practice a
A nurse in a provider's office is assessing a client at her first antepartum visit. The client states that the first day of her last menstrual period was March 8. Use Nagele's rule to calculate the estimated date of delivery.
= December 15, 2020
A nurse is caring for a client who is in labor and requests nonpharmacological pain management. Which of the following nursing actions promotes client comfort? A. Assisting the client into squatting position B. Having the client lie in a supine position C. Applying fundal pressure during contractions D. Encouraging the client to void every 6 hr
A
A nurse is teaching a client who is at 41 weeks of gestation about a non-stress test. Which of the following information should the nurse include in the teaching? A . "This test will confirm fetal lung maturity " B. "This test will determine adequacy of placental perfusion". C. "This test will detect fetal infection". D. "This test will predict maternal readiness for labor"
A . "This test will confirm fetal lung maturity ". - The goal of a nonstress test is to provide useful information about your baby's oxygen supply by checking his or her heart rate and how it responds to your baby's movement.
A nurse is caring for a client who is 14 weeks of gestation. At which the following locations should the nurse place the Doppler device when assessing the fetal heart rate? A . Midline 2 to 3 cm (0.8 to 1.2 in) above the symphysis pubis B. Left Upper Abdomen C. Two fingerbreadths above the umbilicus D. Lateral at the Xiphoid Process
A . Midline 2 to 3 cm (0.8 to 1.2 in) above the symphysis pubis - at 14 weeks AOG this is where to place the doppler probe to note FHT
A nurse is caring for a client who is experiencing sore nipples from breastfeeding. Which of the following actions should the nurse take? A . Place a snug dressing on the client's nipple when not breastfeeding. B. Ensure the newborn's mouth is wide open before latching to the breast. C. Encourage the client to limit the newborn's feeding to 10 min on each breast. D. Instruct the client to begin the feeding with the nipple that is most tender.
A . Place a snug dressing on the client's nipple when not breastfeeding. - to help alleviate pain felt due to tenderness
A nurse is caring for a client who has hyperemesis gravidarum. Which of the following laboratory tests should the nurse anticipate? A . Urine Ketones. B. Rapid plasma regain C.Prothrombin time D.Urine culture
A . Urine Ketones - Hyperemesis gravidarum is a severe form of this 'morning sickness', experience by less than 1% of pregnant women. It can cause dehydration and starvation and the production of compounds called ketones that can be found in the blood and urine.
A nurse is assessing a client following an amniocentesis. Which of the following findings should the nurse recognize as complications? (select all that apply). A . Amnionitis B. Urinary tract infection C. Polyhydramnios D. Leakage of amniotic fluid E. Preterm labor
A, D, E
A nurse is providing discharge teaching to a new parent about car seat safety. Which of the following statements by the parent indicates an understanding of the teaching? A. "I should position my baby's car seat at a 45 degree angle in the car." B. "I should place the car seat rear facing until my baby is 12 months old." C. "I should place the harness snugly in a slot above my baby's shoulders." D. "I should position the retainer clip at the top of my baby's abdomen.
A. "I should position my baby's car seat at a 45-degree angle in the car."Set the seat at a 45-degree angle. Your baby's head should rest at least 2 inches below the top of the car seat.
A nurse is assessing a client who is at 37 weeks of gestation. Which of the following statement by the client requires immediate intervention by the nurse? A. "It burns when I urinate B. "My feet are really swollen today". C. "I didn't have lunch today, but I have breakfast this morning".
A. "It burns when I urinate - sign of a UTI During pregnancy, you are more susceptible to urinary tract infections. Most commonly, such infections are confined to the bladder, when they are known as cystitis. Symptoms of cystitis include a frequent, urgent need to urinate and a painful burning sensation when passing urine; there may be some blood in your urine.
A nurse is caring for a client following a vaginal delivery of a term fetal demise. Which of the following statement should the nurse make? A. "You can bathe and dress your baby if you'd like to." B. "If you don't hold the baby it will make letting go much harder." C. "You should name the baby so she can have an identity." D. "I'm sure you will be able to have another baby when you're ready."
A. "You can bathe and dress your baby if you'd like to." - allowing the mother to hold infant and maintain her parenting role will somehow foster better outcome of finally accepting fetal demise
A nurse is reviewing signs of effective breathing with a client who is 5 days postpartum. Which of the following information should the nurse include in the teaching? A. "You should feel a tugging sensation when the baby is sucking. B. You should expect your baby to have two to three wet diapers in 24hour period C. "Your baby's urine should appear dark and concentrated". D. "Your breast should stay firm after the baby breastfeeds
A. "You should feel a tugging sensation when the baby is sucking. - baby is effectively latching when a tugging sensation is felt when feeding
A nurse on postpartum unit caring for four clients. Which of the following clients should receive Rh, (D) Immune globulin to prevent Rh- is immunization? A. An Rh-negative mother who has an Rh- positive infant B. An Rh -positive mother who has an Rh- negative infant C. An Rh-positive mother who has an Rh- positive infant D. An Rh- negative mother who has an Rh- negative infant
A. An Rh-negative mother who has an Rh- positive infant - risk of RH incompatibility on next pregnancy is certain hence this case the mother should receive this medication
A nurse is preparing to administer methylergonovine 0.2 mg orally to a client who is 2 hr postpartum and has a boggy uterus. For which of the following assessment findings should the nurse withhold the medication? A. Blood pressure 142/92 mm Hg B. Urine output 100 mL in hr C. Pulse 58/min D. Respiratory rate 14/min
A. Blood pressure 142/92 mm Hg - this medication is contraindicated for hypertension
A nurse is assessing a newborn who was born Post term. Which of the following findings should the nurse expect? A. Nails extending over tips of fingers B. Large deposits of subcutaneous fat C. Pale, translucent skin D. Thin covering of fine hair on shoulders and back
A. Nails extending over tips of fingers - postterm babies are characterized to almost always have long fingernails
A nurse is teaching a prenatal class about immunizations that newborns receive following birth. Which of the following immunizations should the nurse include in the teaching? A. Hepatitis B B. Rotavirus C. Pneumococcal D. Varicella
A. Hepatitis B - Part of the EINC and immunizations is Hepa B which follows just when the baby is born
A nurse is planning care for a client who is receiving oxytocin by continuous IV infusion for labor induction. Which of the following interventions should the nurse include in the plan? A. Increase the infusion rate every 30 to 60 min. B. Maintain the client in a supine position. C. Titrate the infusion rate by 4 milliunits/min. D.Limit IV intake to 4 L per 24 hr.
A. Increase the infusion rate every 30 to 60 min.
A nurse is reviewing the electronic medical record of a postpartum client. The nurse should identify that which of the following factors places the client at risk for infection. A. Meconium - stained fluid B. placenta previa C. Midline episiotomy D. Gestational hypertension
A. Meconium - stained fluid - can cause both maternal and fetal infections
A nurse is caring for a client who has bacterial vaginosis. Which of the following medication should the nurse expect to administer? A. Metronidale B. Fluconazole C. Acyclovir
A. Metronidale - protozoan infection requires an anti-protozoan medication
A nurse is assessing a preterm newborn who is at 32 weeks of gestation. Which of the following finding should the nurse expect? A. Minimal arm recoil B. Popliteal angle of less than 90 C. Creases over the entire sole D. Sparse lanugo
A. Minimal arm recoil - preterm babies are less reactive
A nurse is reviewing laboratory results for client who is pregnant. The Nurse should expect which of the following laboratory values to increase? A. RBC count B. Bilirubin C. Fasting blood glucose D. BUN
A. RBC count - the RBC normally increasing during pregnancy due to hormonal changes
A nurse is caring for four newborns. Which of the following newborns should the nurse assess first? A. newborn who has nasal flaring B. newborn who has subconjunctival hemorrhage of the left ey C. A newborn who has overlapping suture lines D. A newborn who has not rust-stained urine
A. newborn who has nasal flaring - sign of respiratory distress
A nurse is providing teaching about terbutaline to a client who is experiencing preterm labor. Which of the following statement by client indicates an understanding of the teaching? A." The medication could cause me to experience heart palpitation" B. "This medication could cause me to experience blurred vision" C. "This medication could cause me to experience ringing in my ears" D. "This medication could cause me to experience frequent ..."
A." The medication could cause me to experience heart palpitation" - This is a serious side effect of terbutaline and must be notifies to the physician immediately
A charge nurse is teaching a group of staff nurses about fetal monitoring during labor. Which of the following findings should the charge nurse instruct the staff members to report to the provider? A. Contraction durations of 95 to 100 seconds B. Contraction frequency of 2 to 3 min apart C. Absent early deceleration of fetal heart rate D. Fetal heart rate is 140/min
A.Contraction durations of 95 to 100 seconds For a normal uterine activity during labor contraction duration remains fairly stable throughout first and second stages, ranging from 45-80 seconds, not generally exceeding 90 seconds.
A nurse is caring for a client who is 4hr postpartum and is experiencing hypovolemic shock. Which of the following actions should the nurse take? A. Administer indomethacin B. Insert a second using a 22 gauge IV catheter C. Insert an indwelling urinary catheter. D. Administer oxygen at 4L/min via nasal cannula.
B. Insert a second using a 22 gauge IV catheter - to give blood products and IV bolus to help manage shock
A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following information should the nurse include? A. Focusing on controlling body functions B . "Synchronized breathing will be required during hypnosis" C. "Hypnosis can be beneficial in you practiced it during the prenatal period" D. "Hypnosis does not work for controlling pain associated with labor
B . "Synchronized breathing will be required during hypnosis" - this helps patient achieve hypnosis as form of pain control
A nurse on a labor and delivery unit is receiving infection control standards with a newly licensed nurse. The nurse should instruct the newly licensed nurse to don gloves for which of the following procedures? A. Assisting a mother with breastfeeding B . Performing a newborn's initial bath C. Administering the measles, mumps, rubella vaccine D. Performing umbilical cord care
B . Performing a newborn's initial bath - fluids from mother is still present from the delivery hence gloves should be used
A nurse is caring for newborn immediately following birth and notes a large amount of mucus in the newborn's mouth and nose. Identify the sequence the nurse should follow when performing suction with a bulb syringe. (Move the streps into the box on the placing them in the selected order of performance. Use all the streps.) A. Assess the newborn for reflex bradycardia. B. Compress the bulb syringe C.Place the bulb syringe in the newborn's mouth. D. Use the bulb syringe to suction the newborn's nose.
B, C, D, A
A nurse is planning to teach a group of clients who are about breastfeeding after returning to work. Which of the following infections should the nurse include in the teaching? A. "Thawed breast milk can be refrigerated for up to 72 hours." B. "Breast milk can be stored in a deep freezer for 12 months." C. Breast milk can be stored at room temperature for up to 12 hours." D. "Thawed breast milk that is unused can be refrozen."
B. "Breast milk can be stored in a deep freezer for 12 months." - Freshly expressed breast milk can be stored in the back of a deep freezer for up to 12 months but using the frozen milk within six months is optimal.
A nurse is providing teaching about expected changes during pregnancy to a client who is at 24 weeks of gestation. Which of the following information should the nurse include? A. "Your stomach will empty rapidly" B. "You should expect your uterus to double in size" C. "You should anticipate nasal stuffiness." D. "Your nipples will become lighter in color".
B. "You should expect your uterus to double in size" - due to rapid fetal growth due to starting of 3rd trimester
A nurse is providing teaching to a client who is at 38 weeks of gestation and has a prescription to receive misoprostol intravaginally. Which of the following statement should the nurse make? A. "you will need to stay in a side-lying position for 30 minutes after each dose." B. "You will receive an IV infusion of oxytocin 1 hour after your last dose." C." You will receive a magnesium supplement immediately following therapy." D." You will need to have a full bladder before the therapy begins.
B. "You will receive an IV infusion of oxytocin 1 hour after your last dose." - to help with uterine contraction
A nurse on the labor and delivery unit is assessing four clients. Which of the following clients is a candidate for an induction of labor with misoprostol? A. A client who has active genital herpes B. A client who has gestational diabetes mellitus C. A client who has a previous uterine incision D. A client who has placenta previa
B. A client who has gestational diabetes mellitus - pregnancy and labor complicated by Gestational DM can be safety treated with misoprostol to induce labor
A nurse is caring for newborn who is 1 hr old and has a respiratory rate of 50/min, a heart rate of 130/min, and an auxiliary temperature of 36.1*C (97F). Which of the following actions should the nurse take? A. Give the newborn a warm bath. B. Apply a cap to the newborn head. C. Reposition the newborn. D. Obtain an oxygen saturation level
B. Apply a cap to the newborn head. - the newborn is slightly hypothermic, and a bath would likely cause the newborn to suffer hypothermia more after the water has evaporated from newborn's skin
A nurse is planning care for a full-term newborn who is receiving phototherapy. Which of the following actions should the nurse include in the plan of care? A. Dress the newborn in lightweight clothing. B. Avoid using lotion or ointment on the newborn skin. C. Keep the newborn supine throughout treatment D. Measure the newborn's temperature every 8hr
B. Avoid using lotion or ointment on the newborn skin -can cause burns
A community health nurse is providing education on gestational diabetes mellitus (GDM) to a group of clients who are pregnant when discussing risk factors, which of the following ethnicities should the nurse identify as having the lowest incidence of GDM? A. Asian B. Non-Hispanic White American C. Hispanic D. African American
B. Non-Hispanic White American
A nurse is developing an educational program about hemolytic diseases in newborns for a group of newly licensed nurses. Which of the following genetic information should the nurse include in the program as a cause of hemolytic disease? A. The mother is Rh-positive and the father is Rh negative B. The mother is Rh-negative and the father is Rh positive C. The mother and the father are both Rh positive D. The mother and the father are both Rh negative
B. The mother is Rh-negative and the father is Rh positive - Hemolytic Diseases in Newborns (HDN) most frequently occurs when a Rh-negative mother has a baby with a Rh-positive father. When the baby's Rh factor is positive, like the father's, problems can develop if the baby's red blood cells cross to the Rh-negative mother. This usually happens at delivery when the placenta detaches.
A nurse is caring for a client who is receiving an epidural block with an opioid analgesic. The nurse should monitor for which of the following findings as an adverse effect of the medication? A. Hypnosis B. Polyuria C . Bilateral crackles D.Hyperglycemia
C . Bilateral crackles - respiratory functions should be monitored when administering medications with any opioid analgesics
A nurse is providing teaching to a client about exercise safety during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply). A. "I will limit my time in the hot tub to 30 minutes after exercise." B. "I should consume three 8-ounce glasses of water after I exercise." C. "I will check my heart rate every 15 minutes during exercise sessions." D. "I should limit exercise sessions to 30 minutes when the weather is humid." E. "I should rest by lying on my side for 10 minutes following exercise."
C, E b-Stay hydrated. Drink two or three 8-oz glasses of water after you exercise to replace the body fluids lost through perspiration for discharge: drink 6-8 8ounce of water per day, which are 2liters of waters ( 4 cups of 8ounce water is 1liter)
A nurse is caring for a client who is receiving prenatal care and is at her 24-week appointment. Which of the following laboratory tests should the nurse plans to conduct? A. Group B strep culture C. 1-hr glucose tolerance test D Rubella titer E. Blood type and Rh
C. 1-hr glucose tolerance test - Most pregnant women have a glucose screening test between 24 and 28 weeks of pregnancy. The test may be done earlier if you have a high glucose level in your urine during your routine prenatal visits, or if you have a high risk for diabetes A-35-38WKS D-Rubella titer NO
A nurse on an antepartum unit is reviewing the medical records for four clients. Which of the following clients should the nurse assess first? A. A client who has diabetes mellitus and an HbA1c of 5.8% B. A client who has preeclampsia and a creatinine level of 1.1 mg/ dL C. A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L D. A client who has placenta previa and a hematocrit of 36% E."I have been seeing spot this morning"
C. A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L *Antepartum, which means occurring or existing before birth, is the name of the unit that you may be admitted to should you require specialized in-hospital care for you and your baby prior to being ready to deliver.
A nurse on the postpartum unit is caring for four clients. For which of the following clients should the nurse notify the provider? A. A client who has a urinary output of 300 ml in 8 hr B. A client who reports abdominal cramping during breastfeeding C. A client who is receiving magnesium sulfate and has absent deep tendon reflexes D.A client who reports lochia rubra requiring changing perineal pads every 3 hr
C. A client who is receiving magnesium sulfate and has absent deep tendon reflexes - this is a sign of early MgSO4 toxicity that if not treated may lead to death
A nurse is caring for a client who is in the transition phase of labor and reports a pain level of 7 on a scale of 0 to 10. Which of the following actions should the nurse take? A. Instruct the client to use effleurage B. Apply counter pressure to the client sacral. C. Assist the client with patterned-paced breathing. D. Teach the client the technique of biofeedback.
C. Assist the client with patterned-paced breathing. - Assist patient with pant-blow breathing to help manage pain
A nurse is teaching about clomiphene citrate to a client who is experiencing infertility. Which of the following adverse effect should the nurse include? A. Tinnitus B. Urinary Frequency C. Breast Tenderness D. Chills
C. Breast TendernessThe adverse effects of clomiphene citrate are stomach upset, bloating, abdominal/pelvic fullness, flushing ("hot flashes"), breast tenderness, headache, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
A nurse is planning care for a newborn who is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan? A. Apply a thin layer of lotion to the newborn skin every 8 hrs. B. Give the newborn 1oz of glucose water every 4 hrs C. Ensure the newborn eyes are closed beneath the shield. D. Dress the newborn in a thin layer of clothing during therapy
C. Ensure the newborn eyes are closed beneath the shield. - to reduce risk of retinopathies
A nurse is assessing a newborn following a forceps assisted birth. Which of the following clinical manifestations should the nurse identify as a complication of the birth method? A. Hypoglycemia B. Polycythemia C. Facial Palsy D. Bronchopulmonary dysplasia
C. Facial Palsy
A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take? A. Provide a stimulating environment B. Monitor blood glucose level every hr. C. Initiate seizure precautions. D. Place the infants on his back with legs extended
C. Initiate seizure precautions. - infants suffer from opioid withdrawal hence the seizures.
A nurse is monitoring a client who has preeclampsia and is receiving magnesium sulfate by continuous IV infusion. Which of the following findings should the nurse reports to the provider? A. Blood pressure 148/94mm Hg B. Respiratory rate 14mm C. Urinary output 20 mL/hr D. 2+deep tendon reflexes
C. Urinary output 20 mL/hr - Urine output should be at least 30 mL/hour while administering magnesium sulfate. If less, notify provider of decreased urine output.
A nurse is caring for a client who has active genital herpes simplex virus type 2. Which of the following medications should the nurse plan to administer? A.Metronidazole B.Penicillin C.Acyclovir D.Gentamicin
C.Acyclovir - viral infection requires an antiviral medication Metronidazole-trichomoniasis Penicillin-group b streptococcus ENDOMETRITIS(aka endometritis) Gentamicin-ENDOMETRITIS(aka endometritis), mastitis, wound
A nurse is caring for four clients. For which of the following clients should the nurse auscultate the fetal heart rate during the prenatal visit? A. A client who has an ultrasound that confirms a molar pregnancy B. A client who has a crown-rump length of 7 weeks gestation C. A client who has a positive urine pregnancy test 1 week after missed menses D . A client who has felt quickening for the first time
D . A client who has felt quickening for the first time - FHT can't be fully appreciated at 7 weeks AOG, pregnancy test just confirmed after missed menses and there's no FHT by an embryo, there is no fetus in h-moles to auscultate FHT hence letter D : For a sensitivity of 90%, the fetal heart should be auscultated after 13 week gestation. If a sensitivity of 80% is acceptable the fetal heart can be auscultated after 12 + 1 week gestation.
A nurse is assessing a client who is at 37 weeks of gestation. Which of the following statement by the client requires immediate intervention by the nurse? A. "It burns when I urinate B. "My feet are really swollen today". C. "I didn't have lunch today, but I have breakfast this morning". D. "I have been seeing spot this morning"
D. "I have been seeing spot this morning" - patient might be undergoing labor and should be managed
A nurse is teaching a prenatal class regarding false labor. Which of the following information should the nurse include? A. "your contraction will become more intense when walking" B. "you will have dilation and effacement of the cervix" C. You will have bloody show" D. "Your contraction will become temporally regular"
D. "Your contraction will become temporally regular"
A nurse is receiving laboratory results for a term newborn who is 24 hr old. Which of the following results require intervention by the nurse? A. WBC count 10,000/mm3 B. Platelets 180,000/mm3 C. Hemoglobin 20g/dL D. Glucose 20 mg/dL - this is neonatal hypoglycemia and should be treated promptly
D. Glucose 20 mg/dL - this is neonatal hypoglycemia and should be treated promptly -normal:40-60
A nurse is providing nutritional guidance to a client who is pregnant and follows a vegan diet. The client asks the nurse which foods she should eat to ensure adequate calcium intake. The nurse should instruct the client that which of the following foods has the highest amount of calcium? A. ½ cup cubed avocado B. 1 large banana C. 1 medium potato D. 1 cup cooked broccoli
D. 1 cup cooked broccoli - there are 47mg of calcium in a 100 grams of broccoli. 1⁄2 cup cubed avocado contains 9 mg of calcium. 1 large banana contains 7 mg of calcium. 1 medium potato 26 mg of calcium. 1 cup cooked broccoli contains 180 mg of calcium.
A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care? A. Instruct the client to stop taking the antiretroviral medication at 32 weeks of gestation. B. Use a fetal scalp electrode during labor and delivery. C. Administer a pneumococcal immunization to the newborn within 4 hr following birth. D. Bathe the newborn before initiating skin-to-skin contact
D. Bathe the newborn before initiating skin-to-skin contact
A nurse is assessing a newborn upon admission to the nursery. Which of the following should the nurse expect? A. Bulging Fontanels B. Nasal Flaring C. Length from head to heel of 40 cm (15.7 in) D. Chest circumference 2 cm (0.8 in) smaller than the head circumference
D. Chest circumference 2 cm (0.8 in) smaller than the head circumference - head circumference is always 2cm more than the chest in normal term babies
A nurse in a woman's health clinic is obtaining a health history from a client. Which of the following findings should the nurse identify as increasing the client's risk for developing pelvic inflammatory disease (PID)? A. Recurrent Cystitis B. Frequent Alcohol Use C. Use of Oral Contraceptives D. Chlamydia Infection
D. Chlamydia Infection - STDs can cause PID
A nurse is caring for a client following an amniocentesis. The nurse should observe the client for which of the following complications? A. Hyperemesis B. Proteinuria C. Hypoxia D. Hemorrhage
D. Hemorrhage - bleeding is sometimes noted after the procedure
A nurse caring for a client who is at 20 weeks of gestation and has trichomoniasis. Which of the following findings should the nurse expect? A. Thick, White Vaginal Discharge B. Urinary Frequency C. Vulva Lesions D. Malodorous Discharge
D. Malodorous Discharge
A nurse is assessing a client who is at 27 weeks of gestation and has preeclampsia. Which of the following findings should the nurse report to the provider? A. Urine protein concentration 200 mg/ 24 hr B. Creatinine 0.8 mg/ dL C. Hemoglobin 14.8 g/ dL D. Platelet Count 60.000/ mm3
D. Platelet Count 60.000/ mm3 - platelet count of less than 100,000 correlates with how severe the condition is.
A nurse is caring for a newborn who is 6 hr old and has a bedside glucometer reading of 65 mg/ dL. The newborn's mother has type 2 diabetes mellitus. Which of the following actions should the nurse take? A. Obtain a blood sample for a serum glucose level B. Feed the newborn immediately C. Administer 50 mL of dextrose solution IV D. Reassess the blood glucose level prior to the next feeding
D. Reassess the blood glucose level prior to the next feeding - newborn blood glucose is normal because it has separated from it's source of energy which is the mother. Blood glucose for newborn to be considered hypoglycemic is 45mg/dl and below. When babies are just 1 hour to 2 hours old, the normal level is just under 2 mmol/L (36 mg/dL), but it will rise to adult levels (over 3 mmol/L or 54 mg/dL) within two to three days. In babies who need treatment for low blood glucose or are at risk for low blood glucose, a level over 2.5 mmol/L (45 mg/dL) is preferred.
A nurse is planning care for a newborn who has neonatal abstinence syndrome. Which of the following interventions should the nurse include in the plan of care. A. Increase the newborn's visual stimulation B. Weigh the newborn every other day C. Discourage parental interaction until after a social evaluation D. Swaddle the newborn in a flexed position
D. Swaddle the newborn in a flexed position - to increase comfort that newborn is receiving
A nurse is caring for a client who is in the second stage of labor. Which of the following manifestations should the nurse expect? A. The client expels the placenta B. The client experiences gradual dilation of the cervix C. The client begins have regular contractions. D. The client delivers the newborn
D. The client delivers the newborn - delivering the fetus is the second stage, first is the labor stage, third is delivering the placenta.
A nurse is caring for a newborn who is 24 hr old. Which of the following Laboratory findings should the nurse report to the provider? A. Hgb 20 g/dL B. Bilirubin 2mg/dL C. Platelets 200 .000/mm3 D. WBC count 32.000/mm3
D. WBC count 32.000/mm3 - sign of a form of neonatal infection
A nurse is caring for a client who is experiencing preterm labor and has a prescription for 4 doses of dexamethasone 6 mg IM 12 hr. Available in dexamethasome 10 mg/mL. How many mL of dexamethasome should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use trailing zero.) mL.
D/H x V 6mg/10mg x 1mL = 0.6mL per dose
A nurse is teaching a client who is 28 weeks of gestation and not up-to date on current immunization. Which of the following immunizations should the nurse inform the client to anticipate receiving following birth? A. Pneumococcal B. Hepatitis C. Human papillomavirus D. Rubella
Hepatitis
A nurse is caring for a client who is receiving oxytocin for induction of labor and notes late decelerations of the fetal heart rate on the monitor tracing. Which of the following action should the nurse take? A. Decrease maintenance IV solution infusion rate. B. Place the client in lateral position. C. Administer misoprostol 25 mcg vaginally D. Administer oxygen via face mask at 2 L/min
Place the client in lateral position.
a nurse is providing prenatal teaching to a client who practice a vegan diet and is trying to increase intake of vitamin B12 which of the following foods should be nurse recommend? a- Fresh citrus fruits b- fortified soy milk c- Brown rice d- raw carrot
b- fortified soy milk
A nurse is providing teaching to a client who has mild preeclampsia and will be caring for herself at home during the last 2 months of pregnancy. This of the following statements by the client indicates an understanding of the teaching. A. "I will count baby's kicks every other day. B. "I will alternate the arm use to check my blood pressure. c. I will consume 50 grams of protein daily d. I will check my urine for protein daily
c. I will consume 50 grams of protein daily
A nurse is assessing a client who is 6hr postpartum and has endometritis. Which of the following findings should the nurse expect? a- Temperature 37.4 C (99.3F) b- Scant lochia c- WBC count 9,000/mm3 d- Uterine tenderness
d- uterine tenderness
A nurse is assessing a newborn immediately following a vaginal birth. For which of the following findings should the nurse intervene? A. Molding b. Vernix Caseosa c.Acrocyanosis d.Sternal retractions - sign of respiratory distress
d.Sternal retractions - sign of respiratory distress
a nurse is caring for a two day old newborn who was born at 35 weeks of gestation period which of the following action should the nurse take? **Nurses notes : decrease activity level over the last 12 hours, abdominal distention, three bloody stools over the last 8 hours, superficial rash on the abdominal wall, light palpation of the abdomen leads to fist clenching, thrashing, and crying. a. Insert an orogastric decompression tube with low wall suction b. administer nitric oxide inhalation therapy to the newborn c. measure the abdominals circumference at the level of the newborns in umbilicus every 12 hours d. provide the newborn with an iron rich formula containing vitamin B12 every two hours
nitric oxide-pain relief for labor
