Maternity
Which assigned pp client should the nurse identify as being at the highest risk for hemorrhage? 1. c-section delivery 2. vaginal delivery of twins 3. vaginal delivery of preemie 4. precipitous delivery of gravida 5
1. c-section delivery
Which complications in a client dx with placental abruption should the nurse be prepared for? SATA 1. hemorrhage 2. DIC 3. Renal failure 4. Hypovolemic shock 5. Placenta previa
1. hemorrhage 2. DIC 3. Renal failure 4. Hypovolemic shock
The nurse is preparing pre-op teaching for the client diagnosed with large fibroid tumors and scheduled for total abdominal hysterectomy. While reviewing the client's hx and lab results, the nurse notes the client H/H has decreased. Which factors does the nurse identify as influencing this decrease? 1. menorrhagia 2. constipation 3. pelvic pressure 4. metrorrhagia 5. backache
1. menorrhagia 4. metrorrhagia
a nurse is teaching a group of women about HPV. What should the nurse tell the women that HPV puts women at risk for? 1. HIV 2. Cervical cancer 3. Hep B 4. Cirrhosis
2. Cervical cancer
The nurse is teaching a pregnant teenage client about resources available through the health department. The client says "I am not sure that I want to have this baby, what do you think about an abortion?" What should the nurse say? 1. what does the baby's father think about an abortion 2. i know this is a difficult decision 3. what are your thoughts about abortion 4. there are many options other than abortion
3. what are your thoughts about abortion
A laboring client, with gestational HTN ahs requested an epidural for pain management. What interventions should the nurse perform to minimize the risk of hypotension? SATA 1. Administer IV bolus NS prior 2. Place 15L O2 nonrebreather face mask 3. avoid supine position after 4. hold nifedipine 5. get out of bed slowly
1. Administer IV bolus NS prior 3. avoid supine position after
The nurse is caring for a 17 year old primigravida at 36 weeks of gestation who has been admitted to the unit with severe manifestations of PreE. Nursing care and assessment is based on the knowledge that which symptoms indicate worsening dz and impending seizures? SATA 1. Pounding headache 2. Blurred vision 3. Hyporeflexia 4. Epigastric pain 5. Mental confusion 6. Diuresis
1. Pounding headache 2. Blurred vision 4. Epigastric pain 5. Mental confusion
the nurse is teaching comfort measures to a PP client with an episiotomy and external hemorrhoids. which teaching points should the nurse include? SATA 1. apply ice to the perineum first 12 hours 2. take sitz bath at temp 107.6-111.2 F 3. use witch hazel compresses on rectal areas for hemorrhoids 4. take ibuprofen for pain 5. apply topical anesthetics to the perineal area 6. avoid sex until episiotomy has healed
1. apply ice to perineum first 12 hours 3. use witch hazel compresses on rectal areas for hemorrhoids 4. take ibuprofen for pain 5. apply topical anesthetics to perineal area 6. avoid sex until episiotomy has healed
The nurse is assessing a newborn to determine gestational age. what findings by the nurse would indicate the infant is premature? 1. folded ear pinna springs back slowly 2. peripheral cyanosis on feet and hands 3. shoulders and chest have moderate lanugo 4. vernix covering axilla, back, buttocks 5. feet soles entirely covered with creases
1. folded ear pinna springs back slowly 3. shoulders and chest have moderate lanugo 4. vernix covering axilla, back, buttocks
A 37 week pregnant woman presents to triage with reports of a headache and begins to have a seizure. what actions should the nurse take? SATA 1. place the client's head in nurse's lap 2. administer oxygen 3. monitor tonic-clonic activity 4. place oral airway into client's mouth 5. administer diazepam
1. place the client's head in nurse's lap 2. administer oxygen 3. monitor tonic-clonic activity
in a client diagnosed with severe preE, which complications would the nurse be concerned about? SATA? 1. placental abruption 2. placenta previa 3. IUGR 4. HELLP syndrome 5. Renal failure
1. placental abruption 3. IUGR 4. HELLP syndrome 5. Renal failure
What term should the nurse use to document that a woman is pregnant for the first time? 1. primigravida 2. multigravida 3. primipara 4. multipara
1. primigravida
A LPN on the L&D unit is assisting the nurse with multiple admissios. What tasks could the LPN complete until the nurse is available? SATA 1. take initial VS 2. measure cervical dilation 3. check fundal height and FHR 4. obtain urine for protein and glucose 5. collect vaginal swab to test for chlamydia
1. take initial VS 4. obtain urine for protein and glucose 5. collect vaginal swab to test for chlamydia
Following report, which newborn infant should the nursery nurse assess first? 1. positive Babinski reflex 2. has circumoral cyanosis 3. negative Ortolani sign 4. has telangiectatic nevi
2. has circumoral cyanosis
Which finding in FHR during a NST would indicate to the nurse that a potential problem for the fetus may exist? 1. increase 30 bpm for 20 sec w/ fetal movement 2. increases 8 bpm for 10 secs w/ fetal movement 3. remains unchanged w/ maternal movement 4. increases 5 bpm for 30 sec w/ maternal movement
2. increases 8 bpm for 10 secs w/ fetal movement
what would the nurse expect to see when performing a neurological assessment on a 1-day old neonate suspected of having asphyxia in utero? 1. grasps nurses finger when placed in neonates hands 2. toes curl downward when the soles of feet stroked 3. turns toward nurses finger when cheek is touched 4. extends arms when nurse claps hands
2. toes curl downward when the soles of feet stroked
A client has been admitted to the L&D unit with a diagnosis of preE. During afternoon rounds, which assessment finding by the nurse should be reported to the primary hcp immediately? 1. DTR +3 2. urine output of 80mL over 4 hrs 3. RR 24 breaths/min 4. severe headache with blurred vision
2. urine output of 80mL over 4 hrs
A client makes an initial visit to the prenatal clinic informing the nurse the probable date of conception was May 15th. The first day of the last menstrual cycle was on May 1st. Using Naegele's rule, the nurse determines the client's due date should be when? 1. Feb 22 2. Aug 8 3. Feb 8 4. Aug 22
3. Feb 8
A client 34 wks gestation w/ PIH reports heartburn. which action is priority? 1. adminster antacid per orders 2. check clients BP 3. call primary HCP immediately 4. assure client this is a normal discomfort of pregnancy
3. call primary HCP immediately
a full-term infant is being assessed 12 hours after birth. the infant's respiratory rate is 50 and shallow, with periods of apnea less than 5 seconds. what action by the nurse takes priority? 1. apply oxygen by mask at 1L 2. prepare for emergency intubation 3. continue monitoring q15min 4. notify primary HCP stat
3. continue monitoring q15min
A client is admitted to the hospital at 36 wks gestation with a diagnosis of placental abruption. Following an initial assessment, what action by the nurse is most important? 1. apply fetal monitor 2. complete abdominal prep 3. insert large bore IV 4. have client sign consent form
3. insert large bore IV
A female client considers using spermicidal agents because she wants both birth control and protection from STIs. what information should the nurse provide the client about spermicidal agents? 1. effectively reduces vaginal fungal infections such as candida albicans 2. eliminates bacterial and viral STIs 3. most effective when used in conjunction with barrier methods such as a diaphragm 4. causes few side effects
3. most effective when used in conjunction with barrier methods such as a diaphragm
The lactation consultant is preparing to make rounds on the breastfeeding clients on the LDRP unit. Which client should the consultant see first? 1. mother who is nursing every 2-3 hrs for 15-20 mins 2. mother who stated that her newborn sucks in short burses and has audible swallowing 3. mother who reported blisters on her nipples and pain whenever newborn latches 4. mother who stated her baby was so good that she has to wake him for each feeding
4. mother who stated her baby was so good that she has to wake him for each feeding
A laboring client with gestational HTN has requested an epidural for pain management. What interventions should the nurse perform to minimize the risk of hypotension? SATA 1. administer IV bolus NS prior 2. place 15L O2 via nonrebreather face mask 3. avoid supine position after placement 4. hold nifedipine 5. get out of bed slowly
1. administer IV bolus NS prior 3. avoid supine position after placement
The nurse is preparing to make the initial shift rounds. which primipara client should the nurse see first? 1. 39 wks with board like abdomen and scant dark red bleeding 2. 38 wks gestation with blood-streaked vaginal discharge 3. 40 wks gestations reporting urinary frequency 4. 36 wks gestation w/ pitting pedal edema
1. 39 wks with board like abdomen and scant dark red bleeding
The nurse is caring for a client that is undergoing an induction for fetal demise at 34 wks. Immediately after delivery the mother asks to see the infant. What is the nurses best response? 1. Bring the swaddled baby to mom 2. explain the COD must be determined before she can see the baby 3. Ask her is she is sure she wants to see the baby 4. Tell her it would be better to wait until she is in her room before she sees baby
1. Bring the swaddled baby to mom
A client who is 36 weeks gestation has been admitted to the labor and delivery area for evaluation due to worsening signs of pregnancy induced hypertension (PIH). The BP upon arrival is 168/96. While being monitored, she reports a sudden onset of severe abdominal pain. Further nursing assessment reveals vaginal bleeding, abdominal rigidity and a fetal heart rate of 90/min on the fetal monitor. What nursing actions would be appropriate for this client? SATA 1. Continuously monitor the clients VS 2. Keep the mother informed of the fetus condition 3. Careful monitoring of the fetal heart rate electronically 4. Accurate measurement of I&O 5. Prepare for emergency vaginal delivery 6. Monitor for restlessness and decreased LOC
1. Continuously monitor the clients VS 2. Keep the mother informed of the fetus condition 3. Careful monitoring of the fetal heart rate electronically 4. Accurate measurement of I&O 6. Monitor for restlessness and decre
Which PP client should the nurse assign to a private room? 1. Has antibodies for Hep C 2. Is rubella non-immune 3. Is rubella immune 4. Has lupus antibodies
1. Has antibodies for Hep C
The nurse is caring for a client who is receiving magnesium sulfate IV. Which client assessment findings would indicate to the nurse that the client has magnesium toxicity? SATA 1. Respiratory rate of 10/min 2. Absence of DTRs 3. Maternal pulse ox reading 95% 4. Increasing urinary output 5. Magnesium level of 9mg/dL
1. Respiratory rate of 10/min 2. Absence of DTRs 5. Magnesium level of 9mg/dL
A client delivered a term infant 4 hrs ago. The infant was stillborn. Which room would be most appropriate for the nurse to assign to this client? 1. a private room on the gyno unit 2. a private room on pp unit 3. discharge her home once stable 4. room with another client w/ loss
1. a private room on the gyno unit
The OB client w/ a hx of abruption asks the clinic nurse is placental abruption is likely to recur during this pregnancy. Which RF for placental abruption should the nurse include in the discussion w/ the client? SATA 1. abdominal trauma 2. primigravida 3. advanced maternal age 4. prior placental abruption 5. Substance use 6. Chronic htn
1. abdominal trauma 3. advanced maternal age 4. prior placental abruption 5. Substance use 6. Chronic HTN
What priority post-op nursing interventions should be included in the plan of care for total abdominal hysterectomy client? SATA 1. assess abdominal dressing 2. monitor VS 3. encourage bedrest 4. count perineal pads 5. assess pain 6: assess for bladder distension
1. assess abdominal dressing 2. monitor VS 4. count perineal pads 5. assess pain 6: assess for bladder distension
A woman at 32 weeks gestation is seen in the clinic with mild BP elevation and is placed on bed rest at home for conservative management of preE without severe features. Which topics would the nurse include when teaching this client? SATA 1. bedrest in lateral recumbent position 2. daily BP monitoring 3. weekly fetal kick counts 4. daily weights 5. Na and fluid restrictions
1. bedrest in lateral recumbent position 2. daily BP monitoring 4. daily weights
A client comes to an OB clinic for routine prenatal checkup at 32 wks. The nurse palpates clients abdomen to determine fetal position so that fetal heart sounds can be assesse. It is determind that the fetal position is left occipital anterior (LOA). WHere should the nurse place the doppler to hear fetal heart sounds? 1. below umbilicus, on moms left side 2. below umbilicus, on moms right side 3. above umbilicus on moms right side 4. above umbilicus on moms left side
1. below umbilicus, on moms left side
The nurse is assisting a new mother with breastfeeding her newborn baby. The mother verbalizes concern that the baby is not getting adequate milk. Which observations by the nurse indicate adequate fluid intake? SATA 1. birth weight regained in 14 days 2. Fontanel soft and depressed 3. pulse rate of 135/min 4. 6-8 wet diapers/day 5. baby appears satisfied after feedings
1. birth weight regained in 14 days 3. pulse rate of 135/min 4. 6-8 wet diapers/day 5. baby appears satisfied after feedings
The nurse is caring for a gravida 4, para 3 client at 30 weeks gestation with sudden onset of bright red vaginal bleeding. What are the initial priority nursing assessments for hemorrhagic conditions of late pregnancy? SATA 1. bleeding 2. maternal vs 3. cervical dilation 4. fetal condition 5. pain 6. uterine contractions
1. bleeding 2. maternal vs 4. fetal condition 5. pain 6. uterine contractions
The pregnant client asks the clinic nurse if having a previous baby who developed jaundice soon after birth will increase her newborn's risk for the development of hyperbilirubinemia. The nurse correctly identifies which risk factors that increase the incidence of jaundice in the newborn? SATA 1. blood incompatibility 2. prematurity 3. hx of affected sibling 4. birth trauma 5. formula feeding
1. blood incompatibility 2. prematurity 3. hx of affected sibling 4. birth trauma
An OB client with new onset bright red vaginal bleeding has read that bleeding during second half of pregnancy is d/t placental abruption or previa. The client asks the nurse about the different s/sx. What info should the nurse include? SATA 1. classic sign of previa is onset painless bright red vaginal bleeding in last half of pregnancy 2. onset of bleeding usually sudden with abruption and onset of bleeding with previa may start and stop abruptly and occur intermittently 3. bleeding can be concealed or visible w/ abruption and is always visible with previa 4. uterine tone is soft and relaxed in abruption and first to rigid in previa 5. classic manifestations of abruption include painful, dark red vaginal bleeding during last half of pregnancy 6. fetal distress is usually absent in abruption and present in previa.
1. classic sign of previa is onset painless bright red vaginal bleeding in last half of pregnancy 2. onset of bleeding usually sudden with abruption and onset of bleeding with previa may start and stop abruptly and occur intermittently 3. bleeding can be concealed or visible w/ abruption and is always visible with previa 5. classic manifestations of abruption include painful, dark red vaginal bleeding during last half of pregnancy
The nurse is providing information to the mother of a newborn with jaundice about the diagnostic tests used to identify blood abnormalities that may contribute to hyperbilirubinemia. The mother asks the nurse about the significance of the indirect Coombs' and the direct Coombs'. what information should the nurse include? SATA 1. during pregnancy, an RH- mother will have blood drawn for an indirect Coombs test to identify the presence of antibodies against fetal blood 2. when an infant is jaundiced, the infant's blood type and a direct Coombs are performed. 3. a positive direct Coombs test indicated that antibodies from the mother have attached to the infant's RBCs 4. RhoGAM is administered to the sensitized Rh- woman at 28 weeks 5. RhoGAM prevents the development of Rh antibodies that would result in destruction of fetal erythrocytes in later pregnancies
1. during pregnancy, an RH- mother will have blood drawn for an indirect Coombs test to identify the presence of antibodies against fetal blood 2. when an infant is jaundiced, the infant's blood type and a direct Coombs are performed. 3. a positive direct Coombs test indicated that antibodies from the mother have attached to the infant's RBCs 5. RhoGAM prevents the development of Rh antibodies that would result in destruction of fetal erythrocytes in later pregnancies
how should the nurse respond to a pregnant client who asks "how will i know when it is time to go to the hospital? 1. go to the hospital immediately if your membranes rupture 2. you should leave for the hospital as soon as you lose your mucous plug 3. go to the hospital when you have a burst of energy followed by a backache 4. you need to go to the hospital when contractions are 2 minutes apart.
1. go to the hospital immediately if your membranes rupture
A home care nurse is visiting a client who delivered her first baby one week ago. What behavior by the client would indicate to the nurse that maternal infant boding is occuring? SATA 1. hold baby face to face 2. take about baby features 3. touches baby frequently 4. talks to baby 5. allows baby to cry vigorously for 15mins
1. hold baby face to face 2. take about baby features 3. touches baby frequently 4. talks to baby
A client is admitted to the L&D unit with severe PreE. Which nursing interventions should the nurse include in the plan of care for this client? SATA 1. monitor for headache 2. placed client in left recumbent position 3. insert indwelling urinary catheter 4. administer lisinopril for BP > 100 diastolic 5. initiate external FHR monitoring
1. monitor for headache 2. placed client in left recumbent position 3. insert indwelling urinary catheter 5. initiate external FHR monitoring
The mother of a newborn diagnosed with hyperbilirubinemia asks the nursery nurse to explain the difference between physiologic and pathologic jaundice. What info should be included? SATA 1. physiologic typically appears during the 3-4th day and begins to decline rapidly over next several wks 2. physiologic occurs within first 24 hrs and newborns bili levels rise rapidly 3. A common condition associated with pathologic jaundice in the newborn is blood incompatibility of mother and seen 4. physiologic is the manifestation of normal hyperbilirubinemia commonly seen in newborns 5. pathologic is more likely to lead to severe hyperbilirubinemia than physiologic
1. physiologic typically appears during the 3-4th day and begins to decline rapidly over next several wks 3. A common condition associated with pathologic jaundice in the newborn is blood incompatibility of mother and newborn 4. physiologic is the manifestation of normal hyperbilirubinemia commonly seen in newborns 5. pathologic is more likely to lead to severe hyperbilirubinemia than physiologic
A first-time mother to be shares with the nurse a sense of indifference towards the impending birth of the infant. The client is concerned about being a good mother because of current lack of interest. What response by the nurse would be most appropriate at this time? 1. such feelings do occur w/ some first time moms 2. once you hold your baby you will be just fine 3. would you like to discuss this problem with the doctor? 4. describe the fears you have regarding your new baby
1. such feelings do occur w/ some first time moms
which priority niursing assessment should be included for the infant receiving phototherapy for hyperbilirubinemia? SATA 1. temperature 2. oral intake 3. teaching parents 4. stools 5. skin
1. temperature 2. oral intake 4. stools 5. skin
a client comes into the ED with intense abdominal pain. the nurse completes a physical assessment and evaluates the vs and lab work. based on the information gathered, the nurse expects which diagnostic test will be priority? 1. transvaginal ultrasound 2. EGD 3. CAT scan of abdomen 4. KUB
1. transvaginal ultrasound
A client in labor is placed on an external fetal monitor. Which interventions should the nurse perform if a late FHR deceleration occurs? SATA 1. turn client to left side 2. administer o2 3. start IV 4. prep for c-section 5. notify primary HCP
1. turn client to left side 2. administer o2 5. notify primary HCP
The nurse is educating a group of sexually active teenagers about chlamydia. What should the nurse teach these clients to prevent them from acquiring or transmitting this disease? SATA 1. use latex condom when having sex to protect against Chlamydia 2. seek advice of primary HCP if there is vaginal discharge or burning on urination 3. suggest that the teens be screened for chlamydia 4. reassure the teens that if they have no symptoms they have no dz 5. take prescribed medication if dx w/chlamydia and repeat screening in 3 months.
1. use latex condom when having sex to protect against Chlamydia 2. seek advice of primary HCP if there is vaginal discharge or burning on urination 3. suggest that the teens be screened for chlamydia 5. take prescribed medication if dx w/chlamydia and repeat screening in 3 months.
the nurse is providing prenatal education for a couple expecting a first child. The expectant mother asks about fetal movements. What is the best explanation by the nurse? 1. you should feel activity between weeks 16-20 2. The fetus is too small to feel any movements 3. maybe around the end of the 1st trimester 4. it is different for each individual woman
1. you should feel activity between weeks 16-20
The nurse is caring for a primipara client at 27 weeks gestation. Which client learning need should the nurse identify as priority at this stage of pregnancy? 1. Appropriate nutrition 2. Signs of preterm labor 3. Fetal teratogens 4. Newborn care
2. Signs of preterm labor
which client should the nurse assign to a room closest to the nurse sgtation? 1. a multigravida admitted with a new diagnosis of gestational diabetes 2. a primigravida admitted with a diagnosis of placenta previa 3. primigravida admitted with a diagnosis of compete spontaneous abortion 4. pregestational diabetic admitted for glycemic control.
2. a primigravida admitted with a diagnosis of placenta previa
The nurse is working in the term nursery. Which task should be perfomred first on a newborn? 1. prepare the circumcision equipment for a 2 day old newborn 2. assess the 5 min apgar of newborn 3. perform the gestational age assessment on a 30 min newborn 4. obtain a blood sample for metabolic testing on a 24 hour newborn
2. assess the 5 min apgar of newborn
a client at 34 weeks gestation presents to the ER reporting n/v, blurred vision, and right upper quadrant pain. based on symptoms, the primary hcp diagnoses HELLP syndrome. What immediate orders does the nurse anticipate for this client? SATA 1. prepare for an immediate C-section 2. check urine for protein or uric acid 3. Obtain a 12-lead ECG 4. type and cross for 2 units of blood 5. initiate a mag sulfate infusion
2. check urine for protein or uric acid 4. type and cross for 2 units of blood 5. initiate a mag sulfate infusion
a nurse has provided PP discharge instructions to a client who had a c-section. what statement by the client would indicate to the nurse that further teaching is necessary? 1. i will relax and contract my pelvic floor muscles 10 times, eight times a day 2. driving is permitted in one week if i am pain free 3. lifting anything heavier than my baby is not advised 4. i will not cross my legs while sitting
2. driving is permitted in one week if i am pain free
a nurse is helping a client to maintain normal voiding habits while recovering from a c-section. what methods should the nurse initiate? SATA 1. have the client recline slightly while using a bedside commode 2. encourage client to push over pubic area with hands 3. suggest client read or listen to music 4. pour warm water over the perineum 5. stay and talk with client while waiting for urge to void
2. encourage client to push over pubic area with hands 3. suggest client read or listen to music 4. pour warm water over the perineum
What instructions should the nurse include when teaching a mother whos newborn has hyperbilirubinemia regarding phototherapy and its effects: SATA 1. breastfeeding should be discontinued until phototherapy is complete 2. feed newborn at least every 2-4 hours 3. make sure newborns eyes are closed when applying eye patches 4. keep the baby quiet and swaddled 5. report immediately if the urine becomes dark in color
2. feed newborn at least every 2-4 hours 3. make sure newborns eyes are closed when applying eye patches
The obstetrical client with a hx of chronic HTN asks the clinic nurse if having HTN will increase her risk for developing preE during pregnancy. The nurse correctly identifies which risk factors for preE? SATA 1. multiparous status 2. hx of HTN 3. hx of diabetes or chronic renal dz 4. age older than 35 5. african american 6. fam hx of preE (mom/sis)
2. hx of HTN 3. hx of diabetes or chronic renal dz 4. age older than 35 5. african american 6. fam hx of preE (mom/sis)
A client with hx of cardiac dz has safely delivered a full-term infant. when discussing discharge instructions, the nurse knows the teaching was successful when the client makes what statement? 1. now that the baby is born, i can eat more salt 2. i must include lots of fiber to prevent constipation 3. i should return to my previous dose of cardiac meds 4. i will need extra fluids to help with breastfeeding needs.
2. i must include lots of fiber to prevent constipation
When assessing a newborn following a breech delivery, what physical findings should the nurse report to the primary HCP as positive indications of congenital hip dysplasia? SATA 1. symmetrical gluteal folds 2. limited abduction of 1 leg 3. pain w/ Barlow maneuver 4. presence of Ortolani click 5. confirmed stepping reflex
2. limited abduction of 1 leg 4. presence of Ortolani click
A female client arrives at the community health clinic seeking a form of contraceptive and tell the nurse that she really desires getting an IUD. Following the assessment, the nurse realizes that the IUD would be contraindicated for this client. What factor would be an absolute contraindication for this client receiving an IUD? 1. hx of irregular menstrual cycles 2. ongoing pelvic infection 3. hx of ectopic pregnancy 4. current fibrocystic breast dz
2. ongoing pelvic infection
A nurse notes late decelerations in the fetus of a client receiving oxytocin via IV infusion. What nursing interventions should the nurse perform? SATA 1. Administer naloxone 2. place client in side lying 3. stop oxytocin 4. increase the rate of IV fluids 5. notify primary HCP 6. adminster o2 at 8L face mask
2. place client in side lying 3. stop oxytocin 4. increase the rate of IV fluids 5. notify primary HCP 6. adminster o2 at 8L face mask
what does a non-stress test tell the nurse about a pregnant client? 1. that the baby is going to be a boy or a girl 2. the baby is doing well and the placenta is providing enough oxygen at this time 3. that the baby's heart is healthy and there are no birth defects 4. that the mother is strong enough to undergo vaginal delivery
2. the baby is doing well and the placenta is providing enough oxygen at this time
A primigravida client at 35 weeks gestation has been diagnosed with HPV. The nurse knows that the most important information to discuss with this client is what? 1. the infant will not be able to breastfeed 2. the mother will need frequent follow-up pap smears 3. the fetus will need to be delivered C-section 4. the mother must start metronidazole immediately
2. the mother will need frequent follow-up pap smears
The nurse is assessing a pregnant client returning for her first, one-month check-up. The client has normal vs, blood count, and urinalysis, but has gained 6 lbs. what is the most important assessment at this time? 1. blood glucose level 2. ankles for edema 3. 24-hour diet recall 4. confirmation of last menstrual period
3. 24-hour diet recall
A client in active labor has an epidural catheter inserted for the management of pain. which finding should the nurse report to the primary hcp? 1. early decelerations 2. FHR 160/min 3. BP 90/62 4. temperature 99.6 F
3. BP 90/62
A client calls the prenatal clinic at 37 weeks gestation to report expelling large amounts of fluid. What instruction by the nurse is most appropriate at this time? 1. Lie on left side and take slow deep breaths 2. Call an ambulance and go to the ER 3. Come to the clinic for assessment and evaluation 4. Go directly to the hospital ER
3. Come to the clinic for assessment and evaluation
Which lab value on a client who is one day pp should the nurse report to the primary HCP? 1. Hb 11 2. WBC 22,000 3. HCT 18% 4. Serum glucose 80
3. HCT 18%
While the pp nurse was in report, four clients called the nurse's station for assistance. which client should the nurse see first? 1. client with 3 dimed sized clots on perineal pad 2. breastfeeding client who reports uterine cramping 3. client reporting blood running down legs upon standing 4. client who had an epidural and is now reporting a headache
3. client reporting blood running down legs upon standing
a clients membranes spontaneously ruptured at 10cm dilation, +2 station. The nurse notes fluid is green colored. Which intervention would the nurse anticipate? 1. emergency c-section 2. immediate high forceps delivery 3. equipment for immediate suction of newborn 4. administer IV oxytocin
3. equipment for immediate suction of newborn
The labor nurse is assessing a client admitted in pretern labor. Which client finding would require a social service consult? 1. very quiet and avoid eye contact 2. reports not married 3. has injuries in various healing stages 4. reports frequent arguments w/ partner
3. has injuries in various healing stages
After artificial ROM the baseline FHR tracking begins to show sharp decreases w/ rapid recovery with and between each contraction. Which of the following actions by the RN has priority? 1. position on left side 2. increase IV fluid rate 3. place client in knee-chest position 4. administer o2 nonrebreather face mask
3. place client in knee-chest position
A full term client is admitted in labor 5 cm dilated and having contractions 3 mins apart which last 60 secods. The current BP is 85/50. What is priority action? 1. turn IV fluids to wide open 2. apply o2 at 2L NC 3. position client on left side 4. recheck BP in opposite arm
3. position client on left side
a client comes into the women's clinic with amenorrhea, breast tenderness and urinary frequency. which term should the nurse use to describe these s/sx of pregnancy? 1. probable 2. positive 3. presumptive 4. early
3. presumptive
A mother of newborn is crying and tells the nurse, "I am worried about my baby. His Apgar score was 6 and the nurses had to help him breathe for a while." what response should the nurse make to this mother? 1. "Don't worry about what score your baby received on the Apgar. The nurses know how to take care of him. 2. "Stop crying, your baby is fine now and will continue to get stronger as the day progresses." 3. "Your baby's Apgar score was normal. The score was 6 at 1 minute which is typical." 4. "It is normal for you to feel this way. Let me explain what the Apgar score is used of newborn.
4. "It is normal for you to feel this way. Let me explain what the Apgar score is used for"
A pregnant woman who has just been admitted to the L&D room states that her "water just broke". What should the nurse do immediately? 1. Confirm that fluid is amniotic fluid with a pH test strip 2. Obtain maternal VS 3. Observe amniotic fluid color 4. Check FHR pattern
4. Check FHR pattern
The nurse is caring for a client in the 8th week of pregnancy. the client is spotting, has a rigid abdomen and is on bedrest. what is the most important assessment at this time? 1. Protein in the urine 2. fetal heart tones 3. cervical dilation 4. Hgb and Hct levels
4. Hgb and Hct levels
An expectant HIV positive client asks why zidovudine (ZDV) must be continued throughout the pregnancy. What is the best explanation by the nurse? 1. the medication permits safe breastfeeding after delivery 2. it protects you against other infections during pregnancy 3. this drug prevents transmission of HIV to partner 4. ZDV decreases the chance the baby will get HIV
4. ZDV decreases the chance the baby will get HIV
what room assignment would be best for the nurse to make for a primigravida with gestational diabetes who was admitted for glycemic control? 1. a private room near nurses' station 2. a room with a client admitted with placenta previa 3. a room with a client in preterm labor 4. a room with a client admitted with pregestational diabetes.
4. a room with a client admitted with pregestational diabetes.
Immediately following the birth of an infant, what is the nurses priority action when caring for the newborn? 1. examine the infant and take a set of vitals 2. confirm identification and apply arm band 3. instill silver nitrate solution into both eyes 4. dry infant and place in warm environment
4. dry infant and place in warm environment
a PP client who is 2 hours post vaginal delivery remains on an oxytocin infusion for bleeding. upon examination, the nurse determines that the client's fundus is boggy and soft. What is the priority nursing intervention? 1. ambulate in the room 2. perform crede exercises 3. reassess the fundus in 30mins 4. massage the fundus
4. massage the fundus
What is the priority nursing action for a pregnant client in labor who is having an epidural catheter inserted for pain management? 1. perform thorough skin prep of insertion site 2. obtain clients consent for procedure 3. assure client that residual effects of procedure wont be felt 4. monitor maternal BP
4. monitor maternal BP
The obstetrics nurse notes minimal variability with a late deceleration on the electric fetal monitor of a client that is 38 weeks gestation. Which action will the nurse take first? 1. notify the primary hcp 2. apply 10L O2 per NC 3. prepare for emergency c-section 4. reposition client to left side
4. reposition client to left side