RN ATI MATERNAL NEWBORN PROCTORED EXAM (VERSION 16)

The nurse is assessing a new mother's efforts to bond with her newly born infant. Identify three (3) factors that can impact effective bonding between mother and infant? 1. Holds the infant face-to-face (en face position) maintaining eye contact 2. Identifies the infant’s unique characteristics and relates them to those of other family members 3. Provides physical care for the infant, such as feeding and diapering A nurse is providing community education regarding risk factors for ovarian cancer. Identify five (5) risk factors associated with the development of ovarian cancer. (Review the Med Surg RM) • Age greater than 40 years • Nulliparity/first pregnancy after 30 years of age • Family history of ovarian, breast, or genetic mutation for hereditary nonpolypolyposis colon cancer (HNPCC) • BRCA1 or BRCA2 gene mutations • Diabetes mellitus • Early menarche/late menopause • History of dysmenorrhea/heavy bleeding • Endometriosis • High-fat diet • Hormone replacement therapy • Use of infertility medications • Older adult clients following surgery for cancer The client enters the obstetrical clinic for birth control information on using a diaphragm. What five (5) instructions would be provided by the nurse to explain use of the diaphragm? • Client should be properly fitted with a diaphragm by provider • Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal/pelvic surgery, and after every pregnancy • Requires proper insertion and removal. Prior to coitus, the diaphragm is inserted vaginally over the cervix with spermicidal jelly/cream, that is applied to the cervical side of the dome and around the rim. The diaphragm can be inserted up to 6 hours before intercourse but for no more than 24 hours. • Spermicide must be reapplied with each act of coitus • A client should empty her bladder prior to insertion of the diaphragm • Diaphragm should be washed with mild soap and warm water after each use What are risks/possible complications/contraindications for the use of intrauterine contraceptive devices? • Best used by women in a monogamous relationship due to the risks of STIs • Can cause irregular menstrual bleeding • Risk of bacterial vaginosis, uterine perforation, or uterine expulsion • Active pelvic infection • Abnormal uterine bleeding • Severe uterine distortion • For copper IUD- Wilson’s diseases and copper allergy A nurse is caring for a client who is considering use of a hormonal intrauterine system. What information regarding the advantages of an Intrauterine Device (IUD) should the nurse provide? IUD can maintain effectiveness for 1 to 10 years (hormonal IUD 3-5 years, copper IUD 10 years) • Can be inserted immediately after abortion, miscarriage, childbirth, and while breastfeeding • Contraception can be reversed with immediate return to fertility • Doesn’t interfere with spontaneity • Safe for mothers who are breastfeeding • It is 99% effective in preventing pregnancy • Hormonal IUDs: decreased menstrual pain and heavy bleeding A nurse is caring for a client undergoing infertility testing. The client asks why a hysterosalpingography has been ordered. What is the nurse's best response? Outpatient radiological procedure in which dye is used to assess the patency of the fallopian tubes. Assess for history of allergies to iodine and seafood prior to beginning the procedure. A nurse is providing education to a new mother regarding storage of breast milk. Identify five (5) teaching points to discuss with the new mother regarding storage of breast milk. • Breast milk can be stored at room temperature under very clean conditions for up to 8 hours. It can be refrigerated in sterile bottles for use within 8 days or can be frozen in sterile containers in the freezer compartment of a refrigerator for up to 6 months. Breast milk can be stored in a deep freezer for 12 months. • Thawing the milk in the refrigerator for 24 hours is the best way to preserve the immunoglobulins present in it. It can also be thawed by holding the container under running lukewarm water or placing it in a container of lukewarm water. The bottle should be rotated often, but not shaken when thawing in this manner. • Thawing in the microwave is contraindicated because it destroys some of the immune factors and lysosomes contained in the milk. microwave thawing also leads to the development of hot spots in the milk because of uneven heating, which can burn the newborn. • Do not refreeze thawed milk. • Used portions of breast milk must be discarded. A nurse is providing discharge teaching to a new parent regarding cord care. What information should be provided? • Before discharge, cord clamp is removed. • Prevent cord infection by keeping the cord dry and keep the top of the diaper folded underneath it. • Sponge baths are given until the cord falls off, which occurs around 10-14 days after birth. Tub bathing and submersion can follow. • Cord infection (complication of improper cord care) can result if the cord is not kept clean/dry. o Monitor for manifestations of a cord that is moist and red, has a foul odor, or has purulent drainage. o Notify provider immediately if findings of cord infection are present.