Maternity

After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at (-1) station. Based on these findings, the nurse-midwife knows that the fetal presenting part is:

1 cm above the ischial spines.

An adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by:

3 full days of elevated basal body temperature and clear, thin cervical mucus.

What is the approximate time that the blastocyst spends traveling to the uterus for implantation?

7 days Explanation: The blastocyst takes approximately 1 week to travel to the uterus for implantation.

A client tells the nurse, "I think my baby likes to hear me talk to him." When discussing neonates and stimulation with sound, which of the following would the nurse include as a means to elicit the best response?

A. High-pitched speech with tonal variations.

Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why should the nurse monitor the patient's fluid intake and output closely during oxytocin administration?

A. Oxytocin causes water intoxication.

A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client's complaint of vaginal bleeding?

Abruptio placentae

Which of the following is the most common kind of placental adherence seen in pregnant women?

Accreta

A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following?

Activity limited to bed rest.

Which of the following would the nurse in charge do first after observing a 2-cm circle of bright red bleeding on the diaper of a neonate who just had a circumcision?

Apply gentle pressure to the site with a sterile gauze pad.

A primigravida patient is admitted to the labor delivery area. Assessment reveals that she is in the early part of the first stage of labor. Her pain is likely to be most intense:

Around the pelvic girdle

During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time?

At the beginning of each fetal movement.

The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time?

Between 16 and 20 weeks' gestation.

A patient is in her last trimester of pregnancy. Nurse Vickie should instruct her to notify her primary health care provider immediately if she notices:

Blurred vision

The nurse plans to instruct the postpartum client about methods to prevent breast engorgement. Which of the following measures would the nurse include in the teaching plan?

Breastfeeding the neonate at frequent intervals.

Normal lochial findings in the first 24 hours post-delivery include:

Bright red blood

The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?

Change the client's position.

When caring for a 3-day-old neonate who is receiving phototherapy to treat jaundice, the nurse in charge would expect to do which of the following?

Check the vital signs every 2 to 4 hours.

Five hours after birth, a neonate is transferred to the nursery, where the nurse intervenes to prevent hypothermia. What is a common source of radiant heat loss?

Cool incubator walls

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis?

Doppler blood flow analysis

Which behaviors would be exhibited during the letting-go phase of maternal role adaptation. Select all that apply.

Emergence of the family unit. Sexual intimacy continues. Defining one's individual roles.

A new mother is having trouble breastfeeding her newborn. The child is making frantic rooting motions and will not grasp the nipple. Which intervention should the nurse implement?

Encourage the mother to stop feeding for a few minutes and comfort the infant.

A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the following would the nurse be alert?

Endometritis

A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions?

Every 15 minutes.

Immediately after delivery, the nurse-midwife assesses the neonate's head for signs of molding. Which factors determine the type of molding?

Fetal body flexion or extension

A patient in her 14th week of pregnancy has presented with abdominal cramping and vaginal bleeding for the past 8 hours. She has passed several clots. What is the primary nursing diagnosis for this patient?

Fluid volume deficit

In the past, factors to determine whether a woman was likely to have a high-risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category?

Geographic

The nurse is teaching care of the newborn to a childbirth preparation class and describes the need for administering antibiotic ointment into the eyes of the newborn. An expectant father asks, "What type of disease causes infections in babies that can be prevented by using this ointment?" Which response by the nurse is accurate?

Gonorrhea

A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:

Grapelike clusters.

When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breastfeeding success?

I support your commitment; however, you may have to supplement each feeding with formula."

When evaluating a client's knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her?

If I have blurred or double vision, I should call the clinic immediately.

A client who delivered by cesarean section 24 hours ago is using a patient-controlled analgesia (PCA) pump for pain control. Her oral intake has been ice chips only since surgery. She is now complaining of nausea and bloating, and states that because she had nothing to eat, she is too weak to breastfeed her infant. Which nursing diagnosis has the highest priority?

Impaired bowel motility related to pain medication and immobility.

With regard to small-for-gestational-age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that:

Infants with asymmetric IUGR have the potential for normal growth and development.

The multigravida mother with a history of rapid labor who is in active labor calls out to the nurse, "The baby is coming!" Which of the following would be the nurse's first action?

Inspect the perineum.

Following a precipitous delivery, examination of the client's vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?

Instructing the client to use two or more peri pads to cushion the area.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST):

Is considered to have a negative result if no late decelerations are observed with the contractions.

Which change would the nurse identify as a progressive physiological change in the postpartum period?

Lactation

After 3 days of breastfeeding, a postpartum patient reports nipple soreness. To relieve her discomfort, the nurse should suggest that she:

Lubricate her nipples with expressed milk before feeding.

A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first?

Maintain a patent airway.

What is an appropriate indicator for performing a contraction stress test?

Maternal diabetes mellitus and postmaturity.

After administering bethanechol to a patient with urine retention, the nurse in charge monitors the patient for adverse effects. Which is most likely to occur?

Nausea and Vomiting

The nurse is caring for a primigravida at about 2 months and 1-week gestation. After explaining self-care measures for common discomforts of pregnancy, the nurse determines that the client understands the instructions when she says:

Nausea and vomiting can be decreased if I eat a few crackers before rising."

A pregnant patient asks the nurse if she can take castor oil for her constipation. How should the nurse respond?

No, it can initiate premature uterine contractions."

A client with type 1 diabetes mellitus who is a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus:

Nonstress testing is performed weekly until 32 weeks' gestation.

While the client is in active labor with twins and the cervix is 5 cm dilated, the nurse observes contractions occurring at a rate of every 7 to 8 minutes in a 30-minute period. Which of the following would be the nurse's most appropriate action?

Notify the physician immediately.

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? Select all that apply.

Observe the patient for possible uterine contractions. Administer RhoGAM to the patient if she is Rh-negative.

A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective?

Perineum

A primigravida client at about 35 weeks gestation in active labor has had no prenatal care and admitted to cocaine use during the pregnancy. Which of the following persons must the nurse notify?

Physician who will attend the delivery of the infant.

When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following?

Pregnancy should be avoided for 3 months after the immunization.

A client who's admitted to labor and delivery has the following assessment findings: gravida 2 para 1, estimated 40 weeks gestation, contractions 2 minutes apart, lasting 45 seconds, vertex +4 station. Which of the following would be the priority at this time?

Preparing for immediate delivery.

When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to

Prevent seizures.

While assessing a primipara during the immediate postpartum period, the nurse in charge plans to use both hands to assess the client's fundus to:

Prevent uterine inversion.

While the postpartum client is receiving heparin for thrombophlebitis, which of the following drugs would the nurse expect to administer if the client develops complications related to heparin therapy?

Protamine sulfate

A patient with pregnancy-induced hypertension probably exhibits which of the following symptoms?

Proteinuria, headaches, double vision

Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta?

Rigid, board-like abdomen

The nurse in charge is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client?

Risk for deficient fluid volume related to hemorrhage.

After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective?

Shortens the second stage of labor.

When the nurse on duty accidentally bumps the bassinet, the neonate throws out its arms, hands open, and begins to cry. The nurse interprets this reaction as indicative of which of the following reflexes?

Startle reflex

A primigravida client at 25 weeks gestation visits the clinic and tells the nurse that her lower back aches when she arrives home from work. The nurse should suggest that the client perform:

Tailor sitting

Forty-eight hours after delivery, the nurse in charge plans discharge teaching for the client about infant care. By this time, the nurse expects that the phase of postpartum psychological adaptation that the client would be in would be termed which of the following?

Taking hold

Which of the following would be inappropriate to assess in a mother who's breastfeeding?

The baby's lips smacking.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate?

The fetus isn't in distress at this time.

For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied?

The membranes must rupture.

A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? Select all that apply

The patient can monitor fetal activity once daily for a 60-minute period and note activity. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted.

The nurse in-charge is reviewing a patient's prenatal history. Which finding indicates a genetic risk factor?

The patient has a child with cystic fibrosis.

A client at 36 weeks gestation is scheduled for a routine ultrasound prior to amniocentesis. After teaching the client about the purpose of the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction?

The ultrasound identifies blood flow through the umbilical cord

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test?

This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby.

A 31-year-old multipara is admitted to the birthing room after initial examination reveals her cervix to be at 8 cm, completely effaced (100 %), and at 0 station. What phase of labor is she in?

Transitional phase

The nurse in charge is caring for a patient who is in the first stage of labor. What is the shortest but most difficult part of this stage?

Transitional phase

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time?

Transvaginal ultrasound

A female adult patient is taking a progestin-only oral contraceptive or mini pill. Progestin use may increase the patient's risk for:

Tubal or ectopic pregnancy

During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies?

Ultrasound

While making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:

Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn.

A client who is 36 weeks pregnant comes to the clinic for a prenatal checkup. To assess the client's preparation for parenting, the nurse might ask which question?

What changes have you made at home to get ready for the baby?"

Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first?

What is your expected due date?"

While caring for a multigravida client in early labor in a birthing center, which of the following foods would be best if the client requests a snack?

Yogurt