OB Exam

A multigravid client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client statements indicates effective teaching? 1. "This method of family planning requires monthly injections." 2. "I should have my first injection during my menstrual cycle." 3. "One possible adverse effect is absence of a menstrual period." 4. "This drug will be given by subcutaneous injections."

3. With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common adverse effects. Other adverse effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses.

After teaching a primiparous client who used opiates during pregnancy about possible gastrointestinal signs and symptoms in her neonate, which of the following, if stated by the mother as common, indicates effective teaching? 1. Hypotonia. 2. Constipation. 3. Vomiting. 4. Abdominal distention.

3. Neonates experiencing opiate withdrawal have gastrointestinal problems similar to those of adults withdrawing from opiates. The neonates exhibit poor sucking, vomiting, drooling, diarrhea, regurgitation, and anorexia. In addition, they are difficult to console and difficult to feed. Because of these problems, the neonate withdrawing from opiates needs to be monitored carefully to prevent dehydration. Neonates with opiate exposure experience hypertonia, not hypotonia, due to increased central nervous system irritability. Diarrhea, not constipation, is seen in these neonates. Abdominal distention is associated with necrotizing enterocolitis, not opiate withdrawal.

Variable decelerations are typically related to: A. Cord compression B. Head compression C. Uteroplacental insufficiency Uterine hyperstimulation due to hypovolemia

A

Which of the following are true statements regarding let-down reflex? Select all that apply. A. Contractions of the myoepithelial cells forces milk into the duct system. B. Oxytocin is released in response to infant suckling and woman's emotions. C. It can occur during sexual arousal. D. It occurs multiple times during feeding session.

A, B, C, D

A neonate born at 37 weeks' gestation is determined to be small for gestational age (SGA). The most common immediate problem for this infant would be: A. Anemia B. Hypovolemia C. Hypoglycemia D. Hypocalcemia

C

A common characteristic of a premature infant is: A. Absence of lanugo B. Dry skin C. Increased flexion of arms and legs D. Transparent and red skin

D

The appropriate recommended weight gain during pregnancy for a woman with a normal BMI is: A. 10-15 lbs. B. 6-20 lbs. C. 21-25 lbs. D. 25-35 lbs.

D

When caring for a neonate weighing 4,564 g (10 lb, 1 oz) born vaginally to a of a mother with diabetes, the nurse should assess the neonate for fracture of the: 1. Clavicle. 2. Skull. 3. Wrist. 4. Rib cage.

1. Infants born to mothers with diabetes tend to be larger than average, and this neonate weighs 10 lb, 1 oz (4,564 g). The most common fractures are those of the clavicle and long bones, such as the femur. In a neonate, the skull bones are not fused and move to allow for vaginal birth, so skull fracture is rarely seen. Wrist and rib cages are rarely fractured.

A definition of menorrhagia is: A. Bleeding that is excessive in number of days and amount of bleeding B. Bleeding between periods or after menopause C. Painful menstruation D. Bleeding related to cervical dysplasia

A

Which of the following would the nurse expect as a common finding for a multiparous client giving birth to a viable neonate at 41 weeks' gestation with the aid of a vacuum extractor? 1. Caput succedaneum. 2. Cephalohematoma. 3. Maternal lacerations. 4. Neonatal intracranial hemorrhage.

1. Caput succedaneum is common after the use of a vacuum extractor to assist the client's expulsion efforts. This edema may persist up to 7 days. Vacuum extraction is not associated with cephalohematoma. Maternal lacerations may occur, but they are more common when forceps are used. Neonatal intracranial hemorrhage is a risk with both vacuum extraction and forceps births, but it is not a common finding.

Which of the following would the nurse most expect to assess in a neonate born at 28 weeks' gestation who is diagnosed with intraventricular hemorrhage (IVH)? 1. Increased muscle tone. 2. Hyperbilirubinemia. 3. Bulging fontanels. 4. Hyperactivity.

3. A common finding of IVH is a bulging fontanel. The most common site of hemorrhage is the periventricular subependymal germinal matrix, where there is a rich blood supply and where the capillary walls are thin and fragile. Rapid volume expansion, hypercarbia, and hypoglycemia contribute to the development of IVH. Other common manifestations include neurologic signs such as hypotonia, lethargy, temperature instability, nystagmus, apnea, bradycardia, decreased hematocrit, and increasing hypoxia. Seizures also may occur. Hyperbilirubinemia refers to an increase in bilirubin in the blood and may be seen if bleeding was severe.

A multiparous client who has a neonate diagnosed with hemolytic disease of the newborn asks the nurse why the neonate has developed this problem. Which of the following responses by the nurse would be most appropriate? 1. "You are Rh positive and the baby is Rh negative." 2. "You and the baby are both Rh negative." 3. "You are Rh negative and the baby is Rh positive." 4. "The baby and you are both Rh positive."

3. Hemolytic disease of the newborn is associated with Rh problems. Hemolytic disease of the newborn occurs most commonly when the mother is Rh-negative and the infant is Rh-positive. About 13% of Caucasians, 7% to 8% of people of African descent, and 1% of people of Asian descent are Rh-negative. Rh-positive cells enter the mother's Rh-negative bloodstream, and antibodies to the Rh-positive cells are produced. In a subsequent pregnancy, the antibodies cross the placenta to the Rh-positive fetus and begin the destruction of Rh- positive cells through hemolysis. This results in severe fetal anemia.

A client at 33 weeks' gestation is admitted in preterm labor. She is given betamethasone 12 mg IM every 24 hours × 2. What is the expected outcome of this drug therapy? 1. The contractions will end within 24 hours. 2. The client will give birth to a neonate without infection. 3. The client will give birth to a full-term neonate. 4. The neonate will be born with mature lungs.

4. Betamethasone is a corticosteroid that induces the production of surfactant. The pulmonary maturation that results causes the fetal lungs to mature more rapidly than normal. Because the lungs are mature, the risk of respiratory distress in the neonate is lowered but not eliminated. Betamethasone also decreases the surface tension within the alveoli. Betamethasone has no influence on contractions or carrying the fetus to full term. It also does not prevent infection.

Which of the following subjects should the nurse include when teaching the mother of a neonate diagnosed with retinopathy of prematurity (ROP) about possible treatment for complications? 1. Laser therapy. 2. Cromolyn sodium eye drops. 3. Frequent testing for glaucoma. 4. Corneal transplants.

1. Because the retina may become detached with ROP, laser therapy has been used successfully in some medical centers to treat ROP. Cromolyn sodium is used to treat seasonal allergies. ROP is not associated with glaucoma, so frequent testing is not necessary. Because the vessels of the eye are affected, not the corneas, corneal transplantation is not used.

A 1-day-old breast-fed infant has a bilirubin level that is at an intermediate risk for jaundice. Which statement by the infant's mother indicates an understanding of the teaching regarding jaundice? 1. I should breast-feed my baby as often as possible. 2. I should supplement with formula after every feeding. 3. I should discontinue breast-feeding and change to formula feeding. 4. I should place my baby in direct sunlight several times a day.

1. Jaundice in a breast-feeding infant is common and is not pathological. Mothers should be taught to breast-feed as often as possible, at least every 2 to 3 hours and until the infant is satiated. Breast-fed babies rarely need to be supplemented with formula. Mothers should be encouraged to continue breast-feeding their infants due to the numerous benefits it provides. Infants should never be placed in direct sunlight.

Which of the following best identifies the reason for assessing a neonate weighing 1,500 g at 32 weeks' gestation for retinopathy of prematurity (ROP)? 1. The neonate is at risk because of multiple factors. 2. Oxygen is being administered at a level of 21%. 3. The neonate was alkalotic immediately after birth. 4. Phototherapy is likely to be prescribed by the primary health care provider.

1. ROP, previously called retrolental fibroplasia, is associated with multiple risk factors, including high arterial blood oxygen levels, prematurity, and very low birth weight (less than 1,500 g). In the early acute stages of ROP, the neonate's immature retinal vessels constrict. If vasoconstriction is sustained, vascular closure follows, and irreversible capillary endothelial damage occurs. Normal room air is at 21%. Acidosis, not alkalosis, is commonly seen in preterm neonates, but this is not related to the development of ROP. Phototherapy is not related to the development of ROP. However, during phototherapy, the neonate's eyes should be constantly covered to prevent damage from the lights.

The primary health care provider prescribes betamethasone for a 34-year-old multigravid client at 32 weeks' gestation who is experiencing preterm labor. Previously, the client has experienced one infant death due to preterm birth at 28 weeks' gestation. The nurse explains that this drug is given for which of the following reasons? 1. To enhance fetal lung maturity. 2. To counter the effects of tocolytic therapy. 3. To treat chorioamnionitis. 4. To decrease neonatal production of surfactant.

1. Betamethasone therapy is indicated when the fetal lungs are immature. The fetus must be between 28 and 34 weeks' gestation and birth must be delayed for 24 to 48 hours for the drug to achieve a therapeutic effect. Antibiotics would be used to treat chorioamnionitis. Betamethasone is not an antagonist for tocolytic therapy. It increases, not decreases, the production of neonatal surfactant.

Four days after a vaginal birth, a client has excessive lochia rubra with clots. The physician prescribes carboprost tromethamine, 0.25 mg intramuscularly. Which statement by the client reflects the need for more teaching about carboprost? 1. "This medication may cause nausea and vomiting." 2. "This medication sometimes causes hypotension that leads to dizziness." 3. "I will also receive medication to help prevent severe diarrhea." 4. "I may run a fever after being treated with carboprost."

2. Carboprost tromethamine (Hemabate) may cause hypertension, not hypotension. More commonly carboprost tromethamine, a synthetic progastgladin, causes nausea, vomiting, diarrhea, and fever. Gastrointestinal symptoms are so common that antiemetic and antidiarreal medications are often given as a pretreatment or immediately following carboprost.

The primary health care provider prescribes an amniocentesis for a primigravid client at 35 weeks' gestation in early labor to determine fetal lung maturity. Which of the following is an indicator of fetal lung maturity? 1. Amount of bilirubin present. 2. Presence of red blood cells. 3. Barr body determination. 4. Lecithin-sphingomyelin (L/S ratio).

4. To determine fetal lung maturity, the sample of amniotic fluid will be tested for the L/S ratio. When fetal lungs are mature, the ratio should be 2:1. Bilirubin indicates hemolysis and, if present in the fluid, suggests Rh disease. Red blood cells should not appear in the amniotic fluid because their presence suggests fetal bleeding. Barr body determination is a chromosome analysis of the sex chromosomes that is sometimes used when a child is born with ambiguous genitalia.

When instilling erythromycin ointment into the eyes of a neonate 1 hour old, the nurse would explain to the parents that the medication is used to prevent which of the following? 1. Chorioretinitis from cytomegalovirus. 2. Blindness secondary to gonorrhea. 3. Cataracts from beta-hemolytic streptococcus. 4. Strabismus resulting from neonatal maturation.

2. The instillation of erythromycin into the neonate's eyes provides prophylaxis for ophthalmia neonatorum, or neonatal blindness caused by gonorrhea in the mother. Erythromycin is also effective in the prevention of infection and conjunctivitis from Chlamydia trachomatis. The medication may result in redness of the neonate's eyes, but this redness will eventually disappear. Erythromycin ointment is not effective in treating neonatal chorioretinitis from cytomegalovirus. No effective treatment is available for a mother with cytomegalovirus. Erythromycin ointment is not effective in preventing cataracts. Additionally, neonatal infection with beta-hemolytic streptococcus results in pneumonia, bacterial meningitis, or death. Cataracts in the neonate may be congenital or may result from maternal exposure to rubella. Erythromycin ointment is also not effective for preventing and treating strabismus (crossed eyes). Infants may exhibit intermittent strabismus until 6 months of age.

The primary health care provider has prescribed prostaglandin gel to be administered vaginally to a newly admitted primigravid client. Which of the following indicate that the client has had a therapeutic response to the medication? 1. Resting period of 2 minutes between contractions. 2. Normal patellar and elbow reflexes for the past 2 hours. 3. Softening of the cervix and beginning of effacement. 4. Leaking of clear amniotic fluid in small amounts.

3. Prostaglandin gel may be used for cervical ripening before the induction of labor with oxytocin. It is usually administered by catheter or suppository, or by vaginal insertion. Two to three doses are usually needed to begin the softening process. Common adverse effects include nausea, vomiting, fever, and diarrhea. Continuous fetal heart rate monitoring and close monitoring of maternal vital signs are necessary to detect subtle changes or adverse effects. Prostaglandin gel usually does not initiate contractions; therefore, the rest period between contractions will be >2 minutes. There is no need to assess reflexes based on prostaglandin use. Leaking of amniotic fluid is not caused by the use of this gel.

The nurse is assessing a cesarean section client who gave birth 12 hours ago. Findings include a distended abdomen with faint bowel sounds × 1 quadrant, fundus firm at umbilicus, lochia scant, rubra, and pain rated 2 on a scale of 1 to 10. The IV and Foley catheter have been discontinued and the client received medication 3 hours ago for pain. The client can have pain medication every 3 to 4 hours. The nurse should first: 1. Give the client pain medication. 2. Have the client use the incentive spirometry. 3. Ambulate the client from the bed to the hallway and back. 4. Encourage the client to begin caring for her baby.

3. The client should have more active bowel sounds by this time postpartum. Ambulation will encourage passing flatus and begin peristaltic action in the gastrointestinal track. Medicating the client should be evaluated prior to ambulating but it is probably too soon because the last dose was 3 hours ago and her pain assessment rating is fairly low. Pain medications should not have codeine as a component as it decreases peristaltic activity. Incentive spirometry or asking the client to turn, cough, and deep breathe are appropriate to encourage good oxygen exchange in the lungs prior to ambulation, and walking can be used concurrently with these interventions. Participating in infant care is another way to encourage the mother to move about but the primary goal would be to have her walk on the unit, a more purposeful activity.

Before placing the fetal monitoring device on a primigravid client's fundus, the nurse performs Leopold's maneuvers. When performing the third maneuver, the nurse explains that this maneuver is done for which of the following reasons? 1. To determine whether the fetal presenting part is engaged. 2. To locate the fetal cephalic prominence. 3. To distinguish between a breech and a cephalic presentation. 4. To locate the position of the fetal arms and legs.

3. The third maneuver involves grasping the lower portion of the abdomen just above the symphysis pubis between the thumb and index finger. This maneuver determines whether the fetal presenting part is engaged. The first maneuver involves facing the woman's head and using the tips of the fingers to palpate the uterine fundus. This maneuver is used to identify the part of the fetus that lies over the inlet to the pelvis. The second maneuver involves placing the palms of each hand on either side of the abdomen to locate the back of the fetus. The fourth maneuver involves placing fingers on both sides of the uterus and pressing downward and inward in the direction of the birth canal. This maneuver is done to determine fetal attitude and degree of extension and should only be done if the fetus is in the cephalic presentation.

Thirty-six hours after a vaginal birth, a multiparous client is diagnosed with endometritis due to β-hemolytic streptococcus. When assessing the client, which of the following would the nurse expect to find? 1. Profuse amounts of lochia. 2. Abdominal distention. 3. Nausea and vomiting. 4. Odorless vaginal discharge.

4. Scant and odorless vaginal discharge is associated with endometritis due to b-hemolytic streptococcus. The client also will exhibit "sawtooth" temperature spikes between 101°F and 104°F (38.3°C to 40°C), tachycardia, and chills. The classic symptom of foul- smelling lochia is not associated with this type of endometritis. Profuse and foul-smelling lochia is associated with classic endometritis from pathogens such as chlamydia or staphylococcus, not group B hemolytic streptococcus. Abdominal distention is associated with parametritis as the pelvic cellulitis advances and spreads, causing severe pain and distention. Nausea and vomiting are associated with parametritis resulting from an abscess and advancing pelvic cellulitis.

Which of the following statements is true regarding hyperbilirubinemia? A. Jaundice covers the entire body in pathological jaundice versus only the face in physiological jaundice. B. Jaundice occurs within the first 24 hours post-birth in pathological jaundice versus after 24 hours in physiological jaundice. C. Kernicterus only occurs in pathological jaundice. D. Jaundice begins to appear in term neonates when the bilirubin level is 3 mg/dL.

B

After the nurse explains to the mother of a male neonate scheduled to receive an injection of vitamin K soon after birth about the rationale for the medication, which of the following statements by the mother indicates successful teaching? 1. "My baby doesn't have the normal bacteria in his intestines to produce this vitamin." 2. "My baby is at a high risk for a problem involving his blood's ability to clot." 3. "The red blood cells my baby formed during pregnancy are destroying the vitamin K." 4. "My baby's liver is not able to produce enough of this vitamin so soon after birth."

1. For vitamin K synthesis in the intestines to begin, food and normal intestinal flora are needed. However, at birth, the neonate's intestines are sterile. Therefore, vitamin K is administered via injection to prevent a vitamin K deficiency that may result in a bleeding tendency. When administered, vitamin K promotes formation in the liver of clotting factors II, VII, IX, and X. Neonates are not normally susceptible to clotting disorders, unless they are diagnosed with hemophilia or demonstrate a deficiency of or a problem with clotting factors. Hemolysis of fetal red blood cells does not destroy vitamin K. Hemolysis may be caused by Rh or ABO incompatibility, which leads to anemia and necessitates an exchange transfusion. Vitamin K synthesis occurs in the intestines, not the liver.

A 38-year-old client at about 14 weeks' gestation is admitted to the hospital with a diagnosis of complete hydatidiform mole. Soon after admission, the nurse would assess the client for signs and symptoms of which of the following? 1. Pregnancy-induced hypertension. 2. Gestational diabetes. 3. Hypothyroidism. 4. Polycythemia.

1. Hydatidiform mole is suspected when the following are present: pregnancy-induced hypertension before the 24th week of gestation, brownish or prune-colored vaginal bleeding, anemia, absence of fetal heart tones, passage of hydropic vessels, uterine enlargement greater than expected for gestational age, and increased human chorionic gonadotropin levels. Gestational diabetes is related to an increased risk of preeclampsia and urinary tract infections, but it is not associated with hydatidiform mole. Hyperthyroidism, not hypothyroidism, occurs occasionally with hydatidiform mole. If it does occur, it can be a serious complication, possibly life-threatening to the mother and fetus from cardiac problems. Polycythemia is not associated with hydatidiform mole. Rather, anemia from blood loss is associated with molar pregnancies.

While caring for the neonate of a human immunodeficiency virus-positive mother, the nurse prepares to administer a prescribed vitamin K intramuscular injection at 1 hour after birth. Which of the following actions should the nurse do first? 1. Bathe the neonate. 2. Place the neonate under a radiant warmer. 3. Wash the injection site with povidone-iodine (Betadine) solution. 4. Wait until the first dose of antiretroviral medication is given.

1. Newborns are typically bathed 2 to 4 hours after birth when their temperatures have had time to stabilize, but early/immediate bathing is recommended for the infants of HIV-positive mothers to decrease blood exposure. Placing the neonate under the radiant warmer for the vitamin K injection is not necessary unless the neonate's temperature is subnormal. Washing the injection site with povidone-iodine before giving the injection is not necessary because of the risk for possible allergy to iodine preparations. The first dose of zidovudine is given when the newborn is 6 to 12 hours old, but vitamin K is recommended to be given within an hour of birth to be most effective. Therefore the vitamin K should not be delayed.

A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. After discussing the various causes of male infertility, the nurse determines that the male partner needs further instruction when he states which of the following as a cause? 1. Seminal fluid with an alkaline pH. 2. Frequent exposure to heat sources. 3. Abnormal hormonal stimulation. 4. Immunologic factors.

1. The client needs further instruction when he says that one cause of male infertility is decreased sperm count due to seminal fluid that has an alkaline pH. A slightly alkaline pH is necessary to protect the sperm from the acidic secretions of the vagina and is a normal finding. An alkaline pH is not associated with decreased sperm count. However, seminal fluid that is abnormal in amount, consistency, or chemical composition suggests obstruction, inflammation, or infection, which can decrease sperm production. The typical number of sperm produced during ejaculation is 400 million. Frequent exposure to heat sources, such as saunas and hot tubs, can decrease sperm production, as can abnormal hormonal stimulation. Immunologic factors produced by the man against his own sperm (autoantibodies) or by the woman can cause the sperm to clump or be unable to penetrate the ovum, thus contributing to infertility.

During an assessment of a neonate born at 33 weeks' gestation, a nurse finds and reports a heart murmur. An echocardiogram reveals patent ductus arteriosis, for which the neonate received indomethacin. An expected outcome after the administration of indomethacin to a neonate with patent ductus arteriosis is: 1. Closure of a patent ductus arteriosus. 2. Decreased bleeding time. 3. Increased gastrointestinal function. 4. Increased renal output.

1. The indication for the use of indomethacin is to close a patent ductus arteriosus. Adverse effects include decreased renal blood flow, platelet dysfunction with coagulation defects, decreased GI motility, and an increase in necrotizing enterocolitis. Thus, increased bleeding time, decreased gastrointestinal function, and decreased renal output would be expected outcomes after the administration of indomethacin.

When assessing a 34-year-old multigravid client at 34 weeks' gestation experiencing moderate vaginal bleeding, which of the following would most likely alert the nurse that placenta previa is present? 1. Painless vaginal bleeding. 2. Uterine tetany. 3. Intermittent pain with spotting. 4. Dull lower back pain.

1. The most common assessment finding associated with placenta previa is painless vaginal bleeding. With placenta previa, the placenta is abnormally implanted, covering a portion or all of the cervical os. Uterine tetany, intermittent pain with spotting, and dull lower back pain are not associated with placenta previa. Uterine tetany is associated with oxytocin administration. Intermittent pain with spotting commonly is associated with a spontaneous abortion. Dull lower back pain is commonly associated with poor maternal posture or a urinary tract infection with renal involvement.

A 34-year-old primigravid client at 39 weeks' gestation admitted to the hospital in active labor has type B Rh-negative blood. The nurse should instruct the client that if the neonate is Rh positive, the client will receive an Rh immune globulin (RHIG) injection for which of the following reasons? 1. To prevent Rh-positive sensitization with the next pregnancy. 2. To provide active antibody protection for this pregnancy. 3. To decrease the amount of Rh-negative sensitization for the next pregnancy. 4. To destroy fetal Rh-positive cells during the next pregnancy.

1. The purpose of the RhoGAM is to provide passive antibody immunity and prevent Rh-positive sensitization with the next pregnancy. It should be given within 72 hours after birth of an Rh-positive neonate. Clients who are Rh-negative and conceive an Rh- negative fetus do not need antibody protection. Rh-positive cells contribute to sensitization, not Rh-negative cells. The RhoGAM does not cross the placenta and destroy fetal Rh-positive cells.

Which of the following instructions should the nurse give to the parents of a neonate diagnosed with hyperbilirubinemia who is receiving phototherapy? 1. Keep the neonate's eyes completely covered. 2. Use a regular diaper on the neonate. 3. Offer feedings every 4 hours. 4. Check the oral temperature every 8 hours.

1. To prevent eye damage from phototherapy, the eyes must remain covered at all times while under the lights. The eye patches can be removed when the neonate is held out of the lights by the parents for feeding. Instead of a regular diaper, a "string" diaper or disposable face mask may be used to help contain loose stools, while allowing maximum skin exposure. Feeding formula or breast milk every 2 to 3 hours is recommended to prevent hypoglycemia and to encourage gastrointestinal motility. Because the phototherapy lights can overheat the neonate, the temperature should be checked by the axillary route every 2 to 4 hours.

When preparing a multigravid client who has undergone evacuation of a hydatidiform mole for discharge, the nurse explains the need for follow-up care. The nurse determines that the client understands the instruction when she says that she is at risk for developing which of the following? 1. Ectopic pregnancy. 2. Choriocarcinoma. 3. Multi-fetal pregnancies. 4. Infertility.

2. A client who has had a hydatidiform mole removed should have regular checkups to rule out the presence of choriocarcinoma, which may complicate the client's clinical picture. The client's human chorionic gonadotropin (hCG) levels are monitored for 1 year. During this time, she should be advised not to become pregnant because this would be reflected in rising hCG levels. Ectopic or multifetal pregnancy is not associated with hydatidiform mole. Women who have molar pregnancies have fertility rates similar to the general population.

Which statement by the client indicates an understanding of the teaching regarding the use of magnesium sulfate and corticosteroids for preterm labor? 1. "I will be on magnesium sulfate and corticosteroids until my baby's due date, so he has the best chance of doing well." 2. "The magnesium sulfate is to stop contractions while the corticosteroids increase lung surfactant in my baby so he can breathe better if he is born early." 3. "The goal of the magnesium sulfate and the corticosteroids is to stop contractions and help me get to my due date." 4. "If I take this magnesium sulfate and the corticosteroids, my baby won't have to spend any time in the neonatal intensive care unit if he is born."

2. Corticosteroids given IM have been shown to increase fetal lung surfactant and reduce the risk of respiratory distress syndrome in premature infants. It is not a guarantee that a premature newborn would not have problems at birth that would require time in the neonatal intensive care unit. The administration of the corticosteroids is normally completed within 24 to 48 hours. Magnesium sulfate is currently given IV to women in preterm labor to stop contractions and therefore prolong gestation long enough for the corticosteroids to be most effective for the fetus. Magnesium sulfate is not always effective at stopping preterm labor.

Carboprost (Hemabate) was injected into the uterus of a client to treat uterine atony during a cesarean section. In preparing to care for this client postpartum, the nurse should assess the client for which of the following common adverse effects of the medication? 1. Vertigo and confusion. 2. Nausea and diarrhea. 3. Restlessness and increased vaginal bleeding. 4. Headache and hypertension.

2. Hemabate is an oxytocic prostaglandin that causes uterine contraction in women who are bleeding heavily. Nausea, vomiting, diarrhea, and fever are common adverse effects of prostaglandin administration. Vertigo and confusion are not associated with this drug. Vaginal bleeding may occur with inadequate amounts of Hemabate if the client continues to bleed. Restlessness may result if inadequate amounts of Hemabate are used and the woman continues to bleed and goes into shock. If too large a dose is given, the client may experience headache and hypertension because Hemabate does contract smooth muscles.

When performing Leopold's maneuvers on a primigravid client at 22 weeks' gestation, the nurse performs the first maneuver to do which of the following? 1. Locate the fetal back and spine. 2. Determine what is in the fundus. 3. Determine whether the fetal head is at the pelvic inlet. 4. Identify the degree of fetal descent and flexion.

2. In the first maneuver, which is done with the nurse facing the client's head, both hands are used to palpate and determine which fetal body part (eg, the head or buttocks) is in the fundus. This first maneuver helps to determine the presenting part of the fetus. In the second maneuver, also done with the nurse facing the client's head, the palms of both hands are used to palpate the sides of the uterus and determine the location of the fetal back and spine. In the third maneuver, one hand gently grasps the lower portion of the abdomen just above the symphysis pubis to determine whether the fetal head is at the pelvic inlet. The fourth maneuver, done with the nurse facing the client's feet, determines the degree of fetal descent and flexion into the pelvis.

While assessing a neonate weighing 3,175 g (7 lb) who was born at 39 weeks' gestation to a primiparous client who admits to opiate use during pregnancy, which of the following would alert the nurse to possible opiate withdrawal? 1. Bradycardia. 2. High-pitched cry. 3. Sluggishness. 4. Hypocalcemia.

2. Manifestations of opiate withdrawal in the neonate include an increased central nervous system irritability, such as a shrill, high-pitched cry, gastrointestinal symptoms, and metabolic, vasomotor, and respiratory disturbances. These signs usually appear within 72 hours and persist for several days. These neonates are difficult to console, have poor feeding behaviors, and have diarrhea. Bradycardia is associated with preterm neonates. Sluggishness and lethargy are associated with neonates whose mothers received analgesia shortly before birth. Hypocalcemia occurs most commonly in infants of mothers with diabetes, premature infants, and low-birth-weight infants.

A woman who is Rh-negative has given birth to an Rh-positive infant. The nurse explains to the client that she will receive Rho (D) Immune Globulin (RhoGAM). The nurse determines that the client understands the purpose of RhoGAM when she states: 1. "RhoGAM will protect my next baby if it is Rh-negative." 2. "RhoGAM will prevent antibody formation in my blood." 3. "RhoGAM will be given to prevent German measles." 4. "RhoGAM will be used to prevent bleeding in my newborn."

2. RhoGAM is given to new mothers who are Rh-negative and not previously sensitized and who have given birth to an Rh- positive infant. RhoGAM must be given within 72 hours of the birth of the infant because antibody formation begins at that time. The vaccine is used only when the mother has borne an Rh-positive infant—not an Rh-negative infant. RhoGAM does not prevent German measles and is not given to a newborn.

After receiving change of shift report in the normal newborn nursery, which neonate should the nurse see first? 1. Neonate A, 1/2 hour of age with intermittent respiratory grunting. 2. Neonate B, 4 hours of age with a blood glucose of 30 (1.7 mmol/L). 3. Neonate C, 12 hours of age with a temperature of 97.4 (36.4 °C). 4. Neonate D, 24 hours of age with no urine output for past 12 hours.

2. The blood glucose of 30 (1.7 mmol/L) is the most critical. Glucose is the only fuel that the brain can use. It is important to protect the central nervous system and levels less than 40 (2.2 mmol/L) in a neonate indicate hypoglycemia. Grunting at 1⁄2 hour of age may be normal transitioning to extrauterine life. A temperature of 97.4 (36.4 °C) is only slightly low for a neonate at this age. Ninety five percent of all neonates will void at least once in the first 24 hours. This is not unusual at this age.

A multigravid client diagnosed with chronic hypertension is now in preterm labor at 34 weeks' gestation. The primary health care provider has prescribed magnesium sulfate at 3 g/h. Which assessment finding indicates that the intended therapeutic effect has occurred? 1. Decrease in fetal heart rate accelerations. 2. Decrease in the frequency and number of contractions. 3. Decrease in maternal blood pressure rate. 4. Decrease in maternal respiratory rate.

2. The intended effect for this client is to decrease the number and frequency of contractions. Even though this client has chronic hypertension, the first goal is to prevent childbirth in a 34 weeks' gestation client. If the blood pressure moves into the therapeutic range, that is a benefit for the client but it is not the major goal. Magnesium sulfate may decrease the accelerations found in this fetus as it decreases the ability of the infant to respond, acting on the infant in the same way it does on the mother. Maternal respiratory rate may also decrease, and a lower respiratory rate to 12 respirations/minute indicates that this level of magnesium sulfate is becoming toxic to this client.

The nurse has received a shift report on a group of newborns. The nurse should make rounds on which of the following clients first? 1. A newborn who is large for gestational age (LGA) who needs a repeat blood glucose prior to the next feeding in 15 minutes. 2. A neonate born at 36 weeks' gestation weighing 5 lb (2,270 g) who is due to breast-feed for the first time in 15 minutes. 3. A neonate who was born 24 hours ago by cesarean section and had a respiratory rate of 62, 30 minutes ago. 4. A newborn who had a borderline low temperature and was double-wrapped with a hat 1⁄2 hour ago to bring up the temperature.

3. The nurse should make rounds and first assess the neonate with the respiratory rate of 62. The respiratory rate is out of the normal range and needs reevaluation. The newborn who is LGA still has 15 minutes before being due for the feeding and much can be accomplished by the nurse in that time. A 36-week newborn weighing 5 lb (2,270 g) will need to be fed on time to maintain the blood glucose level. The nurse should next assess the infant with a borderline low temperature to determine if his body temperature is increasing.

The physician prescribes an intramuscular injection of vitamin K for a term neonate. The nurse explains to the mother that this medication is used to prevent which of the following? 1. Hypoglycemia. 2. Hyperbilirubinemia. 3. Hemorrhage. 4. Polycythemia.

3. Vitamin K acts as a preventive measure against neonatal hemorrhagic disease. At birth, the neonate does not have the intestinal flora to produce vitamin K, which is necessary for coagulation. Hypoglycemia is prevented and treated by feeding the infant. Hyperbilirubinemia severity can be decreased by early feeding and passage of meconium to excrete the bilirubin. Hyperbilirubinemia is treated with phototherapy. Polycythemia may occur in neonates who are large for gestational age or postterm. Clamping of the umbilical cord before pulsations cease reduces the incidence of polycythemia. Generally, polycythemia is not treated unless it is extremely severe.

A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure? 1. "IVF requires supplemental estrogen to enhance the implantation process." 2. "The pregnancy rate with IVF is higher than that with gamete intrafallopian transfer." 3. "IVF involves bypassing the blocked or absent fallopian tubes." 4. "Both ova and sperm are instilled into the open end of a fallopian tube."

3.The client's understanding of the procedure is demonstrated by the statement describing IVF as a technique that involves bypassing the blocked or absent fallopian tubes. The primary health care provider removes the ova by laparoscope- or ultrasound-guided transvaginal retrieval and mixes them with prepared sperm from the woman's partner or a donor. Two days later, up to four embryos are returned to the uterus to increase the likelihood of a successful pregnancy. Supplemental progesterone, not estrogen, is given to enhance the implantation process. Gamete intrafallopian transfer (GIFT) and tubal embryo transfer have a higher pregnancy rate than IVF. However, these procedures cannot be used for clients who have blocked or absent fallopian tubes because the fertilized ova are placed into the fallopian tubes, subsequently entering the uterus naturally for implantation. In IVF, fertilization of the ova by the sperm occurs outside the client's body. In GIFT, both ova and sperm are implanted into the fallopian tubes and allowed to fertilize within the woman's body.

A multiparous client, 28 hours after cesarean birth, who is breast-feeding has severe cramps or afterpains. The nurse explains that these are caused by which of the following? 1. Flatulence accumulation after a cesarean birth. 2. Healing of the abdominal incision after cesarean birth. 3. Adverse effects of the medications administered after birth. 4. Release of oxytocin during the breast-feeding session.

4. Breast-feeding stimulates oxytocin secretion, which causes the uterine muscles to contract. These contractions account for the discomfort associated with afterpains. Flatulence may occur after a cesarean birth. However, the mother typically would have abdominal distention and a bloating feeling, not a "cramplike" feeling. Stretching of the tissues or healing may cause slight tenderness or itching, not cramping feelings of discomfort. Medications such as mild analgesics or stool softeners, commonly administered postpartum, typically do not cause cramping.

The nurse is reviewing discharge instructions with a postpartum breast-feeding client who is going home. She has chosen medroxyprogesterone (Depo-Provera) as birth control. Which statement by the client identifies that she needs further instruction concerning birth control? 1. "I will wait for my 6-week checkup to get my first Depo-Provera shot." 2. "Depo-Provera injections last for 90 days." 3. "My milk supply should be well established before using Depo-Provera." 4. "You will give me my first Depo-Provera shot before I leave today."

4. Depo-Provera is a progestin contraceptive that can reduce the initial production of breast milk. It is given to a breast-feeding woman when she returns for the 6-week postpartum checkup. By this time, the milk supply is well established and will remain at that level. Depo-Provera is effective as a contraceptive for 90 days. Clients who are bottle-feeding may be given Depo-Provera prior to discharge from the hospital.

While caring for a neonate born at 32 weeks' gestation, the nurse assesses the neonate daily for symptoms of necrotizing enterocolitis (NEC). Which of the following would alert the nurse to notify the neonatologist? 1. The presence of 1 mL of gastric residual before a gavage feeding. 2. Jaundice appearing on the face and chest. 3. An increase in bowel peristalsis. 4. Abdominal distention.

4. Indications of NEC include abdominal distention with gastric retention and vomiting. Other signs may include lethargy, irritability, positive blood culture in stool, absent or diminished bowel sounds, apnea, diarrhea, metabolic acidosis, and unstable temperature. A gastric residual of 1 mL is not significant. Jaundice of the face and chest is associated with the neonate's immature liver function and increased bilirubin, not NEC. Typically with NEC, the neonate would exhibit absent or diminished bowel sounds, not increased peristalsis.

During a home visit on the fourth postpartum day, a primiparous client tells the nurse that she is aware of a "let-down sensation" in her breasts and asks what causes it. The nurse explains that the let-down sensation is stimulated by which of the following? 1. Adrenalin. 2. Estrogen. 3. Prolactin. 4. Oxytocin.

4. Oxytocin stimulates the let-down reflex when milk is carried to the nipples. A lactating mother can experience the let-down reflex suddenly when she hears her baby cry or when she anticipates a feeding. Some mothers have reported feeling the let-down reflex just by thinking about the baby. Adrenalin may increase if the mother is excited, but this hormone has no direct influence on breast- feeding. Estrogen influences development of female secondary sex characteristics and controls menstruation. Prolactin stimulates milk production.

During a scheduled cesarean birth of a primigravid client with a fetus at 39 weeks' gestation in a breech presentation, a neonatologist is present in the operating room. The nurse explains to the client that the neonatologist is present because neonates born by cesarean birth tend to have an increased incidence of which of the following? 1. Congenital anomalies. 2. Pulmonary hypertension. 3. Meconium aspiration syndrome. 4. Respiratory distress syndrome.

4. Respiratory distress syndrome is more common in neonates born by cesarean section than in those born vaginally. During a vaginal birth, pressure is exerted on the fetal chest, which aids in the fetal inhalation and exhalation of air and lung expansion. This pressure is not exerted on the fetus with a cesarean birth. Congenital anomalies are not more common with cesarean birth. Pulmonary hypertension occurs more commonly in infants with meconium aspiration syndrome, congenital diaphragmatic hernia, respiratory distress syndrome, or neonatal sepsis, not with cesarean birth. Meconium aspiration syndrome occurs more commonly with vaginal birth, postterm neonate, and prolonged labor, not with cesarean birth.

A male neonate born at 36 weeks' gestation is admitted to the neonatal intensive care nursery with a diagnosis of probable fetal alcohol syndrome (FAS). The mother visits the nursery soon after the neonate is admitted. Which of the following instructions should the nurse expect to include when developing the teaching plan for the mother about FAS? 1. Withdrawal symptoms usually do not occur until 7 days postpartum. 2. Large-for-gestational-age size is common with this condition. 3. Facial deformities associated with FAS can be corrected by plastic surgery. 4. Symptoms of withdrawal include tremors, sleeplessness, and seizures.

4. The long-term prognosis for neonates with FAS is poor. Symptoms of withdrawal include tremors, sleeplessness, seizures, abdominal distention, hyperactivity, and inconsolable crying. Symptoms of withdrawal commonly occur within 6 to 12 hours or, at the latest, within the first 3 days of life. The neonate with FAS is usually growth deficient at birth. Most neonates with FAS are mildly to severely mentally retarded. The facial deformities, such as short palpebral fissures, epicanthal folds, broad nasal bridge, flattened midface, and short, upturned nose, are not easily corrected with plastic surgery.

The nurse determines that a newborn is hypoglycemic based on which of the following findings? Select all that apply. 1. A blood glucose reading of less than 30 mg/dL (1.7 mmol/L) at 1 hour. 2. Family history of insulin-dependent diabetes. 3. Internal fetal monitor tracing. 4. Irregular respirations, tremors, and hypothermia. 5. Large for gestational age.

1, 4. A blood glucose reading at or below 30 mg/dL (1.7 mmol/L) within 2 hours of birth and irregular respirations, tremors, and hypothermia are indicative of hypoglycemia. Blood glucose should be 45 mg/dL (2.5 mmol/L) by 24 hours of age. Internal fetal monitors detect the strength of contractions and the fetal heart rate. An infant of an insulin-dependent mother and a large-for-gestational-age infant are at greater risk of developing hypoglycemia and need to be observed carefully but these findings are not definitive for the diagnosis of hypoglycemia.

When teaching a primiparous client who used cocaine during pregnancy how to comfort her fussy neonate, the nurse can advise the mother to: 1. Tightly swaddle the neonate. 2. Feed the neonate extra, high-calorie formula. 3. Keep the neonate in a brightly lit environment. 4. Touch the baby only when he is crying.

1. A neonate undergoing cocaine withdrawal is irritable, often restless, difficult to console, and often in need of increased activity. It is commonly helpful to swaddle the neonate tightly with a blanket, offer a pacifier, and cuddle and rock the neonate. Offering extra nourishment is not advised because overfeeding tends to increase gastrointestinal problems such as vomiting, regurgitation, and diarrhea. Environmental stimuli such as bright lights and loud noises should be kept to a minimum to decrease agitation. Minimizing touching of the neonate to only when he or she is crying will not aid the bonding process between mother and neonate. Frequent holding and touching are permissible.

A nurse is assessing a preterm baby with a gestational age of 32 weeks and birth weight of 1,389 grams. Which of the following signs if present would be a possible indication of RDS? A. Expiratory grunting and intercostal retractions B. Respiratory rate of 46 breaths per minute and presence of acrocyanosis C. Mild nasal flaring and heart rate of 140 beats per minute D. Bradycardia and bounding pulse

A

Which is not a risk to the infant of a diabetic mother? A. Hyperglycemia B. Poor feeding C. Macrosomia D. Respiratory distress

A

Clinical management strategies for prevention of retinopathy of prematurity (ROP) focus on targeting appropriate _____________ ranges for infants at risk. A. Arterial pH B. Oxygen saturation C. Heart rate D. Core temperature

B

During a routine assessment of a 60-year-old woman in the women's health clinic, the nurse notes numerous bruises at various stages of healing on the woman's chest and abdomen. The first nursing action is: A. Complete a fall risk assessment B. Question the woman about her relationship with her partner C. Question her about medications that can cause bruising D. Assess for vertigo

B

Hypoglycemia is defined as a blood glucose below: A. 60 mg/dL B. 70 mg/dL C. 80 mg/dL D. 90 mg/dL

B

Heat loss through evaporation can be reduced by: A. Closing the door to the room B. Using warming equipment on the neonate C. Drying the neonate D. Placing the crib near a warm wall

C

The primary risk factor for necrotizing enterocolitis (NEC) is: A. Early oral feedings with formula B. Passage of meconium during labor C. Prematurity D. Low birth weight

C