MATERNITY 1: reproductive 1; antepartum 47; labor/delivery 25

A pregnant client has chosen labor induction to have a vaginal birth after cesarean. During labor, which is the most concerning assessment finding? 1. Change in uterine shape and maternal tachycardia 2. Fetal tachycardia and moderate variability in fetal heart rate 3. Increased anxiety and discomfort 4. Intense, intermittent contractions

1

The nurse in the operating room is preparing for an emergency dilation and curettage post vaginal delivery for placenta accreta. What information is most important when reviewing this client's chart? 1. Client has been NPO and has no metal on the body 2. Client has stable vital signs and has signed consent 3. Client has type and crossmatch on file and at least 2 patent large-bore IV sites 4. Client is on oxygen and has a patent IV site

3

The nurse is caring for 4 hospitalized clients. Which client should the nurse assess first? 1. Client with hyperemesis gravidarum who is currently vomiting 2. Client with molar pregnancy who has dark brown vaginal discharge 3. Client with suspected ectopic pregnancy who has abdominal and shoulder pain 4. Client with threatened miscarriage who says, "I am a Jehovah's Witness."

3

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up? 1. Fetal heart rate remains 206/min 2. Fetus kicked 4 times in the past hour 3. Mother reports feeling 2 contractions every hour 4. Mother's hemoglobin is 11 g/dL (110 g/L)

1

A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the health care provider will order which laboratory test(s)? 1. Hemoglobin and hematocrit levels 2. Human chorionic gonadotropin level 3. Serum folate level 4. White blood cell count

1

A nurse is admitting a post-date client at 43 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction? 1. A Bishop score of 10 2. A firm and posterior cervix 3. A history of precipitous labor 4. A reactive nonstress test

1

A nurse is caring for a pregnant client who has hyperemesis gravidarum. Which assessment findings should the nurse anticipate? Select all that apply. 1. Blood pressure 160/94 mm Hg 2. Large urine protein 3. Positive urine ketones (moderate) 4. Pulse 106/min 5. Urine specific gravity 1.010

3,4

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A primigravid client in early labor is admitted and reports intense back pain with contractions. The fetal position is determined to be right occiput posterior. Which action by the nurse would be most helpful for alleviating the client's back pain during early labor? 1. Applying counterpressure to the client's sacrum during contractions 2. Encouraging the client to remain in bed during early labor 3. Positioning the client on the left side with pillows for support 4. Requesting that the nurse anesthetist administer epidural anesthesia

1

During the first prenatal assessment, the client reports the last normal menstrual period starting on March 1 and ending on March 5, but also slight spotting on March 23. The client had unprotected intercourse on March 15. Using Naegele's rule, what is the estimated date of birth (EDB)? 1. December 8 2. December 12 3. December 24 4. December 30

1

The nurse is admitting a client at 41 weeks gestation for induction of labor due to oligohydramnios. Considering the client's indication for induction, what should the nurse anticipate? 1. Additional neonatal personnel present for birth 2. Intermittent fetal monitoring during labor 3. Need for forceps-assisted vaginal birth 4. Need for uterotonic drugs for postpartum hemorrhage

1

The nurse is monitoring a client who is in active labor with a cervical dilation of 6 cm. Which uterine assessment finding requires an intervention by the nurse? 1. Contraction duration of 95 seconds 2. Contraction frequency of every 3 minutes 3. Contraction intensity of 45 mm Hg 4. Uterine resting tone of 10 mm Hg

1

The nurse is triaging a pregnant client at 10 weeks gestation during the first prenatal appointment. Which chart finding indicates that client teaching is needed? 1. Client gained 4 lb (1.8 kg) since pre-pregnancy 2. Client has a pet dog and cat at home 3. Client has thin, milky white vaginal discharge 4. Client swims in the pool 3 times a week

2

The nurse reviews laboratory test results for a pregnant client at 32 weeks gestation. What is the nurse's best action based on these results? Click on the exhibit button for additional information. Exhibit Laboratory results Hemoglobin 11.4 g/dL (114 g/L) Hematocrit 34% (0.34) Red blood cells 5.3 x 106/mm3 (5.3 x 1012/L) White blood cells 14,000/mm³ (14.0 x 109/L) Platelets 230,000/mm3 (230 x 109/L) 1. Complete the client assessment and documentation 2. Draw another sample for repeat complete blood count 3. Prepare for transfusion of packed red blood cells 4. Request a prescription for iron supplementation

1

Which finding is most important for the nurse to report to the health care provider? 1. 24 weeks gestation, hemoglobin is 9 g/dL (90 g/L) 2. 24 weeks gestation, 1-hour (50 g) oral glucose screen is 120 mg/dL (6.7 mmol/L) 3. 27 weeks gestation, vaginal secretion is pH 5 4. 36 weeks gestation, white blood cell count is 13,000/mm3 (13.0 x 109/L)

1

Which meal should the nurse order for a client at 13 weeks gestation? 1. Baked chicken, turnip greens, peanut butter cookie, and grape juice 2. Baked swordfish, fries, baked apples, and fat-free milk 3. Chilled ham and cheese sandwich, broccoli, orange slices, and water 4. Smoked shrimp, fresh fruit cup, pasteurized cheese squares, and water

1

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1

A 36-year-old multigravida is admitted with a diagnosis of severe preeclampsia. IV magnesium sulfate is prescribed. Which nursing measures should the nurse include in this client's plan of care? Select all that apply. 1. Assess for right upper quadrant pain 2. Check deep tendon reflex frequently 3. Ensure bright lighting to prevent falls 4. Ensure calcium gluconate is available 5. Have suction equipment ready to use

1,2,4,5

A client comes to the health care provider for a checkup. The client is G5T1P2A1L2M. Which explanation(s) represent a correct understanding of this terminology? Select all that apply. 1. The client had 1 child born later than 37 weeks gestation 2. The client had 1 pregnancy that ended before 20 weeks gestation 3. The client is currently pregnant 4. The L indicates the number of live births 5. The P indicates parity, the number of deliveries after 20 weeks gestation

1,2,3

A client visits the prenatal clinic for the first time. Which of the following are presumptive signs of pregnancy that the client may report during the intake assessment by the nurse? Select all that apply. 1. Breast fullness and tenderness 2. Last menstrual period 8 weeks ago 3. Nausea and vomiting that are worsening every day 4. Painless contractions at irregular intervals 5. Positive home pregnancy test 3 weeks ago

1,2,3

The nurse is caring for a client who is in active labor at 39 weeks gestation and receiving a continuous intravenous (IV) infusion of oxytocin. The nurse notes frequent and persistent late decelerations on the fetal monitor. What actions should the nurse take? Select all that apply. 1. Administer oxygen via a nonrebreather face mask 2. Change the maternal position to the lateral side 3. Discontinue oxytocin infusion 4. Notify the health care provider (HCP) 5. Perform a nitrazine test

1,2,3,4

A nurse is preparing to administer oxytocin to induce labor in a client. Which of the following assessments are necessary during the infusion? Select all that apply. 1. Blood pressure 2. Fetal heart rate (FHR) tracings 3. Intake and output 4. Knee reflexes 5. Uterine contraction pattern 6. Vaginal examination

1,2,3,5,6

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to decrease the risk of neural tube defects? Select all that apply. 1. Black beans and rice 2. Breakfast cereal and milk 3. Medium baked sweet potato 4. Peanut butter on whole wheat toast 5. Raw carrots with dip

1,2,4

A client indicates a desire to become pregnant. She has a cat at home. The client drinks 1-2 glasses of wine on weekends. Body mass index is 32 kg/m2. Which of the following is proper teaching during preconception health care for this client? Select all that apply. 1. Avoid changing the cat litter box 2. Do not drink alcohol 3. Maintain current body mass index (BMI) 4. Receive regular dental care 5. Take 0.4 mg folic acid supplement daily 6. Take a multivitamin with 10,000 units of vitamin A daily

1,2,4,5

A client comes to the clinic indicating that a home pregnancy test was positive. The client's last menstrual period (LMP) was September 7. Today is December 7. Which of the following are true statements for this client? Select all that apply. 1. According to Naegele's Rule, the expected date of delivery (EDD) is June 14 2. Auscultation of the fetal heart rate is possible 3. Fundal height should be 24 cm above the symphysis pubis 4. The client should be feeling fetal movement 5. Urinary frequency is a common sign

1,2,5

A nurse is evaluating the external fetal monitoring strip of a laboring primigravida at 36 weeks gestation. Which nursing interventions should the nurse implement? Click on the exhibit button for additional information. Select all that apply. Exhibit: https://drive.google.com/open?id=0B40rfZ_Hhbqwa21zdC1ENjkzaG8 1. Administer supplemental oxygen by mask 2. Increase the intravenous (IV) fluid rate 3. Prepare the client for an amnioinfusion 4. Reposition the client to the supine position 5. Stop the client's oxytocin infusion

1,2,5

A pregnant client in the third trimester completes an intake form for a clinic visit. Which signs and symptoms are priority problems for the nurse to evaluate? Select all that apply. 1. Frequent urination with dysuria and nocturia 2. Fullness in both ears and nasal stuffiness 3. Headache and blurred vision 4. Nonmalodorous, copious, clear vaginal discharge 5. Yellowish discharge from both nipples

1,3,4

An obviously pregnant client walks into the emergency department screaming, "I am about to give birth!" What questions are essential to ask in preparation for and performance of possible neonatal resuscitation? Select all that apply. 1. "Are you expecting 1 or 2 babies?" 2. "Did you have prenatal care?" 3. "What drugs did you take in the last 4 hours?" 4. "When is your due date?" 5. "Who is your health care provider (HCP)?"

1,3,4

A 27-year-old client at 10 weeks gestation comes to the prenatal clinic. Which vaccines can be safely given to this client during the pregnancy? Select all that apply. 1. Influenza inactivated vaccine 2. Influenza nasal spray vaccine 3. Measles-mumps-rubella vaccine (MMR) 4. Tetanus, diphtheria, and pertussis (Tdap) immunization 5. Varicella vaccine

1,4

A 28-year-old client is admitted to the labor and delivery unit for severe preeclampsia. She is started on IV magnesium sulfate. Which signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply. 1. 0/4 patellar reflex 2. Blood pressure is 156/84 mm Hg 3. Client voided 600 mL in 8 hours 4. Respirations are 10/min 5. Serum magnesium level is 5 mEq/L (2.5 mmol/L)

1,4

A client who reports sudden-onset severe right lower abdominal pain and dizziness is being evaluated for suspected ectopic pregnancy. Which assessment findings should the nurse anticipate? Select all that apply. 1. Blood pressure 82/64 mm Hg 2. Crackles on auscultation 3. Distended jugular veins 4. Pulse 120/min 5. Shoulder pain

1,4,5

A nulliparous client asks about being in "real" labor. The nurse should teach that which signs are most indicative of true labor? Select all that apply. 1. Contractions that increase in frequency 2. Contractions that lessen after resting 3. Increased blood-tinged, mucoid vaginal discharge 4. Pain in lower back that moves to lower abdomen 5. Progressive cervical effacement and dilation

1,4,5

The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most concerning and warrants priority intervention? 1. Client has not been taking prenatal vitamins 2. Client is taking lisinopril to control hypertension 3. Client reports a whitish vaginal discharge 4. Client reports mild cramping pain in the lower abdomen

2

A laboring client weighing 187 lb is 5 cm dilated and having contractions every 2-3 minutes. The client rates the pain at 7 out of 10. Nalbuphine hydrochloride 10 mg/70 kg IV push × 1 is prescribed by the health care provider. Nalbuphine hydrochloride 10 mg/1 mL is available. How many milliliters does the nurse administer? Record your answer using one decimal place. Answer: (mL)

1.2

The nurse is preparing a nutritional teaching plan for a client planning to become pregnant. Which foods would best prevent neural tube defects? 1. Calcium-rich snacks 2. Fortified cereals 3. Organ meats 4. Wild salmon

2

The nurse is teaching a client, gravida 1 para 0, at 8 weeks gestation about expected weight gain in pregnancy. The client's prepregnancy BMI is 21 kg/m2. Which of the following statements made by the client indicates an understanding about weight gain? 1. "I should gain 10 lb (4.5 kg) during the first trimester." 2. "I should gain about 30 lb (13.6 kg) during pregnancy." 3. "I should gain no more than 0.5 lb (0.2 kg) per week during the second and third trimesters." 4. "If I keep my weight gain to less than 20 lb (9.1 kg) during pregnancy, it will be easier to lose it after the baby is born."

2

A client at 30 weeks gestation is hospitalized for preeclampsia. Which assessment finding requires priority intervention? 1. Elevated liver enzymes 2. Lower abdominal pain and vaginal bleeding 3. Swelling of the hands, feet, and face 4. Urine output of 25 mL/hr

2

A client at 39 weeks gestation with preeclampsia has a blood pressure of 170/100 mm Hg, 2+ proteinuria, and moderate peripheral edema. Immediately after hospital admission, she develops seizures and uterine contractions. Magnesium sulfate is prescribed. Which finding indicates that the drug has achieved the desired therapeutic effect? 1. Blood pressure <130/80 mm Hg 2. Seizure activity stops 3. Urine has 1+ protein 4. Uterine contractions stop

2

A client in labor at 39 weeks gestation was admitted to the labor and delivery unit. The client is ambulating in the hallway to facilitate labor progression when she tells the nurse, "My water broke." Which of the following should be the nurse's priority action? 1. Check the color of the amniotic fluid 2. Escort the client to the labor room and assess FHR 3. Escort the client to the labor room and notify the primary health care provider (PHCP) 4. Have the client lie on the bed and check vital signs

2

A pregnant client admitted for induction of labor is receiving an oxytocin infusion. The baseline fetal heart rate is 140/min and the strip is shown in the exhibit. What is the nurse's best course of action? Click on the exhibit button for additional information. Exhibit https://drive.google.com/open?id=0B40rfZ_HhbqwNTdZQXVvMGhwVjA 1. Apply oxygen 10 L/min face mask 2. Continue to monitor the client 3. Discontinue oxytocin infusion 4. Notify the health care provider (HCP)

2

The precepting nurse is supervising a new obstetric nurse performing a labor admission assessment on a client with suspected spontaneous rupture of membranes. Which action by the new nurse would cause the precepting nurse to intervene? 1. Documenting a positive nitrazine test result when the test strip turns blue 2. Donning nonsterile gloves and using soluble gel for vaginal examination 3. Palpating the client's abdomen before applying external fetal monitors 4. Providing the client with a variety of clear liquids to drink

2

When making assignments in the obstetrical unit, the charge nurse should assign the most experienced staff nurse to which client? 1. G1P0 reporting a small amount of pink vaginal discharge 2. G2P1 reporting rupture of membranes with greenish fluid 3. G3P2 at 7 cm dilation, 100% effacement 4. G4P2 with bilateral +1 pitting ankle edema

2

A 14-year-old client confides to the school nurse that she is about 22 weeks pregnant and has not had prenatal care. Which topics are most important and priorities for the nurse to discuss with the client in anticipation of referral for prenatal care? Select all that apply. 1. Adoption planning 2. Family and social support 3. Future education plans 4. Nutrition and prenatal vitamins 5. Sexual abuse

2,4,5

A client at 34 weeks gestation reports constipation. The client has been taking 325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks ago. Which recommendations should the nurse make for this client? Select all that apply. 1. Decreased daily dairy intake 2. Increased fruit and vegetable intake 3. Moderate-intensity regular exercise 4. One laxative twice daily for a week 5. Two cups of hot coffee each morning

2,3

A nurse is caring for a pregnant client at 33 weeks gestation. The diagnosis of placenta previa is made via ultrasound. What should the nurse include in the plan of care? Select all that apply. 1. Activity as tolerated 2. Biophysical profile 1 or 2 times a week 3. Prepare for cesarean birth at any time 4. Type and screen blood 5. Vaginal examinations twice weekly

2,3,4

A pregnant client at 35 weeks gestation has brisk, painless vaginal bleeding. The health care provider suspects placenta previa. The nurse should prepare for which procedures? Select all that apply. 1. Administration of corticosteroids 2. Blood draw for hemoglobin 3. Electronic fetal monitoring 4. Forceps delivery 5. Pelvic ultrasound 6. Vaginal examination

2,3,5

A client at 21 weeks gestation has intense heartburn (pyrosis). What should the nurse recommend? Select all that apply. 1. Avoid dairy products 2. High-protein, low-fat diet 3. Lie on the left side after meals 4. Six small meals a day 5. Sodium bicarbonate antacid

2,4

A client is at 24 weeks gestation and preeclampsia-eclampsia syndrome is suspected. Which of the following are significant signs/symptoms criteria related to this syndrome? Select all that apply. 1. 2+ pitting pedal edema 2. 300 mg/24 hr (0.3 g/day) protein in urine 3. Frequent urination 4. Headache, blurry vision 5. Hemoglobin 10 g/dL (100 g/L)

2,4

When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first? 1. First-trimester client reporting frequent nausea and vomiting 2. Second-trimester client with dysuria and urinary frequency 3. Second-trimester client with obesity reporting decrease in fetal movement 4. Third-trimester client with right upper quadrant pain and nausea

4

A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse? 1. Advise the client to consume hot, versus cold, foods 2. Instruct the client to drink 2 glasses of water with each meal 3. Suggest the client consume high-protein snacks on awakening 4. Tell the client that morning sickness should pass in a few weeks

3

A couple is excited about finding out the sex of their baby during ultrasound at 14 weeks gestation. What is the nurse's best response? 1. "Basic structures of major organs are not yet formed." 2. "External genitalia are not usually visualized until 21-24 weeks." 3. "If the baby is in the right position, the genitalia may be visualized." 4. "Sex cannot be determined until fetal movement is felt."

3

A nurse is preparing to administer oxytocin to induce labor in a client. The nurse recognizes that the oxytocin infusion can lead to which of the following? 1. Decreased postpartum hemorrhage 2. Delayed milk production 3. Fetal distress and cesarean birth 4. High risk of placenta previa

3

A pregnant client comes for a routine first prenatal examination. According to the last menstrual period, the estimated gestational age is 14 weeks. Where would the nurse expect to palpate the uterine fundus in this client? 1. 14 cm above the symphysis pubis 2. 14 cm above the umbilicus 3. Just above the symphysis pubis 4. Just below the umbilicus

3

A pregnant client provides the following obstetric history to the nurse at the first prenatal visit: elective abortion at age 17; a 5-year-old daughter born at 40 weeks gestation; and 3-year-old twin boys born at 34 weeks gestation. Using the GTPAL system, which option is correct? 1. G 3, T 1, P 1, A 1, L 3 2. G 3, T 1, P 2, A 1, L 3 3. G 4, T 1, P 1, A 1, L 3 4. G 4, T 1, P 2, A 1, L 3

3

A pregnant client's initial prenatal laboratory screening results at 12 weeks gestation indicate a rubella titer of non-immune (<1:8). What will the nurse anticipate as the priority plan of care for this client? 1. Administer measles-mumps-rubella (MMR) vaccine now 2. Administer MMR vaccine in the third trimester 3. Administer MMR vaccine immediately postpartum 4. MMR vaccine is not indicated for this client

3

A woman who is 38 weeks pregnant is brought to the emergency department after a motor vehicle crash. She reports severe abdominal pain with abdominal tenderness, and the nurse notes mild dark vaginal bleeding. What action should the nurse take? 1. Assess the deep-tendon reflexes (DTRs) 2. Check the woman's platelets 3. Monitor for maternal hypotension 4. Perform the Leopold's maneuvers

3

Four clients in labor are requesting pain medication from the nurse. Which client can safely receive an opioid agonist-antagonist analgesic intravenous (IV) push at this time? 1. Gravida 1, 2 cm dilated, 50% effaced, contractions 7-10 minutes apart, crying 2. Gravida 1, 6 cm dilated, 75% effaced, contractions 2-4 minutes apart, has history of heroin use 3. Gravida 2, 5 cm dilated, 100% effaced, contractions 3-4 minutes apart, moaning and shaking 4. Gravida 4, 10 cm dilated, 100% effaced, contractions 2-3 minutes apart, wants to push

3

Of the abdominal lines shown in the exhibit, where would the nurse expect the fundal height of a 20-week gestation client to be felt? Click on the exhibit button for additional information. Exhibit: https://drive.google.com/open?id=0B40rfZ_HhbqwR3lyVXJuWW54NFk 1. A 2. B 3. C 4. D

3

The nurse is documenting assessments of pregnant clients in the antepartum unit. Which client's assessment findings are most important to report to the health care provider? 1. Client at 28 weeks gestation with an asymptomatic systolic murmur 2. Client at 34 weeks gestation with 1+ edema of bilateral lower extremities 3. Client at 35 weeks gestation with painful genital lesions 4. Client at 39 weeks gestation with brownish, mucoid vaginal discharge

3

Which client in a prenatal clinic should the nurse assess first? 1. An 11-week gestation client with backache and 5-lb (2.26-kg) weight gain since conception 2. A 16-week gestation client with hemorrhoid pain and sinus congestion 3. A 21-week gestation client with blurred vision and increased facial edema 4. A 32-week gestation client with chloasma and urinary frequency

3

Which vaccine can safely be given in the second or third trimester of pregnancy? 1. Human papillomavirus vaccine 2. Influenza nasal spray vaccine 3. Measles-mumps-rubella vaccine 4. Tetanus-diphtheria-pertussis vaccine

4

The obstetric nurse is reviewing phone messages. Which client should the nurse call first? 1. 18 weeks gestation client taking ceftriaxone and reporting mild diarrhea 2. 22 weeks gestation client with twins who is taking acetaminophen twice a day 3. 28 weeks gestation client taking metronidazole and has dark-colored urine 4. 32 weeks gestation client taking ibuprofen for moderate back pain

4

A client at 38 weeks gestation is in labor and receiving an oxytocin infusion. The continuous fetal heart rate (FHR) monitor displays the strip shown in the exhibit. Which action by the nurse is most appropriate? Click on the exhibit button for additional information. Exhibit: https://drive.google.com/open?id=0B40rfZ_Hhbqwb0dkZ0hHNEZVdUU 1. Discontinue oxytocin infusion 2. Place client in the side-lying position 3. Provide oxygen 10 L/min via face mask 4. Review medication administration record

4

A client at 39 weeks gestation is brought to the emergency department after a motor vehicle crash. The client, who is secured supine on a backboard, suddenly becomes pale with a blood pressure of 88/50 mm Hg. What action should the nurse take first? 1. Administer normal saline fluid bolus 2. Assess cervix for presenting part 3. Obtain fetal heart rate 4. Turn client laterally

4

A client in labor has reached 8 cm dilation, is fully effaced, and feels an urge to push. The nurse observes thick, blood-tinged mucus during the vaginal examination. What is the nurse's best action? 1. Administer prescribed IV meperidine for pain relief 2. Encourage client to bear down with spontaneous urges to push 3. Place client in the lithotomy position in preparation for birth 4. Provide encouragement and coaching in breathing techniques

4

A client is at 20 weeks gestation. The client reports having to "run to the bathroom all the time," "it hurts to pee," and my urine "smells bad." Which statement by the nurse is the most appropriate? 1. "Drink cranberry juice to relieve the symptoms." 2. "Make sure to wipe from the front to the back after voiding." 3. "Most women have urinary frequency at this stage and it is normal." 4. "You may need to be checked for a urinary tract infection."

4

A diabetic woman has a precipitous delivery in the emergency department. Which initial neonate assessment finding is the priority and requires a nursing response? 1. Apgar score of 7 at 1 minute 2. Apical heart rate of 160/min 3. Circumoral duskiness 4. Jitteriness

4

A nurse is caring for a client following a forceps-assisted vaginal birth. The client reports severe vaginal pain and fullness. On assessment the nurse notices a firm, midline uterine fundus. Lochia rubra is light. Which diagnosis should the nurse anticipate? 1. Cervical laceration 2. Inversion of the uterus 3. Uterine atony 4. Vaginal hematoma

4

A nurse is measuring a uterine fundal height for a client who is at 36 weeks gestation in supine position. The client suddenly reports dizziness and the nurse observes pallor and damp, cool skin. What should the nurse do first? 1. Assess fetal heart rate and pattern 2. Assess heart and lung sounds 3. Notify the health care provider (HCP) immediately 4. Reposition the client into a lateral position

4

A woman delivers her baby immediately on arrival at the emergency department and 5 minutes later delivers the placenta. The nurse's assessment is that the woman's uterus is boggy and midline. What action should the nurse take first? 1. Administer uterotonic oxytocin 2. Ask the woman if afterpains are present 3. Have the woman void 4. Massage the fundus

4

Since the mid to late 1990s, the incidence of neural tube defects has declined significantly in the United States. Which is the best explanation for this occurrence? 1. An increase in the number of women age 15-45 taking folic acid supplements 2. An overall increase in the consumption of green leafy vegetables 3. Improved genetic testing and early identification of the congenital defect 4. Mandatory fortification of cereal grain products, breads, and pasta with folate

4