Practicum: Maternal Neonatal Nursing

A nurse is administering vitamin K to a neonate following birth. The medication comes in a concentration of 2 mg/ml, and the ordered dose is 0.5 mg to be given subcutaneously. How many milliliters would the nurse administer?

0.25 ml

A client at 30 weeks' gestation experiences a rupture of membranes with mild contractions eight minutes apart. Which nursing interventions are included on the plan of care to improve newborn outcomes? Select all that apply. 1. Maintain the client on the fetal monitor throughout the labor process. 2. Administer a dose of betamethasone per health care provider's order. 3. Arrange a neonatologist to be available for the birth. 4. Ensure the mother remains nothing by mouth (NPO) throughout the labor. 5. Position the mother in a supine position with the feet elevated. 6. Begin an oxytocin drip once the monitor reaches 3 cm dilated.

1,2,3

A nurse is caring for a neonate born addicted to opiates in the special care nursery. The neonate is exhibiting signs of withdrawal. When planning care, which nursing interventions would the nurse expect to be included? 1. Maintain intravenous fluids 2. Administer morphine 3. Swaddle and or provide a pacifier 4. Feed every 1 to 2 hours 5. Increase environmental stimuli 6. Encourage parental handling

1,2,3,4

'A nurse is caring for a postterm client at 41 weeks of gestation who is about to undergo a biophysical profile (BPP) to evaluate her fetus's well-being. The client asks, "What will be able to determined from this test?" The nurse is correct to answer which? 1. fetal tone 2. fetal breathing 3. femur length 4. amniotic fluid volume 5. biparietal diameter 6. crown-rump length

1,2,4

Following the admission assessment of a neonate born at 42 weeks of gestation, the nurse documents which findings as normal? 1. A three vessel umbilical cord 2. Peeling skin on the feet 3. Absence of sole creases 4. Absence of vernix caseosa 5. Cyanosis of the hands and feet 6. Large amounts of frothy oral secretions

1,2,4,5

The nurse is giving prenatal instructions to a 32-year-old primigravida. Which nutritional instructions would the nurse review? 1. Caloric intake would be increased by 300 cal/day 2. Protein intake would be increased to more than 30 g/day. 3. Vitamin intake would not increase from prepregnancy requirements 4. Folic acid intake would be increased 800 mg.day 5. Intake of all minerals, especially iron, would be increased 6. Water intake would be doubled

1,2,4,5

A nurse observes several interactions between a client and her neonate son. Which behaviors by the mother would the nurse identify as evidence of mother-infant attachment? 1. talks to and coos at her son 2. cuddles her son close to her 3. does not make eye contact with her son 4. requests that the nurse take the baby to the nursery for feedings 5. counts the fingers and toes of her son 6. takes a nap when the baby is also sleeping

1,2,5

What information would the nurse include when teaching postcircumcision care to the parents of a neonate? 1. The parent must note that the neonate has voided 2. Petroleum jelly or antibiotic ointment would be applied to the glans of the penis with each diaper change 3. The infant can have tub baths while the circumcision heals 4. Any amount of blood noted on the front of the diaper would be reported 5. The circumcision with require for 2 to 4 days after discharge

1,2,5

Five days postpartum following an uneventful vaginal birth, a client phones the obstetrician's office stating various symptoms and requesting an appointment. As the nurse is documenting the symptoms, which indicates a potential puerperal infection? 1. temperature of 100.8 2. serosanguineous drainage on the perineal pad 3. frequent abdominal pain requiring medication 4. reddened area increasing around episiotomy 5. slight edema to perineum 6. ecchymosis in the perineal area

1,3,4

The nurse is caring for a family that is grieving the loss of their newborn. Which tokens of remembrance would be appropriate to provide? 1. A picture of the newborn 2. A certificate of death 3. The footprints 4. A lock of hair 5. An invitation to an annual remembrance service

1,3,4,5

A mother with a history of varicose veins has just delivered her first baby. The nurse suspects that the mother has developed a pulmonary embolus. Which data below would lead to this nursing judgement? 1. sudden dyspnea 2. chills, fever 3. diaphoresis 4. cough 5. confusion 6. chest pain

1,3,4,5,6

The nurse is caring for a newborn boy of Hispanic heritage. According to the beliefs of this heritage, which would the nurse expect? 1. The maternal elders offer advice to the new mother 2. The neonate will be circumcised by a medicine man 3. The umbilical cord will be kept covered by snug clothing 4. Breast feeding is common and strongly encouraged 5. The neonate must be bundled at all times 6. The neonate will wear a red or pink bracelet

1,3,4,5,6

A nurse is evaluating a client who is 34 weeks pregnant for preterm rupture of the membranes (PROM). Which findings indicate that PROM has occurred? 1. Fernlike pattern when vaginal fluid is placed on a glass slide and allowed to dry 2. acidic ph of fluid when tested with nitrazine paper 3. presence of amniotic fluid in the vagina 4. cervical dilation of 6 cm 5. alkaline ph of fluid when tested with nitrazine 6. contractions occurring every 5 minutes

1,3,5

A client at 32 weeks of gestation has mild preeclampsia. She is discharged home with instructions to remain in bed rest. She would also be instructed to call her health care provider if she experiences which symptoms? 1. headache 2. increased urine output 3. blurred vision 4. difficulty sleeping 5. epigastric pain 6. severe nausea and vomiting

1,3,5,6

The nurse is admitting a client with suspected diagnosis of abruptio placentae. When assessing client symptoms, which symptoms require health care provider notification of this medical emergency? 1. overt vaginal bleeding 2. white creamy vaginal discharge 3. a rigid abdomen 4. gastrointestinal upset 5. increased blood pressure 6. rapid uterine contractions

1,3,5,6

A registered nurse is delegating the monitoring of a client who is receiving oxytocin to induce labor to a new graduate nurse. When discussing adverse side effects of oxytocin, which conditions would the graduate nurse notify the registered nurse immediately? 1. a blood pressure of 170/92 2. jaundice in the sclera 3. lab work suggesting dehydration 4. fluid overload with crackles in the lung field 5. palpable uterine tetany 6. a heart rate of 60 bpm

1,4,5

A nurse is caring for a client who is 32 weeks pregnant and being monitored in the antepartum unit for pregnancy induced hypertension. The client suddenly reports continuous abdominal pain and vaginal bleeding. Which nursing interventions are priorities? 1. Evaluate maternal vital signs 2. Prepare for vaginal birth 3. Reassure the client that she will be able to continue the pregnancy 4. Auscultate fetal heart tones 5. Monitor the amount of vaginal bleeding 6. Monitor intake and output

1,4,5,6

A client is being admitted to the labor and birth unit. Her GTPAL classification is 5-2-1-1-2. When providing shift handoff, which information would the nurse include? 1. The client has had four previous pregnancies. 2.The client has had five previous pregnancies. 3. The client has had one full term child, one abortion, and one premature. 4. The client has had two full term children, one premature child, and one abortion. 5. The client has three living children following five pregnancies. 6. The client has two living children and is pregnant again.

1,4,6

A nurse is evaluating the return demonstration of cord care by the mother of a neonate. Which actions would the nurse encourage the mother to perform? 1. placing the diaper below the cord 2. tugging gently on the cord as it begins to dry 3. applying antibiotic ointment to the cord twice daily 4. sponge bathing the infant until the cord falls off 5. cleansing the length of the cord with alcohol several times daily 6. washing the cord with mild soap and water

1,4,6

The obstetric nurse is performing a non-stress test on a 30 week primigravida client sent from a health care provider's office. The client reports a decrease in fetal movement over the past 24 hours. The nurse documents the following nurse note. Which statement is appropriate at this time? 1. "Let's have you change your position and lie on your left side" 2. "I will check with the health care provider to see if further tests are needed" 3. "I bet you are excited about the baby" 4. "Have you done anything different today?"

2

During her first prenatal visit, a client asks a nurse what physiological changes she can expect during pregnancy. The nurse begins the discussion with the presumptive changes of pregnancy. Put the following presumptive changes in ascending chronological order according to when they occur. 1. Frequent urination 2. breast changes 3. quickening 4. appearance of linea nigra, melasma, and striae gravidarum 5. uterine enlargement in which the uterus can be palpated over the symphysis

2,1,5,3,4

A nurse is completing a physical assessment of a neonate following birth. When completing the musculoskeletal assessment which findings would indicate development dysplasia of the hip? (DDH) 1. Negative Ortolanis test 2. Positive Barlows test 3. Asymmetrical leg skin folds 4. Limitation in addicted of the affected leg 5. Lengthening of the affected leg

2,3

During physical assessment of a client who gave birth 3 hours ago, a nurse finds that the client has completely saturated a perineal pad within 15 minutes. Which nursing action would be appropriate? 1. Begin an intravenous infusion of lactated ringer's solution 2. Assess the client's vital signs 3. Palpate the client's fundus 4. Place the client in high Fowler's position 5. Place client on bed rest

2,3

A neonate has been placed on cardiac and apnea monitoring in the neonatal nursery. The nurse notes that the apnea alarm repeatedly triggers. Place the following actions in the order in which they would be completed by the nurse. 1. Silence the alarm to decrease environmental stimuli 2. Perform a focused assessment on the neonate 3. Count the respiratory rate for 60 seconds 4. Document the assessment findings, interventions, and neonates response 5. Check all connects of apnea monitor

2,3,1,5,4

A nurse is caring for a client with a history of warm, reddened, painful area in the breast diagnosed as mastitis as well as cracked and fissured nipples. The client expresses the desire to continue to breast-feeding throughout treatment. Which instructions would the nurse include to prevent recurrence of this condition? 1. Wash the nipples with soap and water 2. Change the breast pads frequently 3. Expose the nipples to air for part of each day 4. Wash hands before handling the breast and breast-feeding 5. Make sure that the baby grasps the nipple only 6. Release the baby's grasp on the nipple before removing the baby from the breast

2,3,4,6

A client who is 29 weeks pregnant comes to the labor and birth unit. She states that she is having contractions every 8 minutes. The client is also 3 cm dilated. Which can the nurse expect to administer? 1. folic acid 2. a beta 2 agonist 3. betamethasone 4. Rho (D) immune globulin (RhoGAM) 5. intravenous fluids 6. nalbuphine

2,3,6

A nurse is caring for a client who is in the third stage of labor. Which characteristic behaviors does the nurse anticipate at this stage? 1. The client is excited about the process. 2. The client is focused on the neonate's condition. 3. The client is exhausted from continued pushing. 4. The client states she has discomfort from uterine contractions. 5. The client is apprehensive about the process. 6. The client is feeling embarrassed as she has an urge to defecate.

2,4

A postpartum client is experiencing thoughts and behaviors common to the taking-hold phase. Which items are characteristics of this phase? 1. prefers having the nurse care for her 2. holds new child and breast-feeds without prompting 3. rests to regain physical strength and calm her swirling thoughts 4. expresses a strong interest in taking care of her child 5. gives up fantasized image of her child and accepts real one

2,4

A nurse is preparing to teach a client about fetal growth and development during the first 3 months of pregnancy. The nurse is assembling teaching aids by milestones. In ascending order (month 1, 2, 3, and months 4-9), how would the nurse arrange the aids? 1. Teeth and bones begin to appear, the kidneys start to function, and at the end of the month, gender is distinguishable 2. The embryo has a definite form; the head, trunk, and tiny buds for arms and legs develop; the cardiovascular system begins to function. 3. Internal and external fetal growth continues at a rapid rate, and the fetus stores the fats and minerals it needs to live outside the womb. 4. They eyes, ears, nose, lips, tongue and tooth buds develop; the umbilical cord has a definite form; the external genitalia are present.

2,4,1,3

The nurse is assigned to a client who experiences a syncopal episode on her first ambulation after birth. Which nursing action will the nurse delegate to the LPN? 1. Obtain orthostatic blood pressures 2. Assist the nurse with ambulating the client back to bed. 3. Monitor hemoglobin and hematocrit level 4. Assess pain level on a 0 to 10 pain scale 5. Obtain a cool compress for the head 6. Assist with ambulation on the next trip to the bathroom

2,5

A postpartum client has been ordered 500 mg of ampicillin oral suspension. The label reads ampicillin 125mg/5ml. How many milliliters would the client receive?

20 ml

A 35 year old client who is 28 weeks pregnant is admitted for testing. After reading the nursing notes below, which rationale best explains why a pregnant client would lie on her left side when resting or sleeping in the later stages of pregnancy? 1. to facilitate digestion 2. to facilitate bladder emptying 3. to prevent compression of the vena cava 4. to prevent development of fetal anomalies

3

When teaching an antepartum client about the passage of the fetus through the birth canal during labor, the nurse describes the cardinal mechanisms of labor. Using a teaching pelvis and fetus, the nurse demonstrates which sequence during birth? Place the events in the proper sequence. 1. flexion 2. external rotation 3. descent 4. expulsion 5. internal rotation 6. extension

3,1,5,6,2,4

A graduate nurse is explaining to the nurse mentor how to assess newborn jaundice and the effects of phototherapy in a dark-skinned neonate. Which statement made by the graduate nurse would need clarification? 1. "It is best to observe for jaundice in the conjunctival sac or oral mucosa" 2. "I will monitor the unconjugated bilirubin carefully as it is the dangerous one" 3. "I will carefully record the neonates intake as limiting fluids is helpful" 4. "the neonate will be irritable from the elevated bilirubin in the system" 5. "Phototherapy treatment can increase the risk of dehydration"

3,4

A nurse is caring for a client who is anxious to know her baby's due date. The nurse instructs the client how to determine the baby's due date according to Nagele's rule. The client is correct to state which when discussing the use of the rule? 1. "I need to know the date of intercourse when fertilization may have occurred" 2. "I will calculate 9 months from my last menstrual period" 3. "Nagele's rule provides a good approximation of the due date" 4. "I will add 7 days to the first day of my last menstrual period and count back 3 months" 5. "Nagele's rule may be used in conjunction with other assessment findings"

3,4,5

The pediatric nurse is being pulled to the nursery for the day. The census is six neonates. Which three neonates are the best client care assignment for the pediatric nurse? 1. an 18 hour, postterm, breast-fed neonate with jaundice 2. a 2 day older who has not passed a meconium stool 3. a recent admission with Apgar score of 8 and 10 4. a 1 day old with caput succedaneum 5. a 4 hour old with a bluish appearance to the hands and feet 6. a 1 day old with a clef palate and cleft lip

3,4,5

A nurse is performing a neurologic assessment on a 1 day old neonate in the nursery. Which findings would indicate possible asphyxia in utero? 1. The neonate grasps the nurses finger when put in the palm of the neonates hand. 2. The neonate does stepping movements when held upright with the sole of the foot touching a surface. 3. The neonates toes do not curl downward when the soles of the feet are touched. 4. The neonate does not respond when the nurse claps hands. 5. The neonate turns toward the nurses finger when touching the cheek. 6. The neonate displays weak, ineffective sucking.

3,4,6

A woman at 15 weeks of gestation comes to the clinic for an amniocentesis. If an abnormal result is found, which characteristics or problems could be identified? Select all that apply. 1. fetal lung maturity 2. gestational diabetes 3. chromosomal defects 4. neural tube defects 5. polyhydramnios 6, sex of the fetus

3,4,6

A nurse is caring for a postpartum client suspected of developing postpartum psychosis. Which statements accurately characterize this disorder? 1. Symptoms appear after the 6 month screening 2. The disorder is common in postpartum women 3. Symptoms include delusions and hallucinations 4. Suicide and infanticide are uncommon in this disorder 5. The disorder rarely occurs without a psychiatric history

3,5

A nurse is monitoring the contractions of a client in the first stage of labor. Order the phases of a uterine contraction from the beginning of the contraction to its conclusion. 1. acme 2. relaxation 3. decrement 4. increment

4,1,3,2

A nurse is providing care to a neonate. Place the following steps in the order that the nurse would implement them to properly perform ophthalmia neonatorum prophylaxis. 1.Close and manipulate the eyelids to spread the medication over the eye. 2. Shield the neonate's eyes from direct light, and tilt the head slightly to the side that will receive the treatment. 3. Repeat the procedure for the other eye. 4. Wash hands and put on gloves. 5. Instill the ointment in the lower conjunctival sac. 6. Gently raise the neonate's upper eyelid with the index finger and pull the lower eyelid down with the thumb.

4,2,6,5,1,3

The nurse is caring for a client in labor. Which assessment findings would prompt the nurse to notify the health care provider? 1. The client is moaning in pain during contractions. 2. The fetal heart rate baseline is between 140 and 150 beats/minute. 3. The client is anxious and requests that someone help her. 4. The client's membranes rupture, and the amniotic fluid is green. 5. Late decelerations are noted on the external fetal monitor strip. 6. Blood-tinged mucus is noted upon internal examination.

4,5

The nurse is performing an assessment of a client progressing through labor. Place the following findings in the order which they occur. 1. uncontrollable urge to push 2. cervical dilation of 7 cm 3. 100% cervical effacement 4. strong Braxton Hicks contractions 5. mild contractions lasting 20 to 40 seconds

4,5,2,3,1

The nurse is preparing to perform a fundal massage on a client who is 2 hours postpartum. Order the sequence of events for performing this procedure. 1. Rotate the upper hand to massage the uterus until firm. 2. Place the client in the supine position. 3. Gently press the fundus between the hands using slight downward pressure. 4. Place one hand around the top of the fundus. 5. Ask the client to void. 6. Place one hand on the abdomen just above the symphysis pubis.

5,2,6,4,1,3

A client is at risk for seizures because of pregnancy induced hypertension. The health care provider orders 4-g magnesium sulfate in 250 ml D5W to be infused at 1 g/hour following a loading dose. What is the flow rate in milliliters per hour?

63 ml/hour

The nurse is caring for a neonate who has a suspected neonatal sepsis. The health care provider's orders is for ampicillin 100 mg/kg/day to be given in four divided doses. The client weighs 7lbs, 8 oz (3.4 kg). How many milligrams would the nurse give with each dose?

85 mg/dose