VATI RN Maternal Newborn 2024
questions and answers with
elaborations
A charge nurse is teaching a newly licensed nurse about substance use disorders
during pregnancy. Which of the following statements by the newly licensed nurse
indicates an understanding of the teaching? - ANS Encourage client who are
prescribed methadone to breastfeed.
-The nurse should encourage clients who are prescribed methadone during pregnancy
to breastfeed their newborns to help with withdrawal symptoms.
A nurse is caring for a client who received terbutaline subcutaneously. Which of the
following findings is an indication the medication was effective? - ANS Decreased
frequency of contractions.
-Terbutaline is a tocolytic medication that is used to halt preterm labor. Terbutaline
cause relaxation of smooth muscle, which decrease uterine activity. Therefore, the
nurse should identify that a decrease in frequency of contractions is an indication that
terbutaline was effective.
A charge nurse is discussing care of clients who are in labor with a newly licensed
nurse. Which of the following actions should the charge nurse include in the teaching
regarding situations requiring an amniotomy? - ANS Placing a fetal scalp electrode.
-A fetal scalp electrode is attached to the presenting part of the fetus in order to provide
accurate continuous monitoring of the fetal heart rate. If the client's membranes are
intact, the amniotic sac must be artificially ruptured prior to attaching the electrode to
enable access to the presenting part.
A nurse is reviewing the medical record of a client who has preeclampsia prior to
administering labetalol. For which of the following findings should the nurse withhold the
medication? - ANS Heart rate 54/min
-The nurse should identify that a heart rate of 54/min is below the expected reference
range of 60 to 100/min. During pregnancy, the heart rate increases 10 to 15/min due to
increased blood volume and increase tissue demands for oxygen. Bradycardia is a
contraindication for the administration of labetalol, an antihypertensive medication.
Therefore, the nurse should withhold the medication and notify the provider.
, A nurse is reviewing the medical records of a client who is at 8 wks. of gestation. Which
of the following findings should the nurse identify as a risk factor for developing
preeclampsia? - ANS Rheumatoid Arthritis.
-The presence of a connective tissue disease, such as rheumatoid arthritis or systemic
lupus erythematosus, increase a client’s risk for developing preeclampsia.
A nurse is reviewing the laboratory results for a postpartum client who is receiving
warfarin for deep-vein thrombosis. Which of the following laboratory tests should the
nurse monitor? - ANS International normalized ratio (INR).
-The nurse should monitor the INR of a client who is taking warfarin. Prothrombin time
(PT) is also measure to regulate warfarin therapy. However, PT values are more difficult
to interpret. INR determined by multiplying the PT by a correction factor based on the
specific thromboplastin preparation used for the test, as a way of equalizing laboratory
to laboratory variations.
A nurse is monitoring a client who is in the active phase of labor and has an intrauterine
pressure catheter and fetal scalp electrode. Which of the following findings should the
nurse expect? - ANS Montevideo units (MVU) of 220 mm Hg.
- The nurse should identify that an MVU of 220 mm Hg is within the expected range
during the active phase of labor. MVUs generally range between 100 to 250 mm Hg
during the first stage of labor and increase to 300 to 400 mm Hg during the second
stage of labor. MVUs are calculated by subtracting the baseline uterine pressure from
the peak contraction pressure for every contraction that occurs during a 10-min period.
The nurse then adds the pressure produced by each contraction during that time to
determine the MVUs.
A nurse is assessing a client who has just undergone a cesarean birth and was given
epidural morphine for postpartum pain relief 1hr ago. The nurse notes that the clients
respiratory rate is 10/min. Which of the following actions should the nurse take first? -
ANS Administer oxygen by nonrebreather face mask.
-The first action the nurse should take when using the airway, breathing, circulation
approach to client care is to administer oxygen by nonrebreather mask to treat
manifestations of respiratory depression due to morphine administration.
A nurse is assessing a client who has placenta previa and is receiving fetal monitoring.
Which of the following clinical findings should the nurse expect? - ANS Painless
vaginal bleeding.
-The placenta implants in the lower uterine segment, partially or completely covering the
cervix. With cervical changes, the placental blood vessels can tear, which results in
bleeding.
A nurse is assessing a client who is at 33wks of gestation. Which of the following
findings should the nurse report to the provider? - ANS Episodes of blurred vision.
questions and answers with
elaborations
A charge nurse is teaching a newly licensed nurse about substance use disorders
during pregnancy. Which of the following statements by the newly licensed nurse
indicates an understanding of the teaching? - ANS Encourage client who are
prescribed methadone to breastfeed.
-The nurse should encourage clients who are prescribed methadone during pregnancy
to breastfeed their newborns to help with withdrawal symptoms.
A nurse is caring for a client who received terbutaline subcutaneously. Which of the
following findings is an indication the medication was effective? - ANS Decreased
frequency of contractions.
-Terbutaline is a tocolytic medication that is used to halt preterm labor. Terbutaline
cause relaxation of smooth muscle, which decrease uterine activity. Therefore, the
nurse should identify that a decrease in frequency of contractions is an indication that
terbutaline was effective.
A charge nurse is discussing care of clients who are in labor with a newly licensed
nurse. Which of the following actions should the charge nurse include in the teaching
regarding situations requiring an amniotomy? - ANS Placing a fetal scalp electrode.
-A fetal scalp electrode is attached to the presenting part of the fetus in order to provide
accurate continuous monitoring of the fetal heart rate. If the client's membranes are
intact, the amniotic sac must be artificially ruptured prior to attaching the electrode to
enable access to the presenting part.
A nurse is reviewing the medical record of a client who has preeclampsia prior to
administering labetalol. For which of the following findings should the nurse withhold the
medication? - ANS Heart rate 54/min
-The nurse should identify that a heart rate of 54/min is below the expected reference
range of 60 to 100/min. During pregnancy, the heart rate increases 10 to 15/min due to
increased blood volume and increase tissue demands for oxygen. Bradycardia is a
contraindication for the administration of labetalol, an antihypertensive medication.
Therefore, the nurse should withhold the medication and notify the provider.
, A nurse is reviewing the medical records of a client who is at 8 wks. of gestation. Which
of the following findings should the nurse identify as a risk factor for developing
preeclampsia? - ANS Rheumatoid Arthritis.
-The presence of a connective tissue disease, such as rheumatoid arthritis or systemic
lupus erythematosus, increase a client’s risk for developing preeclampsia.
A nurse is reviewing the laboratory results for a postpartum client who is receiving
warfarin for deep-vein thrombosis. Which of the following laboratory tests should the
nurse monitor? - ANS International normalized ratio (INR).
-The nurse should monitor the INR of a client who is taking warfarin. Prothrombin time
(PT) is also measure to regulate warfarin therapy. However, PT values are more difficult
to interpret. INR determined by multiplying the PT by a correction factor based on the
specific thromboplastin preparation used for the test, as a way of equalizing laboratory
to laboratory variations.
A nurse is monitoring a client who is in the active phase of labor and has an intrauterine
pressure catheter and fetal scalp electrode. Which of the following findings should the
nurse expect? - ANS Montevideo units (MVU) of 220 mm Hg.
- The nurse should identify that an MVU of 220 mm Hg is within the expected range
during the active phase of labor. MVUs generally range between 100 to 250 mm Hg
during the first stage of labor and increase to 300 to 400 mm Hg during the second
stage of labor. MVUs are calculated by subtracting the baseline uterine pressure from
the peak contraction pressure for every contraction that occurs during a 10-min period.
The nurse then adds the pressure produced by each contraction during that time to
determine the MVUs.
A nurse is assessing a client who has just undergone a cesarean birth and was given
epidural morphine for postpartum pain relief 1hr ago. The nurse notes that the clients
respiratory rate is 10/min. Which of the following actions should the nurse take first? -
ANS Administer oxygen by nonrebreather face mask.
-The first action the nurse should take when using the airway, breathing, circulation
approach to client care is to administer oxygen by nonrebreather mask to treat
manifestations of respiratory depression due to morphine administration.
A nurse is assessing a client who has placenta previa and is receiving fetal monitoring.
Which of the following clinical findings should the nurse expect? - ANS Painless
vaginal bleeding.
-The placenta implants in the lower uterine segment, partially or completely covering the
cervix. With cervical changes, the placental blood vessels can tear, which results in
bleeding.
A nurse is assessing a client who is at 33wks of gestation. Which of the following
findings should the nurse report to the provider? - ANS Episodes of blurred vision.
