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Terms in this set (60)
A nurse is reviewing the medical record of a client who is The nurse should not administer a rectal suppository or enema to a client who
one day postpartum. The client had a vaginal birth with a has a fourth-degree perineal laceration. These can cause separation of the
fourth-degree perineal laceration. The nurse should suture line, bleeding, or infection.
contact the provider regarding which of the following
prescriptions?
A nurse is preparing to administer hepatitis B immune STEP 8: Reassess to determine whether the amount to administer makes sense.
globulin to a newborn. The prescription states, If there are 10 mcg/mL and the prescription reads 5 mcg, it makes sense to
"Administer 5 mcg IM once today." Available is a 5 mL administer 0.5 mL. The nurse should administer hepatitis B immunoglobulin 0.5
vial with 10 mcg/mL. How many mL should the nurse mL IM.
administer? (Round the answer to the nearest tenth. Use
a leading zero if it applies. Do not use a trailing zero.)
A nurse is teaching a client who is at 8 weeks of The nurse should instruct the client to engage in 30 min of moderate exercise
gestation about exercise. Which of the following every day to improve muscle tone throughout her pregnancy.
instructions should the nurse include in the teaching?
A nurse is assessing a client who is in labor and notes The nurse should identify fetal head compression as a likely cause of the early
early decelerations on the fetal monitor. Which of the decelerations on the fetal monitor. Early decelerations are an expected fetal
following findings should the nurse identify as a possible pattern caused by fetal head compression due to uterine contractions, fundal
cause of the early decelerations? pressure, and vaginal examinations.
, A nurse is caring for a client and her partner who have Take photos of the newborn to give to the parents.
experienced a fetal death. Which of the following actions
should the nurse take? The nurse should create a memory box that includes mementos of the newborn
(for example, photos, the newborn's ID bands, the newborn's hat, and the
newborn's blanket).
A nurse is observing a new mother caring for her crying Lays the newborn across her lap and gently sways.
newborn who is bottle feeding. Which of the following
actions by the mother should the nurse recognize as a This is a correct technique for quieting a newborn. This tactile stimulation
positive parenting behavior? promotes a sense of security for the newborn.
A nurse on an antepartum unit is caring for four clients. Epigastric pain is a clinical manifestation of preeclampsia and indicates hepatic
Which of the following clients should the nurse identify as involvement, which is an urgent finding. Therefore, the nurse should identify this
the priority? client as the priority.
A nurse is preparing to administer oxytocin to a client Flaccid uterus is correct. Oxytocin increases the contractility of the uterus.
who is postpartum. Which of the following findings is an
indication for the administration of the medication? Cervical laceration is incorrect. Bleeding resulting from a cervical laceration
(Select all that apply.) continues even when the uterus is contracted and firm. It will require repair by
the provider.
Excess vaginal bleeding is correct. Oxytocin enhances uterine contractility,
decreasing vaginal bleeding.
Increased afterbirth cramping is incorrect. The use of oxytocin will increase,
rather than decrease, afterbirth cramping.
Increased maternal temperature is incorrect. The use of oxytocin will have no
effect on maternal temperature.
A nurse is teaching a new mother about newborn safety. Room-sharing is recommended during the first few weeks. This allows the
Which of the following instructions should the nurse parents to be readily available to the newborn and learn the newborn's cues.
include in the teaching? However, the nurse should instruct the parents to avoid placing the newborn in
their bed as it increases the risk for sudden infant death syndrome.
A nurse is calculating a client's expected date of birth When using Naegele's rule to calculate the estimated date of birth for a client, the
using Naegele's rule. The client tells the nurse that her nurse should subtract 3 months from the first day of the client's last menstrual
last menstrual cycle started on November 27th. Which of cycle and then add 7 days. November 27th minus 3 months equals August 27th.
the following dates is the client's expected date of birth? August 27th plus 7 days equals September 3rd.
A charge nurse on a labor and delivery unit is teaching a Evidence-based practice indicates the nurse should perform this step first when
newly licensed nurse how to perform Leopold performing Leopold maneuvers. During this step, the nurse palpates the client's
maneuvers. Which of the following images indicates the abdomen with her palms to determine which fetal part is in the uterine fundus.
first step of Leopold maneuvers? This step also identifies the lie (transverse or longitudinal) and presentation
(cephalic or breech) of the fetus.
A nurse is caring for a client who is at 38 weeks of The nurse should perform Leopold maneuvers to assess the position of the fetus
gestation. Which of the following actions should the to best determine the optimal placement for the external fetal monitoring
nurse take prior to applying an external transducer for transducer
fetal monitoring?
A staff nurse on an obstetric unit is caring for a client who The nurse manager should take into account the staff nurse's moral beliefs and
is scheduled for an induced abortion. The staff nurse recognize that she also has rights and responsibilities concerning the care of a
informs the nurse manager that she has a moral issue client who is undergoing an induced abortion. Therefore, the nurse manager
with the client's decision. Which of the following actions should reassign the care of the client to another staff nurse.
should the nurse manager take?
A nurse is caring for a client who is pregnant and is at At the end of the first trimester of pregnancy, the client's uterus is approximately
the end of her first trimester. The nurse should place the the size of a grapefruit and is positioned low in the pelvis slightly above the
Doppler ultrasound stethoscope in which of the following symphysis pubis. Therefore, the nurse should begin assessing for FHTs just
locations to begin assessing for the fetal heart tones above the symphysis pubis.
(FHT)?
A nurse is planning care for a client who is to undergo a Fetal movement may not be evident on the fetal monitor and tracing. Instructing
nonstress test. Which of the following actions should the the client to press the button when she detects fetal movement will ensure that
nurse include in the plan of care? the fetal movement is noted.
A nurse in the antepartum clinic is assessing a client's The nurse should recognize and interpret the client's statement as an indication
adaptation to pregnancy. The client states that she is, of emotional lability. Many women experience rapid and unpredictable changes in
"happy one minute and crying the next." The nurse mood during pregnancy. Intense hormonal changes may be responsible for mood
should interpret the client's statement as an indication of changes that occur during pregnancy. Tears and anger alternate with feelings of
which of the following? joy or cheerfulness for little or no reason.
M
a
t
e
r
n
a
l
A
Students
also
studied
Terms in this set (60)
A nurse is reviewing the medical record of a client who is The nurse should not administer a rectal suppository or enema to a client who
one day postpartum. The client had a vaginal birth with a has a fourth-degree perineal laceration. These can cause separation of the
fourth-degree perineal laceration. The nurse should suture line, bleeding, or infection.
contact the provider regarding which of the following
prescriptions?
A nurse is preparing to administer hepatitis B immune STEP 8: Reassess to determine whether the amount to administer makes sense.
globulin to a newborn. The prescription states, If there are 10 mcg/mL and the prescription reads 5 mcg, it makes sense to
"Administer 5 mcg IM once today." Available is a 5 mL administer 0.5 mL. The nurse should administer hepatitis B immunoglobulin 0.5
vial with 10 mcg/mL. How many mL should the nurse mL IM.
administer? (Round the answer to the nearest tenth. Use
a leading zero if it applies. Do not use a trailing zero.)
A nurse is teaching a client who is at 8 weeks of The nurse should instruct the client to engage in 30 min of moderate exercise
gestation about exercise. Which of the following every day to improve muscle tone throughout her pregnancy.
instructions should the nurse include in the teaching?
A nurse is assessing a client who is in labor and notes The nurse should identify fetal head compression as a likely cause of the early
early decelerations on the fetal monitor. Which of the decelerations on the fetal monitor. Early decelerations are an expected fetal
following findings should the nurse identify as a possible pattern caused by fetal head compression due to uterine contractions, fundal
cause of the early decelerations? pressure, and vaginal examinations.
, A nurse is caring for a client and her partner who have Take photos of the newborn to give to the parents.
experienced a fetal death. Which of the following actions
should the nurse take? The nurse should create a memory box that includes mementos of the newborn
(for example, photos, the newborn's ID bands, the newborn's hat, and the
newborn's blanket).
A nurse is observing a new mother caring for her crying Lays the newborn across her lap and gently sways.
newborn who is bottle feeding. Which of the following
actions by the mother should the nurse recognize as a This is a correct technique for quieting a newborn. This tactile stimulation
positive parenting behavior? promotes a sense of security for the newborn.
A nurse on an antepartum unit is caring for four clients. Epigastric pain is a clinical manifestation of preeclampsia and indicates hepatic
Which of the following clients should the nurse identify as involvement, which is an urgent finding. Therefore, the nurse should identify this
the priority? client as the priority.
A nurse is preparing to administer oxytocin to a client Flaccid uterus is correct. Oxytocin increases the contractility of the uterus.
who is postpartum. Which of the following findings is an
indication for the administration of the medication? Cervical laceration is incorrect. Bleeding resulting from a cervical laceration
(Select all that apply.) continues even when the uterus is contracted and firm. It will require repair by
the provider.
Excess vaginal bleeding is correct. Oxytocin enhances uterine contractility,
decreasing vaginal bleeding.
Increased afterbirth cramping is incorrect. The use of oxytocin will increase,
rather than decrease, afterbirth cramping.
Increased maternal temperature is incorrect. The use of oxytocin will have no
effect on maternal temperature.
A nurse is teaching a new mother about newborn safety. Room-sharing is recommended during the first few weeks. This allows the
Which of the following instructions should the nurse parents to be readily available to the newborn and learn the newborn's cues.
include in the teaching? However, the nurse should instruct the parents to avoid placing the newborn in
their bed as it increases the risk for sudden infant death syndrome.
A nurse is calculating a client's expected date of birth When using Naegele's rule to calculate the estimated date of birth for a client, the
using Naegele's rule. The client tells the nurse that her nurse should subtract 3 months from the first day of the client's last menstrual
last menstrual cycle started on November 27th. Which of cycle and then add 7 days. November 27th minus 3 months equals August 27th.
the following dates is the client's expected date of birth? August 27th plus 7 days equals September 3rd.
A charge nurse on a labor and delivery unit is teaching a Evidence-based practice indicates the nurse should perform this step first when
newly licensed nurse how to perform Leopold performing Leopold maneuvers. During this step, the nurse palpates the client's
maneuvers. Which of the following images indicates the abdomen with her palms to determine which fetal part is in the uterine fundus.
first step of Leopold maneuvers? This step also identifies the lie (transverse or longitudinal) and presentation
(cephalic or breech) of the fetus.
A nurse is caring for a client who is at 38 weeks of The nurse should perform Leopold maneuvers to assess the position of the fetus
gestation. Which of the following actions should the to best determine the optimal placement for the external fetal monitoring
nurse take prior to applying an external transducer for transducer
fetal monitoring?
A staff nurse on an obstetric unit is caring for a client who The nurse manager should take into account the staff nurse's moral beliefs and
is scheduled for an induced abortion. The staff nurse recognize that she also has rights and responsibilities concerning the care of a
informs the nurse manager that she has a moral issue client who is undergoing an induced abortion. Therefore, the nurse manager
with the client's decision. Which of the following actions should reassign the care of the client to another staff nurse.
should the nurse manager take?
A nurse is caring for a client who is pregnant and is at At the end of the first trimester of pregnancy, the client's uterus is approximately
the end of her first trimester. The nurse should place the the size of a grapefruit and is positioned low in the pelvis slightly above the
Doppler ultrasound stethoscope in which of the following symphysis pubis. Therefore, the nurse should begin assessing for FHTs just
locations to begin assessing for the fetal heart tones above the symphysis pubis.
(FHT)?
A nurse is planning care for a client who is to undergo a Fetal movement may not be evident on the fetal monitor and tracing. Instructing
nonstress test. Which of the following actions should the the client to press the button when she detects fetal movement will ensure that
nurse include in the plan of care? the fetal movement is noted.
A nurse in the antepartum clinic is assessing a client's The nurse should recognize and interpret the client's statement as an indication
adaptation to pregnancy. The client states that she is, of emotional lability. Many women experience rapid and unpredictable changes in
"happy one minute and crying the next." The nurse mood during pregnancy. Intense hormonal changes may be responsible for mood
should interpret the client's statement as an indication of changes that occur during pregnancy. Tears and anger alternate with feelings of
which of the following? joy or cheerfulness for little or no reason.
