NUR 2633MCH EXAM 2MODULE 3, 4, 5 LESSON CONTENT:,100% CORRECT - $18.49   Add to cart

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NUR 2633MCH EXAM 2MODULE 3, 4, 5 LESSON CONTENT:,100% CORRECT

NUR 2633MCH EXAM 2MODULE 3, 4, 5 LESSON CONTENT: FETAL MONITORING ● Equipment used - Fetal monitor, paper, belts, Ultrasound for fetal heart tones, and Toco - for uterine contractions. ● 5 pieces of information on the fetal monitor - baseline, variability, accelerations, decelerations, maternal uterine activity ● Baseline - where the fetal heart rate is over time. Normal parameter is 110 - 160 ● Variability - the changes the fetal heart rate makes moment to moment due to the influence of the sympathetic nervous system. (can not read prior to 28 weeks, nervous system is immature) ● Accelerations - heart rate above the baseline - this is a very positive finding always a good thing, shows the baby is getting good perfusion through a healthy placenta ● Decelerations - appear for different reasons -heart rate decelerates below the baseline. ● Early decelerations - from head compression the fetal heart rate 'mirrors' the contraction. ● Late decelerations - from placental insufficiency. Placenta has or is under risk of poor perfusion. Risk factors - HTN, DM, poor nutrition, smoking, drugs, alcohol ● Variable decelerations - from cord compression. ● Interuterine resuscitation - needed to improve the fetal circulation. Nursing interventions are as follows: Change the maternal position, increase fluid intake ( IV bolus), Stop Pitocin if running, Add Oxygen - 8-10 liters per mask for greater concentration, Call the provider, document your actions. VAGINAL EXAMINATION; With each vaginal examination the nurse should be able to identify at least 3 things, and possible 5 things. Dilation – opening of cervix (reported by centimeters) Effacement – thinning of cervix ( may occur before dilation and is in percentages) Station –alignment of the presenting part to the ischial spines ( the narrowest portion of the bony pelvis) Status of membranes – ruptured or intact Presentation – what is presenting? Head – or vertex, butt – or breech Do not do a vaginal exam on a patient that is actively bleeding if you are not aware of the location of the placenta. What is the risk? * Vaginal examinations are invasive and should be limited to only when data is needed. For a healthy progressing labor, a vaginal exam is only required 4 times. 1. Upon admission to know the baseline of the cervical exam. 2. When the membranes have ruptures to know what the presenting part is, and how low in the pelvis. 3. If pain management is requested to determine the amount and type of analgesic. 4. If the patient enters the second stage and desire to bear down. We must then prepare for the birth. However, you will note, examinations are done much more frequently in the hospital setting. If membranes have ruptured – what is the risk to mother and baby? Type of emergency Who is at risk Identifying Factors Nursing Interventions Expected management Shoulder Dystocia Prolapsed Cord Placenta Previa Placenta Abruption Uterine Rupture Amniotic Fluid Emboli Define the following terms in relation to labor: • Powers (physiological forces) • Passageway (maternal pelvis) • Passenger (fetus and placenta) • Passageway + Passenger and their relationship (engagement, attitude, position) • Psychosocial influences (previous experiences, emotional status) What are the four stages of labor? What is the best fetal position for delivery (Hint: Three letters)? If a patient is experiencing back labor what position might the fetus be in? What is engagement? What is fetal station? What is cervical dilation? Who is responsible for the time of birth and when is the time of birth determined? What is being assessed when the APGAR is being completed? When is an APGAR assessment completed? What is the best pelvic type for delivery? (Circle the best answer) Android Anthropoid Gynecoid Platypelloid Maternal position: Each contraction represents a moment of hypoxia to the fetus. Can maternal position also contribute to decrease in perfusion to the fetus? What position is the best for your patient to labor in? And what position do you find most patients placed into for the birth process in a hospital setting? Normal labor progression: A laboring patient's cervical examination is 2cms/ 50% effaced/ -1 station which has not changed since last night midnight. It is now 0800. Is this normal or abnormal? A patient has been examined and told she has had no cervical change for 5 hours. Last exam was 5cm/100% effaced/-2 station. Normal or abnormal? What is the risk to mother and fetus in the first scene? What about the second scene? What interventions can you suggest? POST PARTUM HEMMORHAGE 1. Identify who would be at risk for postpartum hemorrhage 2. What lab values will be significant in the care of the postpartum patient that is bleeding. BUBBLEHEEN: Post-Partum Assessment B – Breast Breast vs. Bottle feeding: assess for latching on. If formula feeding, teach about engorgement of breast, mother binds breast 24/7 and no nipple stimulation U – Uterus Firm & Midline, 12 hours after delivery uterus is 1 fingerbreadth above naval, decreases approximately 1 fingerbreadth each day. If uterus is not midline, have patient void. B – Bladder Patients have decreased sensation to void, especially with spinal, patients need to void every 3 hours. Number one cause of hemorrhage is a full bladder. B – Bowel Flatus? Bowel sounds x 4 quadrants? Use stool softener, as needed. Should take stool softener if second degree tear or higher and all C-sections. If C-section, patient should walk at least three times per day (breakfast, lunch, and dinner) L – Lochia Assess flow and ask how many hours since last changed pad, if using one pad per hour, suspect hemorrhage. Lochia flow should progress in color: red, pink, brownish, white, none. E – Episiotomy Check incision for REEDA (redness, edema, ecchymosis, drainage, and approximation) Look for signs and symptoms of infection H – Homan’s Sign, Must assess Homan’s Sign (support leg with dorsiflexion) Teach patient about ambulation and hydration to prevent DVT E – Edema Swelling in lower legs? Pitting? E – Emotions Is the mother bonding with newborn? Changing diapers? N – Nutrition Mothers need 500 calories more when breastfeeding. C-sections cannot have a straw due to the intake of air. Also, no cabbage or broccoli due to causing gas Premature Infant Issues for the Infant PUT X in either PRE or POST Post-mature Infant Breast tissue palpable at 3cm or greater x Erb’s Palsy x Flaccid posture Fractured Clavicle x x Hypothermia/Cold Stress x Lanugo Macrosomia x Meconium Aspiration Syndrome x x Necrotizing Enterocolitis x Retinopathy of the newborn x Respiratory distress x Soles of feet are smooth Scrotum dark pigmentation x Vernix covering the skin x MCH EXAM 2 END OF CHAPTER QUESTIONS Chapter 12 Review Questions 1. When describing the “powers” of labor to a new nurse, the perinatal nurse discusses the uterine contractions and the A. Woman's pushing efforts. B. Unique musculature of the uterus. C. Position of the fetus. D. Hormonal influences regulating labor. 2. The perinatal nurse assesses a primigravida who has just arrived at the birth facility for labor assessment. The woman describes contractions that are 7 to 10 minutes apart and felt in the abdomen. She states the contractions feel better when she is walking. This is most likely A. True labor. B. Transition. C. Early labor. D. False labor. 3. The perinatal nurse describes for the student nurse the lettering used to designate fetal position. The correct use includes A. “P” indicating fetal pelvis location. B. “P” indicating posterior maternal pelvis. C. “M” indicating fetal mandible. D. “A” indicating maternal anus. 4. A nurse is told in a hand off report that a woman's cervix is not yet ripened. What does the nurse understand about this patient? A. She is ready to deliver. B. Her cervix has not yet softened. C. Vaginal delivery will not be possible. D. This change begins labor in all women. 5. The nurse explains to a laboring woman that the relaxation periods between contractions are important for which of the following reasons? A. Avoids uterine rupture B. Allows fetal oxygenation C. Permits fetal assessment D. Prevents uterine ischemia 6. Which of the following is considered the primary force of labor? A. Pushing by the mother B. Uterine contractions C. Contraction decrement D. Uterine elongation 7. A nurse assesses the intensity of a woman's contractions. At the acme of her contraction, the nurse is unable to indent the uterus. How would the nurse document this finding? A. Mild contraction B. Moderate contraction C. Strong contraction D. Intense contraction 8. A nurse assesses the level of a fetal presenting part in a laboring woman at station 0. What does this finding indicate? A. Engagement has occurred. B. The presenting part is above the maternal ischial spines. C. Labor is not progressing. D. The presenting part is at the pelvic outlet. 9. A nurse reads in a patient's chart that she has employed a doula. What does the nurse understand about this role? A. Provides physical and emotional support during labor B. Performs continuous patient assessment during labor C. Performs private duty nursing care during labor and birth D. Assists the surgeon during a cesarean delivery 10. A nurse assesses a woman in labor and finds that her contractions are occurring once every 1 to 1 and one-half minutes with a uterine resting tone greater than 30 mm Hg. How does the nurse document this finding? A. First stage labor, active phase B. First stage labor, transition C. Second stage labor D. Uterine tachysystole CHAPTER 13 REVIEW QUESTIONS 1. In the first stage of labor, the perinatal nurse is aware that pain impulses are transmitted via which route? A. T11, T12 spinal nerve segments B. T9, T10 spinal nerve segments C. L4, L5 spinal nerve segments D. Sacral spinal nerve segments 2. The perinatal nurse is aware that a woman's history of past painful experiences with labor and birth are part of which neural pathway process for pain? A. Transduction B. Transmission C. Perception D. Modulation 3. A laboring woman was given promethazine (Phenergan) and meperidine hydrochloride (Demerol) for pain. The nurse is aware that during the first 24 hours of life, the newborn will have an increased risk for which of the following problems? A. Hyperbilirubinemia B. Tachypnea C. Irritability D. Tremors 4. A nurse is studying therapeutic touch and is explaining it to family and friends. What description is most accurate? A. It is a gentle stroking massage of the patient's abdomen. B. It redirects the patient's energy fields to diminish pain. C. It uses a focal point on which the laboring woman can concentrate. D. It is well documented as a tool to diminish pain during labor. 5. What information about aromatherapy for labor discomfort should the nurse provide the patient? A. Full strength oils on the skin are most effective. B. Aromatherapy does not offer any benefits. C. Not all aromatherapy oils are safe to use in pregnancy D. Oils are only placed on the pillowcase, never the skin. 6. The nurse is applying a hot pack to a laboring woman's perineum. The student nurse asks about the purpose of this intervention. What explanation by the nurse is best? A. Relieves muscle spasms B. Helps regulate temperature C. Prevents tissue trauma D. Relieves muscle ischemia 7. A nursing faculty member is explaining the women's health goals of Healthy People 2020 to a class of nursing students. Which of the following is a goal in this document? A. Reduce the mortality rate to no more than 11/100,000 live births B. Increase the percentage of women using pharmacological pain control C. Decrease the numbers of community-based child- birth education classes D. Increase the number of women referred to a tertiary health-care center 8. A woman in labor complains of back pain and a headache. What action by the nurse is best? A. Call for an epidural or spinal analgesic/anesthesia B. Perform a complete pain assessment on the woman C. Document the findings and reassure the woman D. Ask the support person to provide massage therapy 9. A woman near term expresses fears of not being able to tolerate the pain of childbirth. What response by the nurse is best? A. “Remember that pain in childbirth is normal and expected.” B. “Choose your support person carefully so he or she can really help you.” C. “Be sure to get plenty of sleep in the weeks leading up to the birth.” D. “I wouldn't worry too much; most women end up doing just fine.” 10. What instruction by the nurse will help give the woman a sense of control over her childbirth experience? A. Tour different birthing facilities B. Only use a certified nurse midwife C. Request an elective cesarean birth D. Ask your friends how they handled their birth experiences CHAPTER 14 REVIEW QUESTIONS 1. A nurse is reviewing hypotonic labor with a student nurse. The nurse explains to the student that which of the following is the most common cause of this dysfunctional labor pattern? A. Fetal macrosomia B. Maternal android pelvis C. Inadequate uterine pacemakers D. Fetal occiput–posterior position 2. The perinatal nurse is aware that complications arising from amnioinfusion include which of the following? A. Infection B. Halt in labor C. Neonatal hydrocephalus D. Fluid overload 3. The perinatal nurse understands that one of the risks of oxytocin infusion includes FHR changes related to which of the following? A. Decreased placental perfusion B. Oligohydramnios C. Maternal hypotonic contractions D. Maternal hypotension 4. A nurse reads in a woman's chart that she has a history of dystocia. Based on this information, the nurse assesses the woman for what condition? A. Fetal abnormalities B. Long, difficult labor C. Prior fetal demise D. Bleeding abnormalities 5. A patient has an order for a prostaglandin E2 preparation. What does the nurse understand about this medication? A. Only used when delivery is imminent B. Cervical ripening agent C. Has a high rate of adverse reactions D. Is only given subcutaneously 6. The perinatal nurse is aware that recommendations for elective deliveries specify induction no earlier than what gestational age? A. 30 weeks B. 35 weeks C. 37 weeks D. 39 weeks 7. The perinatal nurse knows that which of the following conditions must be met before assisting at a forceps delivery? A. Presenting part must be engaged B. Membranes must still be intact C. Patient's bladder should be full D. Cervix at least 50% dilated 8. A nurse hears a health-care provider describe a pregnant woman as having tocophobia. What does the nurse understand this to mean? A. Allergy to tocolytics B. Fear of childbirth C. Fear of pain D. Atonic uterus 9. A woman has a history of placenta increta. What does the nurse understand about this condition? A. Slight penetration of the myometrium by the trophoblast B. Placental perforation of the uterus C. Deep placental penetration of the myometrium D. Abnormal implantation of the placenta 10. A woman has a history of a bilobed placenta, each with its own circulation. What condition does this describe? A. Battledore placenta B. Circumvallate placenta C. Succenturiate placenta D. Placenta percreta Chapter 6 Review Questions: 1. According to Masters and Johnson's work on human sexual response phases, in which phase does a woman experience the highest sense of sexual tension? A. Excitement phase B. Plateau phase C. Orgasmic phase D. Resolution phase 2. A family planning nurse is working with an 18-year-old female who has been treated for gonorrhea in the past. In addition, the patient has a previous sexual partner who has tested positive for HIV. Which contraceptive method would probably work best for this patient? A. Spermicide B. Cervical cap C. Latex male condom D. Progestin-only pill 3. A clinic nurse schedules a patient for her initial dose of Depo-Provera (medroxyprogesterone) within A. 24 hours of menstruation. B. 48 hours of menstruation. C. 3 to 4 days of menstruation. D. 5 to 7 days of menstruation. 4. A clinic nurse is working with a woman who has been diagnosed with “sexual dysfunction.” What does this nurse understand as the best explanation of this diagnosis? A. A broad range of problems with sexual and reproductive function B. Any sexual situation that causes personal distress for the woman C. Psychological barriers that prevent expression of sexuality D. Specific medical conditions that interfere with the enjoyment of sex 5. A woman has the diagnosis of “dyspareunia” on her chart. What does the nurse understand this term to mean? A. Infrequent menstrual periods B. Heavy menstrual bleeding C. Lack of orgasmic ability D. Pain with intercourse 6. A patient and her partner are in the clinic to learn about contraception options. They are especially interested in Natural Family Planning. Which of the following would be the most important for the nurse to assess? A. Ability to use the technology B. Commitment to the method C. Literacy and comprehension levels D. Regularity of the woman's cycles 7. A woman is asking the family health nurse if she needs to use contraception while she is breastfeeding. Which response by the nurse is best? A. “It can be very effective for a short time while you are exclusively nursing.” B. “Once your baby is 1 year old, you will need to use contraception.” C. “Yes, you should use contraception; breastfeeding does not prevent pregnancy.” D. “You can rely on breastfeeding to prevent pregnancy after your period returns.” 8. A young woman is being educated on the risks related to her contraceptive sponge. What symptom should the nurse advise the patient to report immediately? A. Excessive vaginal bleeding B. Headache and stiff neck C. Muscle pain and weakness D. Sudden onset of fever over 101.1ºF (38.4ºC) 9. A nurse is discussing contraceptive methods with a new patient. The patient is most interested in birth control pills. Which factor in her health history would be an absolute contraindication for using this method? A. Epilepsy/Seizure disorder B. Moderate hypertension C. Occasional migraine headaches D. Previous pulmonary embolism 10. A woman is being treated for infertility. The physician has prescribed a medication to stimulate follicle development. Which medication should the nurse begin teaching the patient about? A. Clomiphene citrate (Clomid) B. Luteinizing hormone (LH) C. Mifepristone (Mifeprex) D. Misoprostol (Cytotec) CHAPTER 11 REVIEW QUESTIONS: 1. A woman and her partner have experienced a miscarriage at 11 weeks’ gestation. They desire information about miscarriages. The nurse explains that the most common cause of miscarriage is A. nausea and vomiting in early pregnancy. B. prenatal stress. C. chromosomal abnormalities. D. umbilical cord accidents. 2. The perinatal nurse uses the acronym “SPASMS” to teach a new nurse about preeclampsia. What does the “P” refer to? A. Pregnancy B. Proteinuria C. Pelvic circulation D. Pressure 3. A woman is making an appointment in the perinatal clinic after suffering a spontaneous abortion. The nurse schedules extra time for this patient because it is critical to provide what nursing action at this time? A. Time to listen to her grief B. Information about risk factors C. A referral to a high-risk obstetrician D. Appropriate contraceptive information 4. A nurse is reviewing a patient's chart and notes that she has a history of “TORCH infection—T.” What infection has this woman had? A. Toxoplasmosis B. Trigeminal neuralgia C. Tricuspid insufficiency secondary to rheumatic fever D. Tetanus 5. A nurse is teaching a woman who is considering pregnancy in the near future. The woman lives with her husband who smokes; she drinks 2 glasses of wine a day and has both cats and dogs in the house. What action should the nurse suggest to prevent acquiring a TORCH infection? A. Ask the husband to smoke only outside. B. Stop drinking and avoid secondhand smoke. C. Avoid changing the kitty litter. D. Avoid blood and body fluids of other people. 6. A woman is discussing becoming pregnant at the age of 42. What important information should the nurse provide to this woman? A. Women older than 35 are more likely to experience obstetric complications. B. Women older than 40 have SABs at four times the normal rate. C. Women do not have more pregnancy-related problems until they reach their 50s. D. Women older than 40 should not consider having a vaginal birth. 7. A patient is scheduled to have a salpingostomy to treat an ectopic pregnancy. What information should the nurse teach this patient? A. The operation will prevent any further ectopic pregnancies. B. It is an incision into the fallopian tube to remove the pregnancy. C. You will have your entire fallopian tube removed in this procedure. D. This operation has a high risk of causing infertility. 8. A nurse notes that a pregnant patient has 3+ reflexes noted on her chart. How would the nurse describe this finding to a nursing student? A. Average or normal B. Presence of clonus C. Brisker than average D. No response 9. A woman presents to the OB unit in active labor. She has had no prenatal care and tells the nurse that the baby's father has gonorrhea. She has not been treated. For what complication is the newborn at most risk? A. Pneumonia B. Skin lesions C. Blindness D. Intellectual disability 10. A woman with systemic lupus erythematosus (SLE) is being seen for her first prenatal visit. What information about SLE should the nurse provide to this patient? A. Cardiac problems in the newborn present the biggest concern. B. Labor and delivery will most likely exacerbate your disease. C. If the disease flares during pregnancy, elective abortion is needed. D. Medications for SLE are all contraindicated in pregnancy. CHAPTER 15 REVIEW QUESTIONS: 1. In the preadmission clinic, the perinatal nurse describes the advantages to a short hospital stay as including which of the following? A. Decreased risk of nosocomial infection B. Increased rest and recuperation C. Increased opportunity to initiate successful breastfeeding D. Increased teaching about infant care 2. In the immediate postpartum period, the perinatal nurse knows that the postpartum woman most often has A. Bradycardia. B. Tachycardia. C. A pulse within the normal adult range. D. Tachycardia with a return of normal pulse within 4 hours. 3. The postpartum nurse expects a postpartum woman's bladder function to return to normal within what length of time? A. 2 to 4 hours B. 4 to 6 hours C. 6 to 8 hours D. 8 to 12 hours 4. A student nurse in the perinatal clinic sees a notation on the chart of a patient describing her as being in the “puerperium.” What explanation does the registered nurse provide the student? A. Time period when breastfeeding inhibits ovulation B. Time period when the infant loses weight after birth C. Time period from childbirth through 6 weeks postpartum D. Time period when risk of the “baby blues” is highest 5. A nurse performing a perineal assessment on a postpartum woman assists her into which position? A. Sim's B. Prone C. Supine D. Knee–chest 6. The perinatal nurse understands the term “subinvolution” to mean which of the following? A. Inverted uterus B. Abnormally small uterus C. Uterus not returned to prepregnant state D. Uterus with retained placental tissue 7. A nurse notes a postpartum woman's vaginal drainage as red fluid with a fleshy odor. How should the nurse document this finding? A. Lochia maxima B. Lochia alba C. Lochia serosa D. Lochia rubra 8. The nurse knows that during what time frame is a woman most likely to experience heart failure? A. First trimester B. Second trimester C. Third trimester D. Postpartum 9. The perinatal nurse understands the concept of attachment as which of the following? A. Promotion of a unique and powerful relationship between parent and baby B. The tie that exists between parent and baby; recognized as a feeling that binds C. Learning to care for the infant and knowing him or her well enough to anticipate needs D. An urge to protect the infant against the world, which may lead to overprotectiveness 10. During which time frame is the new mother most vulnerable to emotional difficulties? A. First 10 days postpartum B. First 3 months postpartum C. First 6 months postpartum D. First year postpartum CHAPTER 16 REVIEW QUESTIONS 1. As part of a postpartum woman's assessment, the perinatal nurse observes for signs and symptoms of hematoma formation. Which of the following is the most common anatomical site for a hematoma to form? A. Rectum B. Vulva C. Cervix D. Episiotomy site 2. The perinatal nurse promotes postpartum health and prevents infection with the inclusion of information about which concept? A. Good hand washing B. Early ambulation C. Minimal fluid intake D. Restricted protein intake 3. The perinatal nurse is providing information to a postpartum woman being discharged from the hospital on warfarin (Coumadin) therapy. Which drug would the nurse instruct the patient to restrict? A. Acetaminophen (Tylenol) B. Ibuprofen (Motrin) C. Prenatal vitamins D. Docusate sodium (Colace) 4. The perinatal nurse understands that a puerperal infection occurs within how many days after giving birth? A. 10 to 14 B. 15 to 30 C. Within 28 days D. Within 6 months 5. A nurse reads on a patient's chart that she has a clot in her superficial saphenous venous system. What condition should the nurse be prepared to treat? A. Pulmonary embolism B. Superficial venous thrombosis C. Deep venous thrombosis D. Uterine thrombophlebitis 6. A nurse is caring for a patient on IV heparin for a deep vein thrombosis. Which lab value should the nurse monitor as the priority? A. Hemoglobin B. INR C. PTT D. Platelet count 7. The nurse caring for postpartum patients understands that which of the following is the most common type of psychosocial disturbance seen in this population? A. Postpartum blues B. Postpartum depression C. Postpartum psychosis D. Postpartum mania 8. What teaching is important for the woman being treated with lithium for postpartum psychosis? A. Dental visits every 4 months B. Lithium levels drawn every 6 months C. Do not drink any citrus juices D. Use two types of birth control 9. The perinatal nurse is aware of the physical effects that maternal battering can have on a newborn. Which of the following is inconsistent with this knowledge? A. Low-birth-weight infant B. Preterm birth C. Neonatal death D. Prolonged labor 10. A perinatal nurse screens all patients for intimate partner violence. What technique is best when performing this screening? A. Asking direct questions about abuse B. Having the woman fill out a survey C. Scheduling a social worker to visit all new patients D. Distributing flyers that encourage reporting abuse CHAPTER 17 QUESTIONS: 1. The labor and delivery nurse knows that the newborn transition can take how long? A. Minutes to hours B. Minutes to days C. Several hours D. Several weeks 2. The labor and delivery nurse notes the term “acrocyanosis” on a newly born infant's chart. What action should the nurse take? A. Stimulate the infant B. Apply oxygen to the infant C. Continue to monitor D. Warm the baby more 3. The pediatric nurse knows that the foramen ovale is permanently closed in infants by what time frame? A. 24 hours B. 7 days C. 4 weeks D. 6 months 4. A new mother asks why her neonate prefers a flexed position. What information does the nurse provide? A. It is the baby's habit to get in that position. B. It helps to conserve heat. C. It is easy on the joints. D. It helps muscle development. 5. A nurse assesses a polycythemic infant for complications related to this condition. What finding would be inconsistent with neonatal polycythemia? A. Jaundice B. Hypoglycemia C. Respiratory distress D. Infection 6. What term does the nurse use to describe an infant who has chronic neurological problems associated with poorly treated infant jaundice? A. Kernicterus B. Cerebral palsy C. Minimal brain damage D. Acute bilirubin encephalopathy 7. A student nurse in the mother–baby unit is concerned because a neonate has passed a blackish-green, thick, sticky stool. What action by the registered nurse is best? A. Ask the student to document the stool. B. Perform a thorough gastrointestinal assessment. C. Notify the health-care provider. D. Ask if the mother is breast- or bottle-feeding. 8. The perinatal nurse explains to a student that an infant receives passive acquired immunity in which of the following ways? A. Immunizations and antibiotics B. Antibodies passing through the placenta C. Mother's exposure to illness D. Infusion of gamma-globulins 9. What purpose does REM sleep serve in the neonate? A. Allows for complete rest B. Promotes neural development C. Facilitates digestion D. Improves immunity 10. The perinatal nurse knows that the fetal ductus arteriosus closes and becomes what structure? A. Ligamentum teres B. Superior vesical artery C. Closed atrial septum D. Ligamentum arteriosum CHAPTER 18 REVIEW QUESTIONS 1. The nurse uses pre-warmed blankets to wrap the newborn at birth to prevent heat loss by which mechanism? A. Evaporation B. Convection C. Conduction D. Radiation 2. During the reflex assessment, the nurse places the infant in the prone position and strokes one side of the vertebral column. The nurse is assessing which reflex? A. Moro B. Galant C. Babinski D. Stepping 3. The perinatal nurse notes diffuse, soft tissue edema of an infant's head. How will the nurse chart this finding? A. Caput succedaneum B. Cephalhematoma C. Subperiosteal hemorrhage D. Periorbital edema 4. A newborn has the differential diagnosis of polycythemia after a heel stick was obtained at 1 hour of life. What result would the nurse correlate with this condition? A. Hemoglobin: 15.5 g/dL B. Hemoglobin: 23 g/dL C. Hematocrit: 54% D. Hematocrit: 68% 5. The perinatal nurse is caring for an infant with a minor congenital anomaly. What does the nurse understand about this type of defect? A. Affects one or more minor body systems only B. Structural defect impacting only social acceptability C. Defect that only has cosmetic or social significance D. Anomaly that can be corrected with minor surgery 6. A nurse reads the diagnosis “plethora” on an infant's chart. What assessment finding correlates with this condition? A. Pinpoint hemorrhagic areas on the skin B. Tough, leathery, cracked and peeling skin C. Deep purple color caused by too many red blood cells D. Blue discoloration of the soles and palms 7. A nurse sees that an infant's chart has a notation concerning Epstein pearls. What assessment technique does the nurse use to assess for this finding? A. Gently palpates the anterior and posterior fontanelles B. Shines a penlight into the infant's open mouth C. Palpates the skin for evidence of small nodules D. Inspects the skin for tiny, white, raised lesions 8. During hand-off report, the off-going nurse reports that a newborn is tachycardic. What heart rate does the nurse expect to find on assessment? A. 80 to 100 beats/minute B. 100 to 120 beats/minute C. Greater than 140 beats/minute D. Greater than 160 beats/minute 9. A nurse notes that a male infant's urinary meatus is located on the ventral surface of the penis. Which action by the nurse is best? A. Inform the parents that the planned circumcision cannot proceed. B. Have the urologist explain the modifications to the circumcision that are needed. C. Have the parents sign a consent form for an emergency surgical repair. D. Place an indwelling urinary catheter to facilitate bladder emptying. 10. A nurse assessing a newborn for birth injuries knows that the bone most often fractured during delivery is which of the following? A. Clavicle B. Femur C. Wrist D. Ankle CHAPTER 19 REVIEW Q’s 1. Immediate conditions that pose nursing concerns for the small-for-gestational-age (SGA) newborn include which of the following? A. Long-term chronic or end-of-life care B. Bronchopulmonary dysplasia and ischemia C. Muscle contractures and hyperthermia D. Hypothermia and pain management 2. Upon assessing the newborn, the nurse notes shallow rapid respirations, palmar sweating, decreased oxygen saturation, and a high-pitched cry. These clinical assessments are indicative of which of the following? A. A neurological problem B. Hypoglycemia C. Pain D. Transient tachypnea of the newborn (TTN) 3. A 24-hour-old newborn is being treated for hyper-bilirubinemia with phototherapy bilirubin lights. The patient is in an incubator fully undressed. Which of the following nursing actions are inconsistent with best practice for this type of infant? A. Apply eye patches and a covering over the genital area B. Administer proper nutrition to ensure the clearance of bilirubin C. Apply a head covering (stockinet hat) to prevent heat loss D. Maintain adequate hydration to promote excretion of bilirubin 4. A 42-week gestational-aged newborn is assessed 20 hours after delivery by the nurse. On assessment, the nurse auscultates rales and rhonchi and notes the newborn is tachypneic and has meconium-stained nails. The nurse suspects that the newborn has A. sepsis. B. meconium aspiration pneumonia. C. transient tachypnea of the newborn (TTN). D. respiratory distress syndrome (RDS). 5. A 30-week gestational-aged neonate has anemia of prematurity. The neonatologist has ordered recombinant human erythropoietin 250 units/kg subcutaneous 3 times a week. Which intervention does the nurse implement related to this medication? A. Administering the medication prior to feedings B. Applying pressure to the injection site for 5 min C. Assessing hematocrit levels as per hospital policy D. Assessing electrolyte levels weekly 6. A nurse is caring for a premature infant in the neonatal intensive care unit (NICU). When does the nurse begin discharge planning? A. On the baby's admission to the NICU B. 1 week prior to planned discharge C. When parents are able to learn about care D. When the baby is medically stable 7. A premature infant has frequent apnea episodes, and the physician orders mild stimulation when these occur. To perform this intervention correctly, what does the nurse do? A. Flick the heels of the infant's feet B. Increase the oxygen flow rate C. Shake the baby by the shoulders D. Speak loudly to the infant 8. A premature infant born at 35 weeks' gestational age is being discharged pending the results of an Infant Care Seat Challenge. During the testing, the infant has three episodes of apnea lasting longer than 20 seconds. Which action by the nurse is best? A. Arrange for the parents to get an apnea-bradycardia monitor for the trip B. Have the parents bring a different car seat to try with the infant C. Instruct the parents to use supplemental oxygen on the trip home D. Support the parents as they cope with the delay in the baby's discharge 9. A nurse assessing an infant notes the baby has been constipated, is lethargic, and is hypotonic. Which laboratory tests does the nurse anticipate being ordered? A. Complete blood count B. Direct bilirubin C. Hemoglobin and hematocrit D. Thyroxine and triiodothyronine 10. The charge nurse in the neonatal intensive care unit wants to create an atmosphere that is more conducive to developmental growth of their premature infants. Which nursing care action by the staff would best accomplish that goal? A. Instruct the nurses to use quiet gentle voices B. Maintain low, soothing lighting at all times C. Position infants with limbs in an extended position D. Wake the babies up every hour to stimulate them Answers to Chapter Review Questions Chapter 1 1. A 2. A 3. D 4. A 5. C 6. D 7. A 8. D 9. B 10. C Chapter 2 1. C 2. C 3. A 4. A 5. A 6. C 7. B 8. A 9. B 10. C Chapter 3 1. C 2. D 3. A 4. B 5. A 6. D 7. D 8. A 9. B 10. D Chapter 4 1. B 2. A 3. B 4. C 5. A 6. C 7. D 8. A 9. A 10. D Chapter 5 1. B 2. A 3. A 4. A 5. B 6. B 7. A 8. A 9. B 10. C Chapter 6 1. B 2. C 3. D 4. B 5. D 6. B 7. A 8. D 9. D 10. A Chapter 7 1. A 2. A 3. B 4. B 5. A 6. A 7. A 8. D 9. D 10. B Chapter 8 1. B 2. A 3. B 4. D 5. C 6. D 7. A 8. B 9. C 10. D Chapter 9 1. D 2. A 3. A 4. A 5. B 6. C 7. C 8. D 9. D 10. A Chapter 10 1. D 2. A 3. C 4. C 5. A 6. B 7. D 8. A 9. B 10. C Chapter 11 1. C 2. B 3. A 4. A 5. C 6. A 7. B 8. C 9. C 10. A Chapter 12 1. A 2. D 3. B 4. B 5. B 6. B 7. C 8. A 9. A 10. D Chapter 13 1. A 2. C 3. A 4. B 5. C 6. D 7. A 8. B 9. C 10. A Chapter 14 1. A 2. A 3. A 4. B 5. B 6. D 7. A 8. B 9. C 10. C Chapter 15 1. A 2. A 3. C 4. C 5. A 6. C 7. D 8. D 9. B 10. B Chapter 16 1. B 2. A 3. B 4. C 5. B 6. C 7. A 8. B 9. D 10. A Chapter 17 1. B 2. C 3. D 4. B 5. D 6. A 7. A 8. B 9. B 10. D Chapter 18 1. A 2. B 3. A 4. D 5. C 6. C 7. B 8. D 9. A 10. A Chapter 19 1. D 2. C 3. C 4. B 5. C 6. A 7. A 8. D 9. D 10. A Chapter 20 1. C 2. A 3. D 4. C 5. B 6. A 7. D 8. B 9. A 10. B Chapter 21 1. A 2. D 3. D 4. B 5. C 6. A 7. C 8. C 9. A 10. B Chapter 22 1. B 2. B 3. C 4. C 5. D 6. A 7. C 8. B 9. C 10. C Chapter 23 1. B 2. C 3. D 4. A 5. D 6. B 7. C 8. D 9. B 10. D Chapter 24 1. C 2. A 3. D 4. A 5. D 6. B 7. B 8. C 9. B 10. A Chapter 25 1. D 2. C 3. C 4. C 5. A 6. A 7. A 8. B 9. B 10. C Chapter 26 1. C 2. A 3. A 4. D 5. B 6. A 7. D 8. B 9. A 10. D Chapter 27 1. C 2. C 3. B 4. C 5. D 6. A 7. D 8. A 9. B 10. C Chapter 28 1. B 2. A 3. B 4. B 5. A 6. D 7. B 8. C 9. B 10. C Chapter 29 1. A 2. B 3. B 4. B 5. B 6. B 7. B 8. B 9. B 10. D Chapter 30 1. C 2. D 3. B 4. D 5. C 6. A 7. C 8. C 9. C 10. D Chapter 31 1. B 2. A 3. B 4. D 5. A 6. B 7. D 8. B 9. A 10. D Chapter 32 1. C 2. A 3. D 4. B 5. C 6. D 7. C 8. D 9. A 10. B Chapter 33 1. B 2. D 3. B 4. D 5. C 6. C 7. A 8. B 9. D 10. B Chapter 34 1. B 2. C 3. C 4. D 5. A 6. B 7. C 8. B 9. D 10. A Chapter 35 1. B 2. B 3. C 4. A 5. C 6. D 7. A 8. D 9. D 10. B

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