NCLEX UWORLD MATERNAL NEWBORN EXAM QUESTIONS AND ANSWERS

NCLEX UWORLD MATERNAL
NEWBORN EXAM QUESTIONS AND
ANSWERS
Uterine Atony - ANSWERS--"boggy" uterus
vx vx vx vx


-may lead to excessive blood loss and clots
vx vx vx vx vx vx vx


-FIRM fundal massagevx vx


-
if fundal massage causes uterus to become firm nurse should check every 15 minu
vx vx vx vx vx vx vx vx vx vx vx vx vx


tes for first hour after birth
vx vx vx vx vx


-if fundal massage does not work oxytocin may be necessary
vx vx vx vx vx vx vx vx vx




Lochia - ANSWERS-1. birth to 3-
vx vx vx vx vx


4 days after birth: lochia rubra, dark or bright red blood with some small clots
vx vx vx vx vx vx vx vx vx vx vx vx vx vx


2. 4-14 days after birth: lochia serosa, pink brownish decreasing in amount
vx vx vx vx vx vx vx vx vx vx vx


3. 11 days up to 6 weeks after birth: lochia alba, white color/creamy in light quantity
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx




Fetal Strip - ANSWERS--moderate variability expected and indicates movement
vx vx vx vx vx vx vx vx


-accelerations expected vx


-early decelerations are expected
vx vx vx


-late decelerations are cause for concern
vx vx vx vx vx




Late Decelerations - ANSWERS-
vx vx vx


CAUSED BY UTEROPLACENTAL INSUFFICIENCY
vx vx vx




-oxygen
-reposition on left side vx vx vx


-IV fluid bolus
vx vx


-notify HCP and prepare to stop oxytocin
vx vx vx vx vx vx




Presentations
1. cephalic
vx


2. breech
vx


3. prolapsed cord - ANSWERS-1. head down, diamond shape palpated
vx vx vx vx vx vx vx vx vx


2. legs down, fetal legs/buttocks/feet palpated
vx vx vx vx vx


3. soft/rubbery/pulsating structure, requires emergent c-
vx vx vx vx vx


section and mother to be on hands and knees & use sterile/
vx vx vx vx vx vx vx vx vx vx vx


gloved hand to relieve pressure on cord
vx vx vx vx vx vx




Spontaneous Rupture of Membranes - ANSWERS--sterile glovesvx vx vx vx vx vx


-nitrazine pH test strip: positive for amniotic fluid if blue color present on strip
vx vx vx vx vx vx vx vx vx vx vx vx vx




Stages of Labor - ANSWERS-1. latent (1-5 cm dilation) or active (6-
vx vx vx vx vx vx vx vx vx vx vx


10 cm dilation), < 100% effaced
vx vx vx vx vx


2. 10 cm (complete) dilation to birth, 100% effaced
vx vx vx vx vx vx vx vx


3. birth of baby and expulsion of placenta
vx vx vx vx vx vx vx

,4. 1-4 hours after birth, mother's physiologic readjustment
vx vx vx vx vx vx vx




Systemic Analgesia for Labor Pain - ANSWERS--
vx vx vx vx vx vx


given in stage 1 active labor ONLY
vx vx vx vx vx vx


-do not give to opioid dependent women
vx vx vx vx vx vx


-more than 3 doses not recommended d/t ceiling effect
vx vx vx vx vx vx vx vx


-ex. Stadol & Nubain
vx vx vx




*give at peak of contraction for best absorption
vx vx vx vx vx vx vx




Stable Labor - ANSWERS--stable maternal vital signs
vx vx vx vx vx vx


-fetus HR 110-160vx vx


-well established labor contractions
vx vx vx


-satisfactory contraction/fetal strip vx vx




Oxytocin - ANSWERS-STIMULATES UTERINE CONTRACTIONS
vx vx vx vx




RISKS
-late decelerations, bradycardia
vx vx


-emergency C-section vx


-postpartum hemorrhage vx


-water intoxication vx


-uterine tachysystole (>5 contractions in 10 minutes)
vx vx vx vx vx vx




-monitor every 15 minutes in first hour
vx vx vx vx vx vx


-contractions should be 2-3 minutes apart vx vx vx vx vx


-electronic IV pump vx vx


-continuous monitoring vx


-monitor mother's fluid intake vx vx vx


-secondary IV line vx vx


-titrated based on rate and intensity of contractions
vx vx vx vx vx vx vx




Placenta Accreta - ANSWERS- vx vx vx


PLACENTA IMPLANTS IN MYOMETRIUM AND NOT ENDOMETRIUM
vx vx vx vx vx vx




-detected through US vx vx


-prepare for potential hemorrhage
vx vx vx




Precipitous Birth - ANSWERS-lasts 3 hours from onset to birth
vx vx vx vx vx vx vx vx vx




Labor
1. true
vx


2. false - ANSWERS-
vx vx vx


1. regular intervals with increasing intensity, begins in lower back and radiates to a
vx vx vx vx vx vx vx vx vx vx vx vx vx


bdomen, pain increases despite comfort measures, increase in cervical dilation & ef
vx vx vx vx vx vx vx vx vx vx vx


facement, brown/mucoid discharge vx vx


2. irregular intervals, no increase in intensity, starts in lower back and radiates to gr
vx vx vx vx vx vx vx vx vx vx vx vx vx vx


oin, contractions may lessen with comfort measures, no cervical changes
vx vx vx vx vx vx vx vx vx




Group B Strep - ANSWERS--tested at 35-37 weeks gestation
vx vx vx vx vx vx vx vx

, -treated prophylactically with abx
vx vx vx




Choriamniotitis - ANSWERS-infection of amniotic fluid vx vx vx vx vx




Primigravida - ANSWERS-woman's first child vx vx vx vx




Fetal Positions vx


1. occiput
vx


2. anterior
vx


3. posterior - ANSWERS-1. head is in middle of pelvic bone
vx vx vx vx vx vx vx vx vx vx


2. face pointed towards mom's back
vx vx vx vx vx


2. face pointed towards mom's stomach
vx vx vx vx vx




*right or left vx vx


*occiput anterior is ideal vx vx vx




Pudendal Nerve Block - ANSWERS- vx vx vx vx


PAIN RELIEF METHOD GIVEN IN LATER STAGES OF LABOR
vx vx vx vx vx vx vx vx




-local anesthesia injected
vx vx


-does not relieve contraction pain but relieves pressure pain
vx vx vx vx vx vx vx vx




Preeclampsia - ANSWERS-HIGH MATERNAL BP vx vx vx vx




-seizure precautions (if seizure occurs place on left side)
vx vx vx vx vx vx vx vx


-
magnesium sulfate used to treat during labor (check deep tendon reflexes every ho
vx vx vx vx vx vx vx vx vx vx vx vx


ur, calcium gluconate is reversal agent)
vx vx vx vx vx


-limit environmental stimuli
vx vx


-
placental hemorrhage is major risk (watch for abdominal cramps and vaginal bleedi
vx vx vx vx vx vx vx vx vx vx vx


ng)

HELLP Syndrome (severe case)
vx vx vx


-hemolysis
-elevated liver enzymes vx vx


-low platelet count
vx vx


-sx: RUQ pain, nausea, vomiting, malaise
vx vx vx vx vx




MAGNESIUM SULFATE TOXICITY vx vx


-nausea, headache, hyporeflexia, cardiac arrest
vx vx vx vx


-tx: stop magnesium sulfate therapy & use IV calcium gluconate to reverse
vx vx vx vx vx vx vx vx vx vx vx




Adoption - ANSWERS--encourage mother to create memories with the newborn
vx vx vx vx vx vx vx vx vx


-give chance to say goodbye
vx vx vx vx


-notify other health care workers who may interact with client
vx vx vx vx vx vx vx vx vx


-reinforce adoption as a loving decision
vx vx vx vx vx