DEPARTMENT 102RN Maternal Newborn Nursing Practice. Question and Answers with the Rationale.

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Answer Rationale also provided 1. Spina Bifida 2. The client’s fundus is two fingerbreadths above the umbilicus, deviated to the right of the midline and less firm than previously note? 3. 36 wee... ks’ gestation and has prescription for a nonstress test. Nurse provide including in the teaching? 4. Client water just broke. Nurse priority? 5. Adolescents about nutrition during the 3rd trimester pregnancy. Which of the ff statement should the nurse include in the program? 6. 38 weeks’ gestation during a weekly prenatal visit. Which of the following findings should the nurse report to the provider? 7. Car seat properly? 8. Newborn via heel stick. How the nurse to help minimize the pain of the procedure for the newborn? 9. Preeclampsia and on magnesium sulfate via IV. What nurse include in plan? 10. Client in labor. Cervix is dilated at 9cm. what part of a labor is the patient 11. Client reports severe pressure and pain in the lower back. Fetal head is in a posterior position. What nonpharmacological intervention to perform to relieve the clients discomfort? 12. Preterm Newborn. Indication of hypoglycemia? 21. Client is in active labor and notes early decelerations in the FHR on the monitor. Client is at 39 weeks GA and is on Continuous IV infusion of Oxytocin. Which of the ff should the nurse take? 22. Fetal position on Left occipital anterior. Where to put the ultrasound Transducer to point of maximum intensity of the fetal heart? A: Left Lower Quadrant 23. Client on carboprost for PPH. What is the adverse effect of this medication? 24. Idiopathic thrombocytopenia purpura. Which the ff should the nurse expect? 25. Nurse performing a vaginal examination for a client who is in active labor and reports back pain. Nurse determines that the client is 8cm dilated, 100 effaced and -2 station and that the fetus is in the occiput posterior position. Which of the ff actions should the nurse take? 26. 22 weeks of GA reports concern about the blotchy hyperpigmentation on her forehead. What actions should the nurse should? 27. contraindications with oral contraceptives? SATA 28. 40 weeks gestation and is in early labor. Client platelet count of 75000 and is requesting pain relief. Which of the ff treatment modalities should the nurse anticipate? 30. full term newborn 15 min after birth.which of the ff requires intervention by the nurse? 31. A nurse is assessing four newborns.which of the ff findings should the nurse report to the provider? A newborn who is 32 hr old and has not passed a meconium stool A newborn who is 12 hr old and has pink-tinged urine 32. Provide discharge teaching to a client who had C/S 3 days ago. Which of the ff instructions should the nurse include? 33. newborn just had circumcision. Which of the ff should the nurse include? 34. provide discharge teaching to a client who is postpartum? 35. Newborn who was transferred to the nursey 30 min after delivery? 38. Client at 15 weeks RH- negative with following amniocentesis. What priority after that?? 38. Client Identifier. Which one is not correct? 39. 26 weeks gestation. Which manifestation should the nurse report to the provider? 40. 8 weeks gestation increase intake of IRON. 42. Levonorgestrel contraception. Providing teaching? 43. Hyperemesis gravidarum. 44. newborn what nurse expect 45. True and false labor. What is the characteristic of true labor? 46. Risk factor of preeclampsia 47. taking hold phase A: Demonstrate to the client how to perform a newborn bath R: This demonstration occurs the taking hold phase. The new mother moves from being passively dependent to taking a stronger interest in her new role as a mother. She is now focusing on the care of her newborn and acquiring parenting skils. The nurse should provide positive reinforcement during this phase to give the new mother confidence and promote maternal adjustment. 48. providing teaching to a client about physiological changes that occur during pregnancy. 1o weeks GA and has BMI within expected reference range. Which ff indicates understanding of teaching? 49. importance of folic acid during pregnancy. Consume amount of folic acid to prevent which of the abnormalities. 51. 26 weeks’ gestation. Which the nurse recommend for the client to increase circulation to the placenta? 52. Newborn who was delivered vaginally and experience a tight nuchal cord. Which nurse should expect? 54. 1 day postpartum and has a vaginal hematoma. Which of the manisfestation should the nurse expect? 55. newborn safety. Which the ff indicates an understanding of the teaching? 56. client who is in labor and is requesting epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care? 57. newborn who is undergoing phototherapy to treat hyperbilirubinemia. Which of the ff actions should the nurse take? 58. client who is to receive oxytocin to augment her labor. Which of the ff findings contraindicates the initiation of the oxytocin infusion and should be reported to the provider? A charge nurse on the postpartum unit is observing a newly licensed nurse who is preparing o administer pain medication to a client. The charge nurse should intervene when the newly licensed nurse uses which of the following secondary id to identify the client? A nurse is providing discharge teaching to a patient whose newborn has just had a circumcision. Which of the following instructions should the nurse include? A nurse is teaching about effective breastfeeding to a client who is 3 days postpartum. Which of the following information should the nurse include? A nurse planning care for a client who is in labor and is requesting epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care? A nurse is teaching a new mother how to use a bulb syringe to suction her newborn's secretions. Which of the following instructions should the nurse include? A nurse is assessing a client who is 12hr postpartum. The client's fundus is two finger breadths above the umbilicus deviated to the right of the midline, and less firm than previously noted. Which of the following actions should the nurse take? A nurse is reviewing the medical record at 1800 for a client who is at 34wks gestation. Based in the chart findings and documentation the nursing plan of care should include which of the following actions? A nurse is assessing a full-term newborn 15min after birth. Which of the following findings requires intervention by the nurse? A nurse us assessing a client who is at 26wks gestation. Which of the following clinical manifestations should the nurse report to the provider? A nurse is providing teaching to a client about the physiological changes that occur during preg. The client is at 10 wks of gestation and has a BMI w/in the expected reference range. Which of the following client statements indicate an understanding of the teaching? A nurse in a woman health clinic is providing teaching about nutritional intake to a client who is at 8wks of gestation. The nurse should instruct the client to increase her daily intake of which of the following nutrients? A nurse is assessing a client who is in active labor and notes early decelerations in the FHR on the monitor tracing. The client is at 39 wks of gestation and is receiving a continuous IV infusion of oxytocin. Which of the following actions should the nurse take? A nurse is caring for a newborn who was transferred to the nursery 30 min after delivery. Which of the following actions should the nurse take first? A nurse is providing education about the family bonding to parents who recently adopted a newborn. The nurse should make which of the following suggestions to aid the family 7-yr old in accepting the new family member? A nurse is teaching a client who has pre-gestational type 1 DM about management during preg. Which of the following statements by the client indicates an understanding of the teaching? A nurse is providing d/c teaching to a client who is postpartum. For which of the following clinical manifestations should the nurse instruct the client to monitor and report to the provider? A nurse is assessing a client who rec'd carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication? A nurse is caring for a client who is in labor and reports increasing rectal pressure. She is experiencing contractions 2-3 mins apart each lasting 80-90 seconds and a vaginal examination reveals that her cervix is dilated to 9cm. The nurse should identify that the client is in which of the following phases of labor? A nurse is teaching clients in a prenatal class about the importance of taking folic acid during preg. The nurse should instruct the clients to consume an adequate amount of folic acid from various sources to precent which of the following fetal abnormalities? A school nurse is providing teaching to an adolescent about levonorgestrel contraception. Which of the following information should the nurse include in the teaching? A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn? A nurse is assessing a newborn who is 12hr old. Which of the following clinical s/s requires intervention by the nurse? A nurse is caring for a client who is at 40 wks of gestation and is in early labor. The client has a platelet count of 75,000/mm3 and is requesting pain relief. Which of the following treatment modalities should the nurse anticipate? A nurse is providing d/c teaching to a client who had a C-section birth 3 days ago. Which of the following instructions should the nurse include? A nurse is assessing a client who is 1 day postpartum and has a vaginal hematoma. Which of the following s/s should the nurse expect? A nurse is caring for a client who has recently experienced a perinatal death. Which of the following statements should the nurse make to the client? A nurse is speaking with a client who is trying to make a decision about uterine tube occlusion. The client asks what effects will this procedure have on my sec life? Which of the following responses should the nurse make? A nurse is teaching a group parents about newborn safety. Which of the following statements by a patent indicates an understanding of the teaching? A nurse is admitting a client to the labor and delivery unit when the client states. my water just broke. Which of the following interventions is the nurse's priority? A nurse is providing teaching for a client who gave birth 2 hr ago about the facility policy for newborn safety. Which of the following client statements indicates an understanding of the teaching? A nurse is caring for a client who has uterine hypotonicity and is experiencing postpartum hemorrhage. Which of the following actions is the nurses priority? A nurse is assessing four newborns. Which of the following findings should the nurse report to the provider? A nurse is assessing a client who is at 38 wks gestation during a weekly prenatal visit. Which of the following findings should the nurse report to the provider? A nurse is preparing to administer magnesium sulfate 2g/hr IV to a client who is in preterm labor. Available ts 20g magnesium sulfate in 500ml of dextrose 5% in water (D5W). The nurse should set the IV infusion pump to administer how many ml/hr? (round to whole number) A nurse is assessing a newborn who was delivered vaginally and experienced a tight nuchal cord. Which of the following clinical manifestations should the nurse expect? A nurse is caring for a client who is to rec oxytocin to augment her labor. Which of the following findings contraindicates the initiation of the oxytocin infusion and should be reported to the provider? A nurse is caring for a client who is at 22 wks gestation and reports concern about the blotchy hyper pigmentation of her forehead. Which of the following actions should the nurse take? A nurse is assessing FHR for a client who is preg. The nurse has determined as left occipital anterior (LOA). To which of the following areas of the clients abdomen should the nurse apply the ultrasound transducer in order to assess the PMI of the fetal heart? A nurse in a provider's office is reviewing the medical record of a client who is in her first trimester of preg. Which of the following findings should the nurse identify as a risk factor for the development of preeclampsia? A nurse is discussing the differences between true labor and false labor with a group of expectant parents. Which of the following characteristics should the nurse include when discussing true labor? A nurse is developing an educational program for adolescents about nutrition during the third trimester of preg. Which of the following statements should the nurse include in the program? A nurse is performing a vaginal exam on a client who is in labor and reports severe pressure and pain in the lower back. he nurse notes that the fetal head is in a posterior position. The nurse should identify that which of the following is the best non-pharm intervention to perform to relieve the client's discomfort? A nurse is assessing a late preterm newborn. Which of the following clinical manifestation is an indication of hypoglycemia? A nurse is performing a physical assessment of a newborn upon admission to the nursery. Which of the following s/s should the nurse expect A nurse is planning care for a client who is 2 hr postpartum. Which of the following interventions should the nurse plan to implement during the taking hold phase of postpartum behavioral adjustment? A nurse is developing a plan of care for a client who has preeclampsia and is rec magnesium sulfate via a IV. Which of the following interventions should the nurse include in the plan? A nurse is caring for a newborn who is undergoing phototherapy to treat hyperbilirubinemia. Which of the following actions should the nurse take? A nurse caring for a client who is at 15 wks of gestation, is Rh neg and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure? A nurse is planning care for a client who is at 24 wks of gestation and reports daily mild headaches. Which of the following instructions should the nurse include in the plan of care? A nurse is performing vaginal exam for a client who is in active labor and reports back pain. The nurse determines that the client is 8 cm dilated, 100% effaced, -2 station, and that the fetus is in the occiput posterior position. Which of the following actions should the nurse take? A nurse is teaching a client who is at 24 wks regarding a 1 hr glucose tolerance test. Which of the following statements should the nurse include in her teaching? A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicates an understanding of the teaching? A nurse is providing prenatal teaching to a client who is at 26 wks. Which of the following positions should the nurse recommend for the client to increase circulation to the placenta? Side-lying A nurse in a family planning clinic is caring for a client who requests an oral contraceptive. Which of the following findings in the client's hx should the nurse recognize as a contraindication to oral contraceptives A nurse is assessing a client who is postpartum and has idiopathic thrombocytopenia purpura (ITP). Which of the following findings should the nurse expect? A nurse is teaching a client who is at 36 wks of gestation and has a rx for NST. Which of the following statements should the nurse include in the teaching? A nurse is providing d/c teaching to the parents of a newborn about using a car seat properly. Which of the following instructions should the nurse include? A nurse is providing teaching about non-pharm pain management to a client who is breast-feeding and has engorgement. The nurse should recommend the application of which of the following items? A nurse is preparing to preform Leopold maneuvers for a client. Identify the sequence the nurse should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.) A nurse is preforming a newborm assessment. Which of the following images should the nurse identify as n indication of spina bifida occulta? (images) [Show More]

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