OB test 2

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and are moderate to strong. Based on this information, what would a prudent nurse do next? A. Immediately notify the womans primary health care provider. B. Prepare to administer an oxytocic to stimulate uterine activity. C. Document the findings because they reflect the expected contraction pattern for the active phase of labor. D. Prepare the woman for the onset of the second stage of labor.

C. Document the findings because they reflect the expected contraction pattern for the active phase of labor.

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions? A. Placing the hand on the abdomen below the umbilicus and palpating uterine tone with the fingertips B.Determining the frequency by timing from the end of one contraction to the end of the next contraction C. Evaluating the intensity by pressing the fingertips into the uterine fundus D. Assessing uterine contractions every 30 minutes throughout the first stage of labor

C. Evaluating the intensity by pressing the fingertips into the uterine fundus

The first 1 to 2 hours after birth is sometimes referred to as what? A. Bonding period B. Third stage of labor C. Fourth stage of labor D. Early postpartum period

C. Fourth stage of labor

Which statements regarding physiologic jaundice are accurate? (Select all that apply.) A. Neonatal jaundice is common; however, kernicterus is rare. B. Appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. C. Because jaundice may not appear before discharge, parents need instruction on how to assess for jaundice and when to call for medical help. D. jaundice is caused by reduced levels of serum bilirubin E. Breastfed babies have a lower incidence of jaundice.

A. Neonatal jaundice is common; however, kernicterus is rare. B. Appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. C. Because jaundice may not appear before discharge, parents need instruction on how to assess for jaundice and when to call for medical help.

The nurse is preparing to administer a hepatitis B virus (HBV) vaccine to a newborn. Which intervention by the nurse is correct? A. Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration B. Confirming that the newborns mother has been infected with the HBV C. Assessing the dorsogluteal muscle as the preferred site for injection D. Confirming that the newborn is at least 24 hours old

A. Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration

Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position? A. Occiput of the fetus is in a posterior position. B. Fetus is at or above the ischial spines. C. Fetus is in a vertex presentation. D. Membranes have ruptured.

A. Occiput of the fetus is in a posterior position.

The Period of Purple Crying is a program developed to educate new parents about infant crying and the dangers of shaking a baby. Each letter in the acronym PURPLE represents a key concept of this program. Which concepts are accurate? (Select all that apply.) A. P: peak of crying and painful expression B. U: unexpected C. R: baby is resting at last D. L: extremely loud E. E: evening

A. P: peak of crying and painful expression B. U: unexpected E. E: evening

A 3.8-kg infant was vaginally delivered at 39 weeks of gestation after a 30-minute second stage. A nuchal cord occurred. After the birth, the infant is noted to have petechiae over the face and upper back. Based on the nurses knowledge, which information regarding petechiae should be shared with the parents? A. Petechiae (pinpoint hemorrhagic areas) are benign if they disappear within 48 hours of childbirth. B. These hemorrhagic areas may result from increased blood volume. C. Petechiae should always be further investigated. D. Petechiae usually occur with a forceps delivery.

A. Petechiae (pinpoint hemorrhagic areas) are benign if they disappear within 48 hours of childbirth.

The nurse should be cognizant of which physiologic effect of pain? A. Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen. B. Referred pain is the extreme discomfort experienced between contractions. C. Somatic pain of the second stage of labor is more generalized and related to fatigue. D. Pain during the third stage is a somewhat milder version of the pain experienced during the second stage.

A. Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen.

Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? A. Premature infants more easily digest breast milk than formula. B. A glass of wine just before pumping will help reduce stress and anxiety. C. The mother should only pump as much milk as the infant can drink. D. The mother should pump every 2 to 3 hours, including during the night.

A. Premature infants more easily digest breast milk than formula.

Women who have participated in childbirth education classes often bring a birth plan with them to the hospital. Which items might this plan include? (Select all that apply.) A. Presence of companions B. Clothing to be worn C. Care and handling of the newborn D. Medical interventions E. Date of delivery

A. Presence of companions B. Clothing to be worn C. Care and handling of the newborn D. Medical interventions

Hearing loss is one of the genetic disorders included in the universal screening program. Auditory screening of all newborns within the first month of life is recommended by the AAP. What is the rationale for having this testing performed? (Select all that apply.) A. Prevents or reduces developmental delays B. Reassures concerned new parents C. Provides early identification and treatment D. Helps the child communicate better E. Is recommended by the Joint Committee on Infant Hearing

A. Prevents or reduces developmental delays C. Provides early identification and treatment D. Helps the child communicate better E. Is recommended by the Joint Committee on Infant Hearing

In recovery, if a woman is asked to either raise her legs (knees extended) off the bed or flex her knees, and then place her feet flat on the bed and raise her buttocks well off the bed, the purpose of this exercise is to assess what? A. Recovery from epidural or spinal anesthesia B. Hidden bleeding underneath her C. Flexibility D. Whether the woman is a candidate to go home after 6 hours

A. Recovery from epidural or spinal anesthesia

Which technique is an adequate means of controlling the birth of the fetal head during delivery in a vertex presentation? A. Ritgen maneuver B. Fundal pressure C. Lithotomy position D. De Lee apparatus

A. Ritgen maneuver

Which alterations in the perception of pain by a laboring client should the nurse understand? A. Sensory pain for nulliparous women is often greater than for multiparous women during early labor. B. Affective pain for nulliparous women is usually less than for multiparous women throughout the first stage of labor. C. Women with a history of substance abuse experience more pain during labor. D. Multiparous women have more fatigue from labor and therefore experience more pain.

A. Sensory pain for nulliparous women is often greater than for multiparous women during early labor.

Breathing patterns are taught to laboring women. Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes? A. Slow-paced breathing B. Deep abdominal breathing C. Modified-paced breathing D. Patterned-paced breathing

A. Slow-paced breathing

Pain should be regularly assessed in all newborns. If the infant is displaying physiologic or behavioral cues that indicate pain, then measures should be taken to manage the pain. Which interventions are examples of nonpharmacologic pain management techniques? (Select all that apply.) A. Swaddling B. Nonnutritive sucking C. Skin-to-skin contact with the mother D. Sucrose E. Acetaminophen

A. Swaddling B. Nonnutritive sucking C. Skin-to-skin contact with the mother D. Sucrose

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, What is this black, sticky stuff in her diaper? What is the nurses best response? A. Thats meconium, which is your babys first stool. Its normal. B. Thats transitional stool. C. That means your baby is bleeding internally. D. Oh, dont worry about that. Its okay.

A. Thats meconium, which is your babys first stool. Its normal.

Which explanation will assist the parents in their decision on whether they should circumcise their son? A. The circumcision procedure has pros and cons during the prenatal period. B. American Academy of Pediatrics (AAP) recommends that all male newborns be routinely circumcised. C. Circumcision is rarely painful, and any discomfort can be managed without medication. D. The infant will likely be alert and hungry shortly after the procedure.

A. The circumcision procedure has pros and cons during the prenatal period.

A mother expresses fear about changing her infants diaper after he is circumcised. What does the client need to be taught to care for her newborn son? A. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. B. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. C. Gently cleanse the penis with water and apply petroleum jelly around the glans after each diaper change. D. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C. Gently cleanse the penis with water and apply petroleum jelly around the glans after each diaper change.

At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse develop a feeding plan for the infant to increase his weight gain. Which change in dietary management will assist the client in meeting this goal? A. Begin solid foods. B. Have a bottle of formula after every feeding. C. Have one extra breastfeeding session every 24 hours. D. Start iron supplements.

C. Have one extra breastfeeding session every 24 hours.

Where is the point of maximal intensity (PMI) of the FHR located? A. Usually directly over the fetal abdomen B. In a vertex position, heard above the mothers umbilicus C. Heard lower and closer to the midline of the mothers abdomen as the fetus descends and internally rotates D. In a breech position, heard below the mothers umbilicus

C. Heard lower and closer to the midline of the mothers abdomen as the fetus descends and internally rotates

While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a clunk when performing the Ortolani maneuver. These findings are likely indicative of what? A. Polydactyly B. Clubfoot C. Hip dysplasia D. Webbing

C. Hip dysplasia

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients. Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor, when they become more vocal and request pain relief? A. Chinese B. Arab or Middle Eastern C. Hispanic D. African-American

C. Hispanic

A new mother wants to be sure that she is meeting her daughters needs while feeding the baby commercially prepared infant formula. The nurse should evaluate the mothers knowledge about appropriate infant feeding techniques. Which statement by the client reassures the nurse that correct learning has taken place? A. Since reaching 2 weeks of age, I add rice cereal to my daughters formula to ensure adequate nutrition. B. I warm the bottle in my microwave oven. C. I burp my daughter during and after the feeding as needed. D. I refrigerate any leftover formula for the next feeding.

C. I burp my daughter during and after the feeding as needed.

The nurse is teaching new parents about metabolic screening for the newborn. Which statement is most helpful to these clients? A. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. B. Federal law prohibits newborn genetic testing without parental consent. C. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks. D. Hearing screening is now mandated by federal law.

C. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks.

As the nurse assists a new mother with breastfeeding, the client asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? What is the nurses best response? A. More calories B. Essential amino acids C. Important immunoglobulins D. More calcium

C. Important immunoglobulins

The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. This clinical finding may be indicative of what? A. Excessive saliva is a normal finding in the newborn. B. Excessive saliva in a neonate indicates that the infant is hungry. C. It may indicate that the infant has a tracheoesophageal fistula or esophageal atresia. D. Excessive saliva may indicate that the infant has a diaphragmatic hernia.

C. It may indicate that the infant has a tracheoesophageal fistula or esophageal atresia.

A nurse is assessing a newborn girl who is 2 hours old. Which finding warrants a call to the health care provider? A. Blood glucose of 45 mg/dl using a Dextrostix screening method B. Heart rate of 160 beats per minute after vigorously crying C. Laceration of the cheek D. Passage of a dark black-green substance from the rectum

C. Laceration of the cheek

A woman in labor has just received an epidural block. What is the most important nursing intervention at this time? A. Limit parenteral fluids. B. Monitor the fetus for possible tachycardia. C. Monitor the maternal blood pressure for possible hypotension. D. Monitor the maternal pulse for possible bradycardia.

C. Monitor the maternal blood pressure for possible hypotension.

A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate? A. Fentanyl (Sublimaze) B. Promethazine (Phenergan) C. Naloxone (Narcan) D. Nalbuphine (Nubain)

C. Naloxone (Narcan)

A newborn is placed under a radiant heat warmer. The nurse understands that thermoregulation presents a problem for the newborn. What is the rationale for this difficulty? A. The renal function of a newborn is not fully developed, and heat is lost in the urine. B. The small body surface area of a newborn favors more rapid heat loss than does an adults body surface area. C. Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation. D. Their normal flexed posture favors heat loss through perspiration.

C. Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation.

How would the nurse differentiate a meconium stool from a transitional stool in the healthy newborn? A. Observed at age 3 days B. Is residue of a milk curd C. Passes in the first 12 hours of life D. Is lighter in color and looser in consistency

C. Passes in the first 12 hours of life

What marks on a babys skin may indicate an underlying problem that requires notification of a physician? A. Mongolian spots on the back B. Telangiectatic nevi on the nose or nape of the neck C. Petechiae scattered over the infants body D. Erythema toxicum neonatorum anywhere on the body

C. Petechiae scattered over the infants body

A first-time dad is concerned that his 3-day-old daughters skin looks yellow. In the nurses explanation of physiologic jaundice, what fact should be included? A. Physiologic jaundice occurs during the first 24 hours of life. B. Physiologic jaundice is caused by blood incompatibilities between the mother and the infant blood types. C. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life. D. Physiologic jaundice is also known as breast milk jaundice.

C. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life.

newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. What is the most appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy? A. Applying an oil-based lotion to the newborns skin to prevent dying and cracking B. Limiting the newborns intake of milk to prevent nausea, vomiting, and diarrhea C. Placing eye shields over the newborns closed eyes D. Changing the newborns position every 4 hours

C. Placing eye shields over the newborns closed eyes

Which action by the mother will initiate the milk ejection reflex (MER)? A. Wearing a firm-fitting bra B. Drinking plenty of fluids C. Placing the infant to the breast D. Applying cool packs to her breast

C. Placing the infant to the breast

Which type of formula is not diluted with water, before being administered to an infant? A. Powdered B. Concentrated C. Ready-to-use D. Modified cows milk

C. Ready-to-use

What is the primary rationale for the thorough drying of the infant immediately after birth? A. Stimulates crying and lung expansion B. Removes maternal blood from the skin surface C. Reduces heat loss from evaporation D. Increases blood supply to the hands and feet

C. Reduces heat loss from evaporation

The nurse should be cognizant of which important information regarding the gastrointestinal (GI) system of the newborn? A. The newborns cheeks are full because of normal fluid retention. B. The nipple of the bottle or breast must be placed well inside the babys mouth because teeth have been developing in utero, and one or more may even be through. C. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the babys head. D. Bacteria are already present in the infants GI tract at birth because they traveled through the placenta.

C. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the babys head.

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the womans IV fluid for a preprocedural bolus. The nurse reviews her laboratory values and notes that the womans hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for this woman? A. She is too far dilated. B. She is anemic. C. She has thrombocytopenia. D. She is septic.

C. She has thrombocytopenia.

Which information should the nurse provide to a breastfeeding mother regarding optimal self-care? A. She will need an extra 1000 calories a day to maintain energy and produce milk. B. She can return to prepregnancy consumption patterns of any drinks as long as she gets enough calcium. C. She should avoid trying to lose large amounts of weight. D. She must avoid exercising because it is too fatiguing.

C. She should avoid trying to lose large amounts of weight.

If the newborn has excess secretions, the mouth and nasal passages can be easily cleared with a bulb syringe. How should the nurse instruct the parents on the use of this instrument? A. Avoid suctioning the nares. B. Insert the compressed bulb into the center of the mouth. C. Suction the mouth first. D. Remove the bulb syringe from the crib when finished.

C. Suction the mouth first.

Which statement by the client will assist the nurse in determining whether she is in true labor as opposed to false labor? A. I passed some thick, pink mucus when I urinated this morning. B. My bag of waters just broke. C. The contractions in my uterus are getting stronger and closer together. D. My baby dropped, and I have to urinate more frequently now.

C. The contractions in my uterus are getting stronger and closer together.

Which information related to the newborns developing cardiovascular system should the nurse fully comprehend? A. The heart rate of a crying infant may rise to 120 beats per minute. B. Heart murmurs heard after the first few hours are a cause for concern. C. The point of maximal impulse (PMI) is often visible on the chest wall. D. Persistent bradycardia may indicate respiratory distress syndrome (RDS).

C. The point of maximal impulse (PMI) is often visible on the chest wall.

What is the primary rationale for nurses wearing gloves when handling the newborn? A. To protect the baby from infection B. As part of the Apgar protocol C. To protect the nurse from contamination by the newborn D. Because the nurse has the primary responsibility for the baby during the first 2 hours

C. To protect the nurse from contamination by the newborn

A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy, 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light, and asks for her nurse right away, stating Im bleeding a lot. What is the most likely cause of postpartum hemorrhaging in this client? A. Retained placental fragments B. Unrepaired vaginal lacerations C. Uterine atony D. Puerperal infection

C. Uterine atony

Which statements describe the first stage of the neonatal transition period? (Select all that apply.) A. The neonatal transition period lasts no longer than 30 minutes. B. It is marked by spontaneous tremors, crying, and head movements. C. Passage of the meconium occurs during the neonatal transition period. D. This period may involve the infant suddenly and briefly sleeping. E. Audible grunting and nasal flaring may be present during this time.

A. The neonatal transition period lasts no longer than 30 minutes. B. It is marked by spontaneous tremors, crying, and head movements. C. Passage of the meconium occurs during the neonatal transition period. E. Audible grunting and nasal flaring may be present during this time.

The nurse caring for a newborn checks the record to note clinical findings that occurred before her shift. Which finding related to the renal system would be of increased significance and require further action? A. The pediatrician should be notified if the newborn has not voided in 24 hours. B. Breastfed infants will likely void more often during the first days after birth. C. rick dust or blood on a diaper is always cause to notify the physician. D. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

A. The pediatrician should be notified if the newborn has not voided in 24 hours.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the womans fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. What is the nurses assessment of the situation? A. The placenta has separated. B. A cervical tear occurred during the birth. C. The woman is beginning to hemorrhage. D. Clots have formed in the upper uterine segment.

A. The placenta has separated.

The nurse should be cognizant of which important statement regarding care of the umbilical cord? A. The stump can become easily infected. B. If bleeding occurs from the vessels of the cord, then the nurse should immediately call for assistance. C. The cord clamp is removed at cord separation. d. The average cord separation time is 5 to 7 days.

A. The stump can become easily infected.

The nurse is cognizant of which information related to the administration of vitamin K? A. Vitamin K is important in the production of red blood cells. B. Vitamin K is necessary in the production of platelets. C. Vitamin K is not initially synthesized because of a sterile bowel at birth. D. Vitamin K is responsible for the breakdown of bilirubin and the prevention of jaundice.

C. Vitamin K is not initially synthesized because of a sterile bowel at birth.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? A. Fetal head is felt at 0 station during vaginal examination. B. Bloody mucous discharge increases. C. Vulva bulges and encircles the fetal head. D. Membranes rupture during a contraction.

C. Vulva bulges and encircles the fetal head.

In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind? A. The cradle position is usually preferred by mothers who had a cesarean birth. B. Women with perineal pain and swelling prefer the modified cradle position. C. Whatever the position used, the infant is belly to belly with the mother. D. While supporting the head, the mother should push gently on the occiput.

C. Whatever the position used, the infant is belly to belly with the mother.

Which clinical finding indicates that the client has reached the second stage of labor? A. Amniotic membranes rupture. B. Cervix cannot be felt during a vaginal examination. C. Woman experiences a strong urge to bear down. D. Presenting part of the fetus is below the ischial spines.

C. Woman experiences a strong urge to bear down.

According to demographic research, which woman is least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding? A. Between 30 and 35 years of age, Caucasian, and employed part time outside the home B. Younger than 25 years of age, Hispanic, and unemployed C. Younger than 25 years of age, African-American, and employed full time outside the home D. 35 years of age or older, Caucasian, and employed full time at home

C. Younger than 25 years of age, African-American, and employed full time outside the home

The nurse should be aware of which information related to a womans intake and output during labor? A. Traditionally, restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia. B. Intravenous (IV) fluids are usually necessary to ensure that the laboring woman stays hydrated. C. Routine use of an enema empties the rectum and is very helpful for producing a clean, clear delivery. D. When a nulliparous woman experiences the urge to defecate, it often means birth will quickly follow.

A. Traditionally, restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia.

Which actions are examples of appropriate techniques to wake a sleepy infant for breastfeeding? (Select all that apply.) A. Unwrapping the infant B. Changing the diaper C. Talking to the infant D. Slapping the infants hands and feet E. Applying a cold towel to the infants abdomen

A. Unwrapping the infant B. Changing the diaper C. Talking to the infant

What is the correct term for the cheeselike, white substance that fuses with the epidermis and serves as a protective coating? A. Vernix caseosa B. Surfactant C. Caput succedaneum D. Acrocyanosis

A. Vernix caseosa

Which component of the sensory system is the least mature at birth? A. Vision B. Hearing C. Smell D. Taste

A. Vision

The class of drugs known as opioid analgesics (butorphanol, nalbuphine) is not suitable for administration to women with known opioid dependence. The antagonistic activity could precipitate withdrawal symptoms (abstinence syndrome) in both mothers and newborns. Which signs would indicate opioid or narcotic withdrawal in the mother? (Select all that apply.) A. Yawning, runny nose B. Increase in appetite C. Chills or hot flashes D. Constipation E. Irritability, restlessness

A. Yawning, runny nose C. Chills or hot flashes E. Irritability, restlessness

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The FHR has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. What disposition would the nurse anticipate? A. .Admitted and prepared for a cesarean birth B. Admitted for extended observation C. Discharged home with a sedative D Discharged home to await the onset of true labor

D Discharged home to await the onset of true labor

When a nulliparous woman telephones the hospital to report that she is in labor, what guidance should the nurse provide or information should the nurse obtain? A. Tell the woman to stay home until her membranes rupture. B. Emphasize that food and fluid intake should stop. C. Arrange for the woman to come to the hospital for labor evaluation. D. Ask the woman to describe why she believes she is in labor.

D. Ask the woman to describe why she believes she is in labor.

The obstetric nurse is preparing the client for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware of and prepared for the greatest risk of administering general anesthesia to the client. What is this risk? A. Respiratory depression B. Uterine relaxation C. Inadequate muscle relaxation D. Aspiration of stomach contents

D. Aspiration of stomach contents

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurses highest priority in this situation? A. Prepare the woman for imminent birth. B. Notify the womans primary health care provider. C. Document the characteristics of the fluid. D. Assess the fetal heart rate (FHR) and pattern.

D. Assess the fetal heart rate (FHR) and pattern.

A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide at this time? A. Notify the woman's health care provider. B.Administer the prescribed narcotic analgesic. C. Assure her that her labor will be over soon. D. Assist her with simple breathing and relaxation instructions.

D. Assist her with simple breathing and relaxation instructions.

The brain is vulnerable to nutritional deficiencies and trauma in early infancy. What is the rationale for this physiologic adaptation in the newborn? A. Incompletely developed neuromuscular system B. Primitive reflex system C. Presence of various sleep-wake states D. Cerebellum growth spurt

D. Cerebellum growth spurt

A nurse is responsible for teaching new parents regarding the hygienic care of their newborn. Which instruction should the nurse provide regarding bathing? A. Avoid washing the head for at least 1 week to prevent heat loss. B. Sponge bathe the newborn for the first month of life. C. Cleanse the ears and nose with cotton-tipped swabs, such as Q-tips. D. Create a draft-free environment of at least 24 C (75 F) when bathing the infant.

D. Create a draft-free environment of at least 24 C (75 F) when bathing the infant.

The nurse performs a vaginal examination to assess a clients labor progress. Which action should the nurse take next? A. Perform an examination at least once every hour during the active phase of labor. B. Perform the examination with the woman in the supine position. C. Wear two clean gloves for each examination. D. Discuss the findings with the woman and her partner.

D. Discuss the findings with the woman and her partner.

The nurse should be aware of what important information regarding systemic analgesics administered during labor? A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. C. Intramuscular (IM) administration is preferred over IV administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B. Effects on the fetus and newborn can include decreased alertness and delayed sucking.

A woman who is gravida 3 para 2 arrives on the intrapartum unit. What is the most important nursing assessment at this time? A. Contraction pattern, amount of discomfort, and pregnancy history B. FHR, maternal vital signs, and the womans nearness to birth C. Identification of ruptured membranes, womans gravida and para, and her support person D. Last food intake, when labor began, and cultural practices the couple desires

B. FHR, maternal vital signs, and the womans nearness to birth

A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. Which information should the nurse provide regarding this feeding plan? A. Feeding solid foods before your son is 4 to 6 months old may decrease your sons intake of sufficient calories. B. Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding. C. Your feeding plan will help your son sleep through the night. D. Feeding solid foods before your son is 4 to 6 months old will limit his growth.

B. Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding.

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the client place the infant to her breast within 15 minutes after birth. The nurse is aware that the initiation of breastfeeding is most effective during the first 30 minutes after birth. What is the correct term for this phase of alertness? A. Transition period B. First period of reactivity C. Organizational stage D. Second period of reactivity

B. First period of reactivity

Through a vaginal examination, the nurse determines that a woman is 4 cm dilated. The external fetal monitor shows uterine contractions every to 4 minutes. The nurse reports this as what stage of labor? A. First stage, latent phase B. First stage, active phase C. First stage, transition phase D. Second stage, latent phase

B. First stage, active phase

What is the rationale for the use of a blood patch after spinal anesthesia? A. Hypotension B. Headache C. Neonatal respiratory depression D. Loss of movement

B. Headache

What should the laboring client who receives an opioid antagonist be told to expect? A. Her pain will decrease. B. Her pain will return. C. She will feel less anxious. D. She will no longer feel the urge to push.

B. Her pain will return.

Which cardiovascular changes cause the foramen ovale to close at birth? A. Increased pressure in the right atrium B. Increased pressure in the left atrium C. Decreased blood flow to the left ventricle D. Changes in the hepatic blood flow

B. Increased pressure in the left atrium

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What information provided by the nurse would be most useful to these new parents? A. Infants can see very little until approximately 3 months of age. B. Infants can track their parents eyes and can distinguish patterns; they prefer complex patterns. C. The infants eyes must be protected. Infants enjoy looking at brightly colored stripes. D. Its important to shield the newborns eyes. Overhead lights help them see better.

B. Infants can track their parents eyes and can distinguish patterns; they prefer complex patterns.

According to professional standards (the Association of Womens Health, Obstetric and Neonatal Nurses [AWHONN], 2007), which action cannot be performed by the nonanesthetist registered nurse who is caring for a woman with epidural anesthesia? A. Monitoring the status of the woman and fetus B. Initiating epidural anesthesia C. Replacing empty infusion bags with the same medication and concentrate D. Stopping the infusion, and initiating emergency measures

B. Initiating epidural anesthesia

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. What is the nurses ideal response? A. Dont worry about it. Youll do fine. B. Its normal to be anxious about labor. Lets discuss what makes you afraid. C. Labor is scary to think about, but the actual experience isnt. D. You can have an epidural. You wont feel anything.

B. Its normal to be anxious about labor. Lets discuss what makes you afraid.

The condition during which infants are at an increased risk for subgaleal hemorrhage is called what? A. Infection B. Jaundice C. Caput succedaneum D. Erythema toxicum neonatorum

B. Jaundice

Which statement best describes the transition period between intrauterine and extrauterine existence for the newborn? A. Consists of four phases, two reactive and two of decreased responses B. Lasts from birth to day 28 of life C. Applies to full-term births only D. Varies by socioeconomic status and the mothers age

B. Lasts from birth to day 28 of life

A woman who has a history of sexual abuse may have a number of traumatic memories triggered during labor. She may fight the labor process and react with pain or anger. The nurse can implement a number of care measures to help her client view the childbirth experience in a positive manner. Which intervention is key for the nurse to use while providing care? A. Tell the client to relax and that it wont hurt much. B. Limit the number of procedures that invade her body. C. Reassure the client that, as the nurse, you know what is best. D. Allow unlimited care providers to be with the client.

B. Limit the number of procedures that invade her body.

A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until the baby is frantically crying. Which feeding cue would indicate that the baby is ready to eat? A. Waves her arms in the air B. Makes sucking motions C. Has the hiccups D. Stretches out her legs straight

B. Makes sucking motions

Developing a realistic birth plan with the pregnant woman regarding her care is important for the nurse. How would the nurse explain the major advantage of nonpharmacologic pain management? A. Greater and more complete pain relief is possible. B. No side effects or risks to the fetus are involved. C. The woman will remain fully alert at all times. D. Labor will likely be more rapid.

B. No side effects or risks to the fetus are involved.

What is the nurses initial action while caring for an infant with a slightly decreased temperature? A. Immediately notify the physician. B. Place a cap on the infants head, and have the mother perform kangaroo care. C. Tell the mother that the infant must be kept in the nursery and observed for the next 4 hours. D. Change the formula; a decreased body temperature is a sign of formula intolerance.

B. Place a cap on the infants head, and have the mother perform kangaroo care.

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could the nurse use to increase the clients blood pressure? (Select all that apply.) A. Place the woman in a supine position. B. Place the woman in a lateral position. C. Increase IV fluids. D. Administer oxygen. E. Perform a vaginal examination.

B. Place the woman in a lateral position. C. Increase IV fluids. D. Administer oxygen.

Which instruction should the nurse provide to reduce the risk of nipple trauma? A. Limit the feeding time to less than 5 minutes. B. Position the infant so the nipple is far back in the mouth. C. Assess the nipples before each feeding. D. Wash the nipples daily with mild soap and water.

B. Position the infant so the nipple is far back in the mouth.

hat is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum? A. Epidural B. Pudendal C. Local D. Spinal block

B. Pudendal

A first-time mother is concerned about the type of medications she will receive during labor. The client is in a fair amount of pain and is nauseated. In addition, she appears to be very anxious. The nurse explains that opioid analgesics are often used along with sedatives. How should the nurse phrase the rationale for this medication combination? A. The two medications, together, reduce complications. B. Sedatives enhance the effect of the pain medication. C. The two medications work better together, enabling you to sleep until you have the baby. D. This is what your physician has ordered for you.

B. Sedatives enhance the effect of the pain medication.

Anxiety is commonly associated with pain during labor. Which statement regarding anxiety is correct? A. Even mild anxiety must be treated. B. Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on. C. Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. D. Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

B. Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on.

A primiparous woman is watching her newborn sleep. She wants him to wake up and respond to her. The mother asks the nurse how much he will sleep every day. What is an appropriate response by the nurse? A. He will only wake up to be fed, and you should not bother him between feedings. B. The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing. C. He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon. D. He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night.

B. The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing.

The nurse is completing a physical examination of the newborn 24 hours after birth. Which component of the evaluation is correct? A. The parents are excused to reduce their normal anxiety. B. The nurse can gauge the neonates maturity level by assessing his or her general appearance. C. Once often neglected, blood pressure is now routinely checked. D. When the nurse listens to the neonates heart, the S1 and S2 sounds can be heard; the S1sound is somewhat higher in pitch and sharper than the S2 sound.

B. The nurse can gauge the neonates maturity level by assessing his or her general appearance.

A new father wants to know what medication was put into his infants eyes and why it is needed. How does the nurse explain the purpose of the erythromycin (Ilotycin) ophthalmic ointment? A. Erythromycin (Ilotycin) ophthalmic ointment destroys an infectious exudate caused byStaphylococcus that could make the infant blind. B. This ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes, potentially acquired from the birth canal. C. Erythromycin (Ilotycin) prevents potentially harmful exudate from invading the tear ducts of the infants eyes, leading to dry eyes. D. This ointment prevents the infants eyelids from sticking together and helps the infant see.

B. This ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes, potentially acquired from the birth canal.

The nurse is circulating during a cesarean birth of a preterm infant. The obstetrician requests that cord clamping be delayed. What is the rationale for this directive? A. To reduce the risk for jaundice B. To reduce the risk of intraventricular hemorrhage C. To decrease total blood volume D. To improve the ability to fight infection

B. To reduce the risk of intraventricular hemorrhage

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. What is the primary purpose of this activity? A. To facilitate maternal-newborn interaction B. To stimulate the uterus to contract C. To prevent neonatal hypoglycemia D. To initiate the lactation cycle

B. To stimulate the uterus to contract

What is the rationale for the administration of an oxytocic (e.g., Pitocin, Methergine) after expulsion of the placenta? A. To relieve pain B. To stimulate uterine contraction C. To prevent infection D. To facilitate rest and relaxation

B. To stimulate uterine contraction

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination? A. Admission to the hospital at the start of labor B. When accelerations of the FHR are noted C. On maternal perception of perineal pressure or the urge to bear down D. When membranes rupture

B. When accelerations of the FHR are noted

What is the rationale for evaluating the plantar crease within a few hours of birth? A. Newborn has to be footprinted. B.As the skin dries, the creases will become more prominent. C. Heel sticks may be required. D. Creases will be less prominent after 24 hours.

B.As the skin dries, the creases will become more prominent.

The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse range (in beats per minute)? A. 80 to 100 B. 100 to 120 C. 120 to 160 D. 150 to 180

C. 120 to 160

How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? A. 50 to 65 B. 75 to 90 C. 95 to 110 D. 150 to 200

C. 95 to 110

A nulliparous woman has just begun the latent phase of the second stage of her labor. The nurse should anticipate which behavior? A. A nulliparous woman will experience a strong urge to bear down. B. Perineal bulging will show. C. A nulliparous woman will remain quiet with her eyes closed between contractions. D. The amount of bright red bloody show will increase.

C. A nulliparous woman will remain quiet with her eyes closed between contractions.

Which statement accurately describes an appropriate-for-gestational age (AGA) weight assessment? A. AGA weight assessment falls between the 25th and 75th percentiles for the infants age. B. AGA weight assessment depends on the infants length and the size of the newborns head. C. AGA weight assessment falls between the 10th and 90th percentiles for the infants age. D. AGA weight assessment is modified to consider intrauterine growth restriction (IUGR).

C. AGA weight assessment falls between the 10th and 90th percentiles for the infants age.

A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to subside. When the inhalation stops, the valve closes. Which statement regarding this procedure is correct? A. The application of nitrous oxide gas is not often used anymore. B. An inhalation of gas is likely to be used in the second stage of labor, not during the first stage. C. An application of nitrous oxide gas is administered for pain relief. D. The application of gas is a prelude to a cesarean birth.

C. An application of nitrous oxide gas is administered for pain relief.

An infant boy was delivered minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. When should the Apgar assessment be performed? A. Only if the newborn is in obvious distress B. Once by the obstetrician, just after the birth C. At least twice, 1 minute and 5 minutes after birth D. Every 15 minutes during the newborns first hour after birth

C. At least twice, 1 minute and 5 minutes after birth

What is the rationale for the administration of vitamin K to the healthy full-term newborn? A. Most mothers have a diet deficient in vitamin K, which results in the infant being deficient. B. Vitamin K prevents the synthesis of prothrombin in the liver and must be administered by injection. C. Bacteria that synthesize vitamin K are not present in the newborns intestinal tract. D. The supply of vitamin K in the healthy full-term newborn is inadequate for at least 3 to 4 months and must be supplemented.

C. Bacteria that synthesize vitamin K are not present in the newborns intestinal tract.

A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement? A. Skip feedings to enable her sore breasts to rest. B. Avoid using a breast pump. C. Breastfeed her infant every 2 hours. D. Reduce her fluid intake for 24 hours.

C. Breastfeed her infant every 2 hours.

While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the client accordingly. Which statement as part of this discussion would be incorrect? A. Breastfeeding requires fewer supplies and less cumbersome equipment. B. Breastfeeding saves families money. C. Breastfeeding costs employers in terms of time lost from work. D. Breastfeeding benefits the environment.

C. Breastfeeding costs employers in terms of time lost from work.

Which statement regarding the nutrient needs of breastfed infants is correct? A. Breastfed infants need extra water in hot climates. B. During the first 3 months, breastfed infants consume more energy than formula-fed infants. C. Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months. D. Vitamin K injections at birth are not necessary for breastfed infants.

C. Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months.

Which statement is not an expected outcome for the client who attends a reputable childbirth preparation program? A. Childbirth preparation programs increase the womans sense of control. B. Childbirth preparation programs prepare a support person to help during labor. C. Childbirth preparation programs guarantee a pain-free childbirth. D. Childbirth preparation programs teach distraction techniques.

C. Childbirth preparation programs guarantee a pain-free childbirth.

Which description of the phases of the second stage of labor is most accurate? A. Latent phase: Feeling sleepy; fetal station 2+ to 4+; duration of 30 to 45 minutes B. Active phase: Overwhelmingly strong contractions; Ferguson reflux activated; duration of 5 to 15 minutes C. Descent phase: Significant increase in contractions; Ferguson reflux activated; average duration varies D. Transitional phase: Woman laboring down; fetal station 0; duration of 15 minutes

C. Descent phase: Significant increase in contractions; Ferguson reflux activated; average duration varies

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink papular rash with vesicles superimposed on the thorax, back, and abdomen. What action is the highest priority for the nurse to take at this time? A. Immediately notify the physician. B. Move the newborn to an isolation nursery. C. Document the finding as erythema toxicum neonatorum. D. Take the newborns temperature, and obtain a culture of one of the vesicles.

C. Document the finding as erythema toxicum neonatorum.

A woman has requested an epidural block for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the womans IV fluid for a preprocedural bolus. Before the initiation of the epidural, the woman should be informed regarding the disadvantages of an epidural block. Which concerns should the nurse share with this client? (Select all that apply.) A. Ability to move freely is limited. B. Orthostatic hypotension and dizziness may occur. C. Gastric emptying is not delayed. D. Higher body temperature may occur. E. Blood loss is not excessive.

A. Ability to move freely is limited. B. Orthostatic hypotension and dizziness may occur. D. Higher body temperature may occur.

A new mother states that her infant must be cold because the babys hands and feet are blue. This common and temporary condition is called what? A. Acrocyanosis B. Erythema toxicum neonatorum C. Harlequin sign D. Vernix caseosa

A. Acrocyanosis

The AAP recommends pasteurized donor milk for preterm infants if the mothers own milk in not available. Which statements regarding donor milk and milk banking are important for the nurse to understand and communicate to her client? (Select all that apply.) A. All milk bank donors are screened for communicable diseases. B. Internet milk sharing is an acceptable source for donor milk. C. Donor milk may be given to transplant clients. D. Donor milk is used in neonatal intensive care units (NICUs) for severely low-birth-weight infants only. E. Donor milk may be used for children with immunoglobulin A (IgA) deficiencies.

A. All milk bank donors are screened for communicable diseases. C. Donor milk may be given to transplant clients. E. Donor milk may be used for children with immunoglobulin A (IgA) deficiencies.

A laboring woman is reclining in the supine position. What is the most appropriate nursing action at this time? A. Ask her to turn to one side. B. Elevate her feet and legs. C.Take her blood pressure. D. Determine whether fetal tachycardia is present.

A. Ask her to turn to one side.

Which newborn reflex is elicited by stroking the lateral sole of the infants foot from the heel to the ball of the foot? A. Babinski B. Tonic neck C. Stepping D. Plantar grasp

A. Babinski

A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle feeding. Which statement regarding bottle feeding using commercially prepared infant formulas might influence their choice? A. Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies. B. Bottle feeding helps the infant sleep through the night. C. Commercially prepared formula ensures that the infant is getting iron in a form that is easily absorbed. D. Bottle feeding requires that multivitamin supplements be given to the infant.

A. Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies.

Which statements concerning the benefits or limitations of breastfeeding are accurate? (Select all that apply.) A. Breast milk changes over time to meet the changing needs as infants grow. B. Breastfeeding increases the risk of childhood obesity. C. Breast milk and breastfeeding may enhance cognitive development. D. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. E. Benefits to the infant include a reduced incidence of SIDS.

A. Breast milk changes over time to meet the changing needs as infants grow. C. Breast milk and breastfeeding may enhance cognitive development. D. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. E. Benefits to the infant include a reduced incidence of SIDS.

A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. Which findings should the nurse include in the discussion? (Select all that apply.) A. Breast tenderness B. Warmth in the breast C. Area of redness on the breast often resembling the shape of a pie wedge D. Small white blister on the tip of the nipple E. Fever and flulike symptoms

A. Breast tenderness B. Warmth in the breast C. Area of redness on the breast often resembling the shape of a pie wedge E. Fever and flulike symptoms

A nurse providing couplet care should understand the issue of nipple confusion. In which situation might this condition occur? A. Breastfeeding babies receive supplementary bottle feedings. B. Baby is too abruptly weaned. C. Pacifiers are used before breastfeeding is established. D. Twins are breastfed together.

A. Breastfeeding babies receive supplementary bottle feedings.

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. What are these four essential factors? A. Chemical B. Mechanical C. Thermal D. Psychologic E. Sensory

A. Chemical B. Mechanical C. Thermal E. Sensory

Which information regarding the procedures and criteria for admitting a woman to the hospital labor unit is important for the nurse to understand? A. Client is considered to be in active labor when she arrives at the facility with contractions. B. Client can have only her male partner or predesignated doula with her at assessment. C. Children are not allowed on the labor unit. D. NonEnglish speaking client must bring someone to translate.

A. Client is considered to be in active labor when she arrives at the facility with contractions.

A new mother asks whether she should feed her newborn colostrum, because it is not real milk. What is the nurses most appropriate answer? A. Colostrum is high in antibodies, protein, vitamins, and minerals. B. Colostrum is lower in calories than milk and should be supplemented by formula. C. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. D. Colostrum is unnecessary for newborns.

A. Colostrum is high in antibodies, protein, vitamins, and minerals.

A client is experiencing back labor and complains of intense pain in her lower back. Which measure would best support this woman in labor? A. Counterpressure against the sacrum B. Pant-blow (breaths and puffs) breathing techniques C. Effleurage D. Conscious relaxation or guided imagery

A. Counterpressure against the sacrum

While developing an intrapartum care plan for the client in early labor, which psychosocial factors would the nurse recognize upon the clients pain experience? (Select all that apply.) A. Culture B. Anxiety and fear C. Previous experiences with pain D. Intervention of caregivers E. Support systems

A. Culture B. Anxiety and fear C. Previous experiences with pain E. Support systems

When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective? A. Dilation of the cervix B. Descent of the fetus to 2 station C. Rupture of the amniotic membranes D. Increase in bloody show

A. Dilation of the cervix

Which intervention can nurses use to prevent evaporative heat loss in the newborn? A. Drying the baby after birth, and wrapping the baby in a dry blanket B. Keeping the baby out of drafts and away from air conditioners C. Placing the baby away from the outside walls and windows D. Warming the stethoscope and the nurses hands before touching the baby

A. Drying the baby after birth, and wrapping the baby in a dry blanket

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. Which instruction best describes these measures? A. Encouraging the woman to try various upright positions, including squatting and standing B. Telling the woman to start pushing as soon as her cervix is fully dilated C. Continuing an epidural anesthetic so pain is reduced and the woman can relax D. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

A. Encouraging the woman to try various upright positions, including squatting and standing

The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks? A. Flexed posture B. Abundant lanugo C. Smooth, pink skin with visible veins D. Faint red marks on the soles of the feet

A. Flexed posture

The nurse should be cognizant of which statement regarding the unique qualities of human breast milk? A. Frequent feedings during predictable growth spurts stimulate increased milk production. B. Milk of preterm mothers is the same as the milk of mothers who gave birth at term. C. Milk at the beginning of the feeding is the same as the milk at the end of the feeding. D. Colostrum is an early, less concentrated, less rich version of mature milk.

A. Frequent feedings during predictable growth spurts stimulate increased milk production.

As recently as 2005, the AAP revised safe sleep practices to assist in the prevention of SIDS. The nurse should model these practices in the hospital and incorporate this information into the teaching plan for new parents. Which practices are ideal for role modeling? (Select all that apply.) A. Fully supine position for all sleep B. Side-sleeping position as an acceptable alternative C. Tummy time for play D. Infant sleep sacks or buntings E. Soft mattress

A. Fully supine position for all sleep C. Tummy time for play D. Infant sleep sacks or buntings

Which component of the physical examination are Leopolds maneuvers unable to determine? A. Gender of the fetus B. Number of fetuses C. Fetal lie and attitude D. Degree of the presenting parts descent into the pelvis

A. Gender of the fetus

The Baby Friendly Hospital Initiative endorsed by the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which actions are included in the Ten Steps to Successful Breastfeeding for Hospitals? (Select all that apply.) A. Give newborns no food or drink other than breast milk. B. Have a written breastfeeding policy that is communicated to all staff members. C. Help mothers initiate breastfeeding within hour of childbirth. D. Give artificial teats or pacifiers as necessary. E. Return infants to the nursery at night.

A. Give newborns no food or drink other than breast milk. B. Have a written breastfeeding policy that is communicated to all staff members. C. Help mothers initiate breastfeeding within hour of childbirth.

Conscious relaxation is associated with which method of childbirth preparation? A. Grantly Dick-Read childbirth method B. Lamaze method C. Bradley method D. Psychoprophylactic method

A. Grantly Dick-Read childbirth method

A nurse is discussing the storage of breast milk with a mother whose infant is preterm and in the special care nursery. Which statement indicates that the mother requires additional teaching? A. I can store my breast milk in the refrigerator for 3 months. B. I can store my breast milk in the freezer for 3 months. C. I can store my breast milk at room temperature for 4 hours. D. I can store my breast milk in the refrigerator for 3 to 5 days.

A. I can store my breast milk in the refrigerator for 3 months.

Nursing follow-up care often includes home visits for the new mother and her infant. Which information related to home visits is correct? A. Ideally, the visit is scheduled within 72 hours after discharge. B. Home visits are available in all areas. C. Visits are completed within a 30-minute time frame. D. Blood draws are not a part of the home visit.

A. Ideally, the visit is scheduled within 72 hours after discharge.

Under which circumstance should the nurse immediately alert the pediatric provider? A. Infant is dusky and turns cyanotic when crying. B. Acrocyanosis is present 1 hour after childbirth. C. The infants blood glucose level is 45 mg/dl. D. The infant goes into a deep sleep 1 hour after childbirth.

A. Infant is dusky and turns cyanotic when crying.

A new mother asks the nurse what the experts say about the best way to feed her infant. Which recommendation of the American Academy of Pediatrics (AAP) regarding infant nutrition should be shared with this client? A. Infants should be given only human milk for the first 6 months of life. B. Infants fed on formula should be started on solid food sooner than breastfed infants. C. If infants are weaned from breast milk before 12 months, then they should receive cows milk, not formula. D. After 6 months, mothers should shift from breast milk to cows milk.

A. Infants should be given only human milk for the first 6 months of life.

The nurse is caring for a client in early labor. Membranes ruptured approximately 2 hours earlier. This client is at increased risk for which complication? A. Intrauterine infection B. Hemorrhage C. Precipitous labor D. Supine hypotension

A. Intrauterine infection

What is the most critical nursing action in caring for the newborn immediately after the birth? A. Keeping the airway clear B. Fostering parent-newborn attachment C. Drying the newborn and wrapping the infant in a blanket D. Administering eye drops and vitamin K

A. Keeping the airway clear

he most serious complication of an infant heelstick is necrotizing osteochondritis resulting from lancet penetration of the bone. What approach should the nurse take when performing the test to prevent this complication? A. Lancet should penetrate at the outer aspect of the heel. B. Lancet should penetrate the walking surface of the heel. C. Lancet should penetrate the ball of the foot. D. Lancet should penetrate the area just below the fifth toe.

A. Lancet should penetrate at the outer aspect of the heel.

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory? A. Massage the woman's back. B. Change the woman's position. C. Give the prescribed medication. D. Encourage the woman to rest between contractions.

A. Massage the woman's back.

. As the United States and Canada continue to become more culturally diverse, recognizing a wide range of varying cultural beliefs and practices is increasingly important for the nursing staff. A client is from which country if she requests to have the babys father in attendance? A. Mexico B. China C.Iran D. India

A. Mexico

The nurse should be cognizant of which important information regarding nerve block analgesia and anesthesia? A. Most local agents are chemically related to cocaine and end in the suffix caine. B. Local perineal infiltration anesthesia is effective when epinephrine is added, but it can be injected only once. C. Pudendal nerve block is designed to relieve the pain from uterine contractions. D. Pudendal nerve block, if performed correctly, does not significantly lessen the bearing-down reflex.

A. Most local agents are chemically related to cocaine and end in the suffix caine.

Which statement is the best rationale for recommending formula over breastfeeding? A. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. B. Mother lacks confidence in her ability to breastfeed. C. Other family members or care providers also need to feed the baby. D. Mother sees bottle feeding as more convenient.

A. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.

Which alternative approaches to relaxation have proven successful when working with the client in labor? (Select all that apply.) a. Aromatherapy b. Massage c. Hypnosis d. Cesarean birth e. Biofeedback

a. Aromatherapy b. Massage c. Hypnosis e. Biofeedback

Emergency conditions during labor that would require immediate nursing intervention can arise with startling speed. Which situations are examples of such an emergency? (Select all that apply.) a.Nonreassuring or abnormal FHR pattern B. Inadequate uterine relaxation C. Vaginal bleeding D. Prolonged second stage E. Prolapse of the cord

a.Nonreassuring or abnormal FHR pattern B. Inadequate uterine relaxation C. Vaginal bleeding E. Prolapse of the cord

Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information regarding nonpharmacologic pain relief isaccurate? A. Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine. B. Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time. C. Effleurage is permissible, but counterpressure is almost always counterproductive. D. Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

D. Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

Which collection of risk factors will most likely result in damaging lacerations, including episiotomies? A. Dark-skinned woman who has had more than one pregnancy, who is going through prolonged second-stage labor, and who is attended by a midwife B. Reddish-haired mother of two who is going through a breech birth C. Dark-skinned first-time mother who is going through a long labor D. First-time mother with reddish hair whose rapid labor was overseen by an obstetrician

D. First-time mother with reddish hair whose rapid labor was overseen by an obstetrician

A postpartum woman telephones the provider regarding her 5-day-old infant. The client is not scheduled for another weight check until the infant is 14 days old. The new mother is worried about whether breastfeeding is going well. Which statement indicates that breastfeeding is effective for meeting the infants nutritional needs? A. Sleeps for 6 hours at a time between feedings B. Has at least one breast milk stool every 24 hours C. Gains 1 to 2 ounces per week D. Has at least six to eight wet diapers per day

D. Has at least six to eight wet diapers per day

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is approximately twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. Which intervention should the nurse immediately initiate? A. Contact the womans physician. B. Tell the woman to slow her pace of her breathing. C. Administer oxygen via a mask or nasal cannula. D. Help her breathe into a paper bag.

D. Help her breathe into a paper bag.

Nurses should be able to teach breastfeeding mothers the signs that the infant has correctly latched on. Which client statement indicates a poor latch? A. I feel a firm tugging sensation on my nipples but not pinching or pain. B. My baby sucks with cheeks rounded, not dimpled. C. My babys jaw glides smoothly with sucking. D. I hear a clicking or smacking sound.

D. I hear a clicking or smacking sound.

As part of the infant discharge instructions, the nurse is reviewing the use of the infant car safety seat. Which information is the highest priority for the nurse to share? A. Infant carriers are okay to use until an infant car safety seat can be purchased. B. For traveling on airplanes, buses, and trains, infant carriers are satisfactory. C. Infant car safety seats are used for infants only from birth to 15 pounds. D. Infant car seats should be rear facing and placed in the back seat of the car.

D. Infant car seats should be rear facing and placed in the back seat of the car.

What is the most critical physiologic change required of the newborn after birth? A. Closure of fetal shunts in the circulatory system B. Full function of the immune defense system C. Maintenance of a stable temperature D. Initiation and maintenance of respirations

D. Initiation and maintenance of respirations

Which statement correctly describes the effects of various pain factors? A. Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth. B. Upright positions in labor increase the pain factor because they cause greater fatigue. C. Women who move around trying different positions experience more pain. D. Levels of pain-mitigating beta-endorphins are higher during a spontaneous, natural childbirth.

D. Levels of pain-mitigating beta-endorphins are higher during a spontaneous, natural childbirth.

An African-American woman noticed some bruises on her newborn daughters buttocks. The client asks the nurse what causes these. How would the nurse best explain this integumentary finding to the client? A. Lanugo B. Vascular nevus C. Nevus flammeus D. Mongolian spot

D. Mongolian spot

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a C with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive _____ reflex. A. tonic neck B. glabellar (Myerson) C. Babinski D. Moro

D. Moro

The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding ones breath with a closed glottis and a tightening of the abdominal muscles. When is it appropriate to instruct the client to use this maneuver? A. During the second stage to enhance the movement of the fetus B. During the third stage to help expel the placenta C. During the fourth stage to expel blood clots D. Not at all

D. Not at all

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Based on the most recent evidence, which information is incorrect and should be discussed with parents? A. Prevent exposure to people with upper respiratory tract infections. B. Keep the infant away from secondhand smoke. C. Avoid loose bedding, water beds, and beanbag chairs. D. Place the infant on his or her abdomen to sleep.

D. Place the infant on his or her abdomen to sleep.

An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, My contractions are so strong, I don't know what to do. Before making a plan of care, what should the nurses first action be? A. Assess for fetal well-being. B. Encourage the woman to lie on her side. C. Disturb the woman as little as possible. D. Recognize that pain is personalized for each individual.

D. Recognize that pain is personalized for each individual.

How should the nurse interpret an Apgar score of 10 at 1 minute after birth? A. The infant is having no difficulty adjusting to extrauterine life and needs no further testing. B. The infant is in severe distress and needs resuscitation. C. The nurse predicts a future free of neurologic problems. D. The infant is having no difficulty adjusting to extrauterine life but should be assessed again at 5 minutes after birth.

D. The infant is having no difficulty adjusting to extrauterine life but should be assessed again at 5 minutes after birth.

A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. How should the client be instructed to position the infant to facilitate correct latch-on? A. The infant should be positioned with his or her arms folded together over the chest. B. The infant should be curled up in a fetal position. C. The woman should cup the infants head in her hand. D. The infants head and body should be in alignment with the mother.

D. The infants head and body should be in alignment with the mother.

A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago by cesarean section is found to have moist lung sounds. What is the best interpretation of these data? A. The nurse should immediately notify the pediatrician for this emergency situation. B. The neonate must have aspirated surfactant. C. If this baby was born vaginally, then a pneumothorax could be indicated. D. The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth.

D. The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth.

A newly delivered mother who intends to breastfeed tells her nurse, I am so relieved that this pregnancy is over so that I can start smoking again. The nurse encourages the client to refrain from smoking. However, this new mother is insistent that she will resume smoking. How will the nurse adapt her health teaching with this new information? A. Smoking has little-to-no effect on milk production. B. No relationship exists between smoking and the time of feedings. C. The effects of secondhand smoke on infants are less significant than for adults. D. The mother should always smoke in another room.

D. The mother should always smoke in another room.

A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural no matter what! What is the nurses best response? A. Ill make sure you get your epidural. B. You may only have an epidural if your physician allows it. C. You may only have an epidural if you are going to deliver vaginally. D. The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth.

D. The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth.

Which infant response to cool environmental conditions is either not effective or not available to them? A. Constriction of peripheral blood vessels B. Metabolism of brown fat C. Increased respiratory rates D. Unflexing from the normal position

D. Unflexing from the normal position

Early this morning, an infant boy was circumcised using the PlastiBell method. Based on the nurses evaluation, when will the infant be ready for discharge? A. When the bleeding completely stops B. When yellow exudate forms over the glans C. When the PlastiBell plastic rim (bell) falls off D. When the infant voids

D. When the infant voids

Ability to respond to discrete stimuli while asleep

Habituation

Ability to attend to visual and auditory stimuli while alert

Orientation

Measure of general arousability

Range of state

How the infant responds when aroused

Regulation of state

Use sterile gloves and soluble gel for lubrication.

Step 1

Position the woman to prevent supine hypotension.

Step 2

Cleanse the perineum and vulva, if necessary.

Step 3

After obtaining permission, gently insert the index and middle fingers into the vagina.

Step 4

Determine dilation, presenting part, status of membranes, and characteristics of amniotic fluid.

Step 5

Explain the findings to the client.

Step 6

Document findings and report to the health care provider.

Step 7

How would the nurse optimally reassure the parents of an infant who develops a cephalhematoma? A. A cephalhematoma may occur with a spontaneous vaginal birth. B. A cephalhematoma only happens as a result of a forceps- or vacuum-assisted delivery. C. It is present immediately after birth. D. The blood will gradually absorb over the first few months of life.

A. A cephalhematoma may occur with a spontaneous vaginal birth.

A mother is changing the diaper of her newborn son and notices that his scrotum appears large and swollen. The client is concerned. What is the best response from the nurse? A. A large scrotum and swelling indicate a hydrocele, which is a common finding in male newborns. B. I dont know, but Im sure it is nothing. C. Your baby might have testicular cancer. D. Your babys urine is backing up into his scrotum.

A. A large scrotum and swelling indicate a hydrocele, which is a common finding in male newborns.

Part of the health assessment of a newborn is observing the infants breathing pattern. What is the predominate pattern of newborns breathing? A. Abdominal with synchronous chest movements B. Chest breathing with nasal flaring C. Diaphragmatic with chest retraction D. Deep with a regular rhythm

A. Abdominal with synchronous chest movements

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. How would the nurse respond? A. Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him. B. Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him. C. Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him. D. Your baby will easily get cold stressed and needs to be bundled up at all times.

A. Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him.

Signs of stress related to homeostatic adjustment

Autonomic stability

What are the various modes of heat loss in the newborn? (Select all that apply.) A. Perspiration B. Convection C. Radiation D. Conduction E. Urination

B. Convection C. Radiation D. Conduction

At 1 minute after birth a nurse assesses an infant and notes a heart rate of 80 beats per minute, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. Which Apgar score does the nurse calculate based upon these observations and signs? A. 4 B. 5 C. 6 D. 7

B. 5

What is the role of the nurse as it applies to informed consent? A. Inform the client about the procedure, and ask her to sign the consent form. B. Act as a client advocate, and help clarify the procedure and the options. C. Call the physician to see the client D. Witness the signing of the consent form.

B. Act as a client advocate, and help clarify the procedure and the options.

Which description of the phases of the first stage of labor is most accurate? A. Latent: mild, regular contractions; no dilation; bloody show B. Active: moderate, regular contractions; 4 to 7 cm dilation C. Lull: no contractions; dilation stable D. Transition: very strong but irregular contractions; 8 to 10 cm dilation

B. Active: moderate, regular contractions; 4 to 7 cm dilation

Which information about variations in the infants blood counts is important for the nurse to explain to the new parents? A. A somewhat lower-than-expected red blood cell count could be the result of a delay in clamping the umbilical cord. B. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease. C. Platelet counts are higher in the newborn than in adults for the first few months. D. Even a modest vitamin K deficiency means a problem with the bloods ability to properly clot.

B. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease.

Which statement concerning the third stage of labor is correct? A. The placenta eventually detaches itself from a flaccid uterus. B. An expectant or active approach to managing this stage of labor reduces the risk of complications. C. It is important that the dark, roughened maternal surface of the placenta appears before the shiny fetal surface. D. The major risk for women during the third stage is a rapid heart rate.

B. An expectant or active approach to managing this stage of labor reduces the risk of complications.

Which intervention by the nurse would reduce the risk of abduction of the newborn from the hospital? A. Instructing the mother not to give her infant to anyone except the one nurse assigned to her that day B. Applying an electronic and identification bracelet to the mother and the infant C. Carrying the infant when transporting him or her in the halls D. Restricting the amount of time infants are out of the nursery

B. Applying an electronic and identification bracelet to the mother and the infant

The breastfeeding mother should be taught a safe method to remove the breast from the babys mouth. Which suggestion by the nurse is most appropriate? A. Slowly remove the breast from the babys mouth when the infant has fallen asleep and the jaws are relaxed. B. Break the suction by inserting your finger into the corner of the infants mouth. C. A popping sound occurs when the breast is correctly removed from the infants mouth. D. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

B. Break the suction by inserting your finger into the corner of the infants mouth.

The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would provide conflicting information to the client? A. Women who breastfeed have a decreased risk of breast cancer. B. Breastfeeding is an effective method of birth control. C. Breastfeeding increases bone density. D. Breastfeeding may enhance postpartum weight loss.

B. Breastfeeding is an effective method of birth control.

The process during which bilirubin is changed from a fat-soluble product to a water-soluble product is known as what? A. Enterohepatic circuit B. Conjugation of bilirubin C. Unconjugated bilirubin D. Albumin binding

B. Conjugation of bilirubin

Which characteristic of a uterine contraction is not routinely documented? A. Frequency: how often contractions occur B. Intensity: strength of the contraction at its peak C. Resting tone: tension in the uterine muscle D. Appearance: shape and height

D. Appearance: shape and height

Screening for critical congenital heart disease (CCHD) was added to the uniform screening panel in 2011. The nurse has explained this testing to the new mother. Which action by the nurse related to this test is correct? A. Screening is performed when the infant is 12 hours of age. B. Testing is performed with an electrocardiogram. C. Oxygen (O2) is measured in both hands and in the right foot. D. A passing result is an O2 saturation of 95%.

D. A passing result is an O2 saturation of 95%.