RN Maternal Newborn Online Practice 2023 B

Lecithin/sphingomyelin (L/S) ratio 1.4:1 (greater than 2:1) Phosphatidylglycerol (PG) negative (positive) ABO-Rh B-negative Terbutaline 0.25 mg SQ every hr PRN contractions Rho​(D) immune globulin 300 mcg IM once Nalbuphine 10 mg IV every 3 hr PRN pain. A nurse is reviewing the medical record at 1800 for a client who is at 34 weeks of gestation. Based on the chart findings and documentation, the nursing plan of care should include which of the following actions? (Click on the exhibit button for additional information about the client. There are three tabs that contain separate categories of data.)

Administer terbutaline

A nurse is caring for a client who has uterine atony and is experiencing postpartum hemorrhage. Which of the following actions is the nurse's priority?

Massage the client's fundus.

A nurse is developing a plan of care for a client who has preeclampsia and is receiving magnesium sulfate via a continuous IV infusion. Which of the following interventions should the nurse include in the plan?

Monitor the FHR continuously

A nurse in a provider's office is reviewing the medical record of a client who is in the first trimester of pregnancy. Which of the following findings should the nurse identify as a risk factor for the development of preeclampsia?

Pregestational diabetes mellitus

A nurse is providing teaching to a client about the physiological changes that occur during pregnancy. The client is at 10 weeks of gestation and has a BMI within the expected reference range. Which of the following client statements indicates an understanding of the teaching?

"I will likely need to use alternative positions for sexual intercourse."

Day 1, 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting. Drag 1 condition and 1 client finding to fill in each blank in the following sentence.

After reviewing the client's current assessment findings, the nurse should identify that the client is experiencing ectopic pregnancy as evidenced by right lower quadrant abdominal tenderness

8A nurse is providing teaching about nonpharmacological pain management to a client who is breastfeeding and has engorgement. The nurse should recommend the application of which of the following items?

Cold cabbage leaves

Gravida 1, Para 138 weeks of gestation Forceps-assisted birth following failed vacuum-assisted attempt. 3rd degree laceration with a repair. Amniotic membranes ruptured for 18 hr prior to delivery. Pregnancy complicated by gestational diabetes and anemia. Client states "I feel terrible today. I have this feeling of pain and pressure in my pelvis." Client reports general malaise and chills. Uterus firm at the umbilicus and tender to palpation. Moderate amount of dark foul-smelling lochia noted. Generalized perineal edema observed. Frequently voiding large amounts of urine. Client reports an abdominal pain level of 5 on a scale of 0 to 10. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Obtain a culture of vaginal fluid using a sterile swab. Plan to administer IV antibiotics. Endometritis Lochia amount and odor. Temperature.

A nurse is providing education about family bonding to guardians who recently adopted a newborn. The nurse should make which of the following suggestions to aid the family's 7-year-old child in accepting the new family member?

Obtain a gift from the newborn to present to the sibling.

0900:Client reports, ''I've been cramping and have had low back pain since yesterday. It burns when I urinate.'' Client is placed on electronic fetal monitor. Fundal height palpated above the umbilicus. 0930: Fetal heart rate baseline 150/min, moderate variability, spontaneous accelerations present, no decelerations noted. Uterine contractions occurring every 2 minutes, lasting 40-60 seconds, palpate mild to moderate intensity. Vaginal examination reveals cervix is 2 cm dilated and 80% effaced. Which of the following findings should the nurse report to the provider?

Temperature 38.3° C (101° F) Client reports, "I've been cramping and have had low back pain since yesterday. It burns when I urinate." Uterine contractions occurring every 2 minutes, lasting 40-60 seconds, palpate mild to moderate intensity. Vaginal examination reveals cervix is 2 cm dilated and 80% effaced.

A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. Which of the following statements should the nurse include in the teaching?

"Ensure that the newborn has been receiving feeding for 24 hours prior to obtaining the specimen."

A nurse is providing teaching to a client who is at 40 weeks of gestation and has a new prescription for misoprostol. Which of the following instructions should the nurse include in the teaching?

"I can administer oxytocin 4 hours after the insertion of the medication."

A nurse is teaching a client who is in preterm labor about terbutaline. Which of the following statements by the client indicates an understanding of the teaching?

"I will have blood tests because my potassium might decrease."

A nurse is teaching a client who is Rh negative about Rho(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching?

"I will need this medication if I have amniocentesis."

A nurse is providing teaching about family planning to a client who has a new prescription for a diaphragm. Which of the following statements should the nurse include in the teaching?

keep the diaphragm in place for at least 6 hr after intercourse

A nurse is teaching a client who is at 24 weeks of gestation regarding a 1-hr glucose tolerance test. Which of the following statements should the nurse include in the teaching?

"If this test is positive, you will be scheduled for a 3-hr glucose tolerance test."

A nurse is providing teaching for a client who gave birth 2 hr ago about the facility policy for newborn safety. Which of the following client statements indicates an understanding of the teaching?

"The person who comes to take my baby's pictures will be wearing a photo identification badge."

A nurse is caring for a client who is experiencing preterm labor at 29 weeks of gestation and has a prescription for betamethasone. Which of the following statements should the nurse make about the indication for medication administration?

"This medication stimulates fetal lung maturity."

A nurse is speaking with a client who is trying to make a decision about tubal ligation. The client asks, "What effects will this procedure have on my sex life?" Which of the following responses should the nurse make?

"This procedure should have no effect on your sexual performance or adequacy."

A nurse is preparing to administer magnesium sulfate 2 g/hr IV to a client who is in preterm labor. Available is 20 g magnesium sulfate in 500 mL of dextrose 5% in water (D5W). The nurse should set the IV infusion pump to administer how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

50 mL/hr

Day 1, 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting. Select the 3 findings the require immediate follow-up.

Abdomen assessment Vaginal spotting Menstrual period

1400:Client received epidural anesthesia for reports of a pain level of 7 on a scale of 0 to 10 from uterine contractions. Contractions occurring every 4 to 5 min, lasting 60 seconds, palpate moderate. FHR: Baseline 135/min, average variability, accelerations present, no decelerations noted. Oxytocin infusing at 8 milliunit/min. Rate last increased by 2 milliunits/min at 1330. 1415: Client reports feeling light-headed. Contractions occurring every 4 to 5 min, lasting 60 seconds, palpate moderate FHR: Prolonged deceleration of fetal heart rate to 90/min, minimal variability. Select the 4 actions that the nurse should take immediately.

Administer a bolus of IV fluids Reposition the client to their side Apply oxygen at 10 to 12 L/min by nonrebreather mask Elevate the client's legs

A nurse is caring for a client who is at 26 weeks of gestation and has epilepsy. The nurse enters the room and observes the client having a seizure. After turning the client's head to one side, which of the following actions should the nurse take immediately after the seizure?

Administer oxygen via a nonrebreather mask.

Newborn delivered by repeat cesarean birth at 40 weeks of gestation.Birth weight 3,515 g (7 lb 12 oz)Apgar scores 8 at 1 min and 9 at 5 minMaternal history of methadone use during pregnancy. 1100:Newborn is inconsolable with a high-pitched cry. Newborn sucks vigorously on pacifier but breastfeeds poorly. Increased muscle tone with moderate to severe tremors when disturbed. Hyperactive Moro reflex noted. Mottled skin noted on extremities. Frequent sneezing. Several loose stools today. Maternal urine toxicology screen: positive for opiates (negative) The nurse is planning to contact the provider regarding the newborn's status. Which of the following prescriptions regarding the newborn should the nurse anticipate?

Administer scheduled doses of oral morphine. Maintain a low-stimulus environment. Initiate neonatal abstinence syndrome (NAS) scoring.

Day 1, 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting. For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

Anticipated: transvaginal ultrasound, repeat quantitative β-hCG level, methotrexate IM, blood typing Contraindicated: meperidine IM

A nurse is planning discharge for a client who is 3 days postpartum. Which of the following nonpharmacological interventions should the nurse include in the plan of care for lactation suppression?

Apply cabbage leaves to the breasts.

A nurse is caring for a client who is at 36 weeks of gestation and has a positive contraction stress test. The nurse should plan to prepare the client for which of the following diagnostic tests?

Biophysical profile

A nurse is assessing a client who has preeclampsia with severe features. Which of the following manifestations should the nurse expect?

Blurred vision

A nurse is assessing a newborn who is 12 hr old. Which of the following findings should the nurse report to the provider?

Central cyanosis

1100:Newborn held skin-to-skin with client who is breastfeeding for 1 hr and breastfed vigorously for 30 minutes. Large ecchymotic caput succedaneum noted on occiput with molding of the skull. Anterior fontanel level and soft. Respirations shallow and irregular. Crepitus palpated over left clavicle. Skin color consistent with infant's genetic background. Acrocyanosis noted. Active and moves all extremities except for left arm. Limited spontaneous movement of the left arm noted. Wrist unflexed. Left arm remains at side during Moro reflex. Palmar grasp reflex equal bilaterally. For each assessment finding, click to specify if the findings is consistent with a clavicle fracture or Erb-Duchenne paralysis.

Clavicle: birth history, crepitus, decreased movement, absent moro reflex, palmar grasp reflex present Erb-Duchenne paralysis: birth history, absent arm movement, absent moro reflex, palmar grasp reflex present, wrist flexion (?)

A nurse is assessing fetal heart tones for a client who is pregnant. The nurse has determined the fetal position as left occiput anterior. To which of the following areas of the client's abdomen should the nurse apply the ultrasound transducer to assess the point of maximum intensity of the fetal heart?

Left lower quadrant

A nurse is planning care for a client who is 2 hr postpartum. Which of the following interventions should the nurse plan to implement during the taking-hold phase of postpartum behavioral adjustment?

Demonstrate to the client how to perform a newborn bath.

0730: Reports discomfort from contractions as a 4. Client doing slow paced breathing during contractions. Client reports blurred vision and a frontal headache rated at a 6 on a scale of 0 to 10. Deep tendon reflexes 3+. Contractions: every 6-8 min, lasting 45-60 seconds, palpate mild/moderate. Fetal heart rate: Baseline 135/min, moderate variability, accelerations present, no decelerations noted. Oxytocin infusion rate at 4 milliunits/minute. Magnesium sulfate at 2 g/hr with LR at 50 mL/hr infusing via peripheral IV. 1130:Client sleepy. Reports pain of a 6 due to uterine contractions. Denies headache or visual disturbances. Deep tendon reflexes are absent. Contractions: occurring every 4-5 min, lasting 60-75 seconds and palpate moderate. Uterus soft between contractions. Fetal heart rate: Baseline 125/min, minimal variability, no accelerations, no decelerations. Oxytocin infusion rate at 12 milliunits/minute.

Discontinue the magnesium infusion Administer calcium gluconate Apply oxygen at 10 L by nonrebreather mask

A nurse is caring for a client who is at 22 weeks of gestation and reports concern about the blotchy hyperpigmentation on their forehead. Which of the following actions should the nurse take?

Explain to the client this is an expected occurrence.

A nurse is creating a plan of care for a client who is postpartum and adheres to traditional Hispanic cultural beliefs. Which of the following cultural practices should the nurse include in the plan of care?

Protect the client's head and feet from cold air.

A nurse is performing a newborn assessment. Which of the following images should the nurse identify as an indication of spina bifida occulta?

External indications of this neural tube defect include a dimpled area over the defect and the presence of a birthmark or hairy patch above the area.

A nurse is performing a physical assessment of a newborn. Which of the following clinical findings should the nurse expect? (Select all that apply.)

Heart rate 154/min Respiratory rate 58/min Weight 2.6 kg (5 lb 12 oz)

A nurse is assessing a client who received carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication?

Hypertension

Day 1, 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting. The nurse is preparing the client for surgery. Which of the following actions should the nurse take?

Inform the client to be NPO prior to surgery Insert an 18-gauge peripheral IV prior to surgery Obtain a complete blood count Verify a consent is signed by the client

A nurse is caring for a client who is at 35 weeks of gestation and has placenta previa. Which of the following actions should the nurse take?

Initiate continuous external fetal monitoring.

A nurse is performing a vaginal examination on a client who is in labor and observes the umbilical cord protruding from the vagina. After calling for assistance, which of the following actions should the nurse take?

Insert two gloved fingers into the vagina and apply upward pressure to the presenting part.

A nurse is caring for a client who is pregnant and is at the end of their first trimester. The nurse should place the Doppler ultrasound stethoscope in which of the following locations to begin assessing for the fetal heart tones (FHT)?

Just above the symphysis pubis.

A nurse is caring for a client who is at 24 weeks of gestation and has a suspected placental abruption. Which of the following laboratory tests should the nurse expect the provider to prescribe?

Kleihauer-Betke test

A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn?

Place the newborn skin to skin on the caregiver's chest.

A nurse is providing discharge teaching to the guardian of a newborn about car seat safety. Which of the following instructions should the nurse include?

Place the retainer clip at the level of the newborn's armpits.

A nurse is reviewing the medical record of a client who is postpartum and has preeclampsia. Which of the following findings indicate that the client has progressed to preeclampsia with severe features?

Pulmonary edema

A nurse is assessing a client who is at 36 weeks of gestation. Which of the following findings should the nurse report to the provider?

Report of visual disturbances

A nurse is assessing a client who has gestational diabetes mellitus and is experiencing hyperglycemia. Which of the following findings should the nurse expect?

Reports increased urinary output.

A nurse is caring for a client who is at 30 weeks of gestation and has a prescription for magnesium sulfate IV to treat preterm labor. The nurse should notify the provider of which of the following adverse effects?

Respiratory rate 10/min

A nurse is caring for a prenatal client who has parvovirus B19 (fifth disease). Which of the following actions should the nurse take?

Schedule an ultrasound.

A nurse is calculating a client's expected date of birth using Naegele's rule. The client tells the nurse that their last menstrual cycle started on November 27th. Which of the following dates is the client's expected date of birth?

September 3rd

A nurse is teaching a new caregiver how to use a bulb syringe to suction their newborn's secretions. Which of the following instructions should the nurse include?

Stop suctioning when the newborn's cry sounds clear.

A nurse is assessing a newborn who is 12 hr old. Which of the following manifestations requires intervention by the nurse?

Substernal chest retractions while sleeping.

Day 1, 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting. A nurse is evaluating the client following surgery. Which of the following findings indicate that the client is experiencing a potential complication of surgery that requires immediate follow-up?

Temperature 35.3° C (95.5° F) Blood pressure 90/60 mm Hg Oxygen saturation 94% (oxygen @2 L/min via nasal cannula) Skin cool and moist to touch. Pedal pulse +1 bilateral.

Day 1, 1000:Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting. Complete the following sentence by using the list of options.

The nurse should first address the client's heart rate followed by the client's vaginal spotting.

A nurse is caring for a client who is at 36 weeks of gestation and has a prescription for an amniocentesis. For which of the following reasons should the nurse prepare the client for an ultrasound?

To locate a pocket of fluid

A nurse is providing discharge teaching to a client who is postpartum. For which of the following manifestations should the nurse instruct the client to monitor and report to the provider?

Unilateral breast pain

A nurse is demonstrating to a client how to bathe their newborn. In which order should the nurse perform the following actions? (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)

Wipe the newborn's eyes from the inner canthus outward. Wash the newborn's neck by lifting the newborn's chin. Cleanse the skin around the umbilical cord stump. Wash the newborn's legs and feet. Clean the newborn's diaper area.

A nurse is admitting a client who is in labor. The client admits to recent cocaine use. For which of the following complications should the nurse assess?

abruptio placenta

A nurse is assessing a client who is at 38 weeks of gestation during a weekly prenatal visit. Which of the following findings should the nurse report to the provider?

weight gain of 2.2 kg (4.8 lb)