Maternal Neonate Final

A woman with a long history of controlled asthma has just had her first antenatal visit for her fourth child. She is late for a meeting and says she knows what to do. What is the best action the nurse can take?

- Acknowledge her need to leave but ask her to demonstrate the use of her inhaler and her peak flow meter before she goes; make any necessary corrections to her technique. Remind her to take her regular medications

The nurse is reviewing the different pelvis shapes to determine if a pregnant patient might need to deliver through a cesarean section. For which type of pelvis might a cesarean section be required or indicated?

- Android

The nurse is assessing a postpartum patient who had a cesarean section. Which assessments are important for the nurse to perform with this patient? (SATA)

- Bleeding -Urine output -Lung sounds -Bowel sounds

Which mechanical method is used the most often for cervical ripening?

- Membrane stripping

Which maternal reaction is cause for concern and should prompt a consultation with the RN?

- Neglects to engage with or provide care for the baby and shows little interest in it

During a physical examination an infant's shrill cry. What does this indicate to the nurse

- Neurological dysfunction

In evaluating if breastfeeding is going well, what is one positive indication a nurse should look for?

- The mother is experiencing uterine contractions

The nurse is discharging a new mother and notes she is not rubella-immune and administers the rubella vaccine. The patient will breast-feed her infant and plans to get pregnant again as soon as possible. What is the most important information the nurse should give her about this immunization?

- Warn her not to attempt pregnancy for at least three months

A patient in labor with limited prenatal care has an obstetrical history of a prior cesarean birth with a traditional/classical incision. The patient is requesting to attempt to deliver the baby vaginally. How should the nurse respond?

-"Based on your history, a vaginal delivery is not recommended, it might cause your uterus to rupture."

The nurse is caring for a patient on postpartum day 1. Before assessing her uterus, where should the nurse anticipate she will locate the fundus?

-1 cm below the umbilicus

What is the normally accepted fetal heart rate range?

-110-160

The nurse is helping to weigh and measure a term baby. Which of the following weights would the nurse classify as low birth weight?

-2,000 g

A woman in her 1st trimester of pregnancy is worried about the effect her pregnancy will have on her appearance. She is fit, but underweight. She plans to restrict her weight gain as much as possible. How much weight should the nurse advise her to gain?

-28-40 pounds

By what percent does the blood volume in pregnant women increase?

-40-45%

A pregnant woman has been in labor for several hours. She cries out that her contractions are getting harder and that she can't do this. The patient is really irritable, nauseated, annoyed and fearful of being left alone. Considering the patient's behavior, the nurse would expect the cervix to be dilated how many centimeters?

-8 to 10

If a woman is 3 months pregnant, which breast changes should the nurse expect to assess?

-A darkened breast areola

A patient at 36 week's gestation is being monitored for risk of preeclampsia. Which assessment finding is the priority concern for the nurse?

-A dipstick value of 2+ protein

A young woman comes in for an examination, she reports missing her last menstrual period but she is confident that she cannot be pregnant because she took a home pregnancy test and it was negative. If all of the following were present, which one would positively confirm a pregnancy?

-A fetal heartbeat

The nurse is teaching a peer group on the risks associated with infants who die of SIDS. Which infant should the nurse teach as being the most likely at risk for SIDS?

-A low-birth-weight baby boy, born in November to a wealthy, educated, 19-year-old smoker who has no other children

Which pregnant patient in labor should the nurse most likely prepare for an episiotomy?

-A multigravida with a history of heart problems; fetus is in occiput posterior position

A woman in a prenatal clinic thinks she might be pregnant. Which assessment is a probable sign of pregnancy?

-A positive pregnancy test

A patient who is 31 weeks' gestation is experiencing painless, bright red vaginal bleeding. For which diagnostic test should the nurse prepare for the patient?

-A transvaginal ultrasound

A patient is taking oral contraceptives and is experiencing manifestations. Which manifestations should the nurse report to the primary care provider?

-Abdominal pain

Which should the nurse teach a pregnant patient to report to the health care provider as soon as possible?

-Abdominal pain coming and going during the 3rd trimester

What should be the expected fetal heart rate response in an active fetus?

-Acceleration of at least 15 bpm for 15 seconds

A 21-year-old mother who has decided not to breastfeed is seeking advice about formula feeding for her newborn son before leaving the hospital. At which time should the nurse teach the new mother to burp the baby?

-After every 0.5 oz

The nurse should administer RhoGAM to the pregnant woman who is Rho(D) negative after which test?

-Amniocentesis

Why does amniotic fluid not grow stagnant?

-Amniotic fluid is constantly formed/replenished by the amnion.

A woman in her 2nd trimester of pregnancy reports that she is tired all of the time. She appears pale. Her hematocrit is within the normal range but is low. Which recommendation would be most helpful for this woman?

-An iron supplement

A pregnant patient in early labor is showing signs of extreme anxiety over the birth to come. Why should the nurse help this patient relax?

-Anxiety can slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus

A patient has just delivered her second child and will breast-feed. The patient does not want to become pregnant again until her second child is at least 2 years old. When should the nurse counsel the patient to begin birth control?

-As soon as she resumes sexual activity

A patient is recovering from a standard delivery. The nurse has just removed the epidural catheter and applied a sterile pressure dressing. What is it important for the nurse to do now?

-Assess return of the sensory and motor functions to the lower extremities

Weighing a newborn infant is an example of which of a nurse's roles in caring for a new mother start to breastfeed?

-Assessing newborn fluid intake

The pregnant patient is prepared for natural childbirth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacologic pain management is this considered?

-Attention focusing

A patient has just delivered a baby. Her prelabor vital signs were Temp 98.8, B/P 120/70, HR 80, RR 20. Which combination of findings during the early postpartum period should be reported immediately?

-BP 90/50, HR 120, RR 24 (patient may be hemorrhaging)

The patient travels internationally for work and has a lot of job anxiety. She also uses an electric heating blanket every night at home. Which birth control method should the nurse discourage her from using?

-Basal body temperature method

Which nursing intervention is appropriate for preparing a woman for an amniocentesis?

-Be certain that she knows the risk of complications, such as premature labor

A new mother adapts to her role as a mother through four developmental stages. Which stage is the first stage of adaptation?

-Beginning attachment and preparation for family

When assessing a two-day postpartum patient the nurse finds the fundus is boggy, at the level of the umbilicus, and slightly to the right. What is the most likely cause of this assessment finding?

-Bladder distention

Which assessment findings for a one-hour-old infant should the nurse report?

-Blood sugar 42 mg/dL

A pregnant patient at 37 weeks' gestation is leaking clear vaginal fluid. The nitrazine paper test is used on the fluid. If the test is positive, what color will the nitrazine turn?

-Blue

A 52-year-old patient is premenopausal and asks about the severity of her symptoms. What can you accurately tell her about the life-threatening effects of menopause?

-Bone mineral density decreases

A patient who received an epidural is currently in the second stage of labor and is reporting severe, unrelenting abdominal pain that is rated as being 10 on a scale of 0 to 10. What should the nurse do?

-Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication

The nurse is completing the Bishop score for a patient in labor. Which criteria will the nurse use for this score? (SATA)

-Cervical consistency -Fetal station -Dilation -Position

A patient in labor is on continuous fetal monitoring when the nurse notes a decrease in the fetal heart rate with variable deceleration to 75 bpm. What is the initial nursing intervention?

-Change the position of the patient

A patient is three hours post cesarean delivery. The nurse notes the indwelling urinary catheter bag has 30 cc of urine and it has been two hours since it was last checked. What is the appropriate nursing intervention?

-Check indwelling catheter tubing to ensure its patent

A patient is having labor induced because of an infection of the fetal membranes. What is the appropriate term for the infection of the fetal membranes?

-Chorioamnionitis

A patient comes to the hospital in active labor at 0530. She has not eaten since dinner the night before, which was at 1700. She has a gynecoid pelvis, and this will be her fourth child; the first three were delivered vaginally. It is now 0900 and she is 80% effaced and dilated 3 cm. What nourishment should the nurse allow her upon request?

-Clear liquids but no solid foods

A patient wants to discuss birth control options. She is a 36-year-old woman in a long term monogamous relationship. She runs 2 miles a day but also smokes a pack of cigarettes a day. Which birth control method should the nurse discourage her from using?

-Combination oral contraceptives

A 26-year-old, first-time mother who would like to have more children inquires about birth control methods to use while breastfeeding. What should you advise her about the best birth control method?

-Condoms

A pregnant patient is experiencing back labor and complains of intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain?

-Counter pressure against the sacrum

A newborn male is circumcised. What instructions should the nurse include in the discharge teaching plan for his parents?

-Cover the glans generously with vaseline

A nurse making a general assessment notices that the newborn's skin is dark red on one side of the body while the other side of the body is pale. At 10 minutes prior to the assessment, what was the baby most likely doing?

-Crying vigorously (harlequin sign is when nerve bundles are injured and unable to communicate with half of the body)

A pregnant patient receives general anesthesia for a cesarean birth. The nurse is concerned that the patient is developing malignant hyperthermia. What did the nurse assess in this patient? (SATA)

-Cyanosis -Tachycardia -irregular heart rhythm

At what day after fertilization is the embryo fully implanted into the uterine wall?

-Day 10

A patient with cardiac disease is at 32 weeks' gestation and tells the nurse about spells of light-headedness and dizziness every few days. Which interventions should the nurse recommend to the patient?

-Decrease activity and rest more often

A patient's nurse-midwife tells the woman that she has developed dystocia. What should the nurse explain to the patient about the meaning of this term?

-Difficult or aelp abnormal labor

In response to inquiries about producing enough milk for her infant, what is the correct advice a nurse can give a new mother regarding her own nutritional needs while breastfeeding?

-Drink a lot of fluids

A patient with a previous tubal ligation had the procedure reversed in hopes of becoming pregnant. What is the most important risk the nurse should warn the patient about?

-Ectopic pregnancy

A young female adult with abdominal pain reports not having a normal period for two months. The patient explains that irregular periods are common for her and that she has a history of endometriosis. What should the nurse suspect as a possible cause of the patient's abdominal pain?

-Ectopic pregnancy

The number of inductions of labor has increased over the past few years. What is the contributing factor to the increase in induction rates?

-Elective inductions by choice of both the physician and patient

Why are newborns who are born to mothers with diabetes prone to hypoglycemia?

-Elevated insulin production metabolizes glucose faster

What should nursing care for women diagnosed with gestational diabetes include?

-Encourage blood glucose control

A patient is the second stage of labor is expected to deliver within the hour. The epidural is not working and the patient is asking for pain medication. Which is the most appropriate action by the nurse?

-Encourage the patient through her contractions and explain not giving the pain medication

Which patient should the nurse instruct to have monthly follow-up health appointments after being discharged from the hospital?

-Experienced a molar pregnancy

A patient is 20 weeks pregnant. Which new development can the nurse accurately tell the patient that normally occurs in the fetus at 20 weeks?

-Eyebrows and scalp hair are present. Heart sounds could be heard with a fetal heart scope.

The nurse is providing discharge teaching to a new mother about the baby's feeding schedule. What should the nurse include in these instructions? (SATA)

-Feed every two hours -Spitting up is expected -Vomiting is a daily occurrence -Frequent vomiting can cause dehydration

A woman who is 12 wks pregnant wants to know what the baby looks like. How should the nurse respond?

-Fetal stage with an audible heartbeat and identifiable sex characteristics.

The nurse is working in the transition nursery. What is the most critical transition time for a newborn?

-First 6-12 hours

What specific vitamin is known to prevent up to 70% of birth defects of the central nervous system called neural tube defects? What vitamin should women who are at the risk of getting pregnant have daily in their diet?

-Folic acid

A pregnant vegan reports that she eats lots of dark green leafy vegetables, legumes, citrus fruits and berries. What food should the nurse recommend that she add to her diet?

-Fortified cereals

As a part of a first prenatal visit, the nurse records a pregnant woman's obstetric history. She has an 18 month old daughter who was delivered two days after her delivery due date and a 3 year old son who was born at 35 weeks gestation. Before her son was born, she lost 2 pregnancies. 1 at 12 weeks and the other at 21 weeks. Using the GTPAL method, how should the nurse record this history?

-G5,T1, P2, A1, L2

Twelve hours after delivery, the fundus of a patient who has just delivered her fifth child after a 14 hour labor is two fingers above the umbilicus and her uterus feels soft and spongy. What should the nurse do first?

-Gently massage the fundus until it tones up

A group of nursing students is discussing gestational age in relation to newborns they are caring for in the newborn nursery. Which statement made by the nursing students is the most appropriate?

-Gestational age is the length of time between fertilization of the egg and birth.

The urine of a woman in her 2nd trimester of pregnancy is found to contain glucose. For which condition should she be tested?

-Gestational diabetes

The nurse is caring for a pregnant patient with poorly controlled gestational diabetes mellitus. What effect is the patient's condition most likely to have on the fetus?

-Grow to an unusually large size (macrosomia)

The nurse is aware of times when it is contraindicated to breastfeed. What is one maternal contraindication to breastfeeding an infant?

-HIV

The nurse is helping an indigent HIV-positive pregnant patient set up a post delivery care plan for her baby. What should the nurse include during that discussion?

-HIV can be passed to the baby from breast-feeding so it's important that you give the baby formula. Formula is pretty expensive so I'll give you some information for places you can contact if you ever need some help getting it

Infants receive vitamin K within the first hour after delivery. What is the rationale for this?

-Helps in the formation of clotting factors, to prevent bleeding

The nurse is caring for a postpartum patient. Which potential complication during the first hour after delivery is of the most concern to the nurse?

-Hemorrhage

The standard of care and recommendation by the CDC is to administer an immunization to all newborns. Which immunization is recommended to be administered prior to discharge?

-Hep B

The nurse notes that a pregnant patient's maternal serum alpha fetoprotein levels are elevated. What does this finding suggest to the nurse?

-Her child is at risk for neural tube defects

A patient pregnant with a fetus diagnosed with Down Syndrome is weighing the consequences of carrying the baby to term. Which information should the nurse consider regarding the possible concerns for a child with Down Syndrome?

-Higher risk of developing leukemia than those in the general population

The nurse is assisting with an assessment of Ortolani maneuver on an infant. What is the procedure assessing?

-Hip forward dislocation

What is the primary reason for a cesarean delivery?

-History of a previous cesarean

A 14-year-old, in the second trimester of pregnancy, has been hiding the pregnancy from her parents. The nurse is helping them develop a plan of care. What is the best thing she can say to the clearly angry parents?

-I know you must be very upset and angry about your daughter's pregnancy but because she's still an adolescent herself, she'll need your guidance in making nutritional and health choices that will be good for the baby and for herself.

A 32-year-old woman with epilepsy tells the nurse that she is thinking about getting pregnant and asks the nurse's advice. What is an appropriate answer for the nurse to give?

-I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet.

What should the nurse anticipate when caring for a newborn diagnosed with a diaphragmatic hernia?

-Immediate surgery

During which part of the birth process does the cardiac output increase to 80% above the prelabor level?

-Immediately after birth

A woman is inquiring about effective methods of birth control. She is considering the diaphragm, condoms, oral contraceptives, and Implanon. Of these choices, which method could the nurse advise is the most reliable?

-Implanon

The nurse is teaching a prenatal class on the signs and symptoms of true labor. Which statement made by a participant indicates an understanding of true labor contractions?

-Increase even if relaxing and taking a shower

The nurse is instructing a patient pregnant with twins on the additional prenatal care that is needed. What should the nurse include when teaching this patient? (SATA)

-Increase rest to several times each day -Schedule ultrasounds for every 4-6 weeks -After week 24, plan prenatal visits to occur every two weeks -Plan to perform prenatal movement (kick) counts after week 32

The nurse is caring for a patient who is 28 weeks pregnant and preparing for the discomforts that will occur in the final trimester of pregnancy. What will the nurse teach this patient?

-Increased SOB and dyspnea before lightening

While providing care, an infant with tetralogy of fallot has a tet spell. What did the nurse assess in the infant? (SATA)

-Increased cyanosis -Sudden restlessness -Gasping respirations

Over the course of an 8 hour shift caring for a child recovering from a ventriculoatrial shunt placement. The nurse notes that the child's cry has become increasingly shrill and begins projectile vomiting. For which reason should the nurse immediately notify the health care provider?

-Increased intracranial pressure

Which change in blood pressure assessment findings during the second trimester indicates the highest risk for preeclampsia?

-Initial BP 110/70, current BP 140/90

A multigravida is admitted to the hospital in active labor. The patient's and the fetus's condition have been good since admission. The patient suddenly calls out to the nurse, "the baby is coming!" What should the nurse do first?

-Inspect the perineum

When teaching a patient with pregestational diabetes on how to control blood glucose levels the nurse will instruct on diet and exercise. What is the third facet to glycemic control?

-Insulin

What is the process by which the reproductive organs return to the nonpregnant size and function?

-Involution

The nurse is weighing and measuring a term newborn. Which findings would cause the nurse to conclude that the baby is suffering from asymmetrical intrauterine growth restriction (IUGR)?

-Is pale with loose, dry skin

When documenting the fetus is at "zero station", the nurse knows this is where in relation to the pelvic structure?

-Ischial spines

The nurse is caring for a female patient with pelvic inflammatory disease (PID) who wants to have children. What should the nurse explain about the effects of PID on fertility?

-It interferes with the transfer of ovum due to tubal scarring.

In treating a pregnant patient with severe HTN. The physician determines that the baby must be delivered as soon as possible and orders an amniocentesis for the patient. The nurse can tell the patient that the doctor will be determining the baby's readiness for delivery by evaluating which parameter?

-Level of total surfactant

What would the nurse most likely assess on the infant with developmental dysplasia of the hip?

-Limited abduction of the affected hip

What is a common finding in a child who has a ventricular septal defect?

-Loud, harsh murmur

One month postpartum, a breastfeeding mother calls the clinic with a complaint of sore breast and fever. The nurse asks further questions and is given the following information: sore on one side of the breast, feeding on a regular schedule, low-grade fever of 100.4, feeling very tired. What does the nurse suspect is occurring with the mother?

-Mastitis

A patient comes to the emergency department in advanced labor, and birth appears imminent. What is the most important and appropriate aspect of admission that is needed for this patient?

-Measuring blood pressure and determining whether clonus or edema is present

The nurse explains to a pregnant client who is anemic that she will need to take vitamins with iron during the rest of her pregnancy. What food should the nurse include on the patient's diet plan?

-Meats

What should the licensed practical nurse report to the RN if the amniotic fluid is green when the membranes rupture?

-Meconium in the amniotic sac

A patient is a gravida 1, in the active phase of stage 1 labor. The fetal position is LOA. When the patient's membranes rupture. What should the nurse expect to see?

-Moderate amount of clear fluid

Which lochia pattern should the nurse report immediately to the RN or primary practitioner?

-Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5

A patient whose 16-week pregnancy has been determined to be twins and is concerned that the babies might be born conjoined. Which type of twin pregnancy is at risk of being conjoined?

-Monoamniotic/Monochorionic

What should the nurse encourage the mother to avoid when teaching how to have the infant latch onto the breast?

-Nipple tip only

The nurse caring for a newborn notices that at 18 hours of age, the baby's abdomen is distended and by 24 hours, the baby has not passed stool. What should the nurse do?

-Notify the Physician of the findings

A patient who has already had one successful vaginal birth after cesarean (VBAC) has elected to deliver her third child vaginally. She reports a sudden sensation of "something snapping inside", followed by chest pain. What should the nurse do?

-Notify the health care provider for a possible ruptured uterus

The nurse is caring for a child following a cardiac catheterization. What would be the highest priority when providing care within the first 12 hours post procedure?

-Observe the extremity

The nurse explains to a pregnant patient that she will need to take iron during her pregnancy after being diagnosed with iron-deficiency anemia. What can the nurse suggest that the patient take with the iron to increase absorption?

-Orange Juice

One postpartum patient, delivering two days prior, is asking when she needs to use "protection to not get pregnant again right now." How should the nurse respond?

-Ovulation may return as soon as three weeks after delivery

The nurse suspects a newborn has a congenitally acquired infection. What did the nurse assess in this infant? (SATA)

-Pallor -Cyanosis -Thermal instability

A patient has been in labor for five hours. Earlier there was a gradual increase in FHR baseline with variables, but the patient has changed position several times and now the fetus shows no signs of hypoxia. The cervix is almost completely effaced and is dilated to 8 cm. However, the labor graph indicates that the fetus has stopped descending. What should the nurse do first?

-Palpate the area just above the symphysis pubis

The four essential components of labor are known as the "four P's". Which of the four P's involves the pelvis?

-Passageway

A male baby is born at 0515 on a Wednesday. At 1315 on the same day, the nurse notices yellow staining of the skin on the head and face of the infant. What is this finding likely to indicate?

-Pathological jaundice

During a postpartum examination on the day of delivery, a patient complains that she is still so sore that she can't sit comfortably. The nurse examines her perineum and finds the edges of the episiotomy approximated without signs of a hematoma. Which intervention will be most beneficial at this point?

-Place an ice pack

The nurse is providing education to women who had diabetes prior to pregnancy. The nurse is discussing pregnancy-related complications from diabetes. Which of the following is a potential complication?

-Polyhydramnios

A newborn has secretions in the mouth and nose. What are the first steps the nurse should take to clear the newborn's airways?

-Position on his side with his head slightly below his body, use a bulb syringe to clear the mouth

The Ballard scoring system is a common gestational age assessment tool, used in assessing the newborn. Which categories are included in determining the neuromuscular maturity of the newborn? (SATA)

-Posture -Arm recoil -Heel to ear -Scarf sign

The nurse is ensuring a newborn is properly identified after birth. What will the nurse do to prevent misidentification? (SATA)

-Prepare 4 identification bands -Apply one to the mother's wrist -Apply one to the baby's wrist and one to the ankle -Apply one to the wrist of another family member

What is recommended to prevent transmission of HIV to a newborn if the mother has AIDS?

-Prepare for a cesarean delivery

At birth, there are multiple changes in the cardiac and respiratory systems. What is a change that occurs at birth in cardiovascular?

-Pressure changes occur and result in the closure of the ductus arteriosus.

On what should the nurse focus when caring for a newborn with exstrophy of the bladder? (SATA)

-Preventing infection -Preventing skin irritation -Meeting the needs for the newborn to be touched

A pregnant patient who is dilated to 10 cm and feeling the urge to "have a bowel movement" is refusing to push because of the pain. What options should the nurse suggest for pain management to facilitate pushing?

-Pudendal block

A newborn male has been circumcised, has stable temperature, breathing, and heart rate, and is ready to be discharged from the hospital. What should the nurse teach the parents that might indicate the newborn needs medical attention?

-Redness at the base of the umbilical cord

The following hourly assessments are obtained by the nurse on a patient with preeclampsia receiving magnesium sulfate: 97.3, P88, RR10, BP 148/110. What other priority physical assessment by the nurse should be implemented to assess potential toxicity?

-Reflexes

The vital signs of a postpartum patient on day 1 after delivery are: Temp 99, BP 140/90, HR 78, RR 18. What is the appropriate intervention by the nurse?

-Report the slight elevation in the BP

What is the highest concern when caring for a child with esophageal atresia?

-Respiratory distress

A newborn baby by cesarean birth is at risk for complications of which system during the transition phase?

-Respiratory system

The health care provider is using vacuum extraction to help a patient deliver. For which complications should the nurse assess the newborn after the use of this device? (SATA)

-Scalp trauma -Intracranial hemorrhage

What is the primary function of uterine contractions after delivery of the infant and placenta?

-Seal off the blood vessels at the site of the placenta

During a home visit the nurse is concerned that a newborn has maple surgery urine disease. What did the nurse most likely assess in the baby? (SATA)

-Seizures -Spasticity -Maple sugar odor to urine

The first day of the patient's last menstrual period was December 1st. Based on the Naegele rule, what is the patient's estimated due date?

-September 8

The nurse is teaching a first-time mother on the danger signs to report to the health care provider. What information should the nurse include in this teaching? (SATA)

-Shaking chills -Painful urination -Passage of blood clots

The nurse is concerned that a patient in labor is developing abruptio placentae. What did the nurse assess in this patient?

-Sharp fundal pain and discomfort between contractions

A patient is admitted to the hospital with an ectopic pregnancy of the fallopian tube. For which symptom should the nurse assess the patient first?

-Sharp unilateral pain

For which reason would a routine episiotomy be planned?

-Shoulder dystocia

A new mother is determined to breastfeed exclusively for the first 6 months of her baby's life but has to return to work before then and will need to pump and store her expressed breast milk. How long should a nurse advise this woman to wait, if possible, before introducing the expressed milk into the feeding schedule?

-Six weeks

The nurse is providing postpartum care to a woman who has delivered by cesarean section. According to her records, simethicone, diphenhydramine, and naloxone have been prescribed. Which manifestation should the nurse report immediately?

-Slow respirations, less than 12 breaths per minute

The nurse is working with a patient in labor. She is happy and cheerful, and states she is "ready to see her baby." What stage or phase of labor is the patient currently experiencing?

-Stage one, Latent phase

The laboring patient is having contractions every two to three minutes, lasting 45-60 seconds and of strong intensity. The fetal head crowns when the client pushes. The cervix is completely dilated at 10 cm and 100% effaced. In which stage of labor is this patient?

-Stage one, Transition phase or Second stage

A patient at 41 weeks' gestation is having labor induced with IV Pitocin. The fetal monitor strip is noted to have contractions every two minutes lasting 60-90 seconds. What is the highest priority intervention for the nurse?

-Stop the IV Pitocin infusion

What causes pain in the first stage of labor?

-Stretching of the cervix

The nurse is providing discharge education on the newborn care at home. The nurse provides instructions that infants need to be placed on their back to sleep. What is the nurse reducing the risk of?

-Sudden infant death syndrome

A patient in the second stage of labor is becoming increasingly fatigued. Which interventions should the nurse use to help the patient rest? (SATA)

-Support the patient with pillows -Apply cool cloth to the forehead -Provide a back rub between contractions -Assist the patient into a comfortable position

A pregnant patient had planned for a natural childbirth. However, during the labor, the patient can no longer endure the pain and asks for an epidural. What should the nurse do?

-Support the patient's decision and call the obstetrician to discuss the epidural with her.

When caring for a newborn who is jittery and irritable after birth, what should the nurse do?

-Take blood using a heel stick to check for hypoglycemia

Which patient should the nurse be most concerned about on postpartum day 1?

-Temp 98.6, HR 74, RR 16, BP 150/85

A patient is eight weeks' gestation and is a type 1 diabetic. The healthcare provider has classified this patient as a high-risk pregnancy. To which of the following providers will the health provider send this patient?

-The Perinatologist

What should a nurse monitor a newborn more closely after cesarean birth more closely than after a vaginal birth?

-The baby will have more fluid in its lungs, making respiratory adaptation more challenging

A patient who delivered her infant three days ago and was discharged home calls her provider's office with a complaint of sweating all night. What is the cause of the increased perspiration?

-The body is secreting the excess fluids from the pregnancy

A vaginal examination on a laboring woman is recorded by the nurse as 10 cm, 100% and +1. What is the correct interpretation of this data to share with the patient?

-The fetal descent is 1 cm below the ischial spines

A pregnant woman calls her provider's office to report that she thinks she is in labor. The patient reports contractions have been at these times: 1205, 1210, 1215, and 1220. What does this information indicate to the nurse?

-The frequency of the contractions is every five minutes

A newborn has a respiratory rate of 66 bpm, flaring nostrils and is making a grunting sound upon inspiration. What health problem should the nurse consider based on these findings?

-The infant is in respiratory distress.

The nurse is caring for a newborn with hyaline membrane disease. Which statement is the best explanation of this disorder?

-The infant's lungs are immature and deficient in surfactant

A patient who is six weeks pregnant is Rh-negative. The spouse reports being Rh-negative also. What action should the nurse plan to take based upon this information?

-The nurse will perform all normal procedures and follow-up tasks because the Rh is not of concern right now.

Which scenario should the nurse follow up on as a potential indication of intimate partner violence?

-The partner of a patient woman attends each of her appointments. The partner is friendly and outgoing. Each time the nurse asks the patient a question, the partner answers. While the partner speaks, the patient looks at her lap.

A fetus is able to main blood circulation in utero by the presence of circulatory shunts. From where does the ductus arteriosus shunt blood?

-The pulmonary artery to the aorta

Which field structure has the highest oxygen concentration?

-The umbilical vein (the veins bring nutrients to the fetus and the artery takes waste away)

The nurse is reviewing the different types of spina bifida. Which statement best describes spina bifida?

-There is a bony defect that occurs without soft tissue involvement

Which statement should the nurse use to describe the communicating type of congenital hydrocephalus?

-There is a defective absorption of cerebrospinal fluid

The nurse is planning a presentation on hydrocephalus for a group of nurses. Which statement is most accurate about the noncommunicating type of congenital hydrocephalus.

-There is an obstruction that prevents the cerebral spinal fluid from passing between the ventricles in the spinal cord

A newly married couple worried about fertility asks the nurse for counseling. They have been trying to conceive for 4 months with no success. The husband is 38 and the wife is 29. They had previously used combination oral contraceptives as a way to prevent pregnancy. What is the best advice for the nurse to give them?

-They should increase intercourse frequently to 4x a week around the time of ovulation.

A mother is concerned because her newborn has lost 8 oz 3 days after birth. What response by the nurse is appropriate?

-This is a normal and expected finding

A pregnant patient complains of vaginal itching, a great deal of foamy yellow-green discharge, and pain during intercourse. She says this is her first pregnancy and she didn't know this was what happened. What should the nurse tell her?

-This is not normal for pregnancy; the doctor might test for trichomoniasis.

The laboring patient who is at 3-cm dilation and 25% effaced is asking for analgesia. The nurse explains that analgesia is usually not administered prior to the establishment of the active phase. Why is analgesia not provided at this time?

-This may prolong labor and increase complications

A pregnant patient has an Rh-negative blood type. Following the birth of the fetus, the nurse administers RhoGAM (D immune globulin). What is the purpose of this medication?

-To prevent maternal D antibody formation

Assessment for the surfactant level via LS ratio in amniotic fluid is a primary estimation of fetal maturity. What is the purpose of surfactant?

-To prevent the alveoli from collapsing upon expiration

An African-American woman who is 5'10" tall with a history of oral contraceptive use. She stopped taking the pill in January in hopes of becoming pregnant. In March, she was successful. For which condition does the woman have several risk factors if she becomes pregnant?

-Twins

A patient is entering the third stage of labor. What will the nurse assess when the placenta is separating? (SATA)

-Umbilical cord lengthens -Fundus rises in the abdomen -Uterus takes on a globular shape -Blood trickles steadily from the vagina

The nurse is caring for a patient in the fourth stage of the labor process. On what will the nurse focus when providing care to this patient? (SATA)

-Urine output -Comfort level -Signs of infection -Evidence of hemorrhage

27. While caring for a patient in labor the fetal heart monitor demonstrates late decelerations. What is the most common cause for late decelerations?

-Uteroplacental insufficiency

The provider is admitting a patient to ripen her cervix for induction of labor. The order is for prostaglandin E2. How should the nurse prepare to administer this medication?

-Vaginal

In caring for a fully immunized pregnant woman who is a nurse in a family health practice, the obstetric nurse should remind the patient that she must not come in contact with patients that have symptoms that could indicate which infection?

-Varicella (it is important for pregnant women to have an immunity to varicella and rubella bc they are very dangerous- potentially causing neuro defects)

A child with hydrocephalus is scheduled for a procedure where a shunt is surgically inserted to drain cerebrospinal fluid into the chamber of the heart. Which type of surgery is this child having?

-Ventriculoatrial

How should the nurse document the white coating on the infant at delivery?

-Vernix

The nurse is concerned that a pregnant patient is developing HELLP syndrome. What did the nurse assess in this patient? (SATA)

-Visual disturbances -Elevated liver enzymes -Headache -Epigastric pain

Which interventions would a nurse implement to best prevent heat loss in a 1-day-old newborn?

-Warm all surfaces and objects that come in contact with the newborn

What could be considered to be the best practice for the nurse to follow when giving a newborn his or her first bath?

-Wash off all traces of blood and allow the vernix to remain on the skin

A 43-year-old, physically fit, healthy woman who is newly married tells the nurse that she and her husband would like to have a child. What is the appropriate first response?

-Well, I'm sure you know there are some risks involved so it's helpful that you've been taking such good care of yourself.

The nurse advises a woman to change her tampon at least every 2-3 hours, wash hands thoroughly before and after inserting the tampon, use the lowest absorbency that will handle the menstrual flow, and store tampons away from heat and moisture to help prevent bacterial growth. What is the nurse teaching the woman to avoid?

TSS, Toxic shock syndrome