UWORLD MATERNAL & NEWBORN
EXAM QUESTIONS AND ANSWERS
The nurse is caring for a client at 39 weeks gestation in active labor who is receivin
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
g an oxytocin infusion. The nurse notes persistent late decelerations on the fetal m
vx vx vx vx vx vx vx vx vx vx vx vx vx
onitor. Which of the following actions should the nurse take? Select all that apply.
vx vx vx vx vx vx vx vx vx vx vx vx vx
1.
Administer oxygen via a nonrebreather face mask vx vx vx vx vx vx
2.
Change maternal position to the left side
vx vx vx vx vx vx
3.
Discontinue the oxytocin infusion vx vx vx
4.
Notify the health care provider
vx vx vx vx
5.
Perform a nitrazine test - ANSWERS-1,2,3,4
vx vx vx vx vx
The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FHR
vx vx vx vx vx vx vx vx vx vx vx vx vx
) changes noted on monitor tracings.
vx vx vx vx vx
A late deceleration is a decrease in FHR that begins after a contraction, reaches its
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
vxlowest point (nadir) after the contraction peak, and then gradually returns to baseli
vx vx vx vx vx vx vx vx vx vx vx vx
ne. Late decelerations indicate impaired fetal oxygenation associated with decrease
vx vx vx vx vx vx vx vx vx
d uteroplacental perfusion (eg, due to maternal hypotension after epidural placeme
vx vx vx vx vx vx vx vx vx vx
nt or uterine tachysystole). Chronic uteroplacental insufficiency (eg, intrauterine gro
vx vx vx vx vx vx vx vx vx
wth restriction, preeclampsia, diabetes) may also cause late decelerations.
vx vx vx vx vx vx vx vx
Nursing actions to improve fetal perfusion and oxygenation include:
vx vx vx vx vx vx vx vx
Discontinuing uterotonics (eg, oxytocin [Pitocin]) to reduce uterine activity (Option 3
vx vx vx vx vx vx vx vx vx vx
)
Changing maternal position to the left side to relieve compression of the inferior ve
vx vx vx vx vx vx vx vx vx vx vx vx vx
na cava. If the FHR tracing does not improve, a right-
vx vx vx vx vx vx vx vx vx vx
side position may be attempted (Option 2)
vx vx vx vx vx vx
Administering oxygen at 8-10 L/ vx vx vx vx
min via nonrebreather face mask to promote fetal oxygenation (Option 1)
vx vx vx vx vx vx vx vx vx vx
Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve p
vx vx vx vx vx vx vx vx vx vx vx vx vx
lacental perfusion, especially during maternal hypotension
vx vx vx vx vx
Notifying the health care provider (Option 4)
vx vx vx vx vx vx
(Option 5) Nitrazine pH tests are used to detect leaking amniotic fluid, most often if
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
premature (prelabor) rupture of membranes is suspected. This client is at term and
vx vx vx vx vx vx vx vx vx vx vx vx vx
in active labor.
vx vx
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
vx vx vx vx vx vx vx vx vx vx vx vx
at does the nurse suggest to help prevent reflux? Select all that apply.
vx vx vx vx vx vx vx vx vx vx vx vx
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
vx vx vx vx vx vx vx vx vx vx vx vx
at does the nurse suggest to help prevent reflux? Select all that apply.
vx vx vx vx vx vx vx vx vx vx vx vx
1.
Burp during and after feeds
vx vx vx vx
,2.
Engage baby in active play after the feeding
vx vx vx vx vx vx vx
3.
Feed baby in side-lying position
vx vx vx vx
4.
Hold baby upright 20-30 minutes after each feeding
vx vx vx vx vx vx vx
5.
Offer smaller but more frequent feeds
vx vx vx vx vx
6.
Place baby on tummy after feeding - ANSWERS-1,4,5
vx vx vx vx vx vx vx
Gastroesophageal reflux (GER) is attributed to an immature lower esophageal sphi vx vx vx vx vx vx vx vx vx vx
ncter. It is common in infants age ≤3 months and results in spitting up after feeds. I
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
f an infant is gaining weight and meeting developmental milestones, treatment is ai
vx vx vx vx vx vx vx vx vx vx vx vx
med at controlling the symptoms. Because infants with GER are at risk for aspiratio
vx vx vx vx vx vx vx vx vx vx vx vx vx
n and apnea, caregivers should be instructed in cardiopulmonary resuscitation.
vx vx vx vx vx vx vx vx vx
Burping the baby frequently helps expel trapped air before milk builds up over it. If t
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
here is milk over an air pocket, the milk will come up with the burp (Option 1).
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
Holding the baby upright for 20- vx vx vx vx vx
30 minutes after feedings allows gravity to assist in keeping the food in the stomac
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
h while the stomach settles (Option 4).
vx vx vx vx vx vx
A nurse is teaching the parent how to care for a newly circumcised newborn. Whic
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
h statement by the parent indicates that further teaching is needed?
vx vx vx vx vx vx vx vx vx vx
1.
"Discharge and odor indicate infection of the circumcision site."
vx vx vx vx vx vx vx vx
2.
"I will clean the area with alcohol-based wipes or soap water."
vx vx vx vx vx vx vx vx vx vx
3.
"Infant crying during petrolatum gauze changes is expected."
vx vx vx vx vx vx vx
4.
"The diaper should be changed at least every 4 hours." - ANSWERS-2.
vx vx vx vx vx vx vx vx vx vx vx
Common complications of circumcision include hemorrhage, infection, and voiding
vx vx vx vx vx vx vx vx vx
difficulty. Parents should clean the area with warm water (without soap) to remove
vx vx vx vx vx vx vx vx vx vx vx vx vx
urine and feces and prevent infection. Prepackaged alcohol-
vx vx vx vx vx vx vx
based wipes delay healing and cause discomfort; they should be avoided until the
vx vx vx vx vx vx vx vx vx vx vx vx vx
circumcision site has healed (usually takes 5-6 days). vx vx vx vx vx vx vx
a newly circumcised infant should have diapers changed every - ANSWERS-
vx vx vx vx vx vx vx vx vx vx
4 hrs or when soiled
vx vx vx vx
The precepting nurse is supervising a new obstetric nurse performing a labor admis
vx vx vx vx vx vx vx vx vx vx vx vx
sion assessment on a client with suspected spontaneous rupture of membranes. W
vx vx vx vx vx vx vx vx vx vx vx
hich action by the new nurse would cause the precepting nurse to intervene?
vx vx vx vx vx vx vx vx vx vx vx vx
1.
Documenting a positive nitrazine test result when the test strip turns blue
vx vx vx vx vx vx vx vx vx vx vx
2.
Donning nonsterile gloves and using soluble gel for vaginal examination
vx vx vx vx vx vx vx vx vx
, 3.
Palpating the client's abdomen before applying external fetal monitors
vx vx vx vx vx vx vx vx
4.
Providing the client with a variety of clear liquids to drink - ANSWERS-2.
vx vx vx vx vx vx vx vx vx vx vx vx
The nurse should use a sterile glove during vaginal examination in the presence of
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
ruptured membranes to prevent infection. Use of nonsterile gloves and instruments
vx vx vx vx vx vx vx vx vx vx vx
during vaginal examinations increases the risk of infection in the laboring client or f
vx vx vx vx vx vx vx vx vx vx vx vx vx
etus (eg, chorioamnionitis).
vx vx
(Option 1) A nitrazine pH test strip inserted into the vagina can differentiate betwee
vx vx vx vx vx vx vx vx vx vx vx vx vx
n amniotic fluid, which is alkaline, and vaginal fluid, which is acidic. A blue-
vx vx vx vx vx vx vx vx vx vx vx vx vx
green, blue- vx
gray, or deep blue color indicates a positive result and probable rupture of membra
vx vx vx vx vx vx vx vx vx vx vx vx vx
nes. A yellow, olive-
vx vx vx
yellow, or olive green color indicates a negative result and suggests that membrane
vx vx vx vx vx vx vx vx vx vx vx vx
s are intact.
vx vx
(Option 3) Leopold maneuvers help determine fetal presentation and involve syste
vx vx vx vx vx vx vx vx vx vx
matic palpation of the client's abdomen. These maneuvers assist the nurse in locati
vx vx vx vx vx vx vx vx vx vx vx vx
ng the fetal back for optimal placement of the ultrasound transducer for external fet
vx vx vx vx vx vx vx vx vx vx vx vx vx
al heart monitoring.
vx vx
(Option 4) Hospital policy, provider preference, and the client risk profile will dictate
vx vx vx vx vx vx vx vx vx vx vx vx v
xappropriate oral intake during labor. However, there is no evidence to support NPO
vx vx vx vx vx vx vx vx vx vx vx vx
status of low-
vx vx vx
risk laboring clients, and most clients benefit from hydration provided by oral clear li
vx vx vx vx vx vx vx vx vx vx vx vx vx
quids during labor. vx vx
Educational objective: vx
Vaginal examinations of the laboring client with ruptured membranes should be perf
vx vx vx vx vx vx vx vx vx vx vx
ormed using a sterile glove to decrease the risk of infection (eg, chorioamnionitis) t
vx vx vx vx vx vx vx vx vx vx vx vx vx
o the client and fetus. Other labor admission interventions include application of ext
vx vx vx vx vx vx vx vx vx vx vx vx
ernal fetal monitoring and performance of a nitrazine pH test to determine if membr
vx vx vx vx vx vx vx vx vx vx vx vx vx
anes have ruptured. vx vx
The nurse is preparing to assess a client visiting the women's health clinic. The clie
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
nt's obstetric history is documented as G5T1P2A1L2. Which interpretation of this n
vx vx vx vx vx vx vx vx vx vx vx
otation is correct? vx vx
1.
The client had 1 birth at 37 wk 0 d gestation or beyond
vx vx vx vx vx vx vx vx vx vx vx vx
2.
The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
3.
The client has 3 currently living children
vx vx vx vx vx vx
4.
The client is currently not pregnant - ANSWERS-1.
vx vx vx vx vx vx vx
This client (G5T1P2A1L2) has been pregnant 5 times (G5); had 1 term birth (T1), 2
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
preterm births (P2), and 1 abortion (A1); and has 2 currently living children (L2). T
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
he client's term birth is indicated by the T1 portion of the GTPAL notation (Option 1
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
).
(Option 2) The client had 2 preterm births, indicated by the P2 portion of the GTPA
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
L notation.
vx
EXAM QUESTIONS AND ANSWERS
The nurse is caring for a client at 39 weeks gestation in active labor who is receivin
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
g an oxytocin infusion. The nurse notes persistent late decelerations on the fetal m
vx vx vx vx vx vx vx vx vx vx vx vx vx
onitor. Which of the following actions should the nurse take? Select all that apply.
vx vx vx vx vx vx vx vx vx vx vx vx vx
1.
Administer oxygen via a nonrebreather face mask vx vx vx vx vx vx
2.
Change maternal position to the left side
vx vx vx vx vx vx
3.
Discontinue the oxytocin infusion vx vx vx
4.
Notify the health care provider
vx vx vx vx
5.
Perform a nitrazine test - ANSWERS-1,2,3,4
vx vx vx vx vx
The mnemonic VEAL CHOP may help nurses recall causes of fetal heart rate (FHR
vx vx vx vx vx vx vx vx vx vx vx vx vx
) changes noted on monitor tracings.
vx vx vx vx vx
A late deceleration is a decrease in FHR that begins after a contraction, reaches its
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
vxlowest point (nadir) after the contraction peak, and then gradually returns to baseli
vx vx vx vx vx vx vx vx vx vx vx vx
ne. Late decelerations indicate impaired fetal oxygenation associated with decrease
vx vx vx vx vx vx vx vx vx
d uteroplacental perfusion (eg, due to maternal hypotension after epidural placeme
vx vx vx vx vx vx vx vx vx vx
nt or uterine tachysystole). Chronic uteroplacental insufficiency (eg, intrauterine gro
vx vx vx vx vx vx vx vx vx
wth restriction, preeclampsia, diabetes) may also cause late decelerations.
vx vx vx vx vx vx vx vx
Nursing actions to improve fetal perfusion and oxygenation include:
vx vx vx vx vx vx vx vx
Discontinuing uterotonics (eg, oxytocin [Pitocin]) to reduce uterine activity (Option 3
vx vx vx vx vx vx vx vx vx vx
)
Changing maternal position to the left side to relieve compression of the inferior ve
vx vx vx vx vx vx vx vx vx vx vx vx vx
na cava. If the FHR tracing does not improve, a right-
vx vx vx vx vx vx vx vx vx vx
side position may be attempted (Option 2)
vx vx vx vx vx vx
Administering oxygen at 8-10 L/ vx vx vx vx
min via nonrebreather face mask to promote fetal oxygenation (Option 1)
vx vx vx vx vx vx vx vx vx vx
Giving prescribed IV bolus of lactated Ringer solution or normal saline to improve p
vx vx vx vx vx vx vx vx vx vx vx vx vx
lacental perfusion, especially during maternal hypotension
vx vx vx vx vx
Notifying the health care provider (Option 4)
vx vx vx vx vx vx
(Option 5) Nitrazine pH tests are used to detect leaking amniotic fluid, most often if
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
premature (prelabor) rupture of membranes is suspected. This client is at term and
vx vx vx vx vx vx vx vx vx vx vx vx vx
in active labor.
vx vx
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
vx vx vx vx vx vx vx vx vx vx vx vx
at does the nurse suggest to help prevent reflux? Select all that apply.
vx vx vx vx vx vx vx vx vx vx vx vx
The nurse is teaching the mother of a newborn about gastroesophageal reflux. Wh
vx vx vx vx vx vx vx vx vx vx vx vx
at does the nurse suggest to help prevent reflux? Select all that apply.
vx vx vx vx vx vx vx vx vx vx vx vx
1.
Burp during and after feeds
vx vx vx vx
,2.
Engage baby in active play after the feeding
vx vx vx vx vx vx vx
3.
Feed baby in side-lying position
vx vx vx vx
4.
Hold baby upright 20-30 minutes after each feeding
vx vx vx vx vx vx vx
5.
Offer smaller but more frequent feeds
vx vx vx vx vx
6.
Place baby on tummy after feeding - ANSWERS-1,4,5
vx vx vx vx vx vx vx
Gastroesophageal reflux (GER) is attributed to an immature lower esophageal sphi vx vx vx vx vx vx vx vx vx vx
ncter. It is common in infants age ≤3 months and results in spitting up after feeds. I
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
f an infant is gaining weight and meeting developmental milestones, treatment is ai
vx vx vx vx vx vx vx vx vx vx vx vx
med at controlling the symptoms. Because infants with GER are at risk for aspiratio
vx vx vx vx vx vx vx vx vx vx vx vx vx
n and apnea, caregivers should be instructed in cardiopulmonary resuscitation.
vx vx vx vx vx vx vx vx vx
Burping the baby frequently helps expel trapped air before milk builds up over it. If t
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
here is milk over an air pocket, the milk will come up with the burp (Option 1).
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
Holding the baby upright for 20- vx vx vx vx vx
30 minutes after feedings allows gravity to assist in keeping the food in the stomac
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
h while the stomach settles (Option 4).
vx vx vx vx vx vx
A nurse is teaching the parent how to care for a newly circumcised newborn. Whic
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
h statement by the parent indicates that further teaching is needed?
vx vx vx vx vx vx vx vx vx vx
1.
"Discharge and odor indicate infection of the circumcision site."
vx vx vx vx vx vx vx vx
2.
"I will clean the area with alcohol-based wipes or soap water."
vx vx vx vx vx vx vx vx vx vx
3.
"Infant crying during petrolatum gauze changes is expected."
vx vx vx vx vx vx vx
4.
"The diaper should be changed at least every 4 hours." - ANSWERS-2.
vx vx vx vx vx vx vx vx vx vx vx
Common complications of circumcision include hemorrhage, infection, and voiding
vx vx vx vx vx vx vx vx vx
difficulty. Parents should clean the area with warm water (without soap) to remove
vx vx vx vx vx vx vx vx vx vx vx vx vx
urine and feces and prevent infection. Prepackaged alcohol-
vx vx vx vx vx vx vx
based wipes delay healing and cause discomfort; they should be avoided until the
vx vx vx vx vx vx vx vx vx vx vx vx vx
circumcision site has healed (usually takes 5-6 days). vx vx vx vx vx vx vx
a newly circumcised infant should have diapers changed every - ANSWERS-
vx vx vx vx vx vx vx vx vx vx
4 hrs or when soiled
vx vx vx vx
The precepting nurse is supervising a new obstetric nurse performing a labor admis
vx vx vx vx vx vx vx vx vx vx vx vx
sion assessment on a client with suspected spontaneous rupture of membranes. W
vx vx vx vx vx vx vx vx vx vx vx
hich action by the new nurse would cause the precepting nurse to intervene?
vx vx vx vx vx vx vx vx vx vx vx vx
1.
Documenting a positive nitrazine test result when the test strip turns blue
vx vx vx vx vx vx vx vx vx vx vx
2.
Donning nonsterile gloves and using soluble gel for vaginal examination
vx vx vx vx vx vx vx vx vx
, 3.
Palpating the client's abdomen before applying external fetal monitors
vx vx vx vx vx vx vx vx
4.
Providing the client with a variety of clear liquids to drink - ANSWERS-2.
vx vx vx vx vx vx vx vx vx vx vx vx
The nurse should use a sterile glove during vaginal examination in the presence of
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
ruptured membranes to prevent infection. Use of nonsterile gloves and instruments
vx vx vx vx vx vx vx vx vx vx vx
during vaginal examinations increases the risk of infection in the laboring client or f
vx vx vx vx vx vx vx vx vx vx vx vx vx
etus (eg, chorioamnionitis).
vx vx
(Option 1) A nitrazine pH test strip inserted into the vagina can differentiate betwee
vx vx vx vx vx vx vx vx vx vx vx vx vx
n amniotic fluid, which is alkaline, and vaginal fluid, which is acidic. A blue-
vx vx vx vx vx vx vx vx vx vx vx vx vx
green, blue- vx
gray, or deep blue color indicates a positive result and probable rupture of membra
vx vx vx vx vx vx vx vx vx vx vx vx vx
nes. A yellow, olive-
vx vx vx
yellow, or olive green color indicates a negative result and suggests that membrane
vx vx vx vx vx vx vx vx vx vx vx vx
s are intact.
vx vx
(Option 3) Leopold maneuvers help determine fetal presentation and involve syste
vx vx vx vx vx vx vx vx vx vx
matic palpation of the client's abdomen. These maneuvers assist the nurse in locati
vx vx vx vx vx vx vx vx vx vx vx vx
ng the fetal back for optimal placement of the ultrasound transducer for external fet
vx vx vx vx vx vx vx vx vx vx vx vx vx
al heart monitoring.
vx vx
(Option 4) Hospital policy, provider preference, and the client risk profile will dictate
vx vx vx vx vx vx vx vx vx vx vx vx v
xappropriate oral intake during labor. However, there is no evidence to support NPO
vx vx vx vx vx vx vx vx vx vx vx vx
status of low-
vx vx vx
risk laboring clients, and most clients benefit from hydration provided by oral clear li
vx vx vx vx vx vx vx vx vx vx vx vx vx
quids during labor. vx vx
Educational objective: vx
Vaginal examinations of the laboring client with ruptured membranes should be perf
vx vx vx vx vx vx vx vx vx vx vx
ormed using a sterile glove to decrease the risk of infection (eg, chorioamnionitis) t
vx vx vx vx vx vx vx vx vx vx vx vx vx
o the client and fetus. Other labor admission interventions include application of ext
vx vx vx vx vx vx vx vx vx vx vx vx
ernal fetal monitoring and performance of a nitrazine pH test to determine if membr
vx vx vx vx vx vx vx vx vx vx vx vx vx
anes have ruptured. vx vx
The nurse is preparing to assess a client visiting the women's health clinic. The clie
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
nt's obstetric history is documented as G5T1P2A1L2. Which interpretation of this n
vx vx vx vx vx vx vx vx vx vx vx
otation is correct? vx vx
1.
The client had 1 birth at 37 wk 0 d gestation or beyond
vx vx vx vx vx vx vx vx vx vx vx vx
2.
The client had 3 births between 20 wk 0 d and 36 wk 6 d gestation
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
3.
The client has 3 currently living children
vx vx vx vx vx vx
4.
The client is currently not pregnant - ANSWERS-1.
vx vx vx vx vx vx vx
This client (G5T1P2A1L2) has been pregnant 5 times (G5); had 1 term birth (T1), 2
vx vx vx vx vx vx vx vx vx vx vx vx vx vx
preterm births (P2), and 1 abortion (A1); and has 2 currently living children (L2). T
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
he client's term birth is indicated by the T1 portion of the GTPAL notation (Option 1
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
).
(Option 2) The client had 2 preterm births, indicated by the P2 portion of the GTPA
vx vx vx vx vx vx vx vx vx vx vx vx vx vx vx
L notation.
vx
