PN Maternal Newborn Online Practice A Graded A+

PN Maternal Newborn Online Practice A Graded A+ A nurse in a maternal-newborn unit is caring for a newborn in the nursery. The newborn's grandfather asks if he may take the newborn to his daughter's room. Which of the following responses should the nurse make?* "Let me wash my hands and then I'll take your grandson to his mother." Only facility personnel with appropriate ID badges that indicate that the individual works specifically in the maternal-newborn unit should transport newborns. A nurse in a prenatal clinic is caring for a client who Is at 16 weeks of gestation and has a positive hepatitis B result. Which of the following actions should the nurse take? Explain to the client that she will receive the hep B immune globulin immediately to decrease risk of transmission to fetus. Also instruct client that all sexual partners and members of the client's household should see their providers to begin prophylactic treatment A nurse in a prentala clinic is caring for a group of clients. Which of the following clients should the nurse recommend the provider to see first? A client who is at 37 weeks of gestation and reports a persistent headache The nurse should identify that a persistent headache is a manifestation of preeclampsia and recommend that the provider see this client first. A nurse is an antepartum clinic is reinforcing teaching about how to prevent supine hypotension with a client who is at 16 weeks of gestation. Which of the following responses by the clinet indicates an understanding of the teaching? "I will lie on my left side with my head elevated on the pillow" Avoid lying supine during pegnancy to prevent supine hypotension. Uterus compresses the inferior vena cava in the supine position, which decreases blood pressure and casues dizziness and fainting. Lying on left side prevents compression of vena cava and subsequent hypotension A nurse is assisting in the care of a client during the active phase of labor. Which of the following actions should the nurse take to promote the client's comfort? Have the client perform relaxing breathing techniques A nurse is assisting with collecting data from a newborn who was born 2 hr ago and has repiratory distress. Which of the following findings should the nurse report to the provider? Tachypnea Nasal flaring Retractions Expiratory grunting A nurse is assisting with planning care for a client who is breastfeeding and has mastitis. Which of the following recommendations should the nurse include? Instruct the client to apply warm compresses to the affected breast A nurse is assisting with the care of a client who has preeclampsia and is receiving magnesium sulfate via continuous IV infusion. The client has a respiratory rate of 10/min. Which of the following medications should the nurse expect a charge nurse to administer to the client? Calcium gluconate Antidote for magnesium sulfate toxicitiy A nurse is assisting with the care of a client who is at 40 weeks of gestation and is in active labor. Which of the following findings should the nurse report to the charge nurse? Prolonged deceleration of FHR It can be a manifestation of an emergent condition, such as uterine rupture or umbilical cord prolapse A nurse is caring for a client 6 hr after vaginal birth who is going to breastfeed her newborn. The client reports perineal pain of 6 on a scale from 0 to 10. The nurse also notes mild perineal edema and ecchymosis, with a fundus that is 2 cm above the umbilicus with deviation to the right. Which of the following actions is the nurses's priroity? Help the client ambulate to the toilet. The greatest risk for this client is postpartum hemorrhage from uterine atony. Therefore the priority intervention by the nurse is to assis the client to empty her bladder, which will allow the uterus to contract A nurse is caring for a client during the postpartum period. Which of the following findings should the nurse expect during the first 24 hour following delivery? Diuresis Discharge of clear, yellow fluid from the beasts Lower abdominal cramping A nurse is caring for a client who deliverd vaginally 6 hr ago. Which of the following findings should the nurse report to the provider?* Perineal pad soaked in 15 min. The nurse should identify that soaking a perineal pad in 15 min or less is a manifestation of postpartum hemorrhage. Therefore, the nurse should report this finding to the provider. A nurse is caring for a client who has receive methylergonovine. Which of the folowing should the nurse identify and document as an adverse effect of the medication? Hypertension Oxytocic agent that stimulates uterine contractions and is used for postpartum hemorrhage. Can cause N/V, cramping, headache, and dizziness. Report changes in BP to provider because it can cause both hypertension and hypotension A nurse is caring for a client who is at 11 weeks of gestation and reports frequent vomiting. Which of the following findings should the nurse identify as an indication that the client has hyperemesis gravidarum?* Ketonuria The nurse should identify that ketonuria is an indication of hyperemesis gravidarum. Ketonuria occurs due to the breakdown of fat secondary to malnutrition or starvation. A nurse is caring for a client who is at 20 weeks of gestation and is in the clinic for a routine prenatal visit. Which of the following findings in the data from the client's medical record should the nurse report to the provider? Fundal height A nurse is caring for a client who is at 30 weeks of gestation. Which of the following findings shoudl the nurse report to the provider? 2+ urinary protein Manifestation of preeclampsia. A nurse is caring for a client who is planning to become pregnant. The client asks the nurse why folic acid supplements are necessary. The nurse should inform the client that the purpose of the folic acid supplement is to do which of the following? Prevent certain kinds of birth defects The nurse should inform the client that adequate folic acid intake prior to and early pregnancy is necessary to help prevent neural tube defects A nurse is caring for a client who is pregnant and has a prescription for nifedipine. Which of the following outcomes should the nurse expect from this medication? Cessation of uterine contractions. A nurse is caring for a newborn who is large for gestational age and is jittery. Which of the following actions should the nurse take first? Check the newborn's blood glucose leve. Collect data from the client A nurse is caring for a newborn who is receiving phototherapy. Which of the following actions should the nurse take? Place an opaque mask over the newborn's eyes To prevent damage to retinas. Remove mask for feedings A nurse is collecting data from a client who is 32 hr postpartum. Which of the following findings should the nurse expect?* Urine output of 3000 mL in 24 hr The nurse should expect postpartum diuresis to being approximately 12 hr after delivery. Therefore, a urine output of 3000 mL in 24 hr is exepected finding for this client. A nurse is collecting data from a client who is at 33 weeks of gestation. Which of the following findings should the nurse identify as an indication of a potential complication of pregnancy?* Epigastric pain The nurse should identify epigastric pain as a potential complication of pregnancy. Epigastric pain is a manifestation of preeclampsia. A nurse is collecting data from a client who is at 36 weeks of gestaton during a prenatal examination. Which of the following findings should the nurse report to the provider? Blurred vision A nurse is collecting data from a client who is in her second trimester of pregnancy. Which of the following findings should the nurse report to the provider? Frequent uterine contractions. A nurse is collecting data from a newborn who is 8 hr old. Which of the following findings should the nurse report to the provider?* Apical heart rate of 90/min while crying A nurse is collecting data from a newborn whose mother had gestational diabetes mellitus. Which of the following findings should the nurse report to the provider? Blood glucose 28 mg/dL A nurse is contributing to the plan of care for a newborn who has circumcised with a plastic bell device. Which of the following actions should the nurse include in the plan? Apply pressure with sterile gauze if bleeding occurs at the site Frequently monitor for bleeding and apply gentle pressure using a sterile gauze square if bleeding occurs A nurse is discussing family planning with a client who is requesting information about available contraceptive methods. Which of the following client statements indicates an understanding of the teaching? "I should use water-soluble lubricant when my parent wears a condom." Only water-soluble lubricants shuld be used with male condoms, because the use of any other lubricant may compromise the integrity of the condom. A nurse is observing a client bathe her 1-day-old newborn. Which of the following actions should the nurse identify as an indication that the clinet understands how to bathe her newborn? The clinet washes the newborn's hair before unwrapping her A nurse is planning to administer phytonadione to a newborn. Which of the following actions should the nurse take? Use the vastus lateralis as the injection site The nurse should inject phytonadione into the vastus lateralis because this is the most developed muscle in the newborn. A nurse is reinforcing discharge teaching about methods to prevent engorgement during lactation suppression with a client who is bottle-feeding her newborn. WHich of the following statements should the nurse identify as an indication that the client understands the instruction? "I will apply cold cabbage leaves to my breasts throughout the day." Frequent application of cold cabbage leaves to the breasts can prevent engorgement during lactation suppression for a client who is bottle-feeding her newborn. The client should also apply ice packs or cold compresses to her breasts, take mild analgesics, and wear a well-fitting and supportive bra. A nurse is reinforcing teaching about butorphanol tartrate with a client who is in labor. Which of the following client statements indicates an understanding of the teaching? "This medication might make me dizzy." A nurse is reinforcing teaching about car seat safety with a parent of a newborn. Which of the following statements should the nurse identify as an indication that the client understands the instructions? "If my baby rides in a car with no back seat, the passenger air bag must be turned off." A nurse is reinforcing teaching about food sources that are high in folate with a group of women who are pregnant. Which of the following foods should the nurse recommend to this group as a the best source of folate? 1/2 cup of dried peas A nurse is reinforcing teaching about formula feeding a newborn with a group of new parents. Which of the following instructions should the nurse include? All 20 to 30 min for feedings. A nurse is reinforcing teaching about interventions to treat breast engorgement with a client who is breastfeeding. Which of the following instructions should the nurse include in the teaching?* Breastfeed the newborn baby at least every 2 hr. The nurse should instruct the client to breastfeed the newborn every 2 hr during engorgement. Frequent feedings soften the breasts and decrease pain. A nurse is reinforcing teaching with a client who has a new prescription for ferrous sulfate. Which of the following instructions should the nurse include? "Increase your fluid intake with this medication" A nurse is reinforcing teaching with a client who has preeclampsia and is receiving magnesium sulfate via continuous IV infusion. Which of the following statements should the nurse include in the teaching? "Your fluid intake will be limited to no more than 125 millilters per hour." The nurse should restrict the client's fluid intake to no more than 125 mL per hr to prevent fluid overload. A nurse is reinforcing teaching with a client who requests hydrotherapy for pain management during labor. Which of the following statements should the nurse include? "You will need to be in active labor during using hydrotherapy." The nurse should instruct the client that hydrotherapy is initiated once active labor begins. The use of hydrotherapy during the latent phase of labor can decrease the strength and frequency of contractions and slow the progression of labor. A nurse is reinforcing teaching with a new parent about the prevention of newborn abduction. Which of the following statements by the parent indicates an understanding of the teaching? "I will ask the nurse to take care of my baby in the nursey if I need to take a nap." A nurse is reinforcing teaching with the client who is at 9 weeks of gestation and reports frequent episodes of nausea and vomiting. Which of the following instructions should the nurse include? Consume small meals frequently each day. A nurse is reviewing the laboratory results of a 4 hr old newborn. Which of the folowing findings should the nurse report to the provider? Platelet count 120,000/mm3 The nurse should identify that a platelet count of 120,000 is below the expected reference range of 150-300,000 for a new born. Therefore, the nurse should report this finding to the provider. A nurse is reviewing the laboratory results of a client who is at 32 weeks of gestation. Which of the following laboratory findings should the nurse report to the provider? Hematocrit 30% A nurse is reviewing the medication administration record for a client who is receiving nifedipine for gestational hypertension. The nurse should identify that which of the following medications is contraindicated for use with nifedipine? Magnesium sulfate Magnesium sulfate is administered for the treatment of hypertension or to prevent seizures in clients who have preeclampsia. This medication is contraindicated for use with nifedipine because it can cause skeletal muscle blockade, resulting in muscle weakness or paralysis. A nurse is reviewing the prenatal record of a client who is at 34 weeks of gestation. Which of the following results should the nurse identify as a desirable outcome? Reactive nonstress test The nurse should identify that a reactive nonstress test indicates fetal well-being and is a desirable outcome. A nurse on a postpartum unit is assisting in the care of a client who is experiencing hypovolemic shock. Which of the following actions should the nurse take? Insert an indwelling urinary catheter. The nurse should insert an indwelling urinary catheter to monitor output closely. Decreased kidney perfusion caused by shock can lead to oliguria. A nurse on a postpartum unit is assisting with the care of a client who has a hypotonic uterus and excessive vaginal bleeding. Which of the following actions should the nurse take first?* Provide fundal massage for the client. The nurse should identify that the greatest risk to this client is postpartum hemorrhage. Therefore, the first action the nurse should take is to provide fundal massage to increase uterine muscle tone and express blood clots from the uterus, which will decrease bleeding. The nurse is planning to administer terbutaline to a client who is experience preterm labor. Which of the following routes of administration should the nurse plan to use? Subcutaneous Terbutaline relaxes the smooth muscles and inhibits uterine activity. This medication shuld be administered subcutaneously every 4 hr.