MAT (3)
16. When evaluating the preterm infant, the nurse understands that compared with the term infant, what information is important for the nurse to understand? a. Few blood vessels visible through the skin b. More subcutaneous fat c. Well-developed flexor muscles d. Greater surface area in proportion to weight
D
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurse's first priority? a. Leave the infant in the room with the mother. b. Immediately take the infant to the nursery. c. Perform a gestational age assessment to determine whether the infant is large for gestational age. d. Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia
D
A nulliparous woman experiencing a postterm pregnancy is admitted for labor induction. Assessment reveals a Bishop score of 9. The nurse should: A. Call the woman's primary health care provider to order a cervical ripening agent B. Mix 20 units of oxytocin (Pitocin) in 500 mL of 5% glucose in water C. Piggyback the oxytocin solution into the port nearest the drip chamber of the primary IV tubing D. Begin the infusion at a rate of 1 milliunit/minute as determined by the induction protocol
D
A nurse is caring for a pregnant woman at 30 weeks of gestation in preterm labor. The woman's physician orders betamethasone 12 mg IM for two doses, with the first dose to begin at 11 am. In implementing this order the nurse should: A. Consult the physician, because the dose is too high B. Explain to the woman that this medication will reduce her heart rate and help her to breathe easier C. Prepare to administer the medication intravenously between contractions D. Schedule the second dose for 11 am on the next day
D
A postpartum woman in the fourth stage of labor received prostaglandin F2α (Hemabate) 0.25 mg intramuscularly. The expected outcome of care for the administration of this medication is: A. Relief from the pain of uterine cramping B. Prevention of intrauterine infection C. Reduction in the blood's ability to clot D. Limitation of excessive blood loss that is occurring after birth
D
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performedNforRfaiIlureGto pBr.ogCressM. The fetal heart rate (FHR) before birth is USNT O 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn's distress? a. Hypoglycemia b. Phrenic nerve injury c. Respiratory distress syndrome d. Sepsis
D
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring? a. Estriol is not found in maternal saliva. b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2
D
If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be appropriate to correct the cause of this condition? a. Hysterectomy b. Laparoscopy c. Laparotomy d. Dilation and curettage (D&C)
D
The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client? a. Because all women must be considered at risk for preterm labor and prediction is so variable, teaching pregnant women the symptoms of preterm labor probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change
D
A breastfeeding woman asks the nurse about a reliable and safe method of birth control she should use during the postpartum period. The best recommendation for a safe yet effective method during the first 6 weeks after birth is: A. Combination oral contraceptive that she used before she was pregnant B. Barrier method using a combination of a condom and spermicide foam C. The diaphragm she used prior to getting pregnant D. Complete breastfeeding—baby only receives breast milk for nourishment
B
A number of methods can be used for inducing labor. Which cervical ripening method falls under the category of mechanical or physical? a. Prostaglandins are used to soften and thin the cervix. b. Labor can sometimes be induced with balloon catheters or laminaria tents. c. Oxytocin is less expensive and more effective than prostaglandins but creates greater health risks. d. Amniotomy can be used to make the cervix more favorable for labor
B
The nurse should teach breastfeeding mothers about breast care measures to preserve the integrity of the nipples and areola. What should the nurse include in these instructions? A. Cleanse nipples and areola twice a day with mild soap and water. B. Apply vitamin E cream to nipples and areola at least four times each day before a feeding. C. Insert plastic-lined pads into the bra to absorb leakage and protect clothing. D. Apply modified lanolin to both dry and sore nipples.
D
When would an internal version be indicated to manipulate the fetus into a vertex position? a. Fetus from a breech to a cephalic presentation before labor begins b. Fetus from a transverse lie to a longitudinal lie before a cesarean birth c. Second twin from an oblique lie to a transverse lie before labor begins d. Second twin from a transverse lie to a breech presentation during a vaginal birth
D
Which assessment is least likely to be associated with a breech presentation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Postterm gestation
D
A primiparous woman is watching her newborn sleep. She wants him to wake up and respond to her. The mother asks the nurse how much he will sleep every day. What is an appropriate response by the nurse? a. "He will only wake up to be fed, and you should not bother him between feedings." b. "The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing." c. "He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon." d. "He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night."
B
In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? a. NEC b. ROP c. BPD d. Intraventricular hemorrhage (IVH)
B
Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses, followed by 10 to 15 seconds of compensatory rapid respiration, be experiencing? a. Suffering from sleep or wakeful apnea b. Experiencing severe swings in blood pressure c. Trying to maintain a neutral thermal environment d. Breathing in a respiratory pattern common to premature infants
D
Which infant response to cool environmental conditions is either not effective or not available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position
D
Which statement related to the induction of labor is most accurate? a. Can be achieved by external and internal version techniques b. Is also known as a trial of labor (TOL) c. Is almost always performed for medical reasons d. Is rated for viability by a Bishop score
D
Methylergonovine (Methergine) 0.2 mg is ordered for a woman who gave birth vaginally 1 hour ago; it is to be ad-ministered intramuscularly to treat a profuse lochial flow with clots. Her fundus is boggy and does not respond well to massage. She is still being treated for preeclampsia with IV magnesium sulfate at 1 g/hour. Her blood pressure (BP), measured 5 minutes ago, was 155/98 mm Hg. In fulfilling this order, the nurse should: A. Measure the woman's blood pressure again 5 minutes after administering the medication B. Question the order, based on the woman's hypertensive status C. Administer the methylergonovine because it is the best choice to counteract the possible uterine relaxation effects of the magnesium sulfate infusion the woman is receiving D. Tell the woman that the medication will lead to uterine cramping
B
The condition which infants are at an increased risk for during subgaleal hemorrhage is called what? a. Infection b. Jaundice c. Caput succedaneum d. Erythema toxicum neonatorum
B
The nurse is circulating during a cesarean birth of a preterm infant. The obstetrician requests that cord clamping be delayed. What is the rationale for this directive? a. To reduce the risk for jaundice b. To reduce the risk of intraventricular hemorrhage c. To decrease total blood volume d. To improve the ability to fight infection
B
The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth, preterm labor, and low birth weight. Which statement regarding this terminology is correct? a. Terms preterm birth and low birth weight can be used interchangeably. b. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. c. Low birth weight is a newborn who weighs below 3.7 pounds. d. Preterm birth rate in the United States continues to increase
B
What is the rationale for evaluating the plantar crease within a few hours of birth? a. Newborn has to be footprinted. b. As the skin dries, the creases will become more prominent. c. Heel sticks may be required. d. Creases will be less prominent after 24 hours
B
When caring for a preterm infant at 30 weeks of gestation, the nurse should recognize that the newborn's primary nursing diagnosis is: A. Risk for infection related to decreased immune response B. Ineffective breathing pattern related to surfactant deficiency and weak respiratory muscle effort C. Ineffective thermoregulation related to immature thermoregulation center D. Imbalanced nutrition: less than body requirements related to ineffective suck and swallow
B
Which cardiovascular changes cause the foramen ovale to close at birth? a. Increased pressure in the right atrium b. Increased pressure in the left atrium c. Decreased blood flow to the left ventricle d. Changes in the hepatic blood flow
B
Which client is at greatest risk for early PPH? a. Primiparous woman (G 2, P 1-0-0-1) being prepared for an emergency cesarean birth for fetal distress b. Woman with severe preeclampsia on magnesium sulfate whose labor is being induced c. Multiparous woman (G 3, P 2-0-0-2) with an 8-hour labor d. Primigravida in spontaneous labor with preterm twins
B
Which information about variations in the infant's blood counts is important for the nurse to explain to the new parents? a. A somewhat lower-than-expected red blood cell count could be the result of a delay in clamping the umbilical cord. b. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease. c. Platelet counts are higher in the newborn than in adults for the first few months. d. Even a modest vitamin K deficiency means a problem with the blood's ability to properly clot.
B
Which instruction should the nurse provide to reduce the risk of nipple trauma? a. Limit the feeding time to less than 5 minutes. b. Position the infant so the nipple is far back in the mouth. c. Assess the nipples before each feeding. d. Wash the nipples daily with mild soap and water.
B
Which nursing intervention is pUaraSmouNnt Twhen prOoviding care to a client with preterm labor who has received terbutaline? a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia
B
With regard to infants who are SGA and intrauterine growth restriction (IUGR), the nurse should be aware of which information? a. In the first trimester, diseases or abnormalities result in asymmetric IUGR. b. Infants with asymmetric IUGR have the potential for normal growth and development. c. In asymmetric IUGR, weight is slightly larger than SGA, whereas length and head circumference are somewhat less than SGA. d. Symmetric IUGR occurs in the later stages of pregnancy
B
A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement? a. Skip feedings to enable her sore breasts to rest. b. Avoid using a breast pump. c. Breastfeed her infant every 2 hours. d. Reduce her fluid intake for 24 hours.
C
A first-time dad is concerned thUat hSis 3N-daTy-old dOaughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? a. Physiologic jaundice occurs during the first 24 hours of life. b. Physiologic jaundice is caused by blood incompatibilities between the mother and the infant blood types. c. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life. d. Physiologic jaundice is also known as breast milk jaundice
C
A new breastfeeding mother asks the nurse how to prevent nipple soreness. The nurse tells this woman that the key to preventing sore nipples is: A. Limiting the length of breastfeeding to no more than 10 minutes on each breast until the milk comes in B. Applying lanolin to each nipple and areola after each feeding C. Using correct technique for latch-on and removal from the breast D. Using breast shells to protect the nipples and areola between feedings
C
A newborn is placed under a radiant heat warmer. The nurse understands that thermoregulation presents a problem for the newborn. What is the rationale for this difficulty? a. The renal function of a newborn is not fully developed, and heat is lost in the urine. b. The small body surface area of a newborn favors more rapid heat loss than does an adult's body surface area. c. Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation. d. Their normal flexed posture favors heat loss through perspiration
C
A physician has ordered that dinoprostone (Cervidil) be administered to ripen a pregnant woman's cervix in prepa-ration for an induced labor. In fulfilling this order, the nurse should: A. Insert the dinoprostone in the cervical canal just below the internal os B. Tell the woman to remain in bed for at least 15 minutes C. Observe the woman for signs of uterine tachysystole D. Remove the dinoprostone as soon as the woman begins to experience uterine contractions
C
1. A bishops score of 8 or above (13) indicates what type of birth is expected? What if it's lower than 6?
1. Vaginal birth (induced or spontaneous) with cervical ripening , if lower then that means vaginal birth is inducible with cervical ripening agents
A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing precipitous labor
C
A woman has determined that bottle-feeding is the best feeding method for her. Instructions that the woman shouldreceive regarding this feeding method include: A. Check nipple before feeding to ensure that it allows passage of formula in a slow stream. B. Sterilize water by boiling; then cool and mix with formula powder or concentrate. C. Expect a 2-week-old newborn to drink approximately 90 to 150 mL of formula at each feeding D. Microwave refrigerated formula for about 2 minutes before feeding the newborn.
C
A woman is having her first child. She has been in labor for 15 hours. A vaginal examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part of the fetus was at station 0; however, another vaginal examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is associated with this description? a. Prolonged latent phase b. Protracted active phase c. Secondary arrest d. Protracted descent
C
By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress? a. Decreased respiratory rate b. Bradycardia, followed by an increased heart rate c. Mottled skin with acrocyanosis d. Increased physical activity
C
For an infant experiencing symptoms of drug withdrawal, which intervention should be included in the plan of care? a. Administering chloral hydrate for sedation b. Feeding every 4 to 6 hours to allow extra rest between feedings c. Snugly swaddling the infant and tightly holding the baby d. Playing soft music during feeding
C
In planning for home care of a woman with preterm labor, which concern should the nurse need to address? a. Nursing assessments are different from those performed in the hospital setting. b. Restricted activity and medications are necessary to prevent a recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers are necessary
C
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration? a. To enhance uteroplacental perfusion in an aging placenta b. To increase amniotic fluid volume c. To ripen the cervix in preparation for labor induction d. To stimulate the amniotic membranes to rupture
C
Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant? a. Pharmacologic treatment b. Reduction of environmental stimuli c. Neonatal abstinence syndrome (NAS) scoring d. Adequate nutrition and maintenance of fluid and electrolyte balance
C
The nurse is cognizant of which information related to the administration of vitamin K? a. Vitamin K is important in the production of red blood cells b. Vitamin K is necessary in the production of platelets. c. Vitamin K is not initially synthesized because of a sterile bowel at birth. d. Vitamin K is responsible for the breakdown of bilirubin and the prevention of jaundice
C
The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum-assisted delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the care of this neonate? a. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant. b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia. c. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests. d. Spinal cord injuries almost always result from vacuum-assisted deliveries.
C
What is the primary purpose for the use of tocolytic therapy to suppress uterine activity? a. Drugs can be efficaciously administered up to the designated beginning of term at 37 weeks gestation. b. Tocolytic therapy has no important maternal (as opposed to fetal) contraindications. c. The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytic therapy, then intravenous (IV) fluids should be given
C
When assessing a newborn after birth, the nurse notes flat, irregular, pinkish marks on the bridge of the nose, nape of the neck, and over the eyelids. The areas blanch when pressed with a finger. The nurse documents this finding as: A. Milia B. Nevus vasculosus C. Telangiectatic nevi D. Nevus flammeus
C
Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing? a. Iron deficiency anemia b. Hyponatremia c. Respiratory distress syndrome d. Sepsis
C
Which information related to the newborn's developing cardiovascular system should the nurse fully comprehend? a. The heart rate of a crying infant may rise to 120 beats per minute. b. Heart murmurs heard after the first few hours are a cause for concern. c. The point of maximal impulse (PMI) is often visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).
C
Which is the initial treatment for the client with vWD who experiences a PPH? a. Cryoprecipitate b. Factor VIII and von Willebrand factor (vWf) c. Desmopressin d. Hemabate
C
Major adaptations associated with transition from intrauterine to extrauterine life occur during the first ? to ? hours after birth
6 to 8
A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order? a. Tocolytic drug b. Contraction stress test (CST) c. Local anesthetic d. Foley catheter
A
A newborn, at 5 hours old, wakes from a sound sleep and becomes very active and begins to cry. Which signs, if exhibited by this newborn, indicate expected adaptation to extrauterine life? (Circle all that apply.) A. Increased muscle tone B. Passage of meconium C. Heart rate of 160 beats/minute D. Respiratory rate of 24 breaths/minute and irregular E. Fine crackles on auscultation F. Expiratory grunting with nasal flaring
a, b, c
Which risk factors are associated with NEC? (Select all that apply.) a. Polycythemia b. Anemia c. Congenital heart disease d. Bronchopulmonary dysphasia e. Retinopathy
a, b, c
Which statements regarding physiologic jaundice are accurate? (Select all that apply.) a. Neonatal jaundice is common; however, kernicterus is rare. b. Appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. c. Because jaundice may not appear before discharge, parents need instruction on how to assess for jaundice and when to call for medical help. d. Jaundice is caused by reduced levels of serum bilirubin. e. Breastfed babies have a lower incidence of jaundice
a, b, c
A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. Which findings should the nurse include in the discussion? (Select all that apply.) a. Breast tenderness b. Warmth in the breast c. Area of redness on the breast often resembling the shape of a pie wedge d. Small white blister on the tip of the nipple e. Fever and flulike symptoms
a, b, c, e
Which statements describe the first stage of the neonatal transition period? (Select all that apply.) a. The neonatal transition period lasts no longer than 30 minutes. b. It is marked by spontaneous tremors, crying, and head movements. c. Passage of the meconium occurs during the neonatal transition period. d. This period may involve the infant suddenly and briefly sleeping. e. Audible grunting and nasal flaring may be present during this time
a, b, c, e
Women who are obese are at risk for several complications during pregnancy and birth. Which of these would the nurse anticipate with an obese client? (Select all that apply.) a. Thromboembolism b. Cesarean birth c. Wound infection d. Breech presentation e. Hypertension
a, b, c, e
Which medications are used to manage PPH? (Select all that apply.) a. Oxytocin b. Methergine c. Terbutaline d. Hemabate e. Magnesium sulfate
a, b, d
As recently as 2005, the AAP revised safe sleep practices to assist in the prevention of SIDS. The nurse should model these practices in the hospital and incorporate this information into the teaching plan for new parents. Which practices are ideal for role modeling? (Select all that apply.) a. Fully supine position for all sleep b. Side-sleeping position as an acceptable alternative c. "Tummy time" for play d. Infant sleep sacks or buntings e. Soft mattress
a, c, d
At a home visit 1 week after birth, a nurse is evaluating a woman's breastfeeding technique. Which actions indicate that the woman needs further instruction regarding breastfeeding to ensure success? (Circle all that apply.) A. Waits to feed her baby until he wakes up and begins to cry. B. Massages a small amount of breast milk into her nipple and areola before and after each feeding. C. Squeezes her nipple and areola between her thumb and forefinger and then inserts her nipple into the baby's mouth. D. Positions her baby, supporting back and shoulders securely, and then brings her breast toward the baby, putting the nipple in the baby's mouth. E. Inserts her finger into the corner of her baby's mouth between the gums before removing the baby from the breast
a, c, d
Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants, they may receive care that is similar to that of a full-term baby. These infants are at increased risk for which conditions? (Select all that apply.) a. Problems with thermoregulation b. Cardiac distress c. Hyperbilirubinemia d. Sepsis e. Hyperglycemia
a, c, d
Hearing loss is one of the genetic disorders included in the universal screening program. Auditory screening of all newborns within the first month of life is recommended by the AAP. What is the rationale for having this testing performed? (Select all that apply.) a. Prevents or reduces developmental delays b. Reassures concerned new parents c. Provides early identification and treatment d. Helps the child communicate better e. Is recommended by the Joint Committee on Infant Hearing
a, c, d, e
Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence the causes and incidence of obstetric lacerations of the lower genital tract? (Select all that apply.) a. Operative and precipitate births b. Adherent retained placenta c. Abnormal presentation of the fetus d. Congenital abnormalities of the maternal soft tissue e. Previous scarring from infection
a, c, d, e
Which statements concerning the benefits or limitations of breastfeeding are accurate? (Select all that apply.) a. Breast milk changes over time to meet the changing needs as infants grow. b. Breastfeeding increases the risk of childhood obesity. c. Breast milk and breastfeeding may enhance cognitive development. d. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. e. Benefits to the infant include a reduced incidence of SIDS.
a, c, d, e
A woman at 27 weeks of gestation experiences some mild uterine cramping. Which actions should she take? (Circle all that apply.) A. Empty her bladder B. Call her nurse-midwife immediately C. Relax in a chair D. Drink two to three glasses of water or juice E. Palpate her uterus for 1 hour F. Resume the activity she was doing if the cramping subsides
a, d, e
The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (Select all that apply?) a. Rupture of membranes at or near term b. Convenience of the woman or her physician c. Chorioamnionitis (inflammation of the amniotic sac) d. Postterm pregnancy e. Fetal death
a,c,d,e
A newborn male has been scheduled for a circumcision. Essential nursing care measures following this surgical procedure include: (SATA) A. Use the New Ballard Score to determine if the newborn is in pain B. Applying petroleum ointment to the site with every diaper change until the site is healed C. Checking the penis for bleeding every 30 minutes for the first 1 hours D. Teaching the parents to remove the yellowish exudate that forms over the glans using a diaper wipe
b, c
A physician has ordered that a newborn receive a hepatitis B vaccination prior to discharge. In fulfilling this order the nurse should: (Circle all that apply.) A. Confirm that the mother is hepatitis B positive before the injection is given B. Obtain parental consent prior to administering the vaccination C. Inform the parents that the next vaccine in the series needs to be given at 1 to 2 months D. Administer the injection into the vastus lateralis muscle E. Use a 1-inch 23-gauge needle F. Insert the needle at a 45-degree angle
b, c, d
When assessing a pregnant woman, the nurse is alert for factors associated with preterm labor. Which factor, if ex-hibited by this woman, increases her risk for spontaneous preterm labor and birth? (Circle all that apply.) A. Caucasian race B. Obstetric history of 3-0-2-0-1 C. History of bleeding at 20 weeks D. Currently being treated for second bladder infection in 2 months E. Multifetal gestation F. Body mass index (BMI) of 22 and height of 158 cm
b, c, d, e
Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would be less likely to have a successful VBAC? (Select all that apply.) a. Lengthy interpregnancy interval b. African-American race c. Delivery at a rural hospital d. Estimated fetal weight <4000 g e. Maternal obesity (BMI >30)
b, c, e
A nurse is preparing to administer erythromycin ophthalmic ointment 0.5% to a newborn after birth. Which nursing actions are appropriate? (Circle all that apply.) A. Administer the ointment within 30 minutes of the birth B. Wear gloves C. Cleanse the eyes if secretions are present D. Squeeze an ointment ribbon of 3 cm into the lower conjunctival sac E. Wipe away excess ointment after 1 minute F. Apply the ointment from the inner to outer canthus
b, c, e, f
Preterm infants are at risk for cold stress. Which signs should alert the nurse that the preterm infant he or she is caring for may be hypothermic? (Circle all that apply.) A. Acrocyanosis B. Hypoglycemia C. Irritability D. Periodic breathing pattern E. Bradycardia F. Abdominal distention
b, c, e, f
A nurse is caring for a male newborn whose mother had gestational diabetes during pregnancy. His estimated gesta-tional age is 41 weeks and his weight indicates that he is macrosomic. When assessing this newborn, the nurse should be alert for which findings associated with macrosomia? (Circle all that apply.) A. Fracture of the femur B. Hypocalcemia C. Blood glucose level of 38 mg/dL D. Signs of a congenital heart defect E. Pale complexion F. Round "cherubic" face
b, c, f
Preterm infants are at increased risk for developing respiratory distress. The nurse should assess for signs that would indicate that the newborn is having difficulty breathing. Signs of respiratory distress are: (Circle all that apply.) A. Use of abdominal muscles to breathe B. Expiratory grunting C. Periodic breathing pattern D. Suprasternal retraction E. Nasal flaring F. Acrocyanosis
b, d, e
A breast-fed full-term newborn girl is 12 hours old and being prepared for early discharge. If present, which assess-ment findings could delay discharge? (Circle all that apply.) A. Dark green-black stool, thick consistency B. Yellowish tinge in sclera and on face C. Swollen breasts with a scant amount of thin discharge D. Blood-tinged mucoid vaginal discharge E. Blood glucose level of 35 mg/dL F. Acrocyanosis
b, e
A breastfeeding woman's cesarean birth occurred 2 days ago. Investigation of the pain, tenderness, and swelling in her left leg led to a medical diagnosis of deep vein thrombosis (DVT). Care management for this woman during the acute stage of the DVT involves: (Circle all that apply.) A. Explaining that she will need to stop breastfeeding until anticoagulation therapy is completed B. Administering warfarin (Coumadin) orally C. Placing the woman on bed rest with her left leg elevated D. Fitting the woman with an elastic stocking so that she can exercise her legs E. Telling her to avoid changing her position for the first 24 hours F. Administering heparin intravenously for 3 to 5 days
c, f
Caput succedaneum
diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days
Contraindications for methylergonovine: Given for what:
High blood pressure Treat bleeding
chephalohematoma can cause?
Hyper bilirubin
Betamethasone is used for what
Promote fetal lung maturity
A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. How would the nurse respond? a. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." b. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." c. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him." d. "Your baby will easily get cold stressed and needs to be bundled up at all times."
A
A nurse caring for a pregnant woman suspected of being in preterm labor recognizes which sign as diagnostic of preterm labor? A. Cervical dilation of at least 2 cm B. Uterine contractions occurring every 15 minutes C. Spontaneous rupture of the membranes D. Presence of fetal fibronectin in cervical secretions
A
A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents? a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide." b. "The drug keeps your baby from requiring too much sedation." c. "Surfactant is used to reduce episodes of periodic apnea." d. "Your baby needs this medication to fight a possible respiratory tract infection."
A
A radiant warmer will be used to help a newborn girl to stabilize her temperature. The nurse implementing this care measure should: A. Undress and dry the infant before placing her under the warmer B. Set the control panel between 35°C and 38°C C. Place the thermistor probe on her abdomen just below her umbilical cord D. Assess her rectal temperature every hour until her temperature stabilizes
A
A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? a. To stimulate fetal surfactant production b. To reduce maternal and fetal tachycardia associated with ritodrine administration c. To suppress uterine contractions d. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy
A
A woman's labor is being induced. The nurse assesses the woman's status and that of her fetus and the labor process just before an infusion increment of 2 milliunits/minute. The nurse discontinues the infusion and notifies the wom-an's primary health care provider if during this assessment she notes: A. Frequency of uterine contractions: every 1 1⁄2 minutes B. Variability of fetal heart rate (FHR): present C. Deceleration patterns: early decelerations noted with several contractions D. Intensity of uterine contractions at their peaks: 80 to 85 mm Hg
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A woman's labor is being suppressed using IV magnesium sulfate. Which measure should be implemented during the infusion? A. Limit intravenous fluid intake to 125 mL/hour. B. Discontinue infusion if maternal respirations are less than 14 breaths/minute. C. Ensure that indomethacin is available should toxicity occur. D. Assist woman to maintain a comfortable semirecumbent position.
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During the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. In this situation, which condition should the nurse suspect? a. Hypovolemia and/or shock b. Excessively cool environment c. Central nervous system (CNS) injury d. Pending renal failure
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How would the nurse optimally reassure the parents of an infant who develops a cephalhematoma? a. A cephalhematoma may occur with a spontaneous vaginal birth. b. A cephalhematoma only happens as a result of a forceps- or vacuum-assisted delivery. c. It is present immediately after birth. d. The blood will gradually absorb over the first few months of life.
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The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks? a. Flexed posture b. Abundant lanugo c. Smooth, pink skin with visible veins d. Faint red marks on the soles of the feet
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Which information regarding to injuries to the infant's plexus during labor and birth is most accurate? a. If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months. b. Erb palsy is damage to the lower plexus. c. Parents of children with brachial palsy are taught to pick up the child from under the axillae. d. Breastfeeding is not recommended for infants with facial nerve paralysis until the
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What are the complications and risks associated with cesarean births? (Select all that apply.) a. Pulmonary edema b. Wound dehiscence c. Hemorrhage d. Urinary tract infections e. Fetal injuries
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