RN Maternal Newborn Online Practice 2023 B

A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. Which of the following statements should the nurse include in the teaching?

"Ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen." The nurse should ensure that the newborn has been receiving regular feedings for at least 24 hr prior to testing. Other considerations: - The universal newborn screening is mandated by law for all newborns. Therefore, the nurse does not need to obtain informed consent prior to obtaining the specimen. - The nurse should collect a capillary blood sample via heel stick for the newborn screening. - Premature newborns have a delayed development of liver enzymes which can cause a false positive result.

A nurse is teaching a client who is in preterm labor about terbutaline. Which of the following statements by the client indicates an understanding of the teaching?

"I will have blood tests because my potassium might decrease." other Considerations: - Terbutaline is administered subcutaneously every 4 hr for no longer than 24 hr. - An adverse effect of terbutaline is hyperglycemia. - An adverse effect of terbutaline is hypokalemia. - An adverse effect of terbutaline is hypotension.

A nurse is teaching a client who is at 24 weeks of gestation regarding a 1-hr glucose tolerance test. Which of the following statements should the nurse include in the teaching?

"If this test is positive, you will be scheduled for a 3-hr glucose tolerance test." The nurse should instruct the client that if they have an elevated test result, they will be scheduled for a 3-hr glucose tolerance test. Other considerations: - Fasting is not required for a 1-hr glucose tolerance test. - Do not limit their carbohydrate intake. -Drink the glucose solution 1 hr prior to the test.

A nurse is performing a physical assessment of a newborn. Which of the following clinical findings should the nurse expect? (Select all that apply.) Heart rate 154/min Axillary temperature 36° C (96.8° F) Respiratory rate 58/min Length 43 cm (16.9 in) Weight 2,600 g (5 lb 12 oz)

- Heart rate 154/min is correct. The expected reference range for a newborn's heart rate is from 110/min to 160/min while awake. - Axillary temperature 36° C (96.8° F) is incorrect. A healthy newborn's temperature averages 37° C (98.6° F), with a range of 36.5° to 37.5° C (97.7° to 99.5° F). - Respiratory rate 58/min is correct. The expected reference range for a newborn's respiratory rate is from 30/min to 60/min. - Length 43 cm (16.9 in) is incorrect. The expected reference range for a newborn's length is from 45 to 55 cm (17.7 to 21.7 in). - Weight 2.6 kg (5 lb 12 oz) is correct. The expected reference range for a newborn's weight is from 2,500 to 4,000 g (5.5 lb to 8.8 lb).

ectopic pregnancy.

- Transvaginal ultrasound is indicated. The nurse should anticipate a prescription for a transvaginal ultrasound. A transvaginal ultrasound is useful in determining the location of the ectopic pregnancy. - Meperidine IM is contraindicated. Clients who receive methotrexate for an ectopic pregnancy should not take analgesics stronger than acetaminophen, because these medications can mask the manifestations of tubal rupture. - Repeat quantitative β-hCG level is anticipated. The quantitative β-hCG level should be repeated within 48 hr to see if the level has changed from last recording. If increased levels are identified with no intrauterine pregnancy on ultrasound, this is indicative of ectopic pregnancy. - Methotrexate IM is anticipated. The nurse should anticipate a prescription for methotrexate IM administration to prevent further embryonic cell reproduction. - Blood typing is anticipated. The nurse should also anticipate potential surgical intervention for the client; therefore, blood typing is indicated.

laparoscopic right salpingostomy Transvaginal ultrasound: No intrauterine pregnancy. Pelvic ultrasound: Right Fallopian tube- ampulla contains products of conception. Blood type B negative

-Inform the client to be NPO prior to surgery is correct. The nurse should inform the client to be NPO prior to surgery. This will prevent aspiration during surgery. -Administer Rho(D) immune globulin prior to surgery is incorrect. The nurse should administer Rho D immune globulin after surgery. The client is Rh negative and could develop antibody formation if exposed to Rh positive blood. -Prepare to administer AB positive blood products if needed is incorrect. The nurse should only administer O or B negative blood products if the client requires a blood transfusion. Any other blood types are incompatible and can cause a reaction. -Insert an 18-gauge peripheral IV prior to surgery is correct. The nurse should provide IV access prior to surgery by inserting a larger bore IV such as an 18- or 20-gauge. An IV is used to administer IV fluids or blood products during surgery. -Explain the surgical procedure to the client is incorrect. The provider is responsible for explaining the procedure to the client. The nurse is responsible for ensuring that the client is fully informed about the surgery. -Obtain a complete blood count is correct. The nurse should obtain a complete blood count to establish baseline data prior to surgery. -Verify a consent form is signed by the client is correct. The nurse should verify that the client has signed a consent form for surgery. This is mandatory prior to any surgical procedure.

A nurse is caring for a client who is at 24 weeks of gestation and has a suspected placental abruption. Which of the following laboratory tests should the nurse expect the provider to prescribe?

. Kleihauer-Betke test The nurse should expect the provider to prescribe a Kleihauer-Betke test for a client who has suspected placental abruption to determine if fetal blood is in maternal circulation. This test is useful to determine if Rho-(D) immune globulin therapy should be administered to a client who is Rh-negative. Other tests: - Lecithin/sphingomyelin (L/S) ratio is done as a part of an amniocentesis to evaluate fetal lung maturity. At approximately 32 weeks gestation, the number of lamellar bodies increases, which translates into increased surfactant present in the fetal lungs and amniotic fluid. At this point in lung maturity, the ratio of lecithin and sphingomyelin are relatively equal in concentration - Maternal alpha-fetoprotein (AFP) is a laboratory test used to assess for neural tube defects or chromosome disorders. - A progesterone serum level helps to determine if a client is pregnant and if the pregnancy is ectopic.

A nurse is caring for a client who is pregnant. Which of the following actions are the nurse's priorities? Gravida 1, Para 041 weeks of gestation Induction of labor due to postdates

Assess cervical dilation is incorrect. The nurse should plan to assess the client's cervical dilation based on the client's contraction pattern or the client's report of an urge to bear down; however, there are other actions that the nurse should take first. Administer a bolus of IV fluids is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the client's hypotension and fetal bradycardia and minimal variability. The nurse should plan to administer a bolus of IV fluids to increase the client's blood volume and improve uterine and intervillous space blood flow. Insert an indwelling urinary catheter is incorrect. The nurse should plan to insert an indwelling urinary catheter if the client is unable to empty their bladder. A full bladder can impede fetal descent through the pelvis; however, there are other actions that the nurse should take first. Reposition the client to their side is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the fetal bradycardia and minimal variability caused by decreased uteroplacental perfusion. The nurse should plan to turn the client to their side to increase cardiac output and improve uterine and intervillous space blood flow. Apply oxygen at 10 to 12 L/min by nonrebreather mask is correct. A priority intervention that the nurse should perform when using the urgent vs. nonurgent approach to client care is to address the fetal bradycardia and minimal variability caused by decreased uteroplacental perfusion. The nurse should plan to administer oxygen via nonrebreather mask to increase maternal circulating oxygen levels and improve oxygen transfer through the intervillous spaces to the fetus. Elevate the client's legs is c

A nurse is assessing a client who has preeclampsia with severe features. Which of the following manifestations should the nurse expect?

Blurred vision The nurse should identify that a client who has preeclampsia with severe features can have arteriolar vasospasms and decreased blood flow to the retina which can lead to visual disturbances, such as blurred vision, double vision, or dark spots in the visual field. Findings of preeclampsia with severe features: - Increased blood pressure of greater than 160/110 mm Hg. - Pulmonary edema - Blurred vision, double vision, or dark spots in the visual field due to decreased blood flow to the retina - hyperactive reflexes of 3+ or 4+. - urine output or oliguria of 20 mL/hr or less than 400 to 500 mL in 24 hr. This is related to decreased perfusion of the kidneys and possible glomerular damage.

GTPAL

CALCULATING DELIVERY DATE AND DETERMINING NUMBER OF PREGNANCIES FOR PREGNANT CLIENT Nägele's rule: Take the first day of the client's last menstrual cycle, subtract 3 months, and then add 7 days and 1 year, adjusting for the year as necessary. Measurement of fundal height in centimeters from the symphysis pubis to the top of the uterine fundus (between 18 and 30 weeks of gestation). Approximates the gestational age, plus or minus 2 gestational weeks. Gravidity: number of pregnancies. ● Nulligravida: a client who has never been pregnant ● Primigravida: a client in their first pregnancy ● Multigravida: a client who has had two or more pregnancies Parity: number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy, not the number of fetuses. Parity is not affected whether the fetus is born stillborn or alive. ● Nullipara: no pregnancy beyond the stage of viability ● Primipara: has completed one pregnancy to stage of viability ● Multipara: has completed two or more pregnancies to stage of viability Viability: the point in time when an infant has the capacity to survive outside the uterus. There is not a specific weeks of gestation; however, infants born between 22 to 25 weeks are considered on the threshold of viability. GTPAL acronym ● Gravidity ● Term births (37 weeks or more) ● Preterm births (from viability up to 37 weeks) ● Abortions/miscarriages (prior to viability) ● Living children

A nurse is assessing a newborn who is 12 hr old. Which of the following findings should the nurse report to the provider?

Central cyanosis Central cyanosis or mottling can indicate a potential complication and ineffective breathing or circulation and should be reported to the provider. Other considerations: - Subconjunctival hemorrhages occur as a result of capillary rupture caused by increased pressure during birth and typically resolve within 7 to 10 days of birth. - Petechia on the trunk and face can occur as a result of capillary rupture caused by increased pressure during birth and typically resolve within 2 to 3 days of birth.

A nurse is assessing a client who received carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication?

Hypertension The nurse should recognize that carboprost is a vasoconstrictor that can cause hypertension. Common adverse effects of carboprost: - Hypertension - Fever - Diarrhea

A nurse is performing a vaginal examination on a client who is in labor and observes the umbilical cord protruding from the vagina. After calling for assistance, which of the following actions should the nurse take?

Insert two gloved fingers into the vagina and apply upward pressure to the presenting part. Rationale: The nurse should quickly apply gloves and insert two fingers into the vagina toward the cervix, exerting upward pressure onto the presenting part to relieve umbilical cord compression and increase oxygenation to the fetus. Other considerations: - The nurse should place the client into a modified lateral semi-prone recumbent position, Sims' position, knee-chest position, or extreme Trendelenburg to attempt to relieve the compression of the umbilical cord. - The nurse should apply oxygen to the client at 8 to 10 L/min via nonrebreather mask. - The nurse should wrap the visible cord with a loose sterile towel saturated with warm 0.9% sodium chloride solution

A nurse in a provider's office is reviewing the medical record of a client who is in the first trimester of pregnancy. Which of the following findings should the nurse identify as a risk factor for the development of preeclampsia?

Pregestational diabetes mellitus increases a client's risk for the development of preeclampsia. Other risk factors include preexisting hypertension, renal disease, systemic lupus erythematosus, and rheumatoid arthritis. A maternal age of younger than 19 or older than 40 increases the client's risk for the development of preeclampsia. Having a BMI greater than 30 increases a client's risk for the development of preeclampsia. Multifetal gestation, rather than a single fetus pregnancy, increases a client's risk for the development of preeclampsia.

A nurse is creating a plan of care for a client who is postpartum and adheres to traditional Hispanic cultural beliefs. Which of the following cultural practices should the nurse include in the plan of care?

Protect the client's head and feet from cold air. Protecting the client's head and feet from cold air should be included in the plan of care because this is a traditional Hispanic practice during the postpartum period. - traditional Hispanic practices include delaying bathing for 14 days following birth - traditional Hispanic practices include bed rest for 3 days following birth. - traditional Hispanic practices include drinking warm beverages following birth.

A nurse is caring for a prenatal client who has parvovirus B19 (fifth disease). Which of the following actions should the nurse take?

Schedule an ultrasound examination. Rationale: The nurse should schedule serial ultrasound examinations to monitor the fetus during the pregnancy to detect the possible development of fetal hydrops. Also, the virus can cause miscarriage, intrauterine growth restriction, fetal anemia, or stillbirth. Other considerations: - Currently, there are no antiviral medications available to treat fifth disease.

A nurse is assessing a newborn who is 12 hr old. Which of the following manifestations requires intervention by the nurse?

Substernal chest retractions while sleeping Substernal chest retractions can indicate respiratory distress syndrome in the newborn. This manifestation requires further assessment and intervention by the nurse. Expected manifestation in newborns: - Acrocyanosis of the extremities - An audible murmur heard at the left sternal border - A positive Babinski reflex

A nurse is reviewing the medical record of a client who is postpartum and has preeclampsia. Which of the following findings indicate that the client has progressed to preeclampsia with severe features? Pulmonary edema Preeclampsia with severe features: - pulmonary edema - blood pressure of greater than 160/110 mm Hg - severe epigastric or right upper quadrant pain that is unresponsive to medication

The nurse should identify that a client who has preeclampsia and is experiencing pulmonary edema has progressed to preeclampsia with severe features. Blood pressure 152/98 mm Hg The nurse should identify that a blood pressure of greater than 160/110 mm Hg is an indication that the client has progressed to preeclampsia with severe features Elevated liver enzymes The nurse should identify that elevated liver enzymes is a feature of preeclampsia. In preeclampsia with severe features, the liver enzymes would be elevated, and the client would experience additional symptoms such as severe epigastric or right upper quadrant pain unresponsive to medication. Epigastric pain relieved with medication The nurse should identify that a client who has preeclampsia may experience epigastric pain due to elevated liver enzymes which is typically relieved with the administration of pain medication. A client who experiences severe epigastric or right upper quadrant pain that is unresponsive to medication may have progressed to preeclampsia with severe features.

A nurse is assessing a client who is at 38 weeks of gestation during a weekly prenatal visit. Which of the following findings should the nurse report to the provider?

Weight gain of 2.2 kg (4.8 lb) A weight gain of 2.2 kg (4.8 lb) in a week is above the expected reference range and could indicate complications. Therefore, this finding should be reported to the provider. Findings that do not need to be reported to the provider, for a client who is at 38 weeks of gestation: - A blood pressure of 136/88 mm is within the expected reference range - A regular occurrence of insomnia can be expected - Braxton Hicks contractions can be expected

A nurse is assessing a client who has gestational diabetes mellitus and is experiencing hyperglycemia. Which of the following findings should the nurse expect?

manifestation of hyperglycemia - .Increased urinary output - reports of thirst - A report of dim vision - Flushed, dry skin - Rapid breathing - nausea and vomiting, abdominal pain, constipation, drowsiness, and headaches are manifestations of hyperglycemia. Other manifestations include weak rapid pulse, fruity breath odor, urine positive for sugar and acetone, and a blood glucose level greater than 200 mg/dL. finding of hypoglycemia - Blurred or double vision - Diaphoresis or clammy skin - Shallow respirations -

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