UWORLD MATERNAL & NEWBORN
EXAM QUESTIONS AND ANSWERS
The nurse is caring for a client at 39 weeks gestation in active labor who is receivi
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ng an oxytocin infusion. The nurse notes persistent late decelerations on the fetal
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monitor. Which of the following actions should the nurse take?
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Select all that apply.
gv gv gv gv
1.
Administer oxygen via a nonrebreather face mask gv gv gv gv gv gv
2.
Change maternal position to the left side
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3.
Discontinue the oxytocin infusion gv gv gv
4.
Notify the health care provider
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5.
Perform a nitrazine test - ANSWERS-1,2,3,4
gv gv gv gv gv
The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FH
gv gv gv gv gv gv gv gv gv gv gv gv gv
R) changes noted on monitor tracings.
gv gv gv gv gv
A late deceleration is a decrease in FHR that begins after a contraction, reaches it
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s lowest point (nadir) after the contraction peak, and then gradually returns to base
gv gv gv gv gv gv gv gv gv gv gv gv gv
line. Late decelerations indicate impaired fetal oxygenation associated with decreas
gv gv gv gv gv gv gv gv gv
ed uteroplacental perfusion (eg, due to maternal hypotension after epidural placem
gv gv gv gv gv gv gv gv gv gv
ent or uterine tachysystole). Chronic uteroplacental insufficiency (eg, intrauterine gr
gv gv gv gv gv gv gv gv gv
owth restriction, preeclampsia, diabetes) may also cause late decelerations.
gv gv gv gv gv gv gv gv
Nursing actions to improve fetal perfusion and oxygenation include:
gv gv gv gv gv gv gv gv
Discontinuing uterotonics (eg, oxytocin [Pitocin]) to reduce uterine activity (Option 3
gv gv gv gv gv gv gv gv gv gv
)
Changing maternal position to the left side to relieve compression of the inferior ve
gv gv gv gv gv gv gv gv gv gv gv gv gv
na cava. If the FHR tracing does not improve, a right-
gv gv gv gv gv gv gv gv gv gv
side position may be attempted (Option 2)
gv gv gv gv gv gv
Administering oxygen at 8-10 L/ gv gv gv gv
min via nonrebreather face mask to promote fetal oxygenation (Option 1)
gv gv gv gv gv gv gv gv gv gv
Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve
gv gv gv gv gv gv gv gv gv gv gv gv gv
placental perfusion, especially during maternal hypotension
gv gv gv gv gv
Notifying the health care provider (Option 4)
gv gv gv gv gv gv
(Option 5) Nitrazine pH tests are used to detect leaking amniotic fluid, most often if
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
gvpremature (prelabor) rupture of membranes is suspected. This client is at term an
gv gv gv gv gv gv gv gv gv gv gv gv
d in active labor.
gv gv gv
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
gv gv gv gv gv gv gv gv gv gv gv gv
at does the nurse suggest to help prevent reflux? Select all that apply.
gv gv gv gv gv gv gv gv gv gv gv gv
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
gv gv gv gv gv gv gv gv gv gv gv gv
at does the nurse suggest to help prevent reflux? Select all that apply.
gv gv gv gv gv gv gv gv gv gv gv gv
1.
,Burp during and after feeds
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2.
Engage baby in active play after the feeding
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3.
Feed baby in side-lying position
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4.
Hold baby upright 20-30 minutes after each feeding
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5.
Offer smaller but more frequent feeds
gv gv gv gv gv
6.
Place baby on tummy after feeding - ANSWERS-1,4,5
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Gastroesophageal reflux (GER) is attributed to an immature lower esophageal sphi gv gv gv gv gv gv gv gv gv gv
ncter. It is common in infants age ≤3 months and results in spitting up after feeds.
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
If an infant is gaining weight and meeting developmental milestones, treatment is a
gv gv gv gv gv gv gv gv gv gv gv gv
imed at controlling the symptoms. Because infants with GER are at risk for aspirati
gv gv gv gv gv gv gv gv gv gv gv gv gv
on and apnea, caregivers should be instructed in cardiopulmonary resuscitation.
gv gv gv gv gv gv gv gv gv
Burping the baby frequently helps expel trapped air before milk builds up over it. If
gv gv gv gv gv gv gv gv gv gv gv gv gv gv g
vthere is milk over an air pocket, the milk will come up with the burp (Option 1).
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
Holding the baby upright for 20- gv gv gv gv gv
30 minutes after feedings allows gravity to assist in keeping the food in the stomac
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
h while the stomach settles (Option 4).
gv gv gv gv gv gv
A nurse is teaching the parent how to care for a newly circumcised newborn. Whic
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
h statement by the parent indicates that further teaching is needed?
gv gv gv gv gv gv gv gv gv gv
1.
"Discharge and odor indicate infection of the circumcision site."
gv gv gv gv gv gv gv gv
2.
"I will clean the area with alcohol-based wipes or soap water."
gv gv gv gv gv gv gv gv gv gv
3.
"Infant crying during petrolatum gauze changes is expected."
gv gv gv gv gv gv gv
4.
"The diaper should be changed at least every 4 hours." - ANSWERS-2.
gv gv gv gv gv gv gv gv gv gv gv
Common complications of circumcision include hemorrhage, infection, and voiding
gv gv gv gv gv gv gv gv gv
difficulty. Parents should clean the area with warm water (without soap) to remove
gv gv gv gv gv gv gv gv gv gv gv gv gv
urine and feces and prevent infection. Prepackaged alcohol-
gv gv gv gv gv gv gv
based wipes delay healing and cause discomfort; they should be avoided until the
gv gv gv gv gv gv gv gv gv gv gv gv gv
circumcision site has healed (usually takes 5-6 days). gv gv gv gv gv gv gv
a newly circumcised infant should have diapers changed every - ANSWERS-
gv gv gv gv gv gv gv gv gv gv
4 hrs or when soiled
gv gv gv gv
The precepting nurse is supervising a new obstetric nurse performing a labor admi
gv gv gv gv gv gv gv gv gv gv gv gv
ssion assessment on a client with suspected spontaneous rupture of membranes.
gv gv gv gv gv gv gv gv gv gv gv
Which action by the new nurse would cause the precepting nurse to intervene?
gv gv gv gv gv gv gv gv gv gv gv gv
1.
Documenting a positive nitrazine test result when the test strip turns blue
gv gv gv gv gv gv gv gv gv gv gv
2.
, Donning nonsterile gloves and using soluble gel for vaginal examination
gv gv gv gv gv gv gv gv gv
3.
Palpating the client's abdomen before applying external fetal monitors
gv gv gv gv gv gv gv gv
4.
Providing the client with a variety of clear liquids to drink - ANSWERS-2.
gv gv gv gv gv gv gv gv gv gv gv gv
The nurse should use a sterile glove during vaginal examination in the presence of
gv gv gv gv gv gv gv gv gv gv gv gv gv
ruptured membranes to prevent infection. Use of nonsterile gloves and instrument
gv gv gv gv gv gv gv gv gv gv gv
s during vaginal examinations increases the risk of infection in the laboring client o
gv gv gv gv gv gv gv gv gv gv gv gv gv
r fetus (eg, chorioamnionitis).
gv gv gv
(Option 1) A nitrazine pH test strip inserted into the vagina can differentiate betwee
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n amniotic fluid, which is alkaline, and vaginal fluid, which is acidic. A blue-
gv gv gv gv gv gv gv gv gv gv gv gv gv
green, blue- gv
gray, or deep blue color indicates a positive result and probable rupture of membra
gv gv gv gv gv gv gv gv gv gv gv gv gv
nes. A yellow, olive-
gv gv gv
yellow, or olive green color indicates a negative result and suggests that membran
gv gv gv gv gv gv gv gv gv gv gv gv
es are intact.
gv gv
(Option 3) Leopold maneuvers help determine fetal presentation and involve syste
gv gv gv gv gv gv gv gv gv gv
matic palpation of the client's abdomen. These maneuvers assist the nurse in locat
gv gv gv gv gv gv gv gv gv gv gv gv
ing the fetal back for optimal placement of the ultrasound transducer for external fe
gv gv gv gv gv gv gv gv gv gv gv gv gv
tal heart monitoring.
gv gv
(Option 4) Hospital policy, provider preference, and the client risk profile will dictate
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appropriate oral intake during labor. However, there is no evidence to support NP
gv gv gv gv gv gv gv gv gv gv gv gv gv
O status of low-
gv gv gv
risk laboring clients, and most clients benefit from hydration provided by oral clear l
gv gv gv gv gv gv gv gv gv gv gv gv gv
iquids during labor. gv gv
Educational objective: gv
Vaginal examinations of the laboring client with ruptured membranes should be per
gv gv gv gv gv gv gv gv gv gv gv
formed using a sterile glove to decrease the risk of infection (eg, chorioamnionitis)
gv gv gv gv gv gv gv gv gv gv gv gv gv
to the client and fetus. Other labor admission interventions include application of e
gv gv gv gv gv gv gv gv gv gv gv gv
xternal fetal monitoring and performance of a nitrazine pH test to determine if mem
gv gv gv gv gv gv gv gv gv gv gv gv gv
branes have ruptured. gv gv
The nurse is preparing to assess a client visiting the women's health clinic. The cli
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ent's obstetric history is documented as G5T1P2A1L2. Which interpretation of this
gv gv gv gv gv gv gv gv gv gv gv
notation is correct? gv gv
1.
The client had 1 birth at 37 wk 0 d gestation or beyond
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2.
The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation
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3.
The client has 3 currently living children
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4.
The client is currently not pregnant - ANSWERS-1.
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This client (G5T1P2A1L2) has been pregnant 5 times (G5); had 1 term birth (T1),
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
2 preterm births (P2), and 1 abortion (A1); and has 2 currently living children (L2).
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
The client's term birth is indicated by the T1 portion of the GTPAL notation (Option
gv gv gv gv gv gv gv gv gv gv gv gv gv gv g
1).
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EXAM QUESTIONS AND ANSWERS
The nurse is caring for a client at 39 weeks gestation in active labor who is receivi
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
ng an oxytocin infusion. The nurse notes persistent late decelerations on the fetal
gv gv gv gv gv gv gv gv gv gv gv gv gv
monitor. Which of the following actions should the nurse take?
gv gv gv gv gv gv gv gv gv
Select all that apply.
gv gv gv gv
1.
Administer oxygen via a nonrebreather face mask gv gv gv gv gv gv
2.
Change maternal position to the left side
gv gv gv gv gv gv
3.
Discontinue the oxytocin infusion gv gv gv
4.
Notify the health care provider
gv gv gv gv
5.
Perform a nitrazine test - ANSWERS-1,2,3,4
gv gv gv gv gv
The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FH
gv gv gv gv gv gv gv gv gv gv gv gv gv
R) changes noted on monitor tracings.
gv gv gv gv gv
A late deceleration is a decrease in FHR that begins after a contraction, reaches it
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
s lowest point (nadir) after the contraction peak, and then gradually returns to base
gv gv gv gv gv gv gv gv gv gv gv gv gv
line. Late decelerations indicate impaired fetal oxygenation associated with decreas
gv gv gv gv gv gv gv gv gv
ed uteroplacental perfusion (eg, due to maternal hypotension after epidural placem
gv gv gv gv gv gv gv gv gv gv
ent or uterine tachysystole). Chronic uteroplacental insufficiency (eg, intrauterine gr
gv gv gv gv gv gv gv gv gv
owth restriction, preeclampsia, diabetes) may also cause late decelerations.
gv gv gv gv gv gv gv gv
Nursing actions to improve fetal perfusion and oxygenation include:
gv gv gv gv gv gv gv gv
Discontinuing uterotonics (eg, oxytocin [Pitocin]) to reduce uterine activity (Option 3
gv gv gv gv gv gv gv gv gv gv
)
Changing maternal position to the left side to relieve compression of the inferior ve
gv gv gv gv gv gv gv gv gv gv gv gv gv
na cava. If the FHR tracing does not improve, a right-
gv gv gv gv gv gv gv gv gv gv
side position may be attempted (Option 2)
gv gv gv gv gv gv
Administering oxygen at 8-10 L/ gv gv gv gv
min via nonrebreather face mask to promote fetal oxygenation (Option 1)
gv gv gv gv gv gv gv gv gv gv
Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve
gv gv gv gv gv gv gv gv gv gv gv gv gv
placental perfusion, especially during maternal hypotension
gv gv gv gv gv
Notifying the health care provider (Option 4)
gv gv gv gv gv gv
(Option 5) Nitrazine pH tests are used to detect leaking amniotic fluid, most often if
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
gvpremature (prelabor) rupture of membranes is suspected. This client is at term an
gv gv gv gv gv gv gv gv gv gv gv gv
d in active labor.
gv gv gv
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
gv gv gv gv gv gv gv gv gv gv gv gv
at does the nurse suggest to help prevent reflux? Select all that apply.
gv gv gv gv gv gv gv gv gv gv gv gv
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
gv gv gv gv gv gv gv gv gv gv gv gv
at does the nurse suggest to help prevent reflux? Select all that apply.
gv gv gv gv gv gv gv gv gv gv gv gv
1.
,Burp during and after feeds
gv gv gv gv
2.
Engage baby in active play after the feeding
gv gv gv gv gv gv gv
3.
Feed baby in side-lying position
gv gv gv gv
4.
Hold baby upright 20-30 minutes after each feeding
gv gv gv gv gv gv gv
5.
Offer smaller but more frequent feeds
gv gv gv gv gv
6.
Place baby on tummy after feeding - ANSWERS-1,4,5
gv gv gv gv gv gv gv
Gastroesophageal reflux (GER) is attributed to an immature lower esophageal sphi gv gv gv gv gv gv gv gv gv gv
ncter. It is common in infants age ≤3 months and results in spitting up after feeds.
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
If an infant is gaining weight and meeting developmental milestones, treatment is a
gv gv gv gv gv gv gv gv gv gv gv gv
imed at controlling the symptoms. Because infants with GER are at risk for aspirati
gv gv gv gv gv gv gv gv gv gv gv gv gv
on and apnea, caregivers should be instructed in cardiopulmonary resuscitation.
gv gv gv gv gv gv gv gv gv
Burping the baby frequently helps expel trapped air before milk builds up over it. If
gv gv gv gv gv gv gv gv gv gv gv gv gv gv g
vthere is milk over an air pocket, the milk will come up with the burp (Option 1).
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
Holding the baby upright for 20- gv gv gv gv gv
30 minutes after feedings allows gravity to assist in keeping the food in the stomac
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
h while the stomach settles (Option 4).
gv gv gv gv gv gv
A nurse is teaching the parent how to care for a newly circumcised newborn. Whic
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
h statement by the parent indicates that further teaching is needed?
gv gv gv gv gv gv gv gv gv gv
1.
"Discharge and odor indicate infection of the circumcision site."
gv gv gv gv gv gv gv gv
2.
"I will clean the area with alcohol-based wipes or soap water."
gv gv gv gv gv gv gv gv gv gv
3.
"Infant crying during petrolatum gauze changes is expected."
gv gv gv gv gv gv gv
4.
"The diaper should be changed at least every 4 hours." - ANSWERS-2.
gv gv gv gv gv gv gv gv gv gv gv
Common complications of circumcision include hemorrhage, infection, and voiding
gv gv gv gv gv gv gv gv gv
difficulty. Parents should clean the area with warm water (without soap) to remove
gv gv gv gv gv gv gv gv gv gv gv gv gv
urine and feces and prevent infection. Prepackaged alcohol-
gv gv gv gv gv gv gv
based wipes delay healing and cause discomfort; they should be avoided until the
gv gv gv gv gv gv gv gv gv gv gv gv gv
circumcision site has healed (usually takes 5-6 days). gv gv gv gv gv gv gv
a newly circumcised infant should have diapers changed every - ANSWERS-
gv gv gv gv gv gv gv gv gv gv
4 hrs or when soiled
gv gv gv gv
The precepting nurse is supervising a new obstetric nurse performing a labor admi
gv gv gv gv gv gv gv gv gv gv gv gv
ssion assessment on a client with suspected spontaneous rupture of membranes.
gv gv gv gv gv gv gv gv gv gv gv
Which action by the new nurse would cause the precepting nurse to intervene?
gv gv gv gv gv gv gv gv gv gv gv gv
1.
Documenting a positive nitrazine test result when the test strip turns blue
gv gv gv gv gv gv gv gv gv gv gv
2.
, Donning nonsterile gloves and using soluble gel for vaginal examination
gv gv gv gv gv gv gv gv gv
3.
Palpating the client's abdomen before applying external fetal monitors
gv gv gv gv gv gv gv gv
4.
Providing the client with a variety of clear liquids to drink - ANSWERS-2.
gv gv gv gv gv gv gv gv gv gv gv gv
The nurse should use a sterile glove during vaginal examination in the presence of
gv gv gv gv gv gv gv gv gv gv gv gv gv
ruptured membranes to prevent infection. Use of nonsterile gloves and instrument
gv gv gv gv gv gv gv gv gv gv gv
s during vaginal examinations increases the risk of infection in the laboring client o
gv gv gv gv gv gv gv gv gv gv gv gv gv
r fetus (eg, chorioamnionitis).
gv gv gv
(Option 1) A nitrazine pH test strip inserted into the vagina can differentiate betwee
gv gv gv gv gv gv gv gv gv gv gv gv gv
n amniotic fluid, which is alkaline, and vaginal fluid, which is acidic. A blue-
gv gv gv gv gv gv gv gv gv gv gv gv gv
green, blue- gv
gray, or deep blue color indicates a positive result and probable rupture of membra
gv gv gv gv gv gv gv gv gv gv gv gv gv
nes. A yellow, olive-
gv gv gv
yellow, or olive green color indicates a negative result and suggests that membran
gv gv gv gv gv gv gv gv gv gv gv gv
es are intact.
gv gv
(Option 3) Leopold maneuvers help determine fetal presentation and involve syste
gv gv gv gv gv gv gv gv gv gv
matic palpation of the client's abdomen. These maneuvers assist the nurse in locat
gv gv gv gv gv gv gv gv gv gv gv gv
ing the fetal back for optimal placement of the ultrasound transducer for external fe
gv gv gv gv gv gv gv gv gv gv gv gv gv
tal heart monitoring.
gv gv
(Option 4) Hospital policy, provider preference, and the client risk profile will dictate
gv gv gv gv gv gv gv gv gv gv gv gv
appropriate oral intake during labor. However, there is no evidence to support NP
gv gv gv gv gv gv gv gv gv gv gv gv gv
O status of low-
gv gv gv
risk laboring clients, and most clients benefit from hydration provided by oral clear l
gv gv gv gv gv gv gv gv gv gv gv gv gv
iquids during labor. gv gv
Educational objective: gv
Vaginal examinations of the laboring client with ruptured membranes should be per
gv gv gv gv gv gv gv gv gv gv gv
formed using a sterile glove to decrease the risk of infection (eg, chorioamnionitis)
gv gv gv gv gv gv gv gv gv gv gv gv gv
to the client and fetus. Other labor admission interventions include application of e
gv gv gv gv gv gv gv gv gv gv gv gv
xternal fetal monitoring and performance of a nitrazine pH test to determine if mem
gv gv gv gv gv gv gv gv gv gv gv gv gv
branes have ruptured. gv gv
The nurse is preparing to assess a client visiting the women's health clinic. The cli
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
ent's obstetric history is documented as G5T1P2A1L2. Which interpretation of this
gv gv gv gv gv gv gv gv gv gv gv
notation is correct? gv gv
1.
The client had 1 birth at 37 wk 0 d gestation or beyond
gv gv gv gv gv gv gv gv gv gv gv gv
2.
The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
3.
The client has 3 currently living children
gv gv gv gv gv gv
4.
The client is currently not pregnant - ANSWERS-1.
gv gv gv gv gv gv gv
This client (G5T1P2A1L2) has been pregnant 5 times (G5); had 1 term birth (T1),
gv gv gv gv gv gv gv gv gv gv gv gv gv gv
2 preterm births (P2), and 1 abortion (A1); and has 2 currently living children (L2).
gv gv gv gv gv gv gv gv gv gv gv gv gv gv gv
The client's term birth is indicated by the T1 portion of the GTPAL notation (Option
gv gv gv gv gv gv gv gv gv gv gv gv gv gv g
1).
v
