the uterus to increase in size and shift it to the right.

2,5

The nurse is assessing a patient who is 36 hours' postpartum following a cesarean delivery. Which findings cause the nurse to conclude that a wound infection is developing? Select all that apply. 1. Temperature that increases from 99.8°F to 100.5°F 2. Increased margins of incisional redness 3. Incisional tenderness with palpation 4. Serosanguinous drainage from the suture line 5. Notably warm skin around the incision

2

The nurse is assessing a term neonate delivered to a mother with a history of drug and alcohol abuse. Which finding does the nurse relate to the mother's history? 1. Chest circumference is less than the head circumference. 2. Head circumference is below the 10th percentile of normal for gestational age. 3. When crying, the neonate exhibits an absence of tear production. 4. The neonate's pulse rate increases when the neonate cries

1,2,5

The nurse is assessing patients who are postpartum. Which patients does the nurse identify as being at increased risk for respiratory complications? Select all that apply. 1. The patient with leg pain and swelling 2. The patient who received large amounts of IV fluid due to blood loss 3. The patient with a preexisting diagnosis of diabetes mellitus 4. The patient who delivered a neonate after regional anesthesia 5. The patient with preeclampsia treated with magnesium sulfate

4

The nurse is assisting a newborn's primary care provider (PCP) with the performance of a circumcision. Which intervention is used to manage the neonate's pain? 1. A Velcro tourniquet is loosely wrapped around the penis. 2. The neonate is given acetaminophen 3 hours before the procedure. 3. The foreskin is numbed with ice before the nerve block. 4. A sucrose-dipped pacifier is offered during the nerve block.

2

The nurse is assisting with the preparation of a patient admitted for a planned cesarean birth. The patient has signed the consent form and discussed the elected regional anesthesia with the nurse anesthetist. Which is the most important action for the nurse related to anesthesia? 1. Verify the patient has been nothing by mouth (NPO) for 6 to 8 hours. 2. Obtain a baseline fetal heart rate (FHR) monitor strip. 3. Administer preoperative medications per orders. 4. Start an IV line and administer an IV fluid as ordered.

2

The nurse is aware that some parenting skills are acquired through the process of intentional learning. Which activity does the nurse associate with intentional learning? 1. The couple observes other individuals who are mothers and fathers. 2. The couple attends hospital classes addressing newborn and infant care. 3. The couple discusses with each other how they were parented. 4. The couple watches media containing parenting roles.

1,2,4,5

The nurse is aware that there are multiple classifications for cesarean deliveries. Which situations does the nurse classify as an unscheduled cesarean birth? Select all that apply. 1. The cervix fails to fully dilate after prolonged labor. 2. There is evidence of a prolapsed cord with membrane rupture. 3. Patient had a previous cesarean delivery. 4. Patient has a preexisting cardiac health condition. 5. There is recognition of placenta previa with mild bleeding.

1

The nurse is caring for a 33-year-old female patient who has just undergone laparoscopic removal of endometrial lesions. Which statement by the patient illustrates her understanding of the disease process and prognosis? 1. "I realize that this is not a cure for the issue, but I want to have more children within the next year." 2. "I'm happy to know that the surgeon has been able to cure me of this disease without a hysterectomy." 3. "I realize that my type 2 diabetes will be cured now that I have those lesions removed." 4. "I understand that I will not have to have a colostomy now that the growths were removed from my bowels."

2

The nurse is caring for a 70-year-old woman who has been newly diagnosed with first-degree uterine prolapse. She is 5 foot 5 inches and weighs 130 pounds. She walks 30 minutes a day. She states that she has problems with constipation, but denies experiencing stress incontinence. What is the priority teaching need of this patient? 1. Kegel exercises 2. Prevention of constipation 3. Avoiding heavy lifting 4. Weight-reduction strategies

3

The nurse is closely monitoring a patient who is postpartum and at risk for postpartum hemorrhage (PPH). Which assessment finding will cause the nurse to contact the primary care provider (PCP) immediately? 1. The uterus is displaced. 2. The uterine fundus is boggy. 3. Peripad weighs 100 g within 15 minutes. 4. Small clots are expressed with massage.

2

The nurse is collecting information from a new mother who is bottle-feeding her infant. Which comment, if made by the mother, requires the nurse to provide patient teaching? 1. "I wish that I had tried breastfeeding because formula is expensive." 2. "Sometimes I will add a little water to the formula if I am running low." 3. "At least I get a break every evening when my spouse feeds the baby." 4. "I get frustrated if the last bottle is fed to the baby late at night."

4,5

The nurse is collecting information from a parent whose infant has frequent diaper dermatitis. Which comment by the parent indicates a possible cause of the condition? Select all that apply. 1. "I use disposable wipes to clean the diaper area." 2. "I treat any sign of a rash immediately with zinc oxide." 3. "I leave the diaper off while the baby is sleeping." 4. "I buy an antibiotic ointment specified for skin rashes." 5. "I notice a skin rash whenever my baby is teething."

1

The nurse is collecting the urine of a postpartum patient who is passing large clots. For which reason does the nurse examine the large collected clots? 1. To determine the presence of tissue 2. To validate the presence of clotting 3. To obtain an accurate description 4. To document the number of clots

4

The nurse is completing postpartum discharge teaching to a client who had no immunity to rubella and was given the rubella immunization. Which of the following statements by the client indicates understanding of the teaching? 1. "I was given the vaccine because my newborn is Rh positive." 2. "The rubella immunization should be given with each pregnancy within 72 hours of delivery." 3. "If I do not develop immunity to rubella, I should be immunized during the first trimester of my next pregnancy." 4. "I should avoid pregnancy for 4 weeks after being immunized."

1,2,3,5

The nurse is counseling a lesbian couple who have decided to have a child. The couple is having difficulty in deciding who will become pregnant. Which considerations does the nurse present with regard to which partner will become pregnant? Select all that apply. 1. Consider the age and health of each partner. 2. Evaluate each partner's career goals. 3. Decide which partner has better insurance. 4. Determine who will be on the birth certificate. 5. Identify which woman desires to be pregnant.

4

The nurse is developing a plan of care for the 65-year-old obese female patient who states she wishes she could lose the weight but has no stamina for activity. Which nursing intervention would best correlate with the patient's statements? 1. Provide information on local gyms and exercise groups. 2. Provide information on choosemyplate.gov. 3. Provide information on the overall health risks of obesity. 4. Provide guidelines on how to increase daily activity as tolerated.

2

The nurse is observing a new mother interact with her baby and notices the mother holding the baby close to her body. However, the nurse also notices that the mother does not hold the baby in an enface position. Which question is most appropriate for the nurse to ask? 1. "Can I help you with a nice position in which to hold your baby?" 2. "What can you tell me about your family's beliefs and practices with new babies?" 3. "Is there some reason that I have not seen you look into your baby's eyes?" 4. "Your baby is so expressive, have you looked into his eyes yet?"

1,3,5

The nurse is performing a uterus assessment on a patient who is 20 hours' postpartum. The nurse finds the fundus of the uterus to be soft and boggy. In addition, the uterus is displaced to the left and moderate bleeding is noted. If the uterus does not respond to uterine massage, which actions does the nurse implement? Select all that apply. 1. Assist the patient to the bathroom to void. 2. Assist the patient to lay in the left lateral position while assessing vital signs. 3. Administer oxytocin as prescribed. 4. Place an emergency call to the health-care provider (HCP). 5. Make the patient nothing by mouth (NPO) for surgery.

2,3,5

The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider (PCP)? Select all that apply. 1. Mild headache 2. Hot, red, painful breasts 3. Foul-smelling lochia 4. Not sleeping well 5. Frequent, painful urination

3

The nurse is preparing a postpartum patient for discharge. Which patient teaching is most important for the nurse to provide? 1. The signs and symptoms of uterine infection 2. The signs and symptoms of a boggy uterus 3. The signs and symptoms of secondary hemorrhage 4. The signs and symptoms of postpartum depression

1,2,4,5

The nurse is preparing for the discharge of a neonate who was born prematurely. Which examinations or screenings must be done before discharge? Select all that apply. 1. Eye examination 2. Hearing screen 3. Swallow study 4. Congenital heart disease screening 5. Car seat challenge

1,2,3,5

The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments are covered by REEDA? Select all that apply. 1. Perineal coloration 2. Suture line appearance 3. Amount of swelling 4. Description of discomfort 5. Soft-tissue trauma

3

The nurse is presenting information to new parents regarding screening of their newborn. Which information does the nurse identify as being most important to the parents? 1. All babies born in the United States are screened for specific conditions. 2. Newborn screenings consist of a blood test and a hearing test. 3. Screenings are done to identify genetic diseases and inherited disorders. 4. Each state has statutes or regulations on newborn screening

1,2,3,4

The nurse is providing care for a neonate born to a mother with preexisting diabetes mellitus. Which neonatal assessment findings can the nurse expect? Select all that apply. 1. Heart murmur 2. Hypoglycemia 3. Respiratory distress 4. Birth weight over 4,000 gm 5. Hyperglycemia

2

The nurse is providing care for a neonate during the fourth stage of labor. Which action does the nurse take during this stage? 1. Complete the neonate assessment within the first hour. 2. Dry the neonate immediately after birth. 3. Obtain neonate blood glucose levels as soon as possible. 4. Perform Apgar screening until scores are 7

3

The nurse is providing care for a new mother during a follow-up visit 6 weeks after a vaginal delivery. The mother begins to cry and reports difficulty with eating and sleeping. The nurse identifies postpartum blues and cites which reason as the most likely cause? 1. Fatigue related to a "fussy" baby 2. Frustration over physical appearance 3. Changes in hormonal levels 4. Stress related to new mother role

4

The nurse is providing care for a patient who is 1 day postpartum and exhibiting symptoms of postpartum psychosis. Which medical management does the nurse expect for this patient? 1. Prescriptions for antidepressant/antipsychotic drugs 2. Discharge to home with 24-hour observation in place 3. Prescribed neonate visits during inpatient treatment 4. Immediate hospitalization in a psychiatric unit

2

The nurse is providing care for a patient who is 8 hours' postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4-cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take? 1. Continue to apply ice to the area for 24 hours. 2. Contact the primary care provider (PCP) for further evaluation. 3. Monitor vital signs and report any abnormal readings. 4. Relieve pressure by placing the patient in a side-lying position

4

The nurse is providing care for a prenatal patient who is told she will require a cesarean delivery because of cephalopelvic disproportion. Which explanation of the condition will the nurse provide to the patient? 1. The patient has a preexisting medical condition that supports cesarean birth. 2. The patient had a surgery with an incision through the myometrium of the uterus. 3. The placenta is implanted in an unfavorable position in the uterus. 4. The size and/or shape of either the fetal head or patient pelvis is an issue.

1

The nurse is providing care for an infant in the neonatal intensive care unit (NICU) diagnosed with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA). Which specific intervention does the nurse expect for this neonate? 1. Maintain fluid restrictions. 2. Obtain blood glucose levels. 3. Monitor hemoglobin and hematocrit levels. 4. Administer enteral feedings.

2

The nurse is providing care in a post-anesthesia care unit (PACU) for a patient who just delivered a neonate via cesarean section. The patient reports tightness in her chest. Assessment findings include tachypnea, hypotension, and decreasing oxygen saturation levels. Which complication does the nurse report to the health-care provider (HCP)? 1. Postpartum hemorrhage 2. Pulmonary embolism 3. Surgical-site infection 4. Developing endometritis

2

The nurse is providing care to a 25-year-old female patient. The patient informs the nurse that she is a lesbian and lives with her lesbian partner. Lesbian, gay, bisexual, transsexual, and questioning (LGBTQ) patients need a health-care environment that is welcoming and provides a sense of safety and comfort. Primary nursing action for providing such an environment is: 1. Use of gender-neutral terms 2. Self-reflection of one's beliefs and assumptions regarding LGBTQ culture 3. Knowledge of lesbian health-care needs 4. Knowledge of psychological determinants of healt

2

The nurse is providing care to a 35-year-old female patient who complains of low back pain, pain with defecation, pelvic pressure, and premenstrual spotting. The health-care provider (HCP) has prescribed the hormonal therapy Nafarelin for this condition. What is the goal of this prescription? 1. To prevent pregnancy at this time to promote healing 2. To suppress menstruation and further growth of the tissue 3. To prevent retrograde menstruation outside the uterine cavity 4. To increase blood flow to decrease the endometrial lining

2

The nurse is providing care to a 72-year-old female patient. While providing care, the nurse instructs the patient to slowly rise from a sitting or prone position. What is the pathophysiological reason for this instruction? 1. The patient is at higher risk for fractures due to postmenopausal osteoporosis. 2. The patient is at higher risk for hypotension due to decreased baroreceptor sensitivity. 3. The patient is at higher risk for falls due to decreased muscle strength and balance. 4. The patient is at higher risk for adverse drug reactions due to decreased hepatic function.

3

The nurse is providing care to a 75-year-old female patient diagnosed with osteoporosis. Which of the following would be the priority nursing diagnosis? 1. At risk for falls related to impaired balance 2. Knowledge deficit related to new medication regimen 3. Impaired physical mobility related to pain and skeletal changes 4. Ineffective health maintenance related to continued immobility

2,3,4,5

The nurse is providing care to a 75-year-old woman. She asked the nurse when she should stop driving. Which of the following nursing actions should the nurse complete before responding to the patient's question? Select all that apply. 1. Ask the patient about the type of car she drives. 2. Ask when she had her last eye exam. 3. Assess her ability to move her foot up and down and left and right. 4. Ask if she has noted any unexplained dents or scrapes on her car or garage door. 5. Ask her if she has gotten lost in familiar places.

2

The nurse is providing care to a patient who is postpartum. Using anatomy and physiology knowledge, which expectation does the nurse relate to the cardiovascular system? 1. Patient reports being cold related to a 400 mL blood loss during a vaginal birth 2. White blood cell (WBC) laboratory level of 30,000/mm a few hours after delivery 3. A normal postpartum hemoglobin laboratory value of less than 11 g/dL 4. Risk for hemorrhage due to decrease in circulating clotting factors

1

The nurse is providing care to the 24-year-old patient in the OB/GYN clinic. The patient states that she thinks she may be pregnant because she has missed three menstrual cycles. The patient says, "This couldn't be happening at a worse time. I have been training heavily for a triathlon in 4 months." Which response by the nurse is most appropriate? 1. "Secondary amenorrhea, or no menses for 3 months, is not always a sign of pregnancy; it may be due to your heavy athletic activity." 2. "Pregnancy during times of stress such as heavy athletic activity can occur when precautions are not followed." 3. "If the pregnancy test is negative, the physician will need to perform a diagnostic laparoscopy to rule out a neoplasm." 4. "Amenorrhea may occur at times of nutritional disturbances. Are you eating a well-balanced diet?"

2

The nurse is providing care to the adult female patient who presents to the emergency department (ED) with a suspected myocardial infarction (MI). Which symptom indicates a possible MI for the female patient? 1. Chest pain that radiates to the right arm and jaw 2. Episodic nausea or indigestion and palpitations 3. Sudden onset of trouble walking, and loss of balance 4. Swelling of the feet and shortness of breath

1

The nurse is providing discharge teaching for the patient related to prevention of future pregnancy. The following statement by the patient indicates additional education is required. 1. "I will start using a barrier method once my menstrual cycle begins." 2. "Breastfeeding is not an effective form of birth control and I should use another method when I resume sexual activity." 3. "Long-acting reversible contraception (ACR) such as an intrauterine device (IUD) is highly effective in preventing unwanted pregnancy." 4. "Withdrawal has a high failure rate and does not protect against sexually transmitted infections (STIs)."

3

The nurse is providing education for disease prevention to the adult female patient. Which factor puts the patient at a higher risk for multisystem disease processes such as cardiac issues, gynecological issues, and cancers? 1. Consuming two glasses of wine a week 2. Smoking two packs of cigarettes a day 3. Having a body mass index (BMI) of over 32 4. Having poor intake of calcium and vegetables

1,2,4

The nurse is providing education on the prevention of heart disease for adult females ages 35 to 44 years old. Which of the following would be most appropriate for this disease process? Select all that apply. 1. Taking a brisk walk for 50 minutes three times a week 2. Consuming a diet rich in vegetables, fruits, and whole grains 3. Obtaining a varicella vaccine, if no evidence of immunity 4. Recognizing the importance of smoking cessation 5. Taking calcium supplements, if lactose intolerant

2,3,4

The nurse is providing education to the patient who is receiving a bisphosphate medication for osteoporosis. Which instructions should the nurse include in the teaching plan to reduce side effects and enhance absorption while taking bisphosphates? Select all that apply. 1. Take the medication with a small meal at the same time. 2. Take the medication with at least 8 oz. of water. 3. Remain upright for at least 30 minutes after taking a dose. 4. Take the medication on an empty stomach. 5. Take the medication with a calcium supplement.

1

The nurse is providing information to a postpartum mother about circumcision of her neonate. The neonate's father states, "We have never done that to any baby boy in my family." Which statement is best for the nurse to make? 1. "I understand that family culture and beliefs form our way of life." 2. "I can leave information for you to read over and then decide." 3. "I personally think that boys are cleaner and healthier if circumcised." 4. "Most families opt for the procedure for a variety of reasons."

1,3,5

The nurse is providing postoperative care to a patient who underwent a total abdominal hysterectomy 12 hours ago. Which of the following are appropriate nursing interventions? Select all that apply. 1. Assist the patient with ambulation. 2. Maintain the Foley catheter for 48 to 72 hours postoperatively. 3. Monitor intake and output and characteristics of urine. 4. Maintain bedrest while taking narcotic pain medications. 5. Initiate antiembolism therapy as ordered.

2

The nurse is providing postpartum care for a patient after a vaginal delivery. Which assessment finding causes the nurse to suspect endometritis from beta-hemolytic streptococcus? 1. Presence of headache, malaise, and chills 2. Scant amount of odorless lochia 3. Pain or discomfort in the midline lower abdomen 4. Elevated temperature greater than 100.4°F (38°C)

4

The nurse is providing postpartum care for an adolescent mother and her family. Which factor is most important for the nurse to consider when planning teaching about neonatal care? 1. The grandparents decided they want to be involved. 2. The parents need to discuss their expectations of each other. 3. The mother is determined the father should be involved. 4. Information must be presented on an age-appropriate level.

3

The nurse is providing postpartum care to a patient 24 hours after a vaginal delivery. Which action does the nurse perform before assessing the patient's uterus? 1. Place the patient on the left side. 2. Administer a dose of oxytocin. 3. Ask the patient to void. 4. Assess the passage of lochia.

3

The nurse is providing preoperative education on the abdominal hysterectomy. Which statement by the patient verifies understanding of the procedure? 1. "I will use a mild douche solution to keep the surgical area clean." 2. "I'm relieved that I won't have any visible scars on my abdomen." 3. "I understand that there will be some light vaginal bleeding for several days." 4. "I understand that I must remain on bedrest for the first 48 hours post-surgery."

4

The nurse is providing support for the parents of a neonate born with anencephaly. Which response by the nurse would best help the parents process their grief? 1. Tell the parents, "You can always have another baby." 2. Avoid using the baby's name because it would make the parents feel worse. 3. Encourage the parents to leave the hospital. 4. Collect objects to remind parents of the baby, such as pictures and ID bracelets.

2,4,5

The nurse is reviewing the medical record for a patient who is postpartum. The nurse notices the patient is rubella-nonimmune. Which information does the nurse present to the patient? Select all that apply. 1. Maternal immunization carries over to the neonate. 2. The patient should be immunized before discharge. 3. If given rubella vaccination, breastfeeding should be avoided for 24 hours after immunization. 4. There are risks to the fetuses of any future pregnancies. 5. If given rubella vaccination, pregnancy should be avoided for 4 weeks.

4

The nurse is teaching newborn care to an adolescent mother. When the nurse attempts to teach how to swaddle the newborn, the mother states, "What's the big deal about how to wrap up a baby?" The nurse needs to convey which reason as being most important for proper swaddling? 1. Correct swaddling will increase the neonate's comfort. 2. Neonates are swaddled only until they can turn from front to back. 3. Two to three fingers need to fit between the infant's chest and the swaddle. 4. Improper swaddling can cause hip dysplasia.

3

The nurse is teaching the mother of a neonate the benefits of kangaroo care. Which action is explained to the mother regarding the procedure? 1. The neonate is tucked into the front of a parent's shirt. 2. A pouch is formed from a blanket for carrying the neonate. 3. A bare-chested neonate is held against a bare-chested parent. 4. The neonate is placed in a sling and placed on a parent's side.

1

The nurse notices that a neonate being treated for hyperbilirubinemia with phototherapy has had a daily increase of total bilirubin serum levels greater than 5 mg/dL for the past 2 days. The neonatal care provider prescribes an exchange transfusion. Which knowledge does the nurse apply to the procedure? 1. There is a risk of encephalopathy which can cause neurological deficits. 2. Approximately 50% of the neonate's red blood cells (RBCs) are replaced. 3. Donor RBCs are obtained from the neonate's mother. 4. The procedure is exclusive to pathological jaundice.

1

The nurse on a postpartum unit focuses on how to assist the father in identifying his role with the neonate. Which intervention by the nurse is most helpful? 1. Encourage the couple to identify mutual expectations of the fathering role. 2. Critique the father's methods of providing physical care for the neonate. 3. Provide written materials about the physical and emotional role of a father. 4. Observe for a competitive attitude between the parents about providing baby care.

1,2,4,5

The nurse on a postpartum unit is acutely aware that cultural influences impact the patient's process of "becoming a mother." For which cultural influences does the nurse assess? Select all that apply. 1. What amount of time the mother spends in each phase 2. Differences in the mother's expectation related to ability to rest 3. How the mother physically recovers from labor and delivery 4. Mother's involvement in decision-making for the first few months 5. Whether the mother seems interested in how to care for her baby

1

The nurse on a postpartum unit is focused on providing care that will assist the mother and father in making the transition to parenthood. For which reason does the nurse review the prenatal and labor records? 1. Pregnancy and birth experiences, which can either enhance or impede the process of becoming a mother 2. Awareness of prenatal classes that will help identify and focus on learning needs of both parents 3. Identification of preexisting maternal conditions that may interfere with parenting transitions 4. Knowledge regarding questions and concerns the mother and father may have about neonate issues

3

The nurse preparing for the discharge of a premature neonate explains to the parents that the neonate must be able to pass the infant car seat challenge before discharge home. For which reason would the neonate be considered unsafe in a car seat? 1. The neonate requires prescribed oxygen therapy at all times. 2. The parents are reluctant to use the car seat because of the small size of the baby. 3. The infant is unable to maintain adequate oxygenation, heart rate, and respiratory rate during the trial. 4. The neonate appears uncomfortable and is fussy for the entire duration of the trial.

1,3,4,5

The nurse-manager on a labor and delivery unit is monitoring the reasons for cesarean births at the facility. Which reasons contribute to the high rates of cesarean births? Select all that apply. 1. Fetuses in breech position unable to deliver vaginally 2. Decreasing rate of malpractice litigation with cesarean birth 3.Incidences of women of older maternal age getting pregnant 4. Increased number of elective or maternal request cesareans 5. Presence of nonreassuring fetal tracings during labor

1

The nurses in a labor and delivery unit are concerned about the high incidence of cesarean deliveries at their facility and initiate an internal study. Which is the most likely condition the nurses will recognize as a contributor to the rate of cesarean births? 1. Policies and parameters for cesarean need to be reviewed and refined. 2. The facility has a high rating for managing high-risk pregnancies. 3. Community education about the advantages of vaginal birth is deficient. 4. The incidence of maternal requests for cesarean delivery is increasing.

1,2,4,5

The nurses in a postnatal unit are aware of the fears of new parents with regard to infant abduction. Which interventions by the nurse will alleviate the concerns of the parents? Select all that apply. 1. Allow only visitors with identification to enter the unit. 2. Use the hospital abduction alarm systems. 3. Require all hospital personnel to wear name tags. 4. Footprints and a photo of the neonate are taken for identification purposes. 5. Encourage parents to accompany persons transporting the newborn

1

The parents of a newborn male are concerned about providing care for the baby's new circumcision performed with a Plastibell. Which information will the nurse include in the teaching plan for the parents? 1. Report if penis is red, warm, and swollen, or if there is surgical site drainage. 2. Remove the plastic ring gently on the fifth day after surgery. 3 Apply lubricants to the penis to keep the diaper from sticking 4. Contact the health-care provider (HCP) if the newborn does not void for 36 hours

3

The postnatal nurse is making a newborn visit to the parents who are from a different country. The nurse finds the newborn swaddled in a heavy blanket and wearing a knitted cap. The newborn has wet hair and is restless with rapid breathing. Which initial comment from the nurse is appropriate? 1. "Your baby is exhibiting some concerning symptoms." 2. "I want to explain how to dress your baby correctly." 3. "Share with me how babies are cared for in your country." 4. "Let me explain the baby's symptoms of being overheated."

1,3,4

The postpartum nurse is admitting a 3-day-old infant from home for hyperbilirubinemia. Which of the following does the nurse know to be true? Select all that apply. 1. Jaundice affects approximately two-thirds of term infants during the first week of life. 2. Jaundice reliably indicates a clinically significant bilirubin level. 3. Jaundice progresses in a direction from head to lower extremities. 4. Infection can be a cause of hyperbilirubinemia. 5. Jaundice that occurs at 20 hours of age is considered physiological.

3

The postpartum nurse is planning a home visit to a mother who delivered her baby 1 week ago. Which finding indicates to the nurse a possible problem with mother-infant bonding? 1. The mother is pleased to have the nurse visit her home and baby. 2. The baby's grandmother is present and involved with mother/baby care. 3. The mother focuses the visit on her physical recovery and concerns. 4. The baby's father is on "paternity leave" and involved with the baby

1,3,4,5

The postpartum nurse is preparing to present infant care information to a couple who expresses concern about when to bathe their newborn. Which behaviors will the nurse present as general guidelines? Select all that apply. 1. Daily bathing with soap is not necessary for the newborn. 2. Bathing is best after a feeding when the newborn is relaxed. 3. Use a mild preservative-free soap with a neutral pH. 4. Avoid the use of soap on the face of the newborn. 5. Genital and rectal areas should be cleaned at each diaper change.

4

The postpartum nurse notices that a new mother has her neonate unwrapped and undressed "to check out the baby." For which reason does the nurse conclude the neonate is at risk for cold stress? 1. The neonate has an increased metabolic rate. 2. The neonate's respiratory rate has dropped. 3. The neonate's skin is cool and clammy 4. The neonate is moving extremities about.

2,3,5

The postpartum nurse-manager wants the unit to become active as a supporter of the Baby-Friendly Hospital Initiative (BFHI). Which nursing actions will be initiated? Select all that apply. 1. Give pacifiers to infants on demand. 2. Help mothers initiate breastfeeding within 1 hour of birth. 3. Teach breastfeeding and promote lactation to mothers separated from infants. 4. Provide infants with water until a milk supply is established. 5. Refer mothers to support group resources on discharge