Maternity ATI
A nurse is assessing a client who is at 30 weeks gestation during a routine prenatal visit. Which of the following findings should the nurse report to the provider? a. Swelling of the face b. Varicose veins in the calves c. Nonpitting 1+ ankle edema d. Hyperpigmentation of the cheeks
A
A nurse is providing discharge teaching to a parent whose newborn has just had a circumcision. Which of the following instructions should the nurse include? a. Apply slight pressure with sterile gauze pad for mild bleeding b. Inspect the circumcision sit every 6-8hr c. Use baby wipes containing alcohol to cleanse the penis with each diaper change d. Remove yellow exudate daily using a warm wet washcloth
A
A nurse is providing teaching about nonpharmacological pain management to a client who is breastfeeding and had engorgement. The nurse should recommend the application of which of the following items? a. Cold cabbage leaves b. Purified lanolin cream c. A snug-fitting support bra d. Breast shells
A
A nurse is teaching a new mother bout newborn safety. Which of the following instructions should the nurse include in the teaching? a. you can share your room with your baby for the next few weeks b. cover your baby with a light blanket while she is sleeping c. check the temperature of your baby's bath water with your hand d. your baby can nap in her car seat during daytime
A
A nurse is teaching client in a prenatal class about the importance of taking folic acid during pregnancy. The nurse should instruct the clients to consume an adequate amount of folic acid from various sources to prevent which of the following fetal abnormalities? a. Neural tube defect b. Trisomy 21 c. Cleft lip d. Atrial septal defect
A
A nurse on a postpartum unit is caring for a client who is experiencing hypovolemic shock. After notifying the provider, which of the following actions should the nurse take next? a. Massage the client's fundus b. Insert an indwelling urinary catheter c. Administer O2 at 10 L/min d. Elevate the clients right hip
A
41. A nurse is planning care for a client who is in labor and is to have an amniotomy. Which of the following assessments should the nurse identify as the priority? a. O2 sat b. Temp c. Blood pressure d. Urinary output
B
A nurse I speaking with a client who is trying to make a decision about uterine tube occlusion. The client asks, "what effects will this procedure have on my sex life?" which of the following responses should the nurse make a. I think that is something you should discuss with your doctor when she comes in b. This process should have no effect on your sexual performance or adequacy c. You'll be fine. I cant imagine you and your partner will have any problems with sexual function d. If this concerns you perhaps you should reconsider and use another form of contraception
B
A nurse Is caring for a client who is in labor and reports increasing rectal pressure. She is experiencing contractions 2-3 min apart, each lasting 80-90 sec, and a vaginal exam reveals that her cervix is dilated to 9 cm. the nurse should identify that the client is in which of the following phases of labor? a. Active b. Transition c. Latent d. Descent
B
A nurse is assessing a client who is 1 day postpartum and has a vaginal hematoma. Which of the following manifestations should the nurse expect? a. Lochia serosa vaginal drainage b. Vaginal pressure c. Intermittent vaginal pain d. Yellow exudate vaginal drainage
B
A nurse is assessing a client who is 12hr postpartum. The client's fundus is two fingerbreadths above the umbilicus, deviated to the right of the midline, and less firm than previously noted. Which of the following actions should the nurse take? a. Place the client in a side-lying position b. Assist the client to the bathroom to void c. Obtain a prescription for IV oxytocin d. Administer methylergonovine
B
A nurse is caring for a postpartum client who is receiving heparin via a continuous IV infusion for thrombophlebitis in her left calf. Which of the following actions should the nurse take? a. Admin aspirin for pain b. Maintain the client on bedrest c. Massage the affected leg every 12hr d. Apply cold compress to the affected calf
B
A nurse is caring for a prenatal client who has parovirus B19 (fifth disease). Which of the following actions should the nurse take? a. Administer antiviral medication b. Schedule an ultrasound exam c. Administer haemophilus influenzae type b vaccine d. Schedule an indirect Coombs' test
B
A nurse is caring who has recently experienced a perinatal death. Which of the following statements should the nurse make to the client? a. It must be comfort to know you have another child b. I'm sad for you c. There is usually something wrong with the baby d. You will always have an angel in heaven
B
A nurse is performing a vaginal exam on a client who is in labor and reports severe pressure and pain in lower back. The nurse notes that the fetal head is in a posterior position. The nurse should identify that which of the following is the best non-pharmacological intervention to perform to relieve the client's discomfort? a. Back rub b. Counter-pressure c. Playing music d. Foot massage
B
A nurse is calculating a clients expected date of birth using Naegele's rule. The client tells the nurse that her last menstrual cycle started on November 27th. Which of the following dates is the client's expected date of birth? a. 9/3 b. 9/20 c. 8/3 d. 8/20
C
A nurse is providing teaching for a client who gave birth 2hr ago about the facility policy for newborn safety. Which of the following client statements indicates an understanding of the teaching? a. My sister will be able to carry my baby from the nursery to my room when she arrives b. The nurse will match my wrist to my baby's crib card when she brings him to me c. The person who comes to take my baby's pictures will be wearing and ID badge d. My baby doesn't need to wear the electronic security bracelet when he's in my room
C
A nurse is reviewing the laboratory report of a client who is 24 hr postpartum following a vaginal delivery. Which of the following lab results should the nurse identify as an indication of a postpartum infection? a. Platelets 300,000/mm3 b. WBC 9.000/mm3 c. Erythrocyte sedimentation rate 26 mm/hr d. C-reactive protein 0.8mg/dL
C
A nurse is teaching a client who has pregestational type 1 diabetes about management during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a. I should have a goal of maintaining my fasting blood glucose between 100 and 120 b. I should engage in moderate exercise for 30 min if my BG is 250 or greater c. I will continue taking my insulin if I experience N/V d. I will ensure that my bedtime snack is high in refined sugar
C
A nurse is teaching a client who is at 35 weeks of gestation about clinical manifestations of potential pregnancy complications to report to the provider. Which of the following manifestations should the nurse include? a. Shortness of breath when climbing the stairs b. Swelling of feet and ankles at the end of the day c. Headache that is unrelieved by analgesia d. Braxton hicks contractions
C
A client who is at 34 weeks of gestation asks the nurse how she will know when she is in labor and should go to the hospital. Which of the following responses should the nurse make? a. You will feel the contractions primarily in the upper abdominal b. You will feel extremely fatigued when your labor starts c. Your breasts will begin to excrete colostrum d. You will notice blood-tinged discharge from your vagina
D
A nurse in a providers office is reviewing the medical record of a client who is in her first trimester of pregnancy. Which of the following findings should the nurse identify as a risk factor for the development of preeclampsia? a. Singleton pregnancy b. BMI of 20 c. Maternal age of 32 years d. Pregestational DM
D
A nurse is assessing 4 newborns. Which of the following findings should the nurse report to the provider? a. A newborn is a 26 hour old and the erythema toxicum on his face b. A newborn who is 32 hr old and has not passes a meconium stool c. A newborn who is 12 hr old and has pink-tinged urine d. A newborn who is 18hr old and has an axillary temp of 99.9
D
A nurse is caring for a client who becomes unresponsive upon delivery of the placenta. Which of the following actions should the nurse take first? a. Determine resp function b. Increase IV fluid rate c. Access emergency meds from cart d. Collect a maternal blood sample for coagulopathy studies
A
A nurse is providing prenatal teaching to a client who is at 26 weeks gestation. Which of the following positions should the nurse recommend for the client to increase circulation to the placenta a. Supine b. Fowler's c. Side-lying d. Trendelenburg
C
A nurse us teaching a client who is at 36 weeks gestation and has a prescription for a nonstress test. Which of following statements should the nurse include in the teaching? a. You will receive IV fluid prior to this test b. The procedure will take apporx 10-15min c. You will be offered OJ to drink during the test d. You will need to sign an informed consent from each time you have the test
C
The nurse is assessing a newborn who is 12hr old. Which of the following clinical manifestations requires intervention by the nurse? a. Acrocyanosis of the extremities b. Murmur at the left sternal border c. Substernal chest retractions while sleeping d. Positive Babinski reflex
C
A nurse is assessing a client who is at 26 weeks gestation. Which of the following clinical manifestations should the nurse report to the provider? a. Leukorrhea b. Supine hypotension c. Periodic numbness of the fingers d. Decreased urine output
D
A nurse in a prenatal clinic is caring for a client who reports that her menstrual period is 2 weeks late. The client appears anxious and asks the nurse if she is pregnant. Which of the following responses should the nurse make? a. You can miss your period for several other reasons. Describes your typical menstrual cycle b. If you have been sexually active and haven't used protection, it is likely that you are pregnant c. Let's check to see if you have any other signs of pregnancy. Have you noticed any abdominal enlargement yet? d. Because you have missed tour period, you should try taking a home pregnancy test before you start worrying
A
A nurse is assessing a client who is postpartum and has idiopathic thrombocytopenia purpura. Which of the following findings should the nurse expect? a. Decreased platelet count b. Increased ESR c. Decreased megakaryocytes d. Increased WBC
A
A nurse is assessing a client who received carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication? a. Hypertension b. Hypothermia c. Constipation d. Muscle weakness
A
A nurse is assessing a newborn who was born at 26 weeks of gestation using the New Ballard Score. Which of the following findings should the nurse expect? a. Minimal arm recoil b. Popliteal angle of 90d degrees c. Creases over entire foot sole d. Raised areolas with 3-4mm buds
A
A nurse is caring for a client and her partner who have experienced a fetal death. Which of the following actions should the nurse take? a. Take photos of the newborn to give to parents b. Tell the parents that they can consider organ donation c. Encourage the parents to avoid allowing older children to visit them in the hospital d. Explain to the parents the need to name the newborn
A
A nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. Which of the following findings should the nurse report to the provider? a. BUN 25mg/dL b. Serum creatinine 0.8mg/dL c. Urine output of 280mL within 8hr d. Urine negative for ketones
A
A nurse is caring for a newborn who is undergoing phototherapy to treat hyperbilirubinemia. Which of the following actions should the nurse take? a. Cover the newborn's eyes while under phototherapy light b. Keep the newborn in a shirt while under the phototherapy light c. Apply light moisturizing lotion to the newborn's skin d. Turn and reposition the newborn every 4 hrs while undergoing phototherapy
A
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? a. Protect the client's head and feet from cold air b. Bathe the client within 12hr following delivery c. Ambulate the client within 24hr following delivery d. Offer the client a glass of cold milk with her first meal
A
A nurse is developing an educational program for adolescents about nutrition during the third trimester of pregnancy. Which of the following statements should the nurse include in the program? a. Consume 3-4 servings of dairy each day b. Increase your daily caloric intake by 600-700 calories c. Limit your daily sodium intake to less than 1g d. Increase your protein intake to 40-50g/day
A
A nurse is discussing the differences between true labor and false labor with a groups of expectant parents. Which of the following characteristics should the nurse include when discussing true labor? a. Contractions become stronger with walking b. Discomfort can be suppressed with a back massage c. Contractions become irregular with a change in activity d. Discomfort is felt above umbilicus
A
A nurse is observing a new mother caring for her crying newborn who is bottle feeding . which of the following actions by the mother should the nurse recognize as a positive parenting behavior? a. Lays newborn across her lap and gently sways b. Places newborn in the crib in prone position c. Offers the newborn a pacifier dipped in formula d. Prepares a bottle of formula mixed with rice cereal
A
A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicates an understanding of the teaching? a. I will eat foods that appeal to my taste instead of trying to balance my meals b. I will avoid having a snack at bedtime c. I will have 8oz of hot tea with each meal d. I will pair my sweets with a starch instead of eating them alone
A
A nurse is providing discharge teaching to a client who is postpartum and was taking insulin for gestational diabetes mellitus. Which of the following instructions should the nurse include in the teaching? a. You should get a 2hr oral glucose tolerance test in 6-12 weeks b. You should avoid using low-dose oral contraceptives for birth control c. You will need to monitor your blood glucose levels daily at home for 2-3weeks d. You will need to take a lower dose of insulin than you took during your pregnancy
A
A school nurse is providing teaching to an adolescent about levonorgestrel contraception. Which of the following info should the nurse include in the teaching? a. You should take the medication within 72hr following unprotected sexual intercourse b. You should avoid taking this medication if you are on an oral contraception c. If you don't start your period within 5 days of taking this medication, you will need a pregnancy etst d. One dose of the medication will prevent you from becoming pregnant for 14 days after taking it
A
A nurse is preparing to administer oxytocin to a client who is postpartum. Which of the following findings is an indication for the administration of the medication? (select all that apply) a. Flaccid uterus b. Cervical laceration c. Excess vaginal bleeding d. Increased afterbirth cramping e. Increased maternal temp
A C
A nurse is performing a physical assessment of a newborn. Which of the following clinical findings should the nurse expect? (select all that apply) a. Heart rate 154/min b. Axillary temp 36 C (96.8 F) c. Resp rate 58/min d. Length 43cm e. Weight 2.6kg (5lb 12oz)
A C E
A nurse is assessing a full-term newborn 15min after birth. Which of the following findings requires intervention by the nurse? a. HR 168/min b. Resp 18/min c. Tremors d. Fine crackles
B
A nurse is assessing a newborn following a circumcision. Which of the following findings should the nurse identify as an indication that the newborn is experiencing pain? a. Decreased HR b. Chin quivering c. Pinpoint pupils d. Slowed respirations
B
A nurse is caring for a client following an amniocentesis at 18 weeks of gestation. Which of the following findings should the nurse report to the provider as a potential complication? a. Increased fetal movement b. Leakage of fluid from the vagina c. Upper abdominal discomfort d. Urinary frequency
B
A nurse is caring for a client who has uterine hypotonicity and is experiencing postpartum hemorrhage. Which of the following actions nurse's priority? a. Check the client's capillary refill b. Massage the client's fundus c. Insert an indwelling urinary catheter for the client d. Prepare the client for a blood transfusion
B
A nurse is caring for a client who is at 22weeks of gestation and reports concern about the blotchy hyperpigmentation on her forehead. Which of the following actions should the nurse? a. Tell the client to follow up with a dermatologist b. Exlain to the clien that this expected outcome c. Instruct the client to increase her intake of vit D d. Inform the client she might have an allergy to her skin care products
B
A nurse is caring for a client who is at 36 weeks gestation and has a prescription for an amniocentesis. For which of the following reasons should the nurse prepare the client for an ultrasound a. To estimate the fetal weight b. To locate a pocket of fluid c. To determine multiparity d. To prescreen for fetal anomalies
B
A nurse is caring for a client who is at 38 weeks gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring? a. Determine progression of dilatation and effacement b. Perform Leopold maneuvers c. Complete a sterile speculum exam d. Prepare a nitrazine paper test
B
A nurse is caring for a client who is pregnant and is at the end of her first trimester. The nurse should place the doppler ultrasound stethoscope in which of the following locations to begin assessing for fetal heart tones? a. Just above the umbilicus b. Just above the symphysis pubis c. The right lower quadrant d. The left lower quadrant
B
A nurse is caring for a newborn who was transferred to the nursery 30 minutes after delivery. Which of the following actions should the nurse take forts? a. Conform the newborns Apgar score? b. Verify the newborns identification c. Administer vitamin K to the newborn d. Determine obstetrical risk factors
B
A nurse is providing teaching about comfort measures to a client who is breastfeeding and is engorgement. Which of the following nonpharmacological measures should the nurse include in the teaching? a. You may use a breast binder to relieve the discomfort b. You should use cold compresses after each feeding c. You should apply a few drops of colostrum to the nipple following the feeding d. You may place breast shells inside your bra
B
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? a. "you should replace the diaphragm every 5 yrs" b. "You should leave the diaphragm in place for at least 6hrs after intercourse" c. "you should use an oil-based product as a lubricant when inserting the diaphragm" d. "you should insert the diaphragm when your bladder is full"
B
A nurse on an antepartum unit is caring for 4 clients. Which of the following clients should the nurse identify as the priority? a. A client who had gestation diabetes and a fasting blood glucose level of 120 mg/dL b. A client who is at 34 weeks of gestation and reports epigastric pain c. A client who is at 28 weeks of gestation and has an Hgb of 10.4g/dL d. A client who is at 39 weeks of gestation and reports urinary frequency and dysuria
B
A nurse on the postpartum unit is caring for a client following a cesarean birth. Which of the following assessments is the nurse's priority? a. Parent child attachment b. Amount of lochia c. Patency of IV catheter d. Quality and quantity of urine output
B
A nurse is assessing a client who gave birth vaginally 12hr ago and palpates her uterus to the right above the umbilicus. Which of the following interventions should the nurse perform? a. Reassess the client in 2hr b. Administer simethicone c. Assist the client to empty her bladder d. Instruct the client to lie on her right side
C
A nurse is assessing a client who is in labor and notes early decelerations on the fetal monitor. Which of the following findings should the nurse identify as a possible cause of the early deceleration? a. Prolapsed umbilical cord b. Placenta Previa c. Fetal head compression d. Maternal hypotension
C
A nurse is assessing a newborn who was delivered vaginally and experienced a tight nuchal cord. Which of the following clinical manifestations should the nurse expect? a. Bruising over the buttocks b. Hard modules on the roof of the mouth c. Petechiae over the head d. Bilateral periauricular papillomas
C
A nurse is assessing fetal heart tones for a client who is pregnant. The nurse has determined the fetal position as left occipital anterior. To which of the following areas of the client's abdomen should the nurse apply the ultrasound transducer in order to assess the point maximum intensity of the fetal heart? a. Left upper quadrant b. Right upper quadrant c. Left lower quadrant d. Right lower quadrant
C
A nurse is caring for a client who is anemic at 32 weeks of gestation and is in preterm labor. The provider prescribes betamethasone 12mg IM. Which of the following outcomes should the nurse expect? a. Decreased uterine contractions b. An increase in the clients hemoglobin levels c. A reduction in resp distress in the newborn d. Increased production of antibodies in the newborn
C
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? a. Monitor the FHR b. Assess uterine activity c. Administer oxygen via a nonrebreather mask d. Start a bolus of IV fluids
C
A nurse is caring for a client who is at 35 weeks of gestation and is undergoing a non-stress test that reveals a variable deceleration in the FHR. Which of the following actions should the nurse take? a. Give the client OJ b. Elevate the client's legs c. Have the client change position d. Establish IV access
C
A nurse is caring for a client who is at 40 weeks gestation and is in early labor. The client has a platelet count of 75,000/mm3 ans is requesting pain relief. Which of the following treatment modalities should the nurse anticipate? a. Epidural b. Naloxone hydrochloride c. Attention-focusing d. Pudendal nerve block
C
A nurse is developing a plan of care for a client who has preeclampsia and is receiving magnesium sulfate via continuous IV infusion. Which of the following interventions should the nurse include in the plan? a. Monitor the client's blood pressure every hr b. Restrict the total hourly intake to 200mL c. Monitor the FHR continuously d. Administer protamine sulfate for manifestations of toxicity
C
A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan? a. Feed the newborn 1 oz of water every 4 hr b. Apply lotion to the newborn's skin three times per day c. Remove all clothing from the newborn except the diaper d. Discontinue therapy id the newborn develops a rash
C
A nurse is discharge teaching to a client who is postpartum. For which of the following clinical manifestations should the nurse instruct the client to monitor and report to the provider? a. Persistent abdominal striae b. Temp 100.2 c. Unilateral breast pain d. Brownish-red discharge on day 5
C
A nurse is performing a vaginal exam for a client who is in active labor and reports back pain. The nurse determine that the client is 8cm dilated, 100% effaced, -2station, and that the fetus is in the occiput posterior position. Which of the following actions should the nurse take? a. Perform effleurage during contractions b. Place the client in the lithotomy position c. Assist the client to the hands and knees position d. Apply a scalp electrode to the fetus
C
A nurse is planning care for a client who is in labor and is requesting epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care? a. Place the client in a supine position for 30 min following the 1st dose of anesthesia solution b. Admin 1,000mL of dextrose 5% in water prior to the first dose of anesthetic solution c. Monitor the client's BP every 5 min following the first dose of anesthetic solution d. Ensure the client has been NPO 4hr prior to the placement of the epidural and the first of anesthetic solution
C
A nurse is providing discharge teaching to a client who had a C/S 3 days ago. Which of the following instructions should the nurse include? a. You can resume sexual activity in 1 week b. You wont need to do Kegel exercises since you had a cesarean c. You can still become pregnant if you are breastfeeding d. You are safe to start adding sit-ups to your exercise routine in 2 weeks
C
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? a. "I will get injections of the medication once daily until my labor stops" b. "my blood sugar may be low while I'm on the medication" c. "I will have blood tests because my potassium might decrease" d. "my blood pressure may increase while I'm on this medication"
C
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? a. Obtain informed consent prior to obtaining the specimen b. Collect at least 1 mL of urine for the test c. Ensure that the newborn has been receiving feedings for 24hr prior to obtaining the specimen d. Premature newborns may have false negative tests due to immature development of liver enzymes
C
A staff nurse on an obstetric unit is caring for a client who is scheduled for an induced abortion. The staff nurse informs the nurse manager that's she has a moral issue with the client's decision. Which of the following actions should the nurse manager take? a. Inform the staff nurse that she is required to care for the client b. Advise the staff nurse that she will likely receive disciplinary actions c. Reassign the client to another staff nurse d. Advise the staff nurse to transfer to another unit
C
A nurse is assessing a client who is in active labor and notes early decels in the FHR on the monitor tracing. The client is at 39 weeks gestation and is receiving continuous IV infusion of oxytocin. Which of the following actions should the nurse take? a. Discontinue the oxytocin infusion b. Continue monitoring the client c. Request that the provider assess the client d. Increase the infusion rate of the maintenance IV fluid
D
A nurse is assessing a late preterm newborn. Which of the following clinical manifestations is an indication of hypoglycemia? a. Hypertonia b. Increased feeding c. Hyperthermia d. Respiratory distress
D
A nurse is assessing the newborn of a client who took a SSRI during pregnancy. Which of the following manifestations should the nurse identify as an indication of withdrawal from an SSRI? a. LGA b. hyperglycemia c. Bradypnea d. Vomiting
D
A nurse is caring for a client who is at 15 weeks gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure? a. Check the client's temp b. Observe for uterine contractions c. Admin Rho(D) immune globulin d. Monitor the FHR
D
A nurse is caring for a full-term newborn immediately following birth. Which of the following actions should the nurses take first? a. Assign Apgar scores to the newborn b. Weigh the newborn c. Place identification bracelets on the newborn d. Dry the newborn
D
A nurse is teaching a group of parents about newborn safety. Which of the following statements by a parent indicates an understanding of the teaching? a. I will put a bib on my baby at night to keep her clothing dry b. I will cover the crib mattress with plastic to prevent staining c. I will warm my baby's formula using the lowest setting on the microwave d. I will dress my baby in flam-retardant clothing
D
A nurse is teaching a new mother about steps the nurses will take to promote the security and safety of the newborn. Which of the following statements should the nurse make? a. "we will prevent unidentified visitors from entering the unit" b. "we will document the relationship of visitors in your medical record" c. "your baby will stay in the nursery while you are asleep" d. "staff members who take care of your baby will be wearing a photo ID badge"
D
A nurse is teaching a new mother how to use a bulb syringe to suction her newborn's secretions. Which of the following instructions should the nurse indicate? a. Insert the syringe tip before compressing the bulb b. Suction each of the nares before suctioning the mouth c. Insert the tip of the syringe into the center of the newborn's mouth d. Stop suctioning when the newborn's cry sounds clear
D
A nurse is teaching about effective breastfeeding to client who is 3 days postpartum. Which of the following info should the nurse include? a. Your milk will replace colostrum in about 10 days b. Your breasts should feel firm after breastfeeding c. Your newborn should urinate at least 10 times per day d. Your newborn should appear content after each feeding
D
Which of the following statements should the nurse make? a. Let me help you into a comfortable position so you can begin bearing down b. I am going to call the doctor to get a prescription for medication to ripen your cervix c. I will give you some pain medicine to strengthen your contractions d. Your provider will insert an intrauterine pressure catheter to monitor the strength of your contraction
D
A nurse is assessing a client who is at 38weeks gestation during a weekly prenatal visit. Which of the following finding should the nurse report to the provider? a. BP 136/88 mmHg b. Report of insomnia c. Weight gain of 2.2kg (4.8 lb) d. Report of Braxton-Hicks contractions
C
A nurse is performing a routine assessment on a client who is at 18 weeks of gestation. Which of the following findings should the nurse expect? a. Deep tendon reflexes 4+ b. Fundal height 14cm c. Urine protein 2+ d. FHR 152/min
D
A nurse is caring for a client who is 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? a. Biophysical profile b. Amniocentesis c. Cordocentesis d. Kleihauer-Betke test
A
A nurse is caring for a client who is in labor and whose fetus is in the right occiput posterior position. The client is dilated to 8cm and reports back pain. Which of the following actions should the nurse take first? a. Apply sacral counterpressure b. Perform transcutaneous electrical nerve stimulation c. Initiate slow-paced breathing d. Assist with biofeedback
A
A charge nurse on the postpartum unit is observing a newly licensed nurse who is preparing to administer pain med to a client. The charge nurse should intervene when the newly licensed nurse uses which of the following secondary identifiers to identify the client a. The client's room number b. The client's telephone number c. The clients birth date d. The client's medical record number
A
A nurse in a prenatal clinic is assessing a group of clients. Which of the following clients should the nurse request the provider see first? a. A client who is at 11 weeks of gestation and reports abdominal cramping b. A client who is at 15 weeks of gestation and reports tingling and numbness in her right hand c. A client who is at 20 weeks of gestation and reports constipation for the past 4 days d. A client who is at 8 weeks of gestation and reports having three bloody noses in the past week
A
A nurse in the antepartum clinic is assessing a client's adaptation to pregnancy. The client states that she is, " happy one minute and crying the next". The nurse should interpret the clients statements as an indication of which of the following a. Emotional lability b. Focusing phase c. Cognitive restructuring d. Couvade syndrome
A
A nurse is caring for a client who is to receive oxytocin to augment her labor. Which of the following findings contraindicates the initiation of the oxytocin infusion and should be reported to the provider? a. Late decelerations b. Moderate variability of the FHR c. Cessation of uterine dilation d. Prolonged active phase of labor
A
A nurse in a family planning clinic is caring for a client who requests an oral contraceptive. Which of the following findings in the client's history should the nurse recognize as a contraindication to oral contraceptives? (select all that apply) a. Cholecystitis b. Hypertension c. Human papillomavirus d. Migraine headaches e. Anxiety disorder
ACD
A nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow. a. Palpate the fundus to identify fetal part b. Identify the attitude of the head c. Palpate for the fetal part presenting at the inlet d. Determine the location of the fetal back
ADCB
A nurse is planning care for a client who is at 24 weeks gestation and reports daily mild headaches. Which of the following instructions should the nurse include in the plan of care? a. admin ibuprofen 400mg/day b. recommend that the client perform conscious relaxation techniques daily c. give the client ginseng w/ each meal d. instruct the client to soak in the bath with a water temp of 105 for 15min daily
B
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? a. Place warm moist packs on the breasts b. Apply cabbage leaves to the breasts c. Wear loose-fitting bra d. Put green tea bags on the breasts
B
A nurse is providing teaching a client about the physiological changes that occur during pregnancy. The client is at 10 weeks gestation and has a BMI within the expected reference range. Which of the following client statements indicates an understanding of the teaching? a. I will not gain more than 15-20lbs during the pregnancy b. I will likely need to use alternative positions for sexual intercourse c. Im glad I had a breast reduction years ago so they will not enlarge with my pregnancy d. Im glad I have a light complextion and will not get any stretch marks
B
A nurse is performing a physical assessment of a newborn upon administration to the nursery. Which of the following clinical manifestations should the nurse expect? (select all that apply) a. Yellow sclera b. Creases over 2/3 of the soles of the feet c. Posterior fontanel larger than the anterior fontanel d. Molding of the head e. Lanugo on the shoulders
BDE
A nurse I s assessing a newborn 12 hr after birth. Which of the following manifestations should the nurse report to the provider? a. Acrocyanosis b. Transient strabismus c. Jaundice d. Caput succedaneum
C
A nurse in a women's health clinic is providing teaching about nutritional intake to a client who is at 8 weeks of gestation. The nurse should instruct the client to increase her daily intake of which of the following nutrients? a. Calcium b. Vitamin e c. Iron d. Vitamin d
C
A nurse is reviewing the medical record of a client who is one day postpartum. The client had a vaginal birth with a fourth-degree perineal laceration. The nurse should contact the provider regarding which of the following prescriptions? a. Docusate sodium 100,g capsule by mouth three times daily b. Sitz bath two to three times per day as needed for pain c. Bisacodyl rectal suppository daily as needed for constipation d. Ibuprofen 600mg by mouth every 6hr as needed for pain
C
A nurse is roviding education about family bonding to parents who recently adopted a newborn? The nurse should make which of the following suggestions to aid the family's 7yo child in accepting the new family member? a. Allowing the siblings to hold the newborn during a bath b. Make sure the sibling kisses the newborn each night c. Obtain a giftfrom the newborn to present to the sibling d. Switvh the sibling's room with the nursery
C
A nurse is teaching a client who is at 24 weeks gestation regarding a 1hr glucose test. Which of the following statements should the nurse include in her teaching? a. You will need to drink the glucose solution 2hr prior to the test b. Limit your carb intake for 3 days prior to the test c. A blood glucose of 130-140 is considered a positive screening result d. You will need to fast for 12 hr prior to the test
C
A nurse is planning care for a client who Is 2hr postpartum. Which of the following interventions should the nurse plan to implement during taking-hold phase of postpartum behavioral adjustment? a. Discuss contraceptive options with the client and her partner b. Repeat info to ensure client understanding c. Listen to the client and her partner as they reflect upon the birth experience d. Demonstrate to the client how to perform a newborn bath
D
A nurse is planning for a client who is to undergo a nonstress test. Which of the following actions should the nurse include in the plan of care? a. Maintain the client NPO throughout the procedure b. Place the client in a supine position c. Instruct the client to massage the abdomen to stimulate fetal movements d. Instruct the client to press the provided button each time fetal movement is detected
D
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? a. Apply a cool pack for 10 min to the heel prior to the puncture b. Request a prescription for IM analgesic c. Use a manual lance blade to pierce the skin d. Place the newborn skin to skin on the mother's chest
D
A nurse is demonstrating to a client how to bathe her newborn. In which order should the nurse perform the following actions? (Place in order) a. Wash the newborn's neck by lifting newborn's chin b. Clean newborns diaper area c. Wipe newborn's eyes from inner canthus outward d. Cleanse the skin around the umbilical cord stump e. Wash newborns legs and feet
CADEB
A nurse is admitting a client to the labor and delivery unit when the client states, "my water just broke". Which of the following interventions is the nurses priority? a. Perform Nitrazine testing b. Assess the fluid c. Check cervical dilation d. Begin FHR monitoring
D
A nurse is providing discharge teaching to the parents of a newborn about using a car seat properly. Which of the following instructions should the nurse include? a. Place the shoulder harness in the slots above the newborns shoulders b. Place the retainer clip at the level of the newborn's waist c. Position the newborn at a 60 degree angle in the car seat d. Position the care seat rear-facing in the back seat of the vehicle
D
A nurse is reviewing the medical record of a client who is postpartum and has preeclampsia. Which of the following laboratory results should the nurse report to the provider? a. Hct 39% b. Serum albumin 4.5 g/dL c. WBC 9,000/mm3 d. Platelets 50,000/mm3
D
A nurse is teaching a client about Rho(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching? a. "I will receive this med if my baby is Rh-neg" b. "I will receive this med when I am in labor" c. "I will need a second dose of the med when my baby is 6 weeks old" d. " will need this med if I have an amniocentesis"
D
A nurse is teaching a client who is at 10 weeks of gestation about nutrition during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a. "I should increase my protein intake to 60g each day" b. "I should drink 2L of water daily" c. "I should increase my overall daily caloric intake by 300 calories" d. "I should take 600mcg of folic acid each day"
D
A nurse is teaching a client who is at 8 weeks of gestation about exercise. Which of the following instructions should the nurse include in the teaching? a. "you should increase weight-bearing exercises as your pregnancy progresses" b. "you should lie on your back to rest for 5 min after exercising" c. "you should take your pulse every 20 minutes while you are exercising" d. "You should exercise for 30 minutes each day"
D
A nurse is teaching a client who is pregnant about managing N/V. which of the following instructions should the nurse include in the teaching? a. Brush your teeth immediately after eating b. Eat foods served at a warm temperature c. Drink a glass of water with each meal d. Eat high-carb foods
D