maternal newborn ATI PN

A nurse is reinforcing teaching about dietary changes with a client who is pregnant and has pregestational diabetes. Which of the following statements should the nurse include in the teaching?

"Carbohydrates should make up 55% of your diet." For clients who have pregestational diabetes, intake of simple carbohydrates should be limited. The ideal diet is composed of 55% carbohydrates, 20% protein, 25% fat, and less than 10% saturated fat. Incorrect Answers: B. Protein should only make up 20% of the diet for clients who have pregestational diabetes. C. The ideal diet for clients who have pregestational diabetes contains 25% fat. D. There is no limitation on the amount of fiber a client who has pregestational diabetes should consume. Fiber should be recommended to clients to decrease constipation, which can be an effect of pregnancy.

A nurse in an antepartum clinic is reinforcing teaching about recommended weight gain with a client who is at 12 weeks of gestation. The client has a documented prepregnancy BMI of 32. Which of the following client statements indicates an understanding of the teaching?

"I should limit my weight gain to 20 pounds during pregnancy." Clients who have a prepregnancy BMI over 30 are considered to be obese and should plan to limit their weight gain to 5 to 9.1 kg (11 to 20 lb) during pregnancy. Incorrect Answers: A. Clients who have a prepregnancy BMI under 18.5 are considered underweight and should plan to gain between 12.7 to 18.1 kg (28 to 40 lb) during pregnancy. B. Clients who have a prepregnancy BMI of 18.5 to 24.9 are considered to be of normal weight and should plan to limit their weight gain to 11.3 to 15.9 kg (25 to 35 lb) during pregnancy. C. Clients who have a prepregnancy BMI of 25 to 29.9 are considered to be overweight and should plan to limit their weight gain to 6.8 to 11.3 kg (15 to 25 lb) during pregnancy.

A nurse is reinforcing with teaching a postpartum client about how to swaddle her newborn. Which of the following statements by the parent demonstrates an understanding of the teaching?

"I should stop swaddling my baby once she is able to roll over by herself." The parent should discontinue swaddling the baby once the baby is able to roll over, which occurs around 2 months of age. Rolling over can tighten the swaddle and keep the baby from breathing properly.

A nurse is reinforcing teaching with a client who is breastfeeding and has pregestational diabetes controlled with insulin. Which of the following instructions should the nurse include?

"You have a higher risk for hypoglycemia due to breastfeeding." Clients who breastfeed have a greater risk of hypoglycemia due to the increase in carbohydrates used for milk production.

A nurse is reinforcing education with a client who is at 34 weeks of gestation about a non-stress test (NST). Which of the following pieces of information should the nurse include?

"You might have to drink orange juice during the test." An NST monitors for accelerations of the fetal heart rate over a 20-minute period. During this time, the fetus can be asleep and experience hypoactivity. The parent might be asked to drink orange juice during testing to stimulate fetal movements.

A nurse is reinforcing teaching with a client who is pregnant and has type 1 diabetes mellitus. Which of the following statements should the nurse include in the teaching?

"You should expect to decrease your insulin dosage immediately after you deliver your baby." The client will immediately lose insulin resistance upon the delivery of the placenta. Clients who have type 1 diabetes mellitus should need only 50% to 60% of the predelivery dosage of insulin.

A nurse in a clinic is reinforcing teaching with a client who is at 37 weeks of gestation and is scheduled for an external cephalic version. Which of the following statements should the nurse make?

"You will receive a medication to relax your uterus prior to the procedure." A client who is scheduled to undergo an external cephalic version often receives a tocolytic prior to the procedure to allow the uterus to relax. A relaxed uterus allows an easier version by the provider.

A nurse is reinforcing teaching about calcium intake with a client who is breastfeeding. Which of the following amounts of calcium is the daily recommended amount for a woman who is breastfeeding?

1,000 mg The nurse should instruct the client that 1,000 mg of calcium is recommended for women ages 19 and older, as well as those who are lactating. This amount of calcium is sufficient to meet the needs of the client and the infant because additional calcium is absorbed from the intestines.

Breastfeeding calcium recommended intake of

1,000 mg.

The nurse should monitor the client's contractions every

10 to 15 minutes during the transition phase of labor,

The nurse should notify the provider if the client's Hgb is below

11 g/dL because this is an indication of anemia.

Diuresis begins approximately

12 hours following delivery. It is expected for a client to have a urine output of 3,000 mL in a 24-hour period.

The nurse should notify the provider if the client's WBC count is greater than

15,000/mm^3 because this is an indication of infection.

The parent should be able to fit

2 to 3 fingers between the newborn's chest and the swaddled blanket. A swaddle that is too tight can interfere with respiration or cause the newborn to overheat.

An NST will take about

20 to 30 minutes to complete.

A client will have dark red lochia for approximately

3 days following delivery. Large clots are an indication of a complication

The nurse should notify the provider if the client's Hct is under

33% because this is an indication of anemia.

Intraventricular hemorrhage When an infant is born before

34 weeks of gestation, the blood vessels in the brain are fragile. Additionally, premature infants have an impaired coagulation process and fluctuating blood pressure. When combined, these factors increase the risk of bleeding into the ventricles of the brain, causing neurological damage.

The ideal diet For clients who have pregestational diabetes, is composed of

55% carbohydrates, 20% protein, 25% fat, and less than 10% saturated fat.

Although the calcium requirement for a client who is breastfeeding does not increase,

800 mg of calcium is less than the daily recommended intake of 1,000 mg. The nurse should explore additional sources of calcium with the client if she does not drink milk products.

A nurse is assisting with the care of a client who is 8 hours postpartum and is experiencing hemorrhage. Which of the following actions should the nurse implement after notifying the provider? (Select all that apply.)

A. Massage the fundus C. Administer oxytocin with IV fluids D. Insert an indwelling urinary catheter E. Place the client in a lateral position with her legs elevated 30° The nurse should massage the fundus to expel clots and assist the uterus to contract. Also, the nurse should add oxytocin to the intravenous drip and insert an indwelling urinary catheter to monitor urinary output and perfusion to the kidney. Finally, the nurse should place the client in a lateral position with her legs elevated 30°. administer oxygen 10 L/min via nonrebreather face mask.

A nurse is contributing to the plan of care for a newborn who has hyperbilirubinemia and a new prescription for phototherapy. Which of the following interventions should the nurse include in the plan?

A. Reposition the newborn every 3 hours The nurse should reposition the newborn every 2 to 3 hours during phototherapy to maximize skin exposure to the light. Incorrect Answers: B. The nurse should not apply lotions, creams, or ointments to the newborn's skin because they can absorb heat and cause a burn injury. C. The nurse should ensure the newborn is either breastfed or formula-fed every 2 to 3 hours. Glucose water has no nutritional value and does not promote the excretion of bilirubin. D. The nurse should dress the newborn in only a diaper to maximize skin exposure to the light.

A nurse is collecting data from a newborn and notes an axillary temperature of 36°C (96.9°F). Which of the following actions should the nurse take?

Assess the newborn's blood glucose level Infants who become cold attempt to generate heat through increased muscular and metabolic activity. This process increases glucose consumption and puts the newborn at risk for hypoglycemia.

A nurse is contributing to the plan of care for client who is in the active stage of labor and expresses a desire to use nonpharmacological methods of pain relief. Which of the following interventions should the nurse include?

Assist the client into a warm shower Assisting the client into a warm shower is a nonpharmacological method used to decrease labor pain. This method stimulates the release of endorphins and increases circulation. Research supports the use of hydrotherapy as an effective method of labor pain management. Incorrect Answers: A. Music can provide distraction and relaxation while a client is in early labor, but evidence does not support the effectiveness of music as a method of pain relief during active labor. B. Informational biofeedback can be an effective method of increasing relaxation; however, this method must be taught and practiced during the prenatal period to be effective during labor. C. Asking the client to reconsider using regional anesthetics such as epidural or spinal anesthetics does not support the client's wishes to utilize nonpharmacological methods of pain control

A nurse is assisting with the care of an infant who begins displaying manifestations of neonatal abstinence syndrome (NAS). Which of the following actions should the nurse take?

Avoid eye contact during feedings The nurse should avoid maintaining eye contact and talking during feedings. Infants with NAS have difficulty processing multiple forms of stimulation and can quickly become frustrated.

A nurse is collecting data from a newborn who has a congenital diaphragmatic hernia. Which of the following findings should the nurse expect?

Barrel-shaped chest The nurse should expect a newborn who has congenital diaphragmatic hernia to exhibit a barrel-shaped chest as the abdominal organs have shifted into the chest cavity.

A nurse is collecting data from a newborn following a vaginal birth with the assistance of a vacuum extractor device. The newborn has head swelling that crosses the suture line. The nurse should document this finding as which of the following conditions?

Caput succedaneum The nurse should identify and document this finding as caput succedaneum, which is swelling of the soft tissues of the scalp caused by pressure on the fetal head during birth. It can be palpated as a soft edematous mass that crosses the suture line, and it is an expected finding following the use of vacuum extraction. Caput succedaneum usually resolves in 3 to 4 days and does not require treatment.

A nurse is assisting the respiratory therapist with obtaining an arterial blood gas (ABG) specimen from a newborn. Which of the following actions should the nurse take?

Carefully restrain the newborn during the procedure The nurse should carefully restrain the newborn during the procedure to ensure the body and arms are still. This action avoids harming the child during the test. The newborn's heel is warmed with a warm cloth for a heel stick. An ABG specimen, which requires more blood to be drawn, is taken from the newborn's arm. Pressure should be applied over the puncture site with a dry gauze square, not wet gauze; it should be held in place for 3 to 5 minutes to prevent bleeding from the site.

A nurse is collecting data from a client who is 1 day postpartum. Which of the following findings is a sign of a potential complication?

Deep tendon reflexes 4+

why premature infant has a greatly increased risk of hypothermia

Due to limited subcutaneous and brown fat stores, as well as an inability to maintain a flexed position

A nurse is caring for a client who is in the transition phase of labor. Which of the following actions should the nurse take?

Encourage the client to use a rapid pant-blow breathing pattern The nurse should encourage the client to use a rapid pant-blow breathing pattern. This breathing pattern distracts the client, which can reduce the perception of pain.

A nurse is assisting with care for a client who is in labor. Which of the following methods will determine the frequency of the client's contractions?

Evaluating the amount of time from the beginning of a contraction to the beginning of the next contraction The method for timing contractions is to measure the time from the beginning of a contraction to the beginning of the next. That time interval is the frequency of contractions at any given point in time.

A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as a manifestation of a urinary tract infection?

Hematuria Manifestations of a urinary tract infection include low-grade fever, dysuria, urinary retention, hematuria, frequency, and urgency. . D.

A nurse is assisting with the plan of care for a newborn who was born at 30 weeks of gestation. The nurse should plan to collect data for which of the following potential complications associated with prematurity?

Intraventricular hemorrhage When an infant is born before 34 weeks of gestation, the blood vessels in the brain are fragile. Additionally, premature infants have an impaired coagulation process and fluctuating blood pressure. When combined, these factors increase the risk of bleeding into the ventricles of the brain, causing neurological damage.

A nurse is assisting with planning care for a client who is scheduled to have prostaglandin E2 gel inserted for cervical ripening. Which of the following actions should the nurse take?

Maintain the client in a side-lying position for 30 minutes after insertion The client should maintain a side-lying or supine position with lateral tilt for 30 to 40 minutes after insertion of the medication to keep the gel in contact with the cervix.

A nurse is collecting data from a client who is in labor and has received epidural anesthesia for pain control. Which of the following manifestations should the nurse identify as an adverse effect of epidural anesthesia?

Pruritus (severe itching of the skin) is an adverse effect of epidural anesthesia often associated with an opioid. Urinary retention and Hypotension, metallic taste and numbness of the mouth are adverse effects of epidural anesthesia.

a common discomfort of in the second trimester of pregnancy.

Pyrosis (heartburn),Constipation and Periodic tingling in fingers

A nurse is preparing to perform a heel stick on a newborn. Which of the following actions should the nurse take?

Restrain the newborn's foot The nurse should restrain the newborn's foot with a free hand. This is done to prevent the newborn from moving around so that the nurse can quickly get an accurate heel stick\

A nurse is collecting data on a client who is at 8 weeks of gestation. Which of the following findings should the nurse report to the provider?

Small amount of brown vaginal discharge A small amount of brown vaginal discharge can be a warning sign of an ectopic pregnancy, in which the fertilized ovum is implanted outside of the uterus. The nurse should report this finding to the provider. Incorrect Answers: A. A WBC of 14,000/mm^3 is within the expected reference range for a client who is pregnant. B. C.

A nurse is instructing a client about how to use a diaphragm. In what order should the client complete the insertion process? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Step 1. The nurse should instruct the client to inspect the diaphragm using a light source or by filling the diaphragm with water to detect any small holes. Step 2. The nurse should place 2 tsp of contraceptive jelly on the side of the diaphragm that will go against the cervix. Step 3. The nurse should assume a squatting position. Step 4. The nurse should hold the diaphragm between the thumb and fingers. Step 5. The nurse should insert the diaphragm into the vagina

circumcision using a Plastibell device

The Plastibell technique uses a specially designed plastic bell that is fitted over the end of the penis. A suture is then tied around the rim of the bell, and a circle of the prepuce is cut away, allowing the remaining foreskin to be retracted easily. The nurse should instruct the parent to monitor the site frequently and to apply gentle pressure using sterile gauze if bleeding occurs. If this does not stop the bleeding, the parent should notify the provider.

what is the location of the The fundus at the end of the third stage of labor.

The fundus is approximately 2 cm (0.79 in) below the level of the umbilicus

A nurse is reinforcing teaching about the process of involution with a client who is postpartum. Which of the following pieces of information should the nurse provide?

The fundus is not palpable abdominally at 2 weeks postpartum. Involution is the return of the uterus to its normal prepregnancy state; this occurs after the delivery of the placenta. By the end of the third stage of labor, the fundus is 2 cm below the umbilicus. Within 12 hours after delivery, the fundus rises 1 cm above the umbilicus. The fundus descends 1 to 2 cm (0.39 in 0.79 in) every 24 hours. The fundus is not palpable after the sixth postpartum day.

A nurse is collecting data from a newborn who was circumcised 24 hours ago. Which of the following findings should the nurse report to the provider?

The newborn has urinated once since the circumcision. A newborn should void 2 to 6 times a day the first 24 to 48 hours after birth and then 6 to 8 times per day starting on the third day. Therefore, the nurse should report 1 void in 24 hours following circumcision to the provider.

When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the fencing position. This reflex lasts until the baby is about 5 to 7 months old.

This is an expected component of the tonic neck reflex, not the Moro reflex

A nurse collecting data from a full-term newborn who is demonstrating the Moro reflex. Which of the following movements are expected responses to this reflex? (Select all that apply.)

Thumb and forefinger forming a "C" B. Legs extending before pulling upward These are expected components of the Moro reflex. This response is present at birth and absent by 6 months of age in neurologically intact infants.

Pruritus (severe itching of the skin) is an adverse effect of epidural anesthesia often associated with an opioid. Pruritus can be controlled by the use of antipruritic medications. Incorrect Answers: A. Urinary retention, not polyuria, is an adverse effect of epidural anesthesia. C. Hypotension, not hypertension, is an adverse effect of epidural anesthesia. D. A metallic taste and numbness of the mouth are adverse effects of epidural anesthesia.

Urinary urgency Urinary urgency and frequency can be a common discomfort during the third trimester of pregnancy. However, these symptoms can also indicate a complication of pregnancy like a urinary tract infection, which could cause preterm labor. Therefore, the nurse should report these manifestations to the provider.

An oxytocin infusion is used for

a contraction stress test in order to achieve uterine contractions. This is not indicated for an NS

Naloxone should never be administered to

a newborn who is experiencing manifestations of opiate withdrawal. The medication can cause an immediate withdrawal and severe symptoms and seizures in the infant.

Full-term newborns who have an intact Moro reflex

abduct their arms and legs.

The nurse should identify that 2,000 mg of calcium is

above the recommended daily intake of 1,000 mg. A calcium intake this high can result in the development of kidney stones and decrease the absorption of other nutrients such as iron and zinc.

A scant amount of serosanguineous drainage is

an expected finding 24 hours following a circumcision

The parent should lay the newborn on her

back after swaddling to reduce the risk of sudden infant death syndrome (SIDS).

During the external version, the fetal heart-rate pattern is monitored continuously because the fetus is at risk of

bradycardia and variable decelerations. The nurse also monitors the fetal heart rate for at least 60 minutes following the procedure.

The arms of full-term newborns who have an intact Moro reflex form a

complete embrace after startling and then return to flexion and movement.

Discolored hemorrhoid tissue can be an indication of a

complication

. A distended bladder can interfere with the

descent of the newborn. Therefore, the nurse should assist the client to void at least once every 2 hours while in labor.

Measuring the length of a contraction from beginning to end determines the

duration of the contraction, not the frequency.

Preterm infants lack the neurological maturity to complete the

embrace, and their arms fall backward as a result of weakness. E. This is an expected component of the tonic neck reflex, not the Moro reflex

During the first stage of labor, the nurse should

encourage the client to change positions frequently. The nurse can place the client in a lithotomy position during the second stage of labor.

The nurse should monitor the client's contractions every

every 30 to 60 minutes during the latent phase of labor, and every 15 to 30 minutes during the active phase of labor.

1 day postpartum 2+ is an

expected finding

Diuresis is an

expected finding postpartum

During an NST, the nurse is monitoring

fetal wellbeing. Nipple stimulation is used for a contraction stress test in order to achieve uterine contractions

Blood glucose levels can

fluctuate in the postpartum period, and insulin adjustments are expected. The client might be at risk for hypoglycemia as well. Eating consistent carbohydrates is emphasized. Clients who breastfeed might only need half of the prepregnancy dose due to the increase in carbohydrates used for production of human milk. Clients who have diabetes mellitus should eat on a regular schedule regardless of other demands to

Clients who breastfeed typically require

half of their pregnancy insulin dosages due to the carbohydrates used in the process of producing breast milk.

External version is a high-risk procedure that is performed in a

hospital setting in the event of an emergency.

Betamethasone causes

hyperglycemia in the mother, which predisposes the newborn to hypoglycemia in the first hours after delivery. It is important to check the newborn's blood glucose level within the first hour following birth and frequently thereafter until blood glucose levels are stable.

Premature infants have an increased risk of

hypoglycemia due to decreased glycogen stores and increased metabolic needs. They are typically unable to meet nutritional needs with oral intake

Clients who are pregnant and have diabetes mellitus should expect to have

increased insulin needs during the second and third trimesters of pregnancy due to placental hormones causing insulin resistance.

Clients who are pregnant and have diabetes mellitus typically need lower

insulin dosages during the first trimester of pregnancy due to hormonal changes causing an improved response to the insulin

The parent should avoid swaddling the newborn with the

legs extended, as this can cause hip dislocation. The parent should swaddle the newborn with the hips slightly flexed and enough room in the blanket for the newborn to move the knees.

The infant should be tightly swaddled with hands at

midline and legs flexed to reduce self-stimulation behaviors

Asking the client to reconsider using regional anesthetics such as epidural or spinal anesthetics does not support the client's wishes to utilize

nonpharmacological methods of pain control

The puncture is made at the

outer aspect, not the inner aspect, of the heel to help prevent necrotizing osteochondritis resulting from penetration of the bone with the lancet.

The penis should be washed gently using

plain warm water at each diaper change. Soap should be avoided until the site is healed, which is usually 5 to 7 days after the procedure.

Meconium aspiration syndrome is typically a complication of

post-term infants. Insufficient gas exchange from an aging placenta can lead to hypoxic episodes during which the fetus releases meconium into the amniotic sac.

Postpartum depression is more serious and longer-lasting than

postpartum blues. It also includes manifestations of intense fears, anxiety, and despondency

Saturated perineal pads are an indication of

postpartum hemorrhage

deep tendon reflexes. 4+ can be an indication of

preeclampsia

The initiation of an oxytocin infusion should be delayed for 6 to 12 hours after the last instillation of

prostaglandin E2 gel

Fetal heart rate and contractions should be assessed continuously because

prostaglandin E2 gel can cause tachysystole and fetal distress.

Erythema toxicum is a

rash that can appear anywhere on the body of a newborn during the first 3 weeks of life. It is most frequently referred to as newborn rash, and no treatment is required.

A yellow exudate forms on a circumcision site 24 hours after the procedure. This exudate should not be

removed and will remain for 2 to 3 days. Edema or odor at the site should be reported to the provider.

Involution is the

return of the uterus to its normal prepregnancy state; this occurs after the delivery of the placenta.

Within 12 hours after delivery, the fundus

rises 1 cm (0.39 in) above the umbilicus. The fundus descends 1 to 2 cm (0.39 in 0.79 in) every 24 hours.

The nurse should expect a newborn who has congenital diaphragmatic hernia to exhibit a

scaphoid abdomen as abdominal contents have shifted into the chest cavity. decreased blood pressure and cyanosis cyanosis and respiratory distress, not petechiae.

Pancuronium is used for

skeletal muscle paralysis in newborns who are on a ventilator. Paralyzing newborns keeps them from fighting the ventilator. This

Nevus flammeus (port wine stain) is a capillary angioma below the

surface of the skin that is most commonly found on the neck or face of a newborn. It is purple or red in color, varies in size and shape, is most often seen on the face, and does not blanch.

he parent should avoid the application of petrolatum when

the Plastibell technique is used It can be applied to the glans penis for the first 24 hours after circumcision if a Gomco or Mogen clamp was used for the procedur

Cephalohematoma is a collection of blood between

the periosteum and the skull bone that does not cross the suture line. It results from trauma during birth. It appears in the first 1 to 2 days after birth and resolves in 2 to 3 weeks.

Inconsolable crying should be reported to

the provider. A newborn may fuss or cry during diaper changes and cleaning of the circumcision site until the site is healed.

Measuring the time from the end of a contraction to the beginning of the next will determine

the resting period between contractions, not their frequency

The nurse should not obtain a rectal temperature from a newborn due to

the risk for rectal perforation. The nurse should obtain an axillary temperature.

Pruritus can be controlled by

the use of antipruritic medications

A client who is scheduled to undergo an external cephalic version often receives a

tocolytic prior to the procedure to allow the uterus to relax. A relaxed uterus allows an easier version by the provider.

An Hgb of 11.5 g/dL is

within the expected reference range for a client who is pregnant.