Saunders reproductive system review
Apgar scale
appearance, pulse, grimace, activity, respiration
A newborn has just been circumcised. Which describes how the nurse should expect the surgical site to appear?
Reddened, with a small amount of bloody drainage.
During a prenatal visit, the nurse checks the fetal heart rate (FHR) of the client in the 3rd trimester of pregnancy. The nurse determines that the FHRis normal if which heart rate is noted?
150 bpm
a pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus move. the nurse responds by telling the mother that fetal movements will be noted between which weeks of gestation?
16 and 20 weeks
The nurse is collecting data from a pregnant client who is at 28 weeks gestation. The nurse measures the fundal height in centimeters and should expect which finding?
28 cm
The nurse is assigned to assist with caring for a neonate born to a mother who is human immunodeficiency virus (HIV) - positive. The nurse understands that which should be included in the plan of care?
Maintaining standard precautions at all times while caring for the Neonate
The nurse is assigned to work in the delivery room and is assisting with caring for a client who has just delivered a newborn. The nurse is monitoring for signs of placental separation knowing that which Indicates that the placenta has separated?
A change in the uterine contour
The perinatal client is admitted to the obstetric unit during an exacerbation of a heart condition. When planning for the nutritional requirements of the client, the nurse would consult with the dietitian to ensure which dietary measure?
A diet that is high and fluids and fiber to decrease constipation
The client is admitted to the labor suite complaining of pain less vaginal bleeding. The nurse assist with the examination of the client, knowing that which routine labor procedure is contraindicated?
A manual pelvic examination
The nurse is reinforcing instructions to a new mother about cord care And how to monitor for infection. The nurse should tell the mother that which is a sign of infection?
A moist cord with discharge
The nurse is reviewing the record of a client who has just been told that her pregnancy test is positive. The nurse notes that the health care provider has documented the presence of Goodell's sign. The nurse determines that this sign is indicative of which?
A softening of the cervix
The nurse notes hypotonia, irritability, and a poor sucking reflex in a full-term newborn infant after admission to the nursery. The nurse suspects fetal alcohol syndrome (FAS) and is aware that which of the following additional signs would be consistent with FAS?
Abnormal palmar creases
The nurse suspects that the client has a pulmonary embolism. Which is the most important nursing action
Administer oxygen by facemask, as prescribed
The nursing instructor asks a nursing student to list the functions of the amniotic fluid. The student responds correctly by state gn that which are functions of amniotic fluid? Select all that apply.
Allows for fetal movement Is a measure of the kidney function Surrounds, cushions, and protects the fetus Maintains body temp of the fetus
The nurse is assigned to care for the client after A C-section section. To prevent a thrombophlebitis, the nurse should encourage the woman to take with priority action?
Ambulate frequently
After delivery the nurse checks the height of the uterine fundus. Which position of the fundus should the nurse expect to note?
At the level of the umbilicus
The nurse is collecting data from a client who suspects she is pregnant. The nurse is checking the client for probable signs of pregnancy. Which are the probable sign of pregnancy that the nurse should note?
Ballottement Chadwick's sign Uterine enlargement Braxton Hicks contractions
The nurses assigned to care for a client who is in early labor. When collecting data from the client, which should the nurse check first?
Baseline fetal heart rate
A nurse is reinforcing measures regarding the care of a newborn with the mother. To bathe the newborn, what the mother should be taught which intervention?
Begin with the eyes and face
The nurse is assisting in caring for a Post term neonate immediately after admission to the nursery. The priority nursing action should be to monitor which?
Blood glucose levels
A pregnant human immunodeficiency virus (HIV)-positive woman delivers a baby. The nurse provides guidance to help make decisions regarding newborn care. The nurse determines that additional guidance is needed if the woman states that she will:
Breast-feed, especially for the first 6 weeks postpartum.
The nurse is collecting data from a client who has been diagnosed with placenta previa. Which finding should the nurse expect to know? Select all that apply
Bright red vaginal bleeding Soft, relaxed, non-tender uterus
The nurse notes that the for our postpartum client has school, clammy skin and that she is restless and excessively thirsty. The nurse immediately notifies the RN and then performance which action?
Checks the vital signs
The nurse is assigned to assist caring for a client who is at risk for eclampsia. If the clam progresses from preeclampsia to eclampsia, The nurse should take which first action?
Clear and maintain open airway
The nurse in the newborn nursery receives a telephone call to prepare for the admission of a neonate born at 43 weeksgestation with Apgar scores of 1 and 4. When planning for the admission of this infant which is the nurses highest priority?
Connecting the resuscitation bag to the oxygen outlet
The nursing instructor ask a nursing student to describe the process of quickening. Which statement indicates an understanding of this term?
It is the fetal movement that is felt by the mother.
The nurse is reinforcing teaching to a pregnant woman about the physiological effects and hormone changes that occur during pregnancy. The woman asks the nurse about the purpose of estrogen?
It stimulates uterine development to provide a environment for the fetus and stimulates the breasts to prepare for lactation
A primigravida's membranes rupture spontaneously. Which action should the nurse take first?
Determine the fetal heart rate.
The nurse is assigned to assist with caring for a client who is being admitted to the birthing center in early labor. On admission, which action should the nurse take initially?
Determine the maternal and fetal vital signs.
A couple comes to the family planning clinic & asks about sterilization procedures. Which question by the nurse would determine if this method of family planning would be appropriate?
Do you plan to have any other children?
The pregnant woman complains of being awakened frequently by leg cramps. The nurse reinforces instructions To the clients partner and should tell the client to perform which measure?
Dorsiflex the client's foot while extending the knee.
The nurse is reinforcing instructions to a pregnant client regarding measures to prevent heartburn. The nurse should instruct the client to take which best measure?
Drink decaffeinated coffee and tea.
Afterbirth the nurse prevents hypothermia as a result of evaporation by performing which action?
Dryingthe baby with a warm blanket
A primipara is being evaluated in the clinic during her second trimester of pregnancy. Which of the following would indicate an abnormal physical finding that necessitates further testing?
Fetal heart rate of 180 beats per minute
the nurse is collecting data from a client who is pregnant with twins. the client has a healthy 5 year old child who was delivered at 38 weeks and she tells the nurse that she does not have a history of and type of abortion or fetal demise. the nurse should document the GTPAL for this client as which?
G=2, T=1, P=0, A=0, L=1
The nurse is collecting data from a client Who is pregnant. The clients and so has a three-year-old child who was born at 39 weeks gestation. The nurse should document which grávida and para status on this client?
Gravida 2, para 1
A postpartum client is getting ready for discharge. The nurse suspects that the client needs further teaching related to breast-feeding when she makes which statement?
I don't need birth control because I will be breast-feeding
Serena prenatal visit, the nurse is explaining dietary management to a client with diabetes mellitus. The nurse determines that the teaching has been effective when the client makes which statement?
I need to increase the fiber in my diet to control my blood glucose and prevent constipation
The nurse is preparing to care for a newborn who is receiving phototherapy. Which measures should be implemented?
Monitor the skin temperature closely Re-position the newborn every two hours Cover the newborns eyes with shield or patches
A client asked the nurse why her newborn baby needs an injection of vitamin K. The nurse should make which statement to the client?
Newborns are deficient in vitamin K. This injection prevents your baby from abnormal bleeding
Converses caring for your postpartum client. At four hours postpartum, the claims temperature is 102°F (38.9°C). Which is the appropriate nursing action?
Notify the RN, Who will then contact the health care provider
A woman in active labor has contractions every 2 to 3 minutes that last for 45 seconds. The fetal heart rate between contractions is 100 beats per minute. On the basis of these findings, the priority nursing intervention is to:
Notify the registered nurse (RN) immediately
While assisting with a measurement of fundal height, the client at 36 weeks gestation states that she is feeling lightheaded. On the basis of the nurses knowledge of pregnancy, the nurse determines that this is most Likely a result of which?
Passion of the vena cava
The nurse is preparing a list of self care instructions for a postpartum client who has been diagnosed with mastitis. Which instructions should be included on the list?
Rest during the acute phase Where a supportive, non-underwire bra Maintain fluid intake of at least 3000 ML Continue to breast-feed if the breasts are not too sore
The nurse is caring for a client who is in labor. The nurse re-checks the clients blood pressure and notes that it has dropped. To decrease the incidence of supine hypertension, the nurse should encourage the client to remain in which position?
Side lying
The client who is being prepared for a C-section delivery is brought to the delivery room. To maintain the optimal perfusion of oxygenated blood to the fetus, the nurse should place the client in which position?
Supine position with a wedge under the right hip
After a precipitous delivery, the nurse notes that the new mother is passive and only touches her newborn infant briefly with her fingertips. The nurse would do which of the following to help the woman process what has happened?
Support the mother in her reaction to the newborn.
The nurse should monitor for which signs associated with respiratory distress syndrome (RDS) in a preterm newborn?
Tachypnea and retractions
A pregnant client is seen in the health care clinic for a regular prenatal visit. The client tells the nurse that she is experiencing irregular contractions. The nurse determines that the client is experiencing Braxton Hicks contractions. Based on this finding, which nursing action is appropriate?
Tell the client that these are common and they may occur throughout the pregnancy.
The nurse is doing a 48 hour postpartum check on a client with mild gestational hypertension (GH). Which data indicates that the GH is a concern?
The client complains of a headache and blurred vision.
The nurse working in a prenatal clinic reviews a clients chart and notes that the health care provider documents that the client has a gynecologist acteristic of this type of pelvis?
The most favorable for labor and birth
A pregnant woman has a positive history of genital herpes, but she has not had lesions during her pregnancy. The nurse plans to provide which information to the client?
You will be evaluated at the time of delivery for herpetic Genital tract lesions. If they are present, a C-section will be needed.
The nurse is planning to reinforce instructions about cord care to a new mother. The nurse should plan to tell the mother which is about cord care?
The process of keeping the cord clean and dry will decrease bacterial growth
The nurse is assigned to care for the client during the postpartum period. The client asks the nurse what the term involution means. Which description should the nurse give to the client?
The progressive descent of the uterus into the pelvic cavity, which occurs at a rate of approximately 1 cm/day
Hey contractions stress test is scheduled for the client. The woman asked the nurse about the test. Which response describes the most accurate description of the test?
The uterus is stimulated to contract by either small amounts of Oxytocin (pitocin) or by nipple stimulation.
The nurse if student is asked to describe the size of the uterus in a non pregnant client. Which response indicates understanding of the anatomy of this structure?
The uterus weighs about 2 ounces
After the client vaginally delivers a viable newborn, the nurse sees the umbilical cord lengthen and observes a spurt of blood from the vagina. The nurse recognizes these findings as signs of which condition?
Turn the client onto her side
The nurse is assisting with caring for a client with abruptio placentae. While caring for the client, the nurse notes that the client begins to develop signs of shock. The nurse should take which action first?
Turn the client onto her side
The nurse is describing the process of fetal circulation to a client during a prenatal visit. The nurse should tell the client that fetal circulation consists of which?
Two umbilical arteries and one umbilical vein
The nurse is assigned to assist with caring for a client with a abruptio placantae who is experiencing vaginal bleeding. The nurse collects data from the client, knowing that abruptio placentae is accompanied by which additional finding?
Uterine tenderness on palpation
The nurse is caring for a postpartum client with a diagnosis of thrombophlebitis. The client suddenly complains of chest pain and dyspnea. The nurse should initially check which item?
Vital signs
The nurse is collecting data from a pregnant client when the client asks the nurse about the purpose of the Fallopian tubes. Which is the accurate response the nurse should make?
Where fertilization occurs
Coombs test
a blood test to diagnose hemolytic anemias in a newborn
The nurse is assigned to assist with caring for a client who has been admitted to the labor unit. The client is 9 cm dilated and is experiencing precipitous labor. Which is the priority nursing action?
keep the client in a side lying position
Signs of placental separation
lengthening of umbilical cord outside of vagina gush of blood uterus changes from oval (discoid) to globular The client may experience vaginal fullness but not sudden and sharp abdominal pain
The nurse caring for a client with abruptio placentae Is monitoring the client for signs of disseminated intravascular coagulopathy is monitoring the client for signs of disseminated intravascular coagulopathy (DIC). The nurse would suspect DICF which is observed?
pain and swelling of the calf of one leg Petechiae, losing from injection sites, and hematuria
A nursing student is assigned to the client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ducts venosas. The instructor determines that the student understands the structure of the ducts of venosus if the student states which about the ductus venosus?
Objects the umbilical vein to the inferior vena cava
The nurse is assisting with planning care for a postpartum woman who has small vulvar Hematomas.To assist with reducing the swelling, the nurse should perform which action?
Prepare an ice pack for application to the area
The client received epidural anesthesia during labor and had a forceps delivery after pushing for 2 hours. At 6 hours postpartum, the client's systolic blood pressure (BP) dropped 20 points, the diastolic BP dropped 10 points, and her pulse is 120 beats per minute. The client is very anxious and restless. The nurse is told that the client has a vulvar hematoma. On the basis of this diagnosis, the nurse would plan to:
Prepare the client for surgery
The nurse administers erythromycin Ointment (0.5%) to the newborns eyes, and the mother asked the nurse why this is done. The nurse should give which response to the client?
Prevents ophthalmia neonatorum from occurring after delivery to a neonate born to a woman with an untreated gonococcal infection
The nurse is monitoring a pregnant client with gestational hypertension (GH) Who is at risk for preeclampsia. The nurse should check the client for which signs of preeclampsia? Select all that apply
Proteinuria Hypertension
the client asks the nurse about the purpose of the placenta. The nurse plans to respond to the client knowing which about the placenta?
Provides an exchange of nutrients and waste products between the mother and the fetus
Play nurse palpates the fundus and check the character of the lochia of a postpartum client who is in the fourth stage of labor. Which lochia characteristic should the nurse expect to note?
Red
The client is undergoing an amniocentesis at 16 weeks just station to detect the presence of biochemical or chromosomal abnormalities. Which instructions should the nurse reinforced to the client?
The bladder must be full during the exam.
After episiotomy and the delivery of a newborn, the nurse performs a perineal check on the mother. The nurse notes a trickle of bright red blood coming from the perineum. The nurse checks the fundus and notes that it is firm. The nurse determines that:
The bright red bleeding is abnormal and should be reported.
The nurse has a teaching session with a malnourished client regarding iron supplementation to prevent anemia during pregnancy. Which would indicate successful learning?
The iron is needed for the red blood cells
Leopold's maneuvers will be performed on a pregnant client. The client asks the nurse about the procedure. Which information should the nurse provide to the client about Leopold maneuvers?
The maneuvers are a systematic method for palpating the fetus through the maternal abdominal wall.
The nurse is assisting with caring for a postpartum client who is experiencing uterine hemorrhage. When planning to meet the psychosocial needs of the client, the nurse should plan which action?
Keeping the client and her family members informed of her progress
The client is in her second trimester of pregnancy. She complains of frequent low back pain and ankle edema at the end of the day. The nurse should recommend which measure to help relieve both discomforts?
Lie on the floor with the legs elevated onto a couch or padded chair, with the hips and knees at a right angle
A mother is breast-feeding her newborn baby and experiences breast engorgement. The nurse encourages the mother to do which of the following to provide relief of the engorgement?
Massage the breasts before feeding to stimulate let-down.
The client at 28 weeks gestation is Rh negative and coombs antibody negative. The nurse determines that the client understands what the nurse has taught her about Rh sensitization when the client makes which statement?
I will tell the nurse at the hospital that I had RhoGAM during pregnancy.
the client arrives at the prenatal clinic for her first prenatal assessment. the client tells the nurse that the first day of her last menstrual period (LMP) was October 20, 2016. using Nagele's rule, the nurse determines that the estimated date of birth is which?
July 27, 2017
