MC/OB

In most healthy newborns, blood glucose levels stabilize at _________ mg/dL during the first hours after birth:

50 to 60 In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dL during the first several hours after birth. A blood sugar level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. This infant can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life, the blood glucose levels should be approximately 60 to 70 mg/dL.

At 1 minute following birth, the newborn exhibited the following: heart rate of 155; loud, vigorous crying with active movement of all extremities; sneezing when nose is stimulated with a catheter; hands and feet bluish and cool to the touch. The Apgar score of this newborn should be recorded as________.

9 The newborn receives 2 points each for a heart rate over 100 beats/min, a vigorous cry, active movement, and sneezing as a response to nasal stimulation. The newborn receives 1 point for color since he exhibits acrocyanosis

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: A. review the woman's current dietary intake. B. teach the woman about the food pyramid. C. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. instruct the woman to limit the intake of fatty foods.

A Reviewing the woman's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required.

he nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) A. Dried beans B. Seeds C. Peanut butter D. Bagel E. Eggs

A, B, C, E All of the foods listed except a bagel provide protein. A bagel is an example of a whole grain food, not protein.

As part of their teaching function at discharge, nurses should tell parents that the baby's respiratory status should be protected by the following procedures: (Select all that apply.) A. Prevent exposure to people with upper respiratory tract infections B. Keep the infant away from secondhand smoke C. Avoid loose bedding, waterbeds, and beanbag chairs D. Do not let the infant sleep on his or her back E. Keep a bulb suction available at home.

A, B, C, E The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome. Infants can suffocate in loose bedding and furniture that can trap them.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. E. Normal weight women should gain 11.5 to 16 kg.

A, B, C, E Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16kg.

Which of these statements indicate the effect of breastfeeding on the family or society at large. (Select all that apply.) A. Breastfeeding requires fewer supplies and less cumbersome equipment. B. Breastfeeding saves families money. C. Breastfeeding costs employers in terms of time lost from work. D. Breastfeeding benefits the environment. E. Breastfeeding results in reduced annual health care costs.

A, B, D, E Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment, saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother, uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal

A woman is considering using nonpharmacological methods for pain management during her labor. Which of the following are benefits or advantages of their use? (Select all that apply) A. Relief of stress and enhanced relaxation B. Few, if any, maternal or fetal side effects C. Healthcare provider retains control over the birth process D. Do not require the woman to participate E. Usable throughout labor

A, B, E

A woman at 8 weeks gestation has an ectopic pregnancy. Which complication is possible? (Select all that apply) A. Rupture of the involved fallopian tube B. Development of a hydatidiform mole C. Hypovolemic shock D. Progression to placenta previa E. Extreme vomiting, electrolyte imbalance and weight loss

A, C

The nurse is teaching a woman the benefits of breastfeeding to her infant. Which should be included? (Select all that apply). A. Breastfed infants have a reduced risk of developing allergies and asthma B. Breastmilk is absorbed slowly, so feedings are needed less frequently than formula feedings C. Breastfed infants have a reduced risk of respiratory, ear and gastrointestinal infections D. Breastmilk is high in Vitamin D and Iron E. Breastmilk is high in fatty accids that promote brain growth and development

A, C, E

The nurse should include which instructions when teaching a mother about the storage of breast milk? (Select all that apply.) A. Wash hands before expressing breast milk. B. Store milk in 8 to 12 oz containers. C. Store refrigerated milk in the door of the refrigerator. D. Place frozen milk in the microwave for only a few seconds to thaw. E. Milk thawed in the refrigerator can be stored for 24 hours.

A, E

Which factors lead to initiation of breathing immediately after birth? Select all that apply. A. Increased pC02 B. Increased intrathoracic pressue from chest compression C. Warm extrauterine environment D. Delayed suctioning of the mouth and nose E. Drying the newborn

A,B, E

A 27 year old pregnant woman has a preconceptual BMI of 18.0. What would be an adequate weight gain for this women during her pregnancy? A. 38 lbs. B. 25 lbs. C. 15 lbs.

A.

A laboring woman who has a history of opioid abuse is experiencing pain. Which pain management strategy would be LEAST appropriate for her? A. Administer the prescribed dose of Stadol B. Assist the woman with relaxation through breathing technique C. Page anesthesia for epidural placement D. Show the woman how to use effleurage

A.

Maternal signs and symptoms of preeclampsia are directly related to: A. Poor perfusion of maternal organs B. Maternal hypervolemia C. Low levels of maternal serum magnesium D. Fetal hypertension

A.

The nurse is getting a woman up to the bathroom for the first time following birth with epidural anesthesia. Which nursing intervention is MOST important? A. Assess for return of sensation to the lower extremities B. Acquire a wheelchair to assist with getting the woman to the bathroom C. Assess the woman's heart rate D. Assess strength in the upper extremities

A.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

A. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor

The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct? A. A common practice among Mexican women is known as los dos. B. Muslim cultures do not encourage breastfeeding due to modesty concerns. C. Latino women born in the United States are more likely to breastfeed. D. East Indian and Arab women believe that cold foods are best for a new mother.

A. This refers to combining breastfeeding and commercial infant formula. It is based on the belief that by combining the two feeding methods, the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula

The nurse taught new parents the guidelines to follow regarding the bottle-feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they: A. wash the top of the can and can opener with soap and water before opening the can. B. adjust the amount of water added according to the weight gain pattern of the newborn. C. add some honey to sweeten the formula and make it more appealing to a fussy newborn. D. warm formula in a microwave oven for a couple of minutes before feeding.

A. Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for a parent to get into to prevent contamination

The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn's weight was 7 lbs, 12 oz. On the basis of this finding, the nurse should: A. encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs. B. suggest that the mother switch to bottle-feeding since the breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. C. notify the physician since the newborn is being poorly nourished. D. refer the mother to a lactation consultant to improve her breastfeeding technique.

A. Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz.

A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use: A. counterpressure against the sacrum. B. pant-blow (breaths and puffs) breathing techniques. C. effleurage. D. biofeedback.

A. Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back.

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's MOST appropriate analgesic for pain control is: A. fentanyl (Sublimaze). B. promethazine (Phenergan). C. butorphanol tartrate (Stadol). D. nalbuphine (Nubain).

A. Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use.

Nurses should be aware of the difference experience can make in labor pain, such as: A. sensory pain for nulliparous women often is greater than for multiparous women during early labor. B. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. C. women with a history of substance abuse experience more pain during labor. D. multiparous women have more fatigue from labor and therefore experience more pain.

A. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

With regard to protein in the diet of pregnant women, nurses should be aware that: A. many protein-rich foods are also good sources of calcium, iron, and b vitamins. B. many women need to increase their protein intake during pregnancy. C. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. D. high-protein supplements can be used without risk by women on macrobiotic diets.

A. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron

A full term neonate's response to infection is characterized by: A. Limited ability to prevent infection from spreading systemically B. Low levels of IgG due to limited placental transfer C. Enhanced ability of WBCs to move to the site of bacterial infection D. Specific signs of infection that are easy to detect

A. Limited ability to prevent infection from spreading systemically

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae: A. are benign if they disappear within 48 hours of birth B. result from increased blood volume C. should always be further investigated D. usually occur with forceps delivery

A. Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face.

The ductus arteriosus may remain patent in a newborn who is: A. Premature or hypoxic B. Crying C. Hyperthermic D. In the first period of reactivity

A. Premature or hypoxic

In a pregnant woman with gestational diabetes, maternal and neonatal complications can be greatly diminished by maintaining normal blood glucose levels during the pregnancy. A. True B. False

A. TRUE

With regard to umbilical cord care, nurses should be aware that: A. The stump can easily become infected. B. A nurse noting bleeding from the vessels of the cord should immediately call for assistance. C. The cord clamp is removed at cord separation. D. The average cord separation time is 5 to 7 days.

A. The cord stump is an excellent medium for bacterial growth

What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? A. apical heart rate of 90 beats/min, slightly irregular, when awake and active B. Acrocyanosis C. Harlequin color sign D. Weight loss representing 5% of the newborn's birth weight

A. apical heart rate of 90 beats/min, slightly irregular, when awake and active The heart rate of a newborn should range from 120 to 140 beats/min, especially when active. The rate should be regular with sharp, strong sounds. Acrocyanosis is a normal finding in a newborn at 24 hours of age. A harlequin sign is a normal finding related to the immature neurologic system of a newborn. A 5% weight loss is acceptable in the newborn.

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is: A. vision B. hearing C. smell D. taste

A. vision The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant's hearing is similar to that of an adult. Newborns have a highly developed sense of smell. The newborn can distinguish and react to various tastes.

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. a pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. a total of 25 to 35 lbs.

B A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters.

What will the newborn experiencing cold stress exhibit? Select all that apply. A. Hyperglycemia B. Increased respiratory rate and oxygen consumption C. Metabolic acidosis D. Hyperbilirubinemia E. Shivering

B, C, D

Which of these statements are helpful and accurate nursing advice concerning bathing the new baby. (Select all that apply.) A. Newborns should be bathed every day, for the bonding as well as the cleaning B. Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed. C. Only plain warm water can be used to preserve the skin's acid mantle. D. Powders are not recommended because the infant can inhale powder. E. Bathe immediately after feeding while baby is calm and relaxed.

B, D Tub baths may be given as soon as an infant's temperature has stabilized. Unscented mild soap is appropriate to use to wash the infant. Powder is not recommended due to the risk of inhalation

After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient's plan of care? (Select all that apply.) A. Keeping the head of bed elevated at all times B. Administration of oral analgesics C. Avoid caffeine D. Assisting with a blood patch procedure E. Frequent monitoring of vital signs

B, D, E The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012). Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

Signs of effective breastfeeding include: A. Weight loss of 10% 3 days after birth B. 6 - 8 wet diapers after day 4 C. Stools remain dark meconium throughout the first week D. Breastfeeding sessions last 30 minutes

B.

The nurse is teaching a woman about foods that are good sources of iron. Which food would NOT be included? A. Red meat B. Milk C. Spinach D. Raisins

B.

The nurse providing newborn stabilization must be aware that the primary side effect of maternal opioid analgesia in the newborn is: A. Bradycardia B. Respiratory depression C. Acrocyanosis D. Hypothermia

B.

The primary finding in placental abruption which best distinguishes it from placenta previa is: A. Vaginal bleeding B. Presence of abdominal pain C. Rupture of membranes D. Presence of chorioamnionitis

B.

When the infant begins to suckle at the breast, nerve impulses cause the anterior pituitary to secrete two hormones. Which hormone increases milk production? A. Oxytocin B. Prolactin C. Relaxin D. Lactoferrin

B.

Which statement is true concerning pain in the newborn? A. Structures that transmit pain first become functional toward the end of the third trimester of pregnancy B. The physiological response to pain in the newborn can be life threatening C. All newborns cry when they experience pain D. Early exposure to painful stimuli has no effect on future sensitivity and interpretation of pain

B.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. drink warm fluids with each of her meals. B. eat a high-protein snack before going to bed. C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. schedule three meals and one midafternoon snack a day.

B. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea.

A pregnant woman experiencing nausea and vomiting should: A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. eat small, frequent meals (every 2 to 3 hours). C. increase her intake of high-fat foods to keep the stomach full and coated. D. limit fluid intake throughout the day.

B. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods, avoid consuming fluids early in the day or when nauseated, and compensate by drinking fluids at other times.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is: A. an on-demand feeding schedule. B. breastfeeding. C. lower-calorie infant formula. D. smaller, more frequent feedings.

B. Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also assists the woman to return to her prepregnant weight sooner

Which action of a breastfeeding mother indicates the need for further instruction? A. Holds breast with four fingers along bottom and thumb at top. B. Leans forward to bring breast toward the baby. C. Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth. D. Puts her finger into newborn's mouth before removing breast.

B. To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: A. encourage the woman to breathe more slowly. B. help the woman breathe into a paper bag. C. turn the woman on her side. D. administer a sedative.

B. Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level.

With regard to systemic analgesics administered during labor, nurses should be aware that: A. systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. effects on the fetus and newborn can include decreased alertness and delayed sucking. C. IM administration is preferred over IV administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A. visceral. B. referred. C. somatic. D. afterpain.

B. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. critical iron and folic acid levels must be maintained. D. lactating women can go back to their prepregnant calorie intake.

B. A lactating woman needs to avoid consuming too much caffeine

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. spina bifida. B. intrauterine growth restriction. C. diabetes mellitus. D. Down syndrome.

B. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction

Giving formula to breastfeeding infants increases breastfeeding frequency and milk production, making successful breastfeeding more likely. A. True B. False

B. FALSE

A term newborn experienced symptoms of respiratory distress after birth which resolved within 2 hours. Which condition caused this transient tachypnea of the newborn (TTN) ? A. High systemic vascular resistance B. Inadequate clearance of pulmonary fluid C. Inadequate levels of surfactant D. Rapid clamping of the umbilical cord

B. Inadequate clearance of pulmonary fluid

The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a "C." This response is known as a: A. tonic neck reflex B. Moro reflex C. cremasteric reflex D, Babinski reflex

B. Moro reflex Tonic neck reflex refers to the "fencing posture" a newborn assumes when supine and turns the head to the side. These actions show the Moro reflex. The cremasteric reflex refers to retraction of testes when chilled. The Babinski reflex refers to the flaring of the toes when the sole is stroked.

The newborn's nurse should alert the health care provider when which newborn reflex assessment findings are seen? (Select all that apply.) A. Newborn turns head toward stimulus when eliciting rooting reflex. B. Newborn's fingers fan out when palmar reflex checked. C. Newborn forces tongue outward when tongue touched. D. Newborn exhibits symmetric abduction and extension of arms, and fingers form "C" when Moro reflex elicited. E. Newborn's toes hyperextend with dorsiflexion of big toe when sole of foot stroked upward along lateral aspect.

B. Newborn's fingers fan out when palmar reflex checked The baby's fingers should curl around the examiner's fingers when eliciting the palmar reflex. When eliciting rooting reflex, the characteristic response is for the baby to turn head toward stimulus and open mouth. Extrusion is elicited by touching tongue, and newborn's tongue is forced outward. The newborn should elicit symmetric abduction and extension of the arms and fingers form a "C" with the Moro reflex. The Babinski reflex is elicited by stroking upward along the lateral aspect on the sole of the feet. The expected response is hyperextension of the toes with dorsiflexion of the big toe.

O type blood has: A. A type antigens and B antibodies B. No antigens and A and B antibodies C. O type antigens and A and B antibodies D. A and B type antigens and no antibodies

B. No antigens and A and B antibodies

Following circumcision of a newborn, the nurse provides instructions to his or her parents regarding postcircumcision care. The nurse should tell the parents to: A. apply topical anesthetics with each diaper change. B. expect a yellowish exudate to cover the glans after the first 24 hours. C. change the diaper every 2 hours and cleanse the site with soap and water or baby wipes. D. apply constant pressure to the site if bleeding occurs and call the physician.

B. Parents should be taught that a yellow exudate will develop over the glans and should not be removed

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: A. tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. B. alerts the physician that the infant has a dislocated hip. C. informs the parents and physician that molding has not taken place. D. suggests that if the condition does not change, surgery to correct vision problems might be needed.

B. alerts the physician that the infant has a dislocated hip. This is an inappropriate statement that may result in unnecessary anxiety for the new parents. The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified. Molding refers to movement of the cranial bones and has nothing to do with the infant's hips. The Ortolani maneuver is not a technique used to evaluate visual acuity in the newborn. This maneuver checks hip integrity.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern since the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: A. telling the mother not to worry since all breastfed babies have this type of stool. B. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. Correct C. asking the mother what she ate at her last meal. D. suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

B. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements This type of stool is the first stool that all newborns, not just breastfed babies, have. At this early age this type of stool (meconium) is typical of both bottle-fed and breastfed newborns. The mother's nutritional intake is not responsible for the appearance of meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns.

A woman with a history of normal blood pressures arrives at her 30 week gestation visit. Her initial BP is 146/92. She returns for a recheck the next day; BP is 142/92. On both visits, the urine protein is 2+ per dipstick. She has no systemic symptoms. What is her hypertensive classification? A. Gestational hypertension B. Preeclampsia C. Chronic hypertension D. Eclampsia

B. for bitches

When caring for a newborn, the nurse must be alert for signs of cold stress, including: A. decreased activity level B. increased respiratory rate C. hyperglycemia D. shivering

B. increased respiratory rate Infants experiencing cold stress would have an increased activity level. An increased respiratory rate is a sign of cold stress in the newborn. Hypoglycemia would occur with cold stress. Newborns are unable to shiver as a means of increasing heat production; they increase their activity level instead.

A newborn male, estimated to be 39 weeks of gestation, would exhibit: A. extended posture when at rest B. testes descended into scrotum C. abundant lanugo over his entire body D, ability to move his elbow past his sternum

B. testes descended into scrotum The newborn's good muscle tone will result in a more flexed posture when at rest. A full-term male infant will have both testes in his scrotum and rugae on his scrotum. The newborn will exhibit only a moderate amount of lanugo, usually on his shoulders and back. The newborn would have the inability to move his elbow past midline.

A pregnant woman follows a strict vegan diet. What dietary risks are heightened with this diet? (Select all that apply) A. Listeriosis B. Pica C. Vitamin B12 deficiciency D. Inadequate calcium intake E. Heartburn

C, D

A laboring woman has just received an epidural. Which nursing action has priority? A. Limit parenteral fluids B. Monitor for fetal tachycardia C. Monitor for maternal hypotension D. Monitor for maternal bradycardia.

C.

A woman at 9 weeks gestation experiences vaginal bleeding accompanied by cramping. The bleeding and cramping spontaneously resolve without rupture of membranes or passage of tissue. Which term best describes this situation? A. Incomplete abortion B. Complete abortion C. Threatened abortion D. Inevitable abortion

C.

A woman is experiencing back labor due to occiput posterior presentation. She complains of intense pain in her lower back. An effective relief measure would be to use: A. Pant-blow (breaths and puffs) breathing techniques B. Effleurage C. Counterpressure against the sacrum D. Conscious relaxation or guided imagery

C.

During the second and third trimesters of pregnancy, what metabolic change is expected? A. High sensitivity to insulin causes glucose to enter maternal cells quickly B. Maternal insulin crosses the placenta readily C. Insulin resistance allows glucose to be transported to the fetus after a meal D. Maternal requirements for insulin fall dramatically

C.

The primary purpose of administering magnesium sulfate to women with severe preeclampsia is to: A. Lower blood pressure. B. Relieve headache C. Prevent eclamptic seizures D. Improve placental perfusion

C.

Two hours after a meal, the target blood gluse level for a pregnant woman with diabetes is: A. 65-95 mg/dl B. 130-140 mg/dl C. 120 mg/dl or less D. There is no specified limit

C.

While providing care for the breastfeeding mother, the nurse should: A. Recommend that the woman wash her nipples with a mild soap prior to feedings B. Instruct the woman to consume an additional 1000kcal/day more than her pre-pregnancy intake C. Assist the woman to properly position the infant at the breast for feedings D. Teach the woman to wait to initiate feedings after the infant begins to cry

C.

In helping the breastfeeding mother position the baby, nurses should keep in mind that: A. the cradle position is usually preferred by mothers who had a cesarean birth. B. women with perineal pain and swelling prefer the modified cradle position. C. whatever the position used, the infant is "belly to belly" with the mother. D. while supporting the head, the mother should push gently on the occiput.

C. The infant inevitably faces the mother, belly to belly.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? A. Encourage her to empty her bladder. B. Decrease her intravenous (IV) rate to a keep vein-open rate. C. Turn the woman to the left lateral position or place a pillow under her hip. D. No action is necessary since a decrease in the woman's blood pressure is expected.

C. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A. either hot or cold applications may provide relief, but they should never be used together in the same treatment. B. acupuncture can be performed by a skilled nurse with just a little training. C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. D. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

C. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

What is the PRIORITY teaching tip the nurse should provide about bottle-feeding? A. Infants may stool with each feeding in the first weeks. B. Feed newborn at least every 3 to 4 hours. C. Hold infant semiupright while feeding. D. Some infants take longer to feed than others.

C. Airway is priority. The infant might inhale formula or choke on any that was spit up.

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important.

Which infant would be most at-risk for developing hyperbilirubinemia? The infant who is: A. Caucasian B. Female C. 34 weeks gestation D. Feeding regularly

C. 34 weeks gestation

One minute after birth, a newborn has a heart rate of 140, a good cry, well flexed extremeties, pale blue color and grimaces with suctioning. What is the newborn's apgar score? A. 10 B. 9 C. 8 C. 7

C. 7

Increased levels of unconjugated bilirubin require treatment in order to prevent: A. Hemorrhage B. Erythema toxicum C. Neurotoxicity D. Infection

C. Neurotoxicity

Which infant behavioral state is ideal for parent-infant bonding and interaction? A. Active sleep B. Drowsy sleep C. Quiet alert D. Active alert

C. Quiet alert

The nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should: A. Instill within 15 minutes of birth for maximum effectiveness. B. Cleanse eyes from inner to outer canthus before administration. C. Apply directly over the cornea. D. Flush eyes 10 minutes after instillation to reduce irritation.

C. The newborn's eyes should be cleansed from the inner to the outer canthus before the administration of erythromycin ointment.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? A. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. B. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. C. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. D. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C. This action is appropriate when caring for an infant who has had a circumcision

Newborns are at high risk for injury if appropriate safety precautions are not implemented. Parents should be taught to: A. place the newborn on the abdomen (prone) after feeding and for sleep. B. avoid use of pacifiers. C. use a rear-facing car seat. D. use a crib with side rail slats that are no more than 3 inches apart.

C. Your baby should be in a rear-facing infant car safety seat from birth until age 2 years or until exceeding the car seat's limits for height and weight.

Vitamin K is given to the newborn to: A. reduce bilirubin levels. B. increase the production of red blood cells. C. enhance ability of blood to clot. D. stimulate the formation of surfactant

C. enhance ability of blood to clot. Vitamin K does not reduce bilirubin levels. Vitamin K does not increase the production of red blood cells. Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed. Vitamin K is required for the production of certain clotting factors. Vitamin K does not stimulate the formation of surfactant.

When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? (Select all that apply.) A. Maternal blood pressure of 108/79 B. Maternal heart rate of 98 C. Respiratory rate of 14 breaths/min D. Fetal heart rate of 100 beats/min E. Minimal variability on a fetal heart monitor

D, E After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

A laboring woman receives an opioid analgesic for pain, then unexpectedly delivers 45 minutes later. Which medication should be readily available at the time of delivery? A. Vitamin K B. Ephedrine C. Nubain D. Narcan

D.

A woman can prevent engorgement and increase breastmilk production by: A. Wearing a well-fitting bra B. Avoiding breast massage C. Drinking large amounts of fluids D. Feeding at least 8-12 times every 24 hours

D.

Which statement is true concerning calcium intake during pregnancy? A. Supplementation of calcium is recommended for all pregnant women B. Daily recommended intake of calcium is much higher for pregnant women compared to non-pregnant women C. Bone meal supplements are recommended as a calcium source D. Dietary sources of calcium include yogurt, beans and tofu

D.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

D. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

Which statement regarding infant weaning is correct? A. Weaning should proceed from breast to bottle to cup. B. The feeding of most interest should be eliminated first. C. Abrupt weaning is easier than gradual weaning. D. Weaning can be mother or infant initiated.

D. With infant-led weaning, the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother's milk supply. Mother-led weaning means that the mother decides which feedings to drop.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. iron absorption is inhibited by a diet rich in vitamin C. C. iron supplements are permissible for children in small doses. D. constipation is common with iron supplements.

D. Constipation can be a problem

When placing a newborn under a radiant heat warmer to stabilize the temperature after birth, the nurse should: A. place the thermistor probe on the left side of the chest. B. cover the probe with a nonreflective material. C. recheck the temperature by periodically taking a rectal temperature. D. prewarm the radiant heat warmer and place the undressed newborn under it.

D. The radiant warmer should be prewarmed so the infant does not experience more cold stress.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding BEST indicates that preterm labor is occurring? A. Pain in the lower back B. Irregular, mild uterine contractions are occurring every 15 minutes C. Fetal fibronectin is present in vaginal secretions D. The cervix is 90% effaced and dilated to 2 cm

D. for dicks

When weighing a newborn, the nurse should: A. leave its diaper on for comfort B. place a sterile scale paper on the scale for infection control C. keep hand on the newborn's abdomen for safety D. weigh the newborn at the same time each day for accuracy

D. weigh the newborn at the same time each day for accuracy The baby should be weighed without a diaper or clothes. Clean scale paper is acceptable; it does not need to be sterile. The nurse's hand should be above, not on, the abdomen for safety. Weighing a newborn at the same time each day allows for accurate weights.

Newborns undergoing painful procedures should be swaddled tightly with legs extended and close together. True False

False

According to the Gate Control Theory, applying a stimulus during labor such as heat, cold or pressure can block transmission of pain sensations to the brain. True False

True