CH 22 Nursing Management of the Postpartum Woman at Risk; CH 23 Nursing Care of the Newborn With Special Needs; CH 24 Nursing Care of the Newborn at Risk PrepU (Developmental)

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. Which action by the nurse should be implemented first? a. Call the woman's health care provider b. Assess the woman's fundus c. Begin an IV infusion of Ringer's lactate solution d. Assess the woman's vital signs

b. Assess the woman's fundus

The perinatal nurse is assessing a large-for-gestational age infant born by breech birth and notes that the infant is irritable and does not move the right arm. For what would the nurse assess? a. Brachial plexus injury b. Midclavicular fracture c. Cranial nerve trauma d. Phrenic nerve injury

b. Midclavicular fracture

Which finding is indicative of hypothermia of the preterm neonate? a. Pink skin b. Nasal flaring c. Oxygen saturation of 95% d. Regular respirations

b. Nasal flaring

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis? a. Meconium stools b. High-pitched cry c. Bloody stools d. Poor suck reflex

c. Bloody stools

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? a. "I will make handprints and footprints of the baby for you to keep." b. "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" c. "Have you named your baby yet? I would like to know your baby's name." d. "I know you are hurting, but you can have another baby in the future."

d. "I know you are hurting, but you can have another baby in the future."

The nurse is caring for a client who is at her due date. The client asks. "How long is the health care provider going to let me go?" The nurse is correct to state that typical a mother should not pass how many weeks' gestation? a. 40 weeks b. 41 weeks c. 44 weeks d. 42 weeks

d. 42 weeks

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement? a. "All congenital disorders can be diagnosed at birth." b. "Congenital defects may be caused by genetic or environmental factors." c. "Hydrocephalus may be recognized at birth." d. "Hydrocephalus may not be diagnosed until after a few weeks or months of life."

a. "All congenital disorders can be diagnosed at birth."

The nurse is caring for a client in the early stages of labor. What maternal history factors will alert the nurse to plan for the possibility of a small-for-gestational-age (SGA) newborn? Select all that apply. a. Drug use b. Asthma exacerbated during pregnancy c. Hypotension upon admission d. Pregnancy weight gain of 25lb (11kg) e. Smoking during pregnancy

a. Drug use b. Asthma exacerbated during pregnancy e. Smoking during pregnancy

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn? a. During the first 24h of life b. Between 2 and 4 days of life c. After 5 days postpartum d. Often with formula-fed babies

a. During the first 24h of life

What is a consequence of hypothermia in a newborn? a. Holds breath 25 seconds b. Respirations of 46 c. Heart rate of 126 d. Skin pink and warm

a. Holds breath 25 seconds

Which intervention is helpful for the neonate experiencing drug withdrawal? a. Place the isolette in a quiet area of the nursery b. Withhold all medications to help the liver metabolize drugs c. Dress the neonate in loose clothing so the infant will not feel restricted d. Place the isolette near the nurses station for frequent contact with health care workers

a. Place the isolette in a quiet area of the nursery

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? a. Symptom include fever, chills, malaise, and localized breast tenderness b. A breast abscess is a common complication of mastitis c. The most common pathogen is group A streptococcus (GAS) d. Mastitis usually develops in both breasts of a breastfeeding client

a. Symptom include fever, chills, malaise, and localized breast tenderness

The nurse in the NICU is caring for preterm newborns. Which guidelines are recommended for care of these newborns? Select all that apply. a. Take the newborn's temperature often b. Supply oxygen for the newborn, if necessary c. Dress the newborn in ways to preserve warmth d. Handle the newborn as much as possible e. Discourage contact with the parents to maintain asepsis f. Give the newborn a warm bath immediately

a. Take the newborn's temperature often b. Supply oxygen for the newborn, if necessary c. Dress the newborn in ways to preserve warmth

The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement? a. "Late preterm infant complications are considered minor compared to the preterm newborn." b. "A late preterm newborn may have more clinical problems compared with full-term newborns." c. "Late preterm newborns have fewer clinical problems leading to shorter hospital stays." d. "The late preterm infant is more mature and able to cope as well as a full-term infant."

b. "A late preterm newborn may have more clinical problems compared with full-term newborns."

A woman presents to her first postpartum visit reporting she does not feel well. Which findings would lead the nurse to suspect that she has developed endometritis? Select all that apply. a. Hematuria b. Pain on both sides of the abdomen c. Odorless lochia d. Leukocytosis e. Flank pain

b. Pain on both sides of the abdomen d. Leukocytosis

A newborn girl who was born at 38 weeks' gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will be placed in which classification? a. Term, small-for-gestational age and very-low-birth-weight infant b. Term, small-for-gestational-age, and low-birth-weight infant c. Late preterm and appropriate for gestational age d. Late preterm, large-for-gestational-age, and low-birth-weight infant

b. Term, small-for-gestational-age, and low-birth-weight infant

A nurse decides to perform fundal massage based on findings that support which condition? a. Uterine contraction b. Uterine atony c. Uterine subinvolution d. Uterine prolapse

b. Uterine atony

The nursing instructor is leading a discussion exploring the various conditions that can result in postpartum hemorrhage. The instructor determines the session is successful when the students correctly choose which condition is most frequently the cause of postpartum hemorrhage? a. Perineal lacerations b. Uterine atony c. Disseminated intravascular coagulation d. Hematoma

b. Uterine atony

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement? a. "Appropriate for gestational age means a newborn is born with a weight that falls in the 10th percentile." b. "Infants who are larger for gestational age at birth have fewer complications than the other groups." c. "Newborns who are appropriate for gestational age at birth have lower chance of complications than others." d. "Appropriate for gestational age describes a newborn with a weight over the 90th percentile at birth."

c. "Newborns who are appropriate for gestational age at birth have lower chance of complications than others."

A postpartum woman is developing thrombophlebitis in her right leg. Which assessment should the nurse no longer use to assess for thrombophlebitis? a. Assess for redness and warmth b. Ask if she has pain or tenderness in the lower extremities c. Ask about increased pain with weight bearing d. Dorsiflex her right foot and ask if she has pain in her calf

d. Dorsiflex her right foot and ask if she has pain in her calf