OB Final

D. Assess respiratory rate Rationale: Magnesium sulfate is a central nervous system depressant and has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus. Care of the woman on Magnesium sulfate includes assessment of vital signs every 5-15 minutes during loading dose and then every 30-60 minutes until stabilization. Assess deep tendon reflexes (DTRs) every 2 hours; decreasing DTRs may be a sign of impending respiratory depression. Respiratory depression, <14 breaths/minute, is the primary complication of Magnesium sulfate use.

A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety. Select one: a. Assess uterine contractions continuously. b. Assess fetal heart rate continuously. c. Assess urinary output. d. Assess respiratory rate.

A. Strawberries

A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because "I hate oranges." The nurse states that 1 cup of which of the following raw foods will meet the patient's daily vitamin C needs? Select one: a. Strawberries b. Asparagus c. Iceberg lettuce d. Cucumber

C. Blood pressure change from 110/70 to 140/90

A patient at 28 weeks' gestation was last seen in the prenatal clinic at 24 weeks' gestation. Which of the following changes should the nurse bring to the attention of the Certified Nurse Midwife? Select one: a. Weight change from 128 pounds to 132 pounds b. Pulse change from 88 bpm to 92 bpm c. Blood pressure change from 110/70 to 140/90 d. Respiratory change from 16 rpm to 20 rpm

A. "I hate it when the baby moves."

A pregnant client at 20 weeks' gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? Select one: a. "I hate it when the baby moves." b. "I've started calling my mom every day." c. "My partner and I can't stop talking about the baby." d. "I still don't know much time I'm going to take off work after the baby comes."

A. Platelet count <100,000/mm3 Rationale: With HELLP, hemolysis is a result of red blood cell destruction and low platelets result from aggregation at the site of damaged vascular endothelium causing platelet consumption.

A primiparous woman has been admitted at 35 weeks' gestation and diagnosed with HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. Which of the following laboratory changes is consistent with this diagnosis? Select one: a. Platelet count <100,000/mm3 b. Platelets increased to 300,000 cells/mm3. c. Red blood cells increased to 5.1 million cells/mm3. d. Sodium dropped to 132 mEq/dL.

D. Neonatal macrosomia Rationale: Most pregnant women maintain a normal glucose level in pregnancy despite increasing insulin resistance by producing increased insulin. To spare glucose for the developing fetus, the placenta produces several hormones that antagonize insulin. Risks for the fetus and newborn include growth disturbances such as macrosomia which is related to fetal hyperinsulinemia. Postpartum hemorrhage is not related to diabetes and neonates are more likely to be hypoglycemic at delivery due to excess insulin.

A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? Select one: a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia

A. Immediate evacuation of hydatiform mole by aspiration/suction D&C Rationale: A hydatiform mole is a benign proliferating growth with formation of vascular transparent vesicles in grape-like clusters without a viable fetus. Due to the use of Ultrasound, this condition is diagnosed early in pregnancy. The mole must be immediately evacuated and hCG levels are drawn at the time of diagnosis and as follow-up for at least 6 months to detect trophoblastic neoplasia.

A woman at 10 weeks' gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). The nurse is aware that this condition puts the woman at an increased risk for choriocarcinoma. Medical management the nurse would expect to see include: Select one: a. Immediate evacuation of hydatiform mole by aspiration/suction D&C b. Platelet transfusions c. Blood draw for hCG analysis d. Amniocentesis

C. Resolution of thrombocytopenia Rationale: With HELLP, hemolysis is a result of red blood cell destruction as the cells travel through constricted vessels. Elevated liver enzymes result from decreased blood flow and damage to the liver. Low platelets (thrombocytopenia) result from aggregation at the site of damaged vascular endothelium causing platelet consumption. Medical management includes replacement of platelets; a resolution of thrombocytopenia would indicate successful treatment.

A woman at 32 weeks' gestation is diagnosed with severe preeclampsia with HELLP (Hemolysis, elevated Liver enzymes, Low Platelets) syndrome. The nurse will identify which of the following as a positive patient care outcome? Select one: a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia

Tachysystole, previously referred to as hyperstimulation, is defined as: Select one or more: a. Contractions lasting 2 minutes or longer b. Five or more contractions in 10 minutes over a 30-minute window c. Contractions occurring within 1 minute of each other d. Uterine resting tone below 20 mm/Hg

A, B, and C Rationale: Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for tachysystole. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone. Rationale: Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for tachysystole. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone. Rationale: Contractions lasting more than 2 minutes, five or more contractions in 10 minutes, and contractions occurring within 1 minute of each other describe the criteria for tachysystole. Uterine resting tone below 20 mm/Hg reflects normal uterine resting tone.

Intrauterine resuscitation techniques are generally initiated by nurses in an effort to improve maternal blood flow to the placenta and oxygen delivery to the fetus. These techniques include: Select one or more: a. IV fluid bolus to correct hypovolemia and/or hypotension b. Oxygen by nasal cannula to increase saturation c. Increase uterine activity to enhance blood flow to the fetus D. Reposition mother off her back and onto the right or left side to correct/prevent aortocaval syndrome.

A, D Rationale: Intrauterine resuscitation techniques are generally initiated by nurses in an effort to improve maternal blood flow to the placenta and oxygen delivery to the fetus. These techniques include lateral repositioning of the mother to prevent aortocaval syndrome; reduction of uterine activity to prevent interruption of blood flow to the placenta; intravenous fluid administration to correct hypovolemia and hypotension; oxygen administration by non-rebreather facemask to increase oxygen saturation; correction of maternal hypotension through position change, IV bolus, or IV medication as ordered; Amnioinfusion to correct umbilical cord compression due to oligohydramnios; altering pushing efforts during 2nd stage to prevent fetal stress as evidenced by decelerations. Rationale: Intrauterine resuscitation techniques are generally initiated by nurses in an effort to improve maternal blood flow to the placenta and oxygen delivery to the fetus. These techniques include lateral repositioning of the mother to prevent aortocaval syndrome; reduction of uterine activity to prevent interruption of blood flow to the placenta; intravenous fluid administration to correct hypovolemia and hypotension; oxygen administration by non-rebreather facemask to increase oxygen saturation; correction of maternal hypotension through position change, IV bolus, or IV medication as ordered; Amnioinfusion to correct umbilical cord compression due to oligohydramnios; altering pushing efforts during 2nd stage to prevent fetal stress as evidenced by decelerations.

A post-cesarean birth woman has been diagnosed with paralytic ileus. Which of the following symptoms would the nurse expect to see? Select one: a. Abdominal distension b. Polyuria c. Diastasis recti d. Dependent edema

A. Abdominal distension Rationale: Signs and symptoms of paralytic ileus include abdominal distention, diffuse and persistent abdominal pain, and nausea or vomiting

It would be most important for a nurse caring for a mother and the infant in the fourth stage of labor to do which of the following? Select one or more: a. Assess and massage the fundus every 15 minutes or more often if needed to maintain tightly contracted uterus b. Massage the uterus continuously c. Administer oxytocin per protocol or provider order d. Assess the patient for a distended bladder

A. Assess and massage the fundus every 15 minutes or more often if needed to maintain tightly contracted uterus C. Administer oxytocin per protocol or provider order Rationale: The fourth stage of labor immediately follows the delivery of the placenta. The nurse should be assessing the fundus every 15 minutes for position, tone, and location. The provider may order oxytocin at this stage, and the nurse should assist the woman to the bathroom if she has a distended bladder which could interfere with the contraction of the uterus. Rationale: The fourth stage of labor immediately follows the delivery of the placenta. The nurse should be assessing the fundus every 15 minutes for position, tone, and location. The provider may order oxytocin at this stage, and the nurse should assist the woman to the bathroom if she has a distended bladder which could interfere with the contraction of the uterus.

The perinatal nurse providing care to a laboring woman recognizes a Category II fetal heart rate tracing. The most appropriate initial action for uterine resuscitation is to: Select one: a. Assist the laboring woman to change her position b. Decrease the intravenous solution c. Request that the physician/certified nurse-midwife come to the hospital STAT d. Document the fetal heart rate and variability

A. Assist the laboring woman to change her position. Rationale: Category II tracings are indeterminate and call for increased vigilance. The initial step in intrauterine resuscitation is a change in maternal position. If no improvement is seen in the FHR tracing, other resuscitation measures are indicated such as IV fluid bolus and the use of oxygen. Following resuscitation, document all findings and interventions. Keep obstetric providers aware of nursing actions and results.

The nurse is developing a plan of care for a client who is in the "taking-in" phase after delivering a healthy baby boy. Which of the following should the nurse include in the plan? Select one: a. Assist the woman in selecting a nutritious meal plan. b. Teach baby care skills like diapering. c. Discuss the pros and cons of circumcision. d. Counsel her regarding future sexual encounters.

A. Assist the woman in selecting a nutritious meal plan Rationale: The "taking-in" phase is a period of dependent behaviors and occurs during the first 24-48 hours. Assisting her in ordering her meals allows her to focus on her comfort while acknowledging her decreased ability to make decisions. Teaching infant skills is probably more appropriate during the "taking-hold" phase.

The perinatal nurse is caring for a woman in the recovery room immediately following cesarean birth. Which of the following assessment findings would indicate the need for immediate notification of the obstetrical provider? Select one or more: a. Catheter is draining blood-tinged urine. B. Woman complains of itching C. Woman complains of nausea D. Lochia is moderate

A. Catheter is draining blood-tinged urine. Rationale: Blood in the urine occurs when there has been trauma to the bladder. Bladder, ureter, and bowel trauma are surgical complications requiring prompt attention. Itching and nausea are common reactions to anesthesia and are treated with ordered medications. Moderate lochia is an expected finding.

A woman is considered in active labor when the following characteristics have occurred: Select one: a. Cervical dilation progresses from 4 to 7 cm with effacement of 40%-80%, contractions becoming more intense, occurring every 2 to 5 minutes with duration of 45-60 seconds. b. Cervical dilation progresses to 4 cm with effacement, contractions become more intense, occurring every 1-2 minutes with duration of 50-90 seconds. c. Cervical dilation progresses to 8 cm with full effacement of 100%, contractions become more intense, occurring every 1 to 2 minutes with duration of 45 to 60 seconds. d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.

A. Cervical dilation progresses from 4 to 7 cm with effacement of 40-80%, contractions becoming more intense, occurring every 2 to 5 minutes with duration of 45-60 seconds. Rationale: Active phase of labor indicates cervical dilation of 4-7 centimeters, increasing effacement, contractions every 3-5 minutes, moderate/strong in intensity, and lasting 30-45 seconds.

A postpartum woman has been diagnosed with postpartum psychosis and will shortly be admitted to the psychiatric unit. Which of the following actions should the nurse perform to ensure safety for both mother and infant? Select one: a. Closely monitor all mother-infant interactions b. Maintain client on strict bed rest. c. Restrict visitation to her partner. d. Carefully monitor toileting.

A. Closely monitor all mother-infant interactions Rationale: Postpartum psychosis (PPP) is a variant of bipolar disorder and is the most serious form of postpartum mood disorders. Onset of symptoms can be as early as the 3rd postpartum day. Assessment findings include paranoia, delusions associated with the baby, mood swings, extreme agitation, confused thinking, and strange beliefs.

Which of the following actions can decrease the risk for a postpartum infection? (Select all that apply.) Select one or more: a. Diet high in protein and vitamin C b. Increased fluid intake c. Ambulating within a few hours after delivery d. Good hand washing techniques by staff and patients

A. Diet high in protein and vitamin C B. Increased fluid intake C. Ambulating within a few hours after delivery D. Good hand washing techniques by staff and patients Rationale: Protein and vitamin C assist with tissue healing. Rehydrating a woman after delivery can assist with decreasing risk for infections. Early ambulation decreases risk for infection by promoting uterine drainage. Hand washing by staff and patients has been shown to be the number one measure in the transmission of infection.

A first-time mother informs her nurse that she is concerned about infant abduction. The nurse should explain to the parents which of the following? (Select all that apply.) Select one or more: a. Do not allow a person without proper unit specific hospital ID to take their baby. b. Encourage parents to accompany any person who removes their infant from the hospital room c. Instruct parents not to leave their newborn unattended at any time d. Inform parents that ID bands with matching identification numbers are placed on the parents and infant at birth to ensure identification of the correct infant with the correct parents

A. Do not allow a person without proper unit specific hospital ID to take their baby C. Instruct parents not to leave their newborn unattended at any time D. Inform parents that ID bands with matching identification numbers are placed on the parents and infant at birth to ensure identification of the correct infant with the correct parents

The nurse is caring for a postpartum woman who gave birth to a healthy, full-term baby girl. She has a 2-year-old son. She voices concern about her older child's adjustment to the new baby. Nursing actions that will facilitate the older son's adjustment to having a new baby in the house would include which of the following? (Select all that apply.) Select one or more: a. Explain to the mother that she can have her son visit her in the hospital b. Teach her son how to change the baby's diapers. d. Recommend that she spend time reading to her older son while he sits in her lap.

A. Explain to the mother that she can have her son visit her in the hospital C. Assist her son in holding his new baby sister. Rationale: Younger children experience a sense of loss over no longer being the baby of the family while older children may have a sense of increased responsibility. Siblings should be introduced to the newest family member as soon as possible and spend time with his/her mother and new sibling during the postpartum hospitalization. Rationale: Younger children experience a sense of loss over no longer being the baby of the family while older children may have a sense of increased responsibility. Siblings should be introduced to the newest family member as soon as possible and spend time with his/her mother and new sibling during the postpartum hospitalization.

Which of the following are primary risk factors for subinvolution of the uterus? (Select all that apply.) Select one or more: a. Fibroids b. Retained placental tissue C. Metritis D. Urinary tract infection

A. Fibroids B. Retained placental tissue D. Metritis Rationale: Uterine fibroids can interfere with involution. Retained placental tissue does not allow the uterus to remain contracted. Infection in the uterus is a risk factor for subinvolution. UTI does not interfere with involution of the uterus.

Jennifer is 3 hours postpartum following the vaginal delivery of a 9lb 15oz baby girl. Estimated blood loss at delivery was 800 ml. The RN is aware that Jennifer experienced an early-postpartum hemorrhage). Select the appropriate nursing actions for the care of this patient. (Select all that apply.) Select one or more: a. Maintain IV site in case fluids/medication for PPH are indicated b. Frequent fundal assessment to prevent uterine atony and further blood loss

A. Maintain IV site in case fluids/medication for PPH are indicated B. Frequent fundal assessment to prevent uterine atony and further blood loss c. Assess for displaced uterus secondary to overdistended bladder. d. Assess lochia for amount and for clots Rationale: PPH is blood loss greater than 500 ml for vaginal deliveries and 1000 ml for cesarean with a 10% drop in hemoglobin and/or hematocrit. Unfortunately, postpartum women may not show signs/symptoms of PPH until about 1/3 of entire blood volume is lost. RNs must frequently assess uterine tone, location, and position as well as blood loss amount and characteristics (slow, steady, sudden, massive, presence of clots, possible distended bladder). Keeping the IV site intact will allow immediate access to fluids and/or medications should PPH worsen.

The most appropriate time to give prophylactic antibiotics to the women undergoing cesarean section is: Select one: a. One hour before the surgery b. Two hours before the surgery c. Not indicated unless she has an active infection d. At the time the cord is clamped

A. One hour before the surgery Rationale: Administration of narrow-spectrum prophylactic antibiotics should occur within 60 minutes prior to the skin incision.

A pregnant woman who has a history of cesarean births is requesting to have a vaginal birth after cesarean (VBAC). In which of the following situations should the nurse advise the patient that her request may be declined? Select one: a. Previous uterine surgery b. Flexed fetal attitude c. Previous low flap uterine incision d. Positive vaginal candidiasis

A. Previous uterine surgery Rationale: Contraindications for trial of labor after cesarean (TOLAC) leading to VBAC include vertical uterine incision, previous uterine surgery, previous uterine rupture, pelvic abnormalities, complications preventing vaginal delivery, lack of personnel required for operative delivery.

An infant admitted to the newborn nursery has a blood glucose level of 55 mg/dL. Which of the following actions should the nurse perform at this time? Select one: a. Provide the baby with routine feedings b. Assess the baby's blood pressure. c. Place the baby under the infant warmer. d. Monitor the baby's urinary output.

A. Provide the baby with routine feedings Rationale: Neonatal hypoglycemia is defined as <40mg/dL; 55mg/dL is a normal glucose value requiring no treatment

Heat loss through radiation can be reduced by: Select one or more: a. Removing wet blankets used to dry the infant after birth from the crib b. Placing a stocking cap on the neonate's head and placing in a crib c. Providing skin-to-skin contact with the mother and covering both with a warm blanket when the room temperature is cool d. Placing crib near a warm wall

A. Removing wet blankets used to dry the infant after birth from the crib b. Placing a stocking cap on the neonate's head and placing in a crib c. Providing skin-to-skin contact with the mother and covering both with a warm blanket when the room temperature is cool Rationale: Loss of body heat through radiation results from transfer of heat from the neonate to cooler objects not in direct contact with the neonate, such as cold walls of the crib, cold equipment, wet blankets, cold room temperature, etc.

Painful nipples are a major reason why women stop breastfeeding. A primary intervention to decrease nipple irritation is: Select one: a. Teaching proper techniques for latching-on and releasing of suction. b. Applying hot compresses to breast prior to feeding c. Instructing woman to express colostrum or milk at the end of the feeding session and rub it on her nipples d. Air drying nipples for 10 minutes at the end of the feeding session

A. Teaching proper techniques for latching-on and releasing of suction Rationale: While all these interventions are correct, the primary intervention is to ensure correct latching-on and suction release as problems with these lead to early cessation of breastfeeding.

The postpartum nurse caring for a 20-year-old G1 P1 woman who 3 hours ago delivered a healthy full-term infant, observes the woman who is lightly touching her baby girl with her fingertips but who seems to be uncomfortable holding her baby close to her body. Which of the following is an accurate interpretation of these observed behaviors? Select one: a. The woman is in the initial stage of maternal touch. b. The woman is in the taking-in phase. c. The woman is having difficulty in bonding with her baby. d. The woman needs to be medicated for pain.

A. The woman is in the initial stage of maternal touch. Rationale: These are classical signs of the initial stage of Rubin's maternal touch.

You are caring for a woman in the 4th stage of labor and birth. Fundal massage reveals a firm, well-contracted uterus but you note unusual swelling of the perineum. This might indicate formation of a hematoma. Select one: True False

A. True Rationale: During the 4th stage of labor and birth, the nurse closely monitors the perineum for unusual swelling which may indicate internal bleeding and hematoma formation.

A low-risk patient calls the labor unit and says "I need to come in to be checked right now, there were pink streaks on the toilet paper when I went to the bathroom. I think I'm bleeding." What response should the nurse say first? Select one: a. "How much blood is there?" b. "You sound concerned, what other labor symptoms do you have? c. "Don't worry that sounds like a mucus plug." d. "Does it burn when you urinate?"

B. "You sound concerned, what other labor symptoms do you have?" Rationale: The nurse is using reflection to acknowledge the woman's concerns and asks for further assessment. The woman's fear must first be acknowledged and then other questions or comments can be made.

The perinatal nurse is preparing a woman for a scheduled cesarean birth. The woman will be receiving spinal anesthesia for the birth. In order to prevent maternal hypotension, the nurse: Select one: a. Assists the woman to lie down in a supine position. b. Administers an intravenous preload infusion of 500 mL of normal saline. Assesses blood pressure and pulse every 5 minutes, three times, before the spinal insertion. d. Encourages frequent cleansing breaths after the patient has been placed in the correct position for the anesthesia administration.

B. Administers an intravenous preload infusion of 500 mL of normal saline Rationale: An IV fluid preload of 500-1000 mL is given before administration of spinal or epidural anesthesia to increase fluid volume and decrease risk of hypotension related to the effects of anesthetic agents.

A nurse is preparing to monitor a patient who is to receive an amnioinfusion. Which of the following actions should the nurse make at this time? Select one: a. Attach the patient to an electronic blood pressure cuff. b. Assist in insertion of an intrauterine pressure catheter (IUPC). c. Attach the patient to an oxygen saturation monitor. d. Perform an amniotic fluid Nitrazine test.

B. Assist in insertion of an intrauterine pressure catheter (IUPC). Rationale: Amnioinfusion involves the introduction of room-temperature saline through the cervix into the uterus via intrauterine pressure catheter (IUPC). The main purpose for amnioinfusion is to correct cord compression associated with too little amniotic fluid (oligohydramnios). Prior to amnioinfusion an IUPC must be inserted.

A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal problems could have resulted in this complication? (Select all that apply.) Select one or more: a. Cholecystitis b. Chronic Hypertension with Preclampsia c. Cigarette smoker d. Candidiasis e. Cerebral palsy

B. Chronic hypertension with preclampsia C. Cigarette smoker Rationale: Babies born to women with cholecystitis, cerebral palsy, or candida are not especially high risk for IUGR. Babies born to women with chronic hypertension and/or preeclampsia or who smoke are high risk for IUGR.

The nurse notes that a new father gazes at his baby for prolonged periods of time and comments that his baby is beautiful and he is very happy having a baby. These behaviors are commonly associated with: Select one: a. Bonding b. Engrossment c. Couvade syndrome d. Attachment

B. Engrossment Rationale: Engrossment is defined as an absorption, preoccupation, and interest shown by fathers with their newborns. New fathers gaze at their newborns for prolonged periods of time as if they are in a hypnotic trance. characteristics of engrossment include a perception that the newborn is perfect.

Which of the following nursing actions are important in the care of a postpartum woman who is at risk for orthostatic hypotension? (Select all that apply.) Select one or more: a. Have patient remain in bed for the first 4 hours postbirth. b. Instruct patient to slowly rise to a standing position. c. Open an ammonia ampule and have the patient smell the ammonia prior to getting out of bed. d. Explain to the patient the cause and incidence of orthostatic hypotension.

B. Instruct patient to slowly rise to a standing position D. Explain to the patient the cause and incidence of orthostatic hypotension. Rationale: Postpartum women are at risk for orthostatic hypotension during the first few hours postdelivery. Orthostatic hypotension is a sudden drop in the blood pressure when the woman stands up due to decreased vascular resistance in the pelvis. The woman should be instructed to sit on the edge of her bed for a few minutes and then slowly stand up. The nurse or aide should be with the woman the first few times she ambulates. Ammonia ampules are used when the woman faints and is not given prior to fainting. Rationale: Postpartum women are at risk for orthostatic hypotension during the first few hours postdelivery. Orthostatic hypotension is a sudden drop in the blood pressure when the woman stands up due to decreased vascular resistance in the pelvis. The woman should be instructed to sit on the edge of her bed for a few minutes and then slowly stand up. The nurse or aide should be with the woman the first few times she ambulates. Ammonia ampules are used when the woman faints and is not given prior to fainting.

During a cesarean section, which action by the nurse is done to prevent compression of the descending aorta and vena cava? Select one: a. Right lateral tilt b. Left lateral tilt c. Elevate head of gurney at 30 degrees d. Administration of IV fluid preload of 500 to 1000 mL

B. Left lateral tilt Rationale: Positioning of the patient with a left tilt maintains a left uterine displacement to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava due to weight of the gravid uterus.

Typical signs of abusive head trauma (AHT, also known as Shaken Baby Syndrome) include which of the following? (Select all that apply.) Select one or more: a. Broken clavicle b. Poor feeding c. Vomiting d. Breathing problems

B. Poor feeding C. Vomiting D. Breathing problems Rationale: Symptoms of abusive head trauma are extreme irritability, poor feeding, breathing problems, convulsions, vomiting, and pale or bluish skin.

A primigravida woman at 42 weeks' gestation received Prepidil (dinoprostone) for induction 12 hours ago. The Bishop score is now 3. Which of the following actions by the nurse is appropriate? Select one: a. Perform Nitrazine analysis of the amniotic fluid. b. Report the lack of progress to the obstetrician. c. Place the woman on her left side. d. Ask the provider for an order for oxytocin.

B. Report the lack of progress to the obstetrician Rationale: Prepidil is indicated for cervical ripening, the process of physical softening and opening of the cervix. Cervical status is the most important predictor of successful induction of labor. Cervical status is assessed before induction of labor using the Bishop score. A score of 6 or more is considered favorable for successful induction of labor.

The mechanisms of labor include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. These mechanisms are also referred to as: Select one: a. Stages of labor b. The cardinal movements of labor c. First stage of labor d. Fetal lie

B. The cardinal movements of labor Rationale: The cardinal movements of labor allow passage of the fetus through the birth canal. These include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.

The perinatal nurse understands that the purpose of the surgical "time-out" is to: Select one: a. Confirm that the surgeon is ready to begin b. Verify that it is the correct site, procedure, and patient c. Verify that anesthesia is adequate d. Confirm that the neonatal team is in attendance

B. Verify that it is the correct site, procedure, and patient. Rationale: Surgical "time-out" is performed by the entire surgical team and the patient prior to the administration of anesthesia. The purpose is to validate correct patient, site, and procedure.

A. Stimulate the production of surfactant in the preterm infant between 24 and 34 weeks gestation B. decrease the severity of respiratory distress C. accelerate fetal lung maturity Rationale: Betamethasone is a steroid that is given to pregnant women with signs of preterm labor between 24 and 34 weeks' gestation. It stimulates the production of surfactant in the preterm infant and accelerates fetal lung maturity.

Betamethasone is a steroid that is given to a pregnant woman with signs of preterm labor. The purpose of giving steroids is to (select all that apply): Select one or more: a. Stimulate the production of surfactant in the preterm infant between 24 and 34 weeks gestation b. Stop labor contractions c. Decrease the severity of respiratory distress d. Accelerate fetal lung maturity

Approximately 8 hours ago, Juanita, a 32-year-old G1 P0, gave birth after 2 mc009-1.jpg hours of pushing. She required an episiotomy and an assisted birth (forceps) due to the weight and size of her baby (9 lb. 9 oz.). The perinatal nurse is performing an assessment of Juanita's perineal area. A slight bulge is palpated and the presence of ecchymoses to the right of the episiotomy is noted. The area feels "full" and is approximately 4 cm in diameter. Juanita describes this area as "very tender." The perinatal nurse notifies the physician of the findings related to Juanita's assessment. The first step in care will most likely be to: a. Prepare Juanita for surgery b. Administer intravenous fluids c. Apply ice to the perineum d. Insert a urinary catheter

C. Apply ice to the perineum Rationale: If the hematoma is less than 3 to 5 centimeters in diameter, the physician usually orders palliative treatments such as ice to the area for the first 12 hours along with pain medication. After 12 hours, sitz baths are prescribed to replace the application of ice. However, a hematoma larger than 5 centimeters may require incision and drainage with the possible placement of a drain.

A nurse is preparing a woman in early labor for an urgent cesarean birth related to breech presentation. Select the best nursing action for reducing the couple's anxiety levels. Select one: a. Explain the reason for the need for a cesarean section. b. Inform parents that their baby is in distress. c. Ask the couple to share their concerns. d. Reassure the couple that both the woman and baby are in no danger.

C. Ask the couple to share their concerns. Rationale: Urgent cesarean births, rather than emergent, should allow the RN time to discuss with the family their feelings and concerns. The RN should provide emotional support during the preparation for surgery in an attempt to facilitate communication and decrease fear, anxiety, and distress. Medical management includes the determination of the need for cesarean birth and the explanation of the procedure in order to obtain consent.

You are caring for a woman in active labor who is 6 cm dilated with a normal fetal heart rate (FHR) pattern and regular strong uterine contractions (UCs). The fetal heart rate (FHR) and UCs during active labor should be assessed: Select one: a. Continuously b. Every 10 minutes c. Every 15-30 minutes d. Every 60 minutes

C. Every 15-30 minutes Rationale: During the active phase of labor, FHR and UCs should be assessed every 15-30 minutes or by hospital protocol

Which of the following clients is most likely to complain of aftepains during her postpartum period? Select one: a. G1 P1, diagnosed with preeclampsia b. G2 P2, group B streptococci in the vagina c. G3 P2, gave birth to a 4100-gram baby and is breastfeeding d. G4 P1, diagnosed with preterm labor

C. G3 P2, gave birth to a 4100-gram baby and is breastfeeding Rationale: Primiparous women usually do not experience discomfort related to uterine contractions during the postpartum period. Multiparous women or women who are breastfeeding may experience afterpains during the first few postpartum days due to the release of oxytocin during infant suckling.

The perinatal nurse is providing care to Carol, a 28-year-old multiparous woman in labor. Upon arrival to the birthing suite, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as "strong." Carol states she labored for 1 hour at home. As the nurse assists Carol from the assessment area to her labor and birth room, Carol states that she is feeling some rectal pressure. Carol is most likely experiencing: Select one: a. Hypertonic contractions b. Hypotonic contractions c. Precipitous labor d. Uterine hyperstimulation

C. Precipitous labor Rationale: Precipitous labor that lasts fewer than 3 hours from onset to birth. Precipitous labor is more likely to be seen in woman who have previously given birth or have a previous history of rapid labors. As the fetal head descends, the woman may feel rectal pressure indicating delivery is imminent.

The NICU nurse recognizes that respiratory distress syndrome results from a developmental lack of: Select one: a. Lecithin b. Calcium c. Surfactant d. Magnesium

C. Surfactant Rationale: Respiratory distress syndrome (RDS) is a life-threatening lung disorder resulting from underdeveloped and small alveoli and insufficient level of pulmonary surfactant.

A woman on the day of discharge from the postpartum unit asks a number of questions regarding breastfeeding and shares that she is nervous about taking her baby home and not being able to remember everything she has been taught. These are behaviors associated with: Select one: a. Bonding b. Taking in c. Taking hold D. Attachment

C. Taking hold Rationale: The "taking hold" phase indicates the movement between dependent and independent behaviors. During this phase, the mother may have feelings of inadequacy and being overwhelmed.

On day four following the birth of an average size baby, the nurse would expect the fundus to be at: Select one: a. 1 cm below umbilicus b. 2 cm below umbilicus c. 3 cm below umbilicus d. 4 cm below umbilicus

D. 4 cm below umbilicus Rationale: After birth, the uterine fundus is palpated midway between the umbilicus and the symphysis pubis. Within 12 hours after birth of the placenta, the fundus is located at the level of the umbilicus. 24 hours after birth of the placenta, the fundus is located at 1 cm below the umbilicus. The uterus descends 1 cm per day; by postpartum day #4, the uterine fundus would be palpated 4 cm below the umbilicus.

A client delivered a 2800-gram neonate 4 hours ago by cesarean section with epidural anesthesia. Which of the following interventions should the nurse perform on the mother at this time? Select one: a. Maintain the client flat in bed. b. Assess the client's patellar reflexes. c. Monitor hourly urinary outputs. d. Assess the client's respiratory rate.

D. Assess the client's respiratory rate

The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: Select one: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions

D. Braxton-Hicks contractions Rationale: Braxton-Hicks contractions are irregular and do not result in cervical change; also referred to as "false labor." Regular contractions causing cervical change are true indicators of labor. True labor (regular contractions with cervical change including effacement and dilation) at 34+ weeks would be preterm.

A patient, G1 P0, is admitted to the labor and delivery unit for induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6°F, 88, 20, BP 120/80, negative obstetrical history. A prostaglandin suppository was inserted at that time. Which of the following findings, 6 hours after insertion, would warrant the removal of the Cervidil (dinoprostone)? Select one: a. Bishop score of 5 b. Fetal heart of 152 bpm c. Respiratory rate of 24 rpm d. More than 5 contractions in 10 minutes

D. More than 5 contractions in 10 minutes Rationale: Cervidil should be removed in the presence of tachysystole or Category II/III FHR patterns.

You are in the process of admitting a multiparous woman to labor and delivery from the triage area. One hour ago her vaginal exam was 7 cm dilated/70% effaced/0 station. While completing your review of her prenatal record and completing the admission questionnaire, she tells you she has an urge to have a bowel movement and feels like pushing. Your priority nursing intervention is to: Select one: a. Reassure the patient and rapidly complete the admission. b. Assist your patient to the bathroom to have a bowel movement. c. Assess the fetal heart rate and uterine contractions. d. Perform a vaginal exam as delivery may be imminent.

D. Perform a vaginal exam as delivery may be imminent Rationale: Mutiparous women can move from active labor to transition within 1-2 hours; an urge to have a bowel movement may indicate the fetal head has descended rapidly and delivery is imminent. Performing a sterile vaginal exam (SVE) will assess how quickly delivery might be anticipated and allow appropriate preparations to be made.

A neonate is admitted to the nursery. The nurse makes the following assessments: weight 2845 grams, overriding sagittal suture, molding, and point of maximal impulse (PMI) at the xiphoid process. Which of the assessments should be reported to the health-care practitioner? Select one: a. Birth weight b. Sagittal suture line c. Closed posterior fontanel d. Point of maximum intensity

D. Point of maximum intensity Rationale: PMI should be at the 3rd or 4th intercostal space. Displaced PMI occurs with cardiomegaly. Molding and sagital suture overrides are expected findings.

When intrathecal morphine is used for post-operative pain, the anesthesiologist manages the woman's pain for the first 24 hours. The perinatal RN is aware that the most serious complication of intrathecal morphine in the first 24 hours following surgery is: Select one or more: A. Urinary retention B. Nausea and itching C. Decreased sensation in the legs D. Respiratory depression

D. Respiratory depression Rationale: Severe respiratory depression is a life-threatening adverse reaction to intrathecal morphine. Naloxone and resuscitative equipment need to be available whenever intrathecal morphine is administered and during the 24 hours post-procedure.

Ms. P has delivered her first baby 30 minutes ago and the placenta delivered 15 minutes ago. She is attempting to breastfeed her newborn daughter for the first time. Which action by the nurse would NOT be appropriate? Select one: a. The nurse is checking the BP every 15 minutes b. The nurse is massaging the fundus vigorously c. The nurse is auscultating the infant's heart and lungs while on the mother's chest d. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn

D. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn Rationale: During the fourth stage of labor the mothers should not be left unattended as maternal bleeding needs to be closely monitored.

C. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension

During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to: Select one: a. Order an EKG. b. Report this abnormal finding immediately to her care provider. c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension. d. Order a nonstress test to assess fetal well-being.

During an emergency cesarean birth the "time-out" procedure may be omitted based on the obstetrical emergency. Select one: True False

False Rationale: Joint commission guidelines for patient safety necessitate there always be a time-out to prevent wrong patient, wrong site, wrong procedure, and medical errors

A, B, and D Utilizing proper body mechanics, applying ice or heat to affected area, using additional pillows for support during sleep

Interventions for low back pain during pregnancy should include (select all that apply): Select one or more: a. Utilizing proper body mechanics b. Applying ice or heat to affected area c. Avoiding pelvic rock and pelvic tilt d. Using additional pillows for support during sleep

B. Couvade syndrome

Jane's husband Brian has begun to put on weight. What is this a possible sign of? Select one: a. Culturalism syndrome b. Couvade syndrome c. Moratorium phase d. Attachment

A, Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week

Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to: Select one: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.

A. Orthopnea, B. Nocturnal dyspnea, and C. Palpitations Rationale: Signs and symptoms of deteriorating cardiac status with cardiac disease include orthopnea, nocturnal dyspnea, and palpitations, but do not include irritation.

Marked hemodynamic changes in pregnancy can impact the pregnant woman with cardiac disease. Signs and symptoms of deteriorating cardiac status include (select all that apply): Select one or more: a. Orthopnea b. Nocturnal dyspnea c. Palpitations

A. Dysuria - UTI symtptoms include dysuria, hematuria, and urgency B. Hematuria - UTI symptoms include dysuria, hematuria, and urgency

Physiologic changes that occur in the renal system during pregnancy predispose the pregnant woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all that apply): Select one or more: a. Dysuria b. Hematuria c. Urgency d. Delayed urination

A. True Because of strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day

The clinic nurse knows that every time a woman of childbearing age comes in to the office for a health maintenance visit, she should be counseled about the benefits of daily folic acid supplementation. Select one: True False

A. A genetics counselor/specialist Rationale: -Quadruple screening includes four chemical markers (AFP, hCG, estriol levels, inhibin-A) along with maternal age to detect trisomies and neural tube defects (NTD). Women with abnormal values should be referred to a genetics counselor/specialist for further testing.

The clinic nurse meets with Rebecca, a 30-year-old woman who is experiencing her first pregnancy. Rebecca's quadruple marker screen result is positive at 17 weeks' gestation. The nurse explains that Rebecca may need a referral to: Select one: a. A genetics counselor/specialist for further diagnostic testing b. An obstetrician c. A gynecologist d. A social worker

A. First maneuver

The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: Select one: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver

B. Couvade syndrome

The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as: Select one: a. Influenza b. Couvade syndrome c. Acid reflux d. Cholelithiasis

D. The patient with eclampsia Rationale: Hypertensive disorders of pregnancy is the only risk factor of placental abruption in these responses.

The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? Select one: a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia

A. Cultural prescription

The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of: Select one: a. Cultural prescription b. Cultural taboo c. Cultural restriction d. Cultural demonstration

A,B, and D Increased size of the thyroid gland is normal, increased function of the thyroid gland is normal, the thyroid gland will return to its normal size and function during the postpartal period

The perinatal nurse examines the thyroid gland as part of the physical examination of Savannah, a pregnant woman who is now at 16 weeks' gestation. The perinatal nurse informs Savannah that during pregnancy (select all that apply): Select one or more: a. Increased size of the thyroid gland is normal b. Increased function of the thyroid gland is normal c. Decreased function of the thyroid gland is normal d. The thyroid gland will return to its normal size and function during the postpartal period

A. Preeclampsia Rationale: Hypertensive women who develop new-onset proteinuria or proteinuria before the 20th week of gestation or sudden increase in proteinuria and BP are classified as preeclampsia superimposed on chronic hypertension.

The perinatal nurse knows that the term to describe a woman at 26 weeks' gestation with a history of hypertension prior to pregnancy and who now presents with a new onset proteinuria (by dipstick) is: Select one: a. Preeclampsia and eclampsia syndrome b. Chronic hypertension c. Gestational hypertension d. Preeclampsia superimposed on chronic hypertension

A. True

The perinatal nurse recommends strengthening exercises during pregnancy, as this can improve posture and increase energy levels. A. True B. False

D. Infection

The primary complications of amniocentesis are: Select one: a. Damage to fetal organs b. Puncture of umbilical cord c. Maternal pain d. Infection

The nurse assessing a newborn for heat loss is aware that nonshivering thermogenesis utilizes the newborn's stores of brown adipose tissue (BAT) to provide heat in the cold-stressed newborn. Select one: True False

True Rationale: Brown adipose tissue, also known as "brown fat," is a unique highly vascular fat found only in newborns. BAT promotes an increase in metabolism, heat production, heat transfer to the peripheral system. Heat is produced by intense lipid metabolic metabolism but reserves are rapidly depleted during periods of cold stress.

Metritis is an infection that usually starts at the placental site. Select one: True False

True Rationale: Metritis is an infection of the endometrium that usually starts at the placental site and spreads to encompass the entire endometrium.

Lesbian women are at a higher risk for heart disease than heterosexual women. Select one: True False

True Rationale: The rates of smoking and obesity in lesbians are higher than those of heterosexual women which places them at higher risk for heart disease.

The perinatal nurse teaches the postpartum woman that the most critical time to achieve effectiveness from the application of ice packs to the perineum is during the first 24 hours following birth. Select one: True False

True Rationale: To reduce perineal swelling and pain that result from bruising, ice packs may be applied every 2 to 4 hours. Patients obtain the most relief when ice packs are applied within the first 24 hours after childbirth.

D. Happiness - The maternal tasks of pregnancy include acceptance of pregnancy and generally happy feelings during this time. Adaptation to pregnancy in the second trimester, more specifically, includes anxiety regarding body changes, and the presence of fears and phobias. Feelings of anxiety in addition to changes in body image include loss of old life, changing relationships with friends and family, changes in sexual activity and "tuning in" to the fetus in terms of movement, etc.

When providing a psychosocial assessment on a pregnant woman at 21 weeks' gestation, the nurse would expect to observe which of the following signs? Select one: a. Ambivalence b. Depression c. Anxiety d. Happiness

False About one third of women with GDM will have a recurrence in subsequent pregnancies and are at high risk to devlop type 2 diabetes later in life

Women with gestational diabetes (GDM) do not need to be monitored for type 2 diabetes after the birth. Select one: True False

D. "Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements within 2 hours." Rationale: Maternal assessment of fetal movement by counting fetal movements in a period time can identify potentially hypoxic fetuses. Fetal activity is diminished in the compromised fetus. The pregnant woman is instructed to palpate her abdomen and track fetal movements daily for 1-2 hours. Ten distinct fetal movements within 2 hours is considered normal. Once movement is achieved, counts can be discontinued for the day.

Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do "kick counts." The best response by the nurse would be to explain: Select one: a. "Here is an information sheet on how to do kick counts." b. "It is not important to do kick counts because you have a low-risk pregnancy." c. "Fetal kick counts are not a reliable indicator of fetal well-being in the third trimester." d. "Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements within 2 hours."

D. "CVS can be done earlier in your pregnancy, and the results are available more quickly."

Your patient is a 37-year-old pregnant woman who is 5 weeks pregnant and is considering genetic testing. During your discussion, the woman asks the nurse what the advantages of chorionic villus sampling (CVS) are over amniocentesis. The best response is: Select one: a. "You will need anesthesia for amniocentesis, but not for CVS." b. "CVS is a faster procedure." c. "CVS provides more detailed information than amniocentesis." d. "CVS can be done earlier in your pregnancy, and the results are available more quickly."

B. "The test will help to determine how many weeks you are pregnant."

Your pregnant patient is in her first trimester and is scheduled for an abdominal ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is: Select one: a. "The test will help to determine the baby's position." b. "The test will help to determine how many weeks you are pregnant." c. "The test will help to determine if your baby is growing appropriately." d. "The test will help to determine if you have a boy or girl."

Which of the following is considered to be a "reassuring" or Category 1 Fetal Heart Rate (FHR) pattern? Select one: a. Baseline rate of 110-160; moderate variability; presence of accelerations; absence of decelerations Correct A "reassuring" or Category 1 FHR pattern is defined as: baseline rate of 110-160 beats per minute (bpm); moderate variability; presence of accelerations; absence of decelerations. b. Baseline rate of 150-200; moderate variability; occasional accelerations; variable decelerations c. Baseline rate of 120; absent variability; presence of accelerations; early decelerations present d. Baseline rate of 100-150; minimal variability; presence of accelerations; occasional decelerations

a. Baseline rate of 110-160; moderate variability; presence of accelerations; absence of decelerations Rationale: A "reassuring" or Category 1 FHR pattern is defined as: baseline rate of 110-160 beats per minute (bpm); moderate variability; presence of accelerations; absence of decelerations.

Which of the following women is at highest risk for osteoporosis? Select one: a. A 70-year-old non-Hispanic Caucasian woman who has smoked for 50 years b. A 70-year-old non-Hispanic black woman who is a heavy drinker c. A 60-year-old Asian woman who takes steroids to treat SLE d. A 70-year-old Hispanic woman who has had weight loss surgery

a. A 70-year-old non-Hispanic Caucasian woman who has smoked for 50 years Rationale: Each of the women has a risk factor for osteoporosis, but answer (a) has the additional risk factor of being a non-Hispanic white woman.

The nurse is teaching the parents of a female baby how to change a baby's diapers. Which of the following should be included in the teaching? Select one: a. Always wipe the perineum from front to back. b. Use an antibiotic ointment at the first sign of diaper rash c. Put powder on the buttocks every time the baby stools. d. Weigh every diaper in order to assess for hydration.

a. Always wipe the perineum from front to back. Rationale: Clean female genitals by washing from front to back to decrease the risk of cystitis

The nurse knows that a FHR monitor printout indicates a Category III abnormal fetal heart rate pattern when: Select one: a. Baseline variability is minimal or absent with decelerations. b. FHR mirrors the uterine contractions. c. Occasional periodic accelerations occur. d. Baseline variability is 6 to 25 bpm with decelerations

a. Baseline variability is minimal or absent with decelerations.

During a health visit, a 23-year-old patient shares with her health-care provider that she has been experiencing a yellowish mucus vaginal discharge, pain during sexual intercourse, and burning on urination. A culture of the cervical epithelial cells is obtained. Based on the patient information, the culture is obtained to assist in the diagnosis of which of the following? (Select all that apply.) Select one or more: a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis

a. Chlamydia b. Gonorrhea Rationale: These are symptoms that can be related to either chlamydia or gonorrhea. Syphilis is diagnosed via blood test. Genital herpes has symptoms similar to the flu, and the person usually has an itching or burning sensation in the genital or anal area.

A mother of a 10-day-old infant calls the clinic and reports that her baby is having loose, green stools. The mother is breastfeeding her infant. Which of the following is the best nursing action? Select one: a. Instruct the woman to bring her infant to the clinic. b. Instruct the woman to decrease the amount of feeding for 24 hours and to call if the stools continue to be loose. c. Explain that this is a normal stool pattern. d. Instruct the woman to eat a bland diet for the next 24 hours and call back if the stools continue to be loose and green.

a. Instruct the woman to bring her infant to the clinic. Rationale: Instruct parents to notify the health care provider if stools are runny and green and/or if newborn/infant has less than 6 wet diapers per day.

To accurately measure the neonate's head, the nurse places the measuring tape around the head: Select one: a. Just above the ears and eyebrows b. Middle of the ear and over the eyes c. Middle of the ear and over the bridge of the nose d. Just below the ears and over the upper lip

a. Just above the ears and eyebrows

The perinatal nurse is assisting the student nurse with completion of documentation. The laboring woman has just given birth to a 2700 gram infant at 36 weeks' gestation. The most appropriate term for this is: Select one: a. Late premature birth b. Term birth c. Very premature birth d. Large for gestational age infant

a. Late premature birth Rationale: Late premature birth is a neonate born between 34 and 37 weeks' gestation; term is considered 38 - 40 weeks' gestation; very premature is less than 32 weeks' gestation; LGA refers to an infant who is large for gestational age.

A 37-year-old gravida 8 para 8 woman was admitted to the postpartum unit at 2 hours postbirth. On admission to the unit, her fundus was palpated at the umbilicus, midline, and firm; lochia was moderate rubra. An hour later, her fundus is midline and boggy, and the lochia is heavy with small clots. Based on this assessment data, the first nursing action is: Select one: a. Massage the fundus of the uterus. b. Assist the woman to the bathroom and reassess the fundus. c. Notify the physician or midwife. d. Start IV oxytocin therapy as per standing orders.

a. Massage the fundus of the uterus. Rationale: Uterine atony is a decreased tone of the uterine muscle and the major cause of postpartum hemorrhage (PPH). Uterine atony results in soft, boggy fundus; bleeding may be slow and steady or sudden and massive; blood clots may be presents; tachycardia; hypotension. Nursing management for a boggy uterus is massage and reassessment. If the uterus is displaced to either side of midline, consider full bladder as the cause for atony.

A 42-weeks' gestation neonate is admitted to the NICU (neonatal intensive care unit). This neonate is at risk for which complication? Select one: a. Meconium aspiration b. Failure to thrive c. Necrotizing enterocolitis d. Intraventricular hemorrhage

a. Meconium aspiration Rationale: A post-term neonate is one who is delivered after the completion of 41 weeks' gestation and is at higher risk of morbidity and mortality. Post mature infants are at risk for meconium aspiration, fetal hypoxia related to placental insufficiency, neurological complications related to asphyxia, hypoglycemia, hypothermia, polycythemia, and birth trauma related to macrosomia ( birth weight above 4000-4500 grams).

Secondary amenorrhea results from (select all that apply): Select one or more: a. Polycystic ovary syndrome b. Uncontrolled Diabetes c. Secondary amenorrhea is no menses in 6 months in a woman who has had normal menstrual cycles. May result from: lack of ovarian production, pregnancy, polycystic ovary syndrome, nutritional and endocrine disturbances, uncontrolled diabetes, heavy athletic activity, or emotional distress. d. Pregnancy

a. Polycystic ovary syndrome b. Uncontrolled Diabetes d. Pregnancy Rationale: Secondary amenorrhea is no menses in 6 months in a woman who has had normal menstrual cycles. May result from: lack of ovarian production, pregnancy, polycystic ovary syndrome, nutritional and endocrine disturbances, uncontrolled diabetes, heavy athletic activity, or emotional distress.

A neonate is born at 33 weeks' gestation. This neonate would be classified as: Select one: a. Premature b. Very premature c. Late premature d. Term

a. Premature Rationale: Very premature infants are those born at less than 32 weeks' gestation; premature infants are born between 32 and 34 weeks' gestation; late premature are neonates born between 34 and 37 weeks' gestation; term infants are those born between 37-40 weeks' gestation.

The nurse is advising parents of a full-term neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? Select one: a. Put the car seat facing forward only after the baby reaches 20 pounds. b. The infant car seat should be placed facing the rear seat in the front seat of the car. c. Car seats are recommended only when traveling longer distances from home; holding the infant is safe for short trips d. It is safe to leave an infant in a car seat alone as long as the windows are down at least 1 inch.

a. Put the car seat facing forward only after the baby reaches 20 pounds. Rationale: Infants are safest when secured in the back seat. Rear-facing car seats are used with infants until they are 1 year of age and weigh 20 pounds. It is never safe to leave an infant unattended in a car seat and car seats should be used whenever traveling in a motor vehicle.

Excessive drinking places the woman at risk for (select all that apply): Select one or more: a. Suicide b. Stroke c. Breast cancer d. Menstrual disorders

a. Suicide b. Stroke c. Breast cancer Rationale: Excessive drinking places a woman at risk for alcoholism, elevated blood pressure, obesity, diabetes, stroke, breast cancer, suicide and accidents.

The woman's health clinic nurse is providing information to a 21-year-old woman who is being scheduled for a pelvic exam and Pap test. This information should include (select all that apply): Select one or more: a. The Pap test is a diagnostic test for cervical cancer. b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam. c. The best time to have a Pap test is 5 days after the menstrual period has ended. d. The woman should have a yearly Pap test.

a. The Pap test is a diagnostic test for cervical cancer. b. The woman should not use tampons or vaginal medication or engage in sexual intercourse within 48 hours of the exam. c. The best time to have a Pap test is 5 days after the menstrual period has ended. Rationale: The Pap test is a screening versus a diagnostic test. Women should not douche; use tampons; use vaginal creams, spermicide foams, creams, or jellies; use vaginal lubricants or moisturizers; use vaginal medications; or have sexual intercourse for 48 hours prior to the exam. The best time to obtain a Pap test is 5 days after the period ends. Women ages 21 to 29 should have a Pap test every 3 years.

Nursing actions that decrease the risk of skin breakdown include which of the following? (Select all that apply.) Select one or more: a. Using gelled mattresses b. Using emollients in dry areas c. Using transparent adhesive dressings d. Few diaper changes

a. Using gelled mattresses b. Using emollients in dry areas Rationale: The skin of the preterm neonate is predisposed to injury related to it being thin and fragile. Recommendations for appropriate skin care include: use of a neutral pH cleanser and sterile water when bathing; bathe only soiled areas; use adhesives sparingly, change diapers frequently, change positions frequently; apply emollients to dry areas, and use water/air/gel mattresses.

During the assessment of the newborn at 3 hours of age, the perinatal nurse documents the presence on the infant's scalp of a unilateral, well-defined mass which does not cross the suture lines. The mother's chart indicates a prolonged labor with use of a vacuum extractor. The RN identifies this finding as: Select one: a. Caput succedaneum b. Cephalohematoma c. Molding d. Intraventricular hemorrhage

b. Cephalohematoma Rationale: Cephalohematoma is hematoma formation between the periosteum and skull with unilateral swelling. It appears within a few hours of birth and can increase in size over the next few days. It has a well-defined outline and does not cross suture lines.

Physical activity can lower a woman's risk for (select all that apply): Select one or more: a. Endometriosis b. Depression c. Colon cancer d. Arthritis

b. Depression c. Colon cancer Rationale: According to the US Department of Health and Human Services, Office of Women's Health, physical activity can lower a woman's risk for heart disease, type 2 diabetes, colon cancer, breast cancer, falls, and depression.

Which of the following neonatal signs or symptoms would the nurse expect to see in a breastfed neonate with an elevated bilirubin level in the first 24 hours of life? Select one: a. Low glucose b. Ineffective breastfeeding c. Hyperactivity d. Hyperthermia

b. Ineffective breastfeeding Rationale: Physiological jaundice results from hyperbilirubinemia occurring after the first 24 hours and within the first week of life. Risk factors include fetal hypoxia, ABO incompatibility, ineffective breastfeeding, dehydration, etc.

Postoperative nursing care and education for a woman who had an abdominal hysterectomy includes (select all that apply): Select one or more: a. Administering hormone replacement therapy as per provider orders b. Informing the woman that she will experience small amounts of vaginal bleeding for several days c. Instructing the woman not to use tampons until advised by surgeon d. Instructing the woman to increase her ambulation to facilitate return of normal intestinal peristalsis

b. Informing the woman that she will experience small amounts of vaginal bleeding for several days c. Instructing the woman not to use tampons until advised by surgeon d. Instructing the woman to increase her ambulation to facilitate return of normal intestinal peristalsis

Karen, a G2 P2, experienced a precipitous birth 90 minutes ago. Her infant is 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that Karen's uterus is boggy. Furthermore, it is noted that Karen's vaginal bleeding has increased. The nurse's most appropriate first action is to: Select one: a. Assess vital signs including blood pressure and pulse. b. Massage the uterine fundus with continual lower segment support. c. Measure and document each perineal pad changed in order to assess blood loss. d. Ensure appropriate lighting for a perineal repair if it is needed.

b. Massage the uterine fundus with continual lower segment support. Rationale: As the primary caregiver, the registered nurse may be the first person to identify excessive blood loss and initiate immediate actions. The nurse should first locate the uterine fundus and initiate fundal massage. Nursing actions performed after the massage are frequent vital sign measurements, measuring the length of time it takes for blood loss to saturate a pad, and assessing for bladder distention.

The nurse assesses that a full-term neonate's temperature is 97.1°F (36.2°C). The first nursing action is to: Select one: a. Turn up the heat in the room. b. Place the neonate on the mother's chest with a warm blanket over the mother and baby. c. Take the neonate to the nursery and place in a radiant warmer. d. Notify the neonate's primary provider.

b. Place the neonate on the mother's chest with a warm blanket over the mother and baby. Rationale: Preventative nursing actions to prevent cold stress include skin-to-skin contact with the mother withe a warm blanket over both.

Jennifer is a 32 year old lawyer 37 weeks pregnant with her first child. She tells you that she has been on Paroxetine (an SSRI) for anxiety throughout her pregnancy. She asks you if she needs to worry about any side effects for her baby. Your best response would be: a. Yes, taking SSRIs in late pregnancy can be dangerous to the baby. You need to stop taking your Paroxetine immediately. Incorrect b. SSRIs have been linked to symptoms in the newborn and while they don't usually last too long I will alert your pediatrician and our high-risk nursery so everyone is aware. c. Yes, taking SSRIs in late pregnancy can cause symptoms in the baby but these won't show up for several months so I'll share with you what to look for before you are discharged. d. You probably don't need to worry as the use of SSRIs in pregnancy is not a problem.

b. SSRIs have been linked to symptoms in the newborn and while they don't usually last too long I will alert your pediatrician and our high-risk nursery so everyone is aware. Rationale: SSRI are commonly used for the management of depression and anxiety in pregnant women. SSRI use during the last trimester of pregnancy has been associated with symptoms in the baby very similar to clinical signs of Neonatal Abstinence Syndrome (NAS). The onset of clinical signs for infants exposed to SSRIs range from several hours after birth to several days after birth, with symptomatology lasting 1-2 weeks after birth.

A patient is admitted for a total hysterectomy. The RN knows this is removal of what organs? Select one: a. The uterus only b. The uterus and cervix c. The uterus, cervix, fallopian tubes, and ovaries d. The uterus, cervix, fallopian tubes, ovaries, upper portion of the vagina, and lymph nodes

b. The uterus and cervix Rationale: Total hysterectomy is the removal of the uterus and the cervix. Supracervical hysterectomy is removal of the uterus only. Hysterectomy with salpingo-oophorectomy is removal of the uterus, cervix, fallopian tubes and ovaries. Radical hysterectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, upper portion of the vagina, and the lymph nodes.

A postpartum woman, who gave birth 12 hours ago, is breastfeeding her baby. She tells her nurse that she is concerned that her baby is not getting enough food since her milk has not come in. The best response for this patient is: Select one: a. "I understand your concern, but your baby will be okay until your milk comes in." b. "Your baby seems content, so you should not worry about him getting enough to eat." c. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health." d. "You can bottle feed until your milk comes in."

c. "Milk normally comes in around the third day. Prior to that, he is getting colostrum which is high in protein and immunoglobulins which are important for your baby's health."

It is noted that the amniotic fluid of a 42-week gestation baby, born 30 seconds ago, is thick and green. Which of the following actions by the nurse is critical at this time? Select one: a. Perform a gavage feeding immediately. b. Assess the brachial pulse. c. Assist a physician with intubation and suctioning. d. Stimulate the baby to cry.

c. Assist a physician with intubation and suctioning Rationale: Direct tracheal suctioning using a tracheal tube is recommended to remove meconium stained fluid is recommended as medical management. The RN should be prepared to assist the provider with insertion of a tracheal tube, suctioning, and other resuscitation practices.

A nurse is providing discharge teaching to the parents of a 2-day-old neonate. Which of the following information should be included in the discharge teaching on umbilical cord care? Select one: a. Cleanse the cord twice a day with hydrogen peroxide. b. Remove the cord with sterile tweezers if the cord does not fall off by 10 days of age. c. Call the provider if greenish discharge appears. d. Cover the cord with sterile dressing until it falls off.

c. Call the provider if greenish discharge appears. Rationale: The umbilical cord is clamped at birth and the clamp is removed after 24 hours of life. The cord falls off and the site heals within 2 weeks. The diaper is placed below the cord to facilitate drying. Parents should be instructed to contact the provider if there is bleeding from the cord site, foul-smelling drainage, redness, or fever. Follow institutional guidelines for cord cleaning; generally, the cord is left alone except when soiled with stool or urine - wipe clean with plain water and allow to dry.

The nurse is teaching the parents of a 1-day-old baby how to give their baby a bath. Which of the following actions should be included? Select one: a. Clean the eye from the outer aspect to the inner aspect. b. Keep the door of the room open to allow for ventilation. c. Gather all supplies before beginning the bath. d. Bathe daily with warm soapy water.

c. Gather all supplies before beginning the bath. Rationale: Bathing is done in a warm room free from drafts. Gather all items required prior to beginning the bath. Cleanse eyes from the inner to outer aspects using a clean corner of the washcloth per eye. Daily bathing with soap is not necessary and can cause skin irritation.

A new mother notices what appears to be bruising over her newborn's buttocks. She asks the nurse if the baby has been injured in some way. The nurse explains that this is: Select one: a. Erythema Toxicum b. Jaundice c. Mongolian spots d. Milia

c. Mongolian spots Rationale: Mongolian spots are flat, bluish discolored areas on the lower back and/or buttock which might be mistaken for bruising. Nursing actions include documentation of size and location. Usually resolve by school age

A baby was born 4 days ago at 34 weeks' gestation. She is receiving phototherapy as ordered by the physician for physiological jaundice. She has symptoms of temperature instability, dry skin, poor feeding, lethargy, and irritability. The nurse's priority nursing action(s) is (are) to (select all that apply): Select one or more: a. Verify laboratory results to check for hypomagnesia. b. Verify laboratory results to check for hypoglycemia. c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake and output to check for dehydration.

c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake and output to check for dehydration. Rationale: There are two priority nursing interventions for hyperbilirubinemia. Hydration status is important if the newborn shows signs of dehydration such as dry skin and mucus membranes, poor intake, concentrated urine or limited urine output, and irritability. The newborn should also be kept warm while receiving phototherapy. When an infant is under phototherapy, the temperature needs to be monitored closely because the lights give off extra heat, but if the newborn is in an open crib and undressed, hypothermia may occur. Hypomagnesia and hypoglycemia are not related to phototherapy.

A primary topic for health promotion for a 25-year-old woman with a history of polycystic ovary syndrome (PCOS or Stein-Leventhal syndrome) is (select the most important topic): Select one: a. The adverse effects of cigarette smoking b. The adverse effects of excessive alcohol consumption c. Nutrition for prevention of obesity and Type 2 Diabetes d. Self-esteem issues

c. Nutrition for prevention of obesity and Type 2 Diabetes Rationale: Women with PCOS are at higher risk for being obese. Obesity increases the woman's risk for type 2 diabetes. Obesity and type 2 diabetes increase the woman's risk for cardiovascular disease, hypertension, dyslipidemia, and metabolic syndrome. It is also important to talk about self-esteem issues related to hirsutism and the effects of smoking and drinking, but the long-term effects of obesity are a greater risk to a woman with PCOS.

One of the following neonates is at highest risk for cold stress: Select one: a. LGA neonate at 38 weeks gestation b. AGA neonate at 32 weeks gestation c. SGA neonate at 33 weeks gestation d. SGA neonate at 40 weeks gestation

c. SGA neonate at 33 weeks gestation Rationale: Risk factors for cold stress include prematurity, small for gestational age (SGA); hypoglycemia, prolonged resuscitation efforts, sepsis, neurological/endocrine/cardiorespiratory problems

A nurse is performing a postpartum assessment 30 minutes after a vaginal delivery. Which of the following actions indicates that the nurse is performing the assessment correctly? Select one: a. The nurse measures the fundal height in relation to the symphysis pubis. b. The nurse monitors the client's central venous pressure. c. The nurse assesses the client's perineum for edema and ecchymoses. d. The nurse performs a sterile vaginal exam.

c. The nurse assesses the client's perineum for edema and ecchymoses. Rationale: Fundal height is measured in relation to the umbilicus. Assessment of the perineum for edema and bruising is appropriate. Central venous pressure is not routinely measured nor is SVE indicated.

A nurse is making a home visit on the twelfth postpartum day to assess a 23-year-old primipara woman and her full-term, healthy baby. Breastfeeding is the method of infant nutrition. The woman tells the nurse that she does not think her milk is good because it looks very watery when she expresses a little before each feeding. The nurse's best response is: Select one: a. "This is normal. You only have to be concerned when your baby does not gain weight." b. "What types of foods are you eating? A lack of protein in the diet can cause watery looking breast milk." c. "How much fluid are you drinking while you are nursing your baby? Too much fluid during the feeding session can dilute the breast milk." d. "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance."

d. "This is normal and is referred to as foremilk which is higher in water content. Later in the feeding the fat content increases and the milk becomes richer in appearance." Rationale:There are 3 stages of human milk production: Stage 1 is colostrum, a yellowish fluid present for 2-3 days after birth and rich is protein; Stage 2 is transitional milk and consists of colostrum and milk and is present from day 3-10; Stage 3 is mature milk and consists of foremilk which is produced and stored between feedings and is higher in water content and hind milk which is produced during the feeding session and is higher in fat content.

The clinic nurse sees Xiao and her infant in the clinic for their 2-week follow-up visit. Xiao appears to be tired, her clothes and hair appear unwashed, and she does not make eye contact with her infant. She is carrying her son in the infant carrier and when asked to put him on the examining table, she holds him away from her body. The clinic nurse's most appropriate question to ask would be: Select one: a. "What has happened to you?" b. "Do you have help at home?" c. "Is there anything wrong with your son?" d. "Would you tell me about the first few days at home?"

d. "Would you tell me about the first few days at home?" Rationale: The well-baby checkup that generally takes place 1 to 2 weeks following the hospital discharge may offer the first opportunity to assess the mother-baby dyad. In this setting, the nurse needs to be alert for subtle cues from the new mother, such as making negative comments about the baby or herself, ignoring the baby's or other children's needs, as well as the mother's physical appearance. In a private area, the nurse should take time to explore the new mother's feelings. A nonthreatening way to open the dialogue might be to say: "Tell me how the first few days at home have gone." This statement provides the new mother with an opportunity to share both positive and negative impressions.

Instructions to a mother of an uncircumcised male infant should include which of the following? Select one: a. Instruct her to use a cotton swab to clean under the foreskin. b. Instruct her to clean the penis by retracting the foreskin. c. Instruct her to clean the penis with alcohol. d. Instruct her not to retract the foreskin.

d. Instruct her not to retract the foreskin Rationale: Do not force the foreskin over the penis or use cotton swabs to clean under the foreskin as this may damage the inner layer of the foreskin which can lead to adhesion formation. Gently cleanse the penis when bathing the infant and when changing the diaper.

The nurse is massaging a boggy uterus. The uterus does not respond to the massage. Which medication would the nurse expect would be given first: Select one: a. Methergine b. Epinephrine c. Carboprost (Hemabate) d. Oxytocin or pitocin

d. Oxytocin or pitocin Rationale: If the cause of the hemorrhage is uterine atony, continual fundal massage with lower uterine segment support is mandatory. While one member of the team massages the fundus, another nurse establishes intravenous access with a large bore needle and administers oxytocic drugs in the following order: oxytocin (Pitocin), followed by methylergonovine (Methergine), and carboprost (Hemabate).

When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is: Select one: a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact. b. True labor contractions result in increasing anxiety and discomfort, and false labor does not. c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.