Answers | 2025 New Update | 100% Correct -
Galen College of Nursing
Terms in this set (107) QUIZZES VERIFIED ANSWERS
1) When assessing a newborn infant's 3. Count the heart rate for at least one
heart rate, which technique is most full minute.
important for the nurse to use?
It is most important for the nurse to
1. Quiet the infant before counting the count the heart rate for at least one full
heart rate. minute (C) so that irregularities or
2. Listen at the apex of the heart. murmurs can be detected. (A) is not
3. Count the heart rate for at least one necessary for the heart rate to be
full minute. correctly auscultated. The heart rate can
4. Palpate the umbilical cord be heard clearly over any point of an
infant's chest, not just (B). Immediately
after delivery, (D) will allow the nurse
, to assess the rate, but (B) is the most
accurate method of obtaining a
newborn's heart rate.
2) A client at 25-weeks gestation tells the 2. The fetus can respond to sound by
nurse that she dropped a cooking 24-weeks gestation.
utensil last week and her baby jumped
in response to the noise. What At 24-weeks gestation, the fetus's
information should the nurse provide? ability to hear loud environment sounds
can illicit a startle response (B).
1. This is a demonstration of the fetus's Acoustic stimulations can evoke a fetal
acoustical reflex. heart rate response and fetal movement,
2. The fetus can respond to sound by but (A and C) are inaccurate. (D) is not
24-weeks gestation. indicated.
3. It is a coincidence the fetus
responded at the same time.
4. Report the fetus's behavior to the
healthcare provider.
3) A client at 28-weeks gestation 3. Changes in fetal heart rate patterns.
experiences blunt abdominal trauma.
Which parameter should the nurse Hypoperfusion of the fetus may be
assess first for signs of internal present before the onset of clinical
hemorrhage? signs of maternal compromise or shock
in a pregnant woman, so the external
, 1. Vaginal bleeding. fetal monitor tracings should be
2. Complaints of abdominal pain. assessed first to determine signs of fetal
3. Changes in fetal heart rate patterns. hypoxia due to internal bleeding in the
4. Alteration in maternal blood pressure mother. (A, B, and D) are not the first
findings of internal hemorrhage in the
pregnant client.
4) The nurse assesses a male newborn and 3. Assess the infant's blood glucose
determines that he has the following level.
vital signs: axillary temperature 95.1 F,
heart rate 136 beats/minute and a The nurse should first assess the
respiratory rate 48 breaths/minute. infant's blood glucose level (C),
Based on these findings, which action because the infant is displaying signs of
should the nurse take first? hypothermia (normal newborn axillary
temperature is 96 to 98 F) and
1. Check the infant's arterial blood hypoglycemia may occur as glucose is
gases. metabolized in an effort to meet cellular
2. Notify the pediatrician of the infant's energy demands. The infant's
vital signs. respiratory and heart rates are within
3. Assess the infant's blood glucose normal limits, so (A) is not a priority.
level. (B and D) would be implemented after
4. Encourage the infant to take the information regarding the blood sugar
breast or sugar water. level has been obtained.
5) A client at 29-weeks gestation with 2. Ultrasonography.
, possible placental insufficiency is being
prepared for prenatal testing. Gestational age, fetal growth, and the
Information about which diagnostic status and position of the placenta are
study should the nurse provide monitored by ultrasound.
information to the client?
1. Amniocentesis.
2. Ultrasonography.
3. Chorionic villus sampling.
4. Maternal serum alpha-fetoprotein.
6) A multigravida client at 40+ weeks 2. Intensity of contractions is 130 mm
gestation is induced using oxytocin Hg.
(Pitocin). An intrauterine pressure
catheter (IUPC) is in place when the The goal of induction of labor with
client's membranes rupture after 5 oxytocin is to produce an effective
hours of active labor. Which finding labor, which can be measured by an
should require the nurse to implement IUPC reading of 40 to 90 mm Hg for
further action? contractions when giving oxytocin, so
(B) requires further intervention. (A, C,
1. Labor has progressed at 1 cm/hr and D) are goals for induction of labor
dilation. using oxytocin.
2. Intensity of contractions is 130 mm
Hg.