ATI - Maternal Newborn Dynamic Quiz

A nurse is teaching a client with pre-eclampsia who is scheduled to receive magnesium sulfate via continuous IV infusion about expected adverse effects. Which of the following adverse effects should the nurse include in the teaching

A. Elevated blood pressure

B. Feeling of warmth

C. Hyperactivity

D. Generalized pruritu?

B. Feeling of warmth

Magnesium sulfate can be used as a tocolytic, but is primarily used for fetal neuroprotection.

Relaxes smooth muscle

Why might magnesium sulfate be administered?

- Magnesium sulfate can be used as a tocolytic, but is primarily used for fetal neuroprotection.

- Relaxes smooth muscle

- Magnesium sulfate, a CNS depressant, has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus.

When is magnesium sulfate contraindicated?

Pulmonary edema

Renal failure

Myasthenia gravis (autoimmune disorder)

Tocolytics are medicines that are used to slow or stop what?

They are typically given to women who are in preterm labour to try to delay birth for 1 to 2 days.

Contractions of a woman's uterus during pregnancy

The nurse should tell the client to expect a ____________ all over her body while the magnesium sulfate is infusing.

feeling of warmth

Generalized pruritus can be a manifestation of an __________ to magnesium sulfate.

allergic reaction

What is generalized pruritus?

Itching sensation

The client should expect a decrease in ___________ while the magnesium sulfate is infusing.

blood pressure

A nurse is caring for a client who asks, "How will I know if I'm having true or false labor contractions?" Which of the following responses should the nurse make?

A. "True contractions will begin irregularly and then become regular in timing."

B. "True contractions will go away with ambulation."

C. "False contractions increase in frequency and duration the closer you are to your due date."

D. "False contractions are first felt in the pelvic area and then in the lower back and abdomen."

A. "True contractions will begin irregularly and then become regular in timing."

False contractions will usually go away if the client _________ or _________, whereas true contractions will continue regardless of the client's activity level.

ambulates

goes to sleep

False contractions do not increase in ________, _________, or _________ no matter how close the client is to her due date.

duration

frequency

intensity

If the frequency and duration are increasing, the contractions are considered ______ contractions.

true

False contractions are felt in the client's __________ and remain in the ________ and _______ area, whereas true contractions begin in the lower back and spread around to the abdomen.

abdomen

abdominal

groin

True contractions begin in the __________ and spread around to the __________.

lower back

abdomen

A nurse is teaching a parent of a newborn how to care for the newborn's umbilical cord stump. What instructions should the nurse include?

Clean the cord stump with tap water.

The nurse should instruct the parent to cleanse around the cord stump with _________ to promote healing and prevent infection.

tap water

Regarding the care of the umbilical cord stump, the nurse should instruct the parent to do what with the diaper?

Fold the edge of the diaper below the cord to ensure that it stays dry to promote healing and prevent infection

Regarding the care of the umbilical cord stump, the nurse should instruct the parent to keep the cord stump ______, ______, _________ and loosely covered by clothing.

clean

dry

open to the air

Regarding the care of the umbilical cord stump, the nurse should instruct the parent not to put _______ on or ________ the cord stump.

pressure

pull

The umbilical cord stump will dry and fall off naturally within ______ to _____ days after birth.

10 - 14

A nurse is performing a nonstress test (NST) on a client who is at 41 weeks of gestation. The client asks what the purpose of the test is. What explanation should the nurse provide?

This test will help determine if your baby is healthy.

The NST is used as a prenatal fetal assessment. It tracks __________ expected with fetal movement and can help identify fetal __________.

fetal heart rate patterns

distress

Fetal lung maturity is assessed by performing an ___________.

amniocentesis

A contraction stress test is used to assess the fetal response to ____________.

uterine contractions

The NST is used as a prenatal fetal assessment to measure certain expected patterns that occur with _________.

fetal movement

A nurse is caring for a client who is at 26 weeks gestation and reports constipation. What is an appropriate response from the nurse?

You should walk for at least 30 min every day

The nurse should encourage the client to participate in moderate physical activity, such as walking or swimming, every day. This activity increases __________, which will help alleviate constipation.

intestinal peristalsis

The client should NOT consume ________ to treat constipation during pregnancy because this can lead to severe cramping, diarrhea, fluid loss, and preterm contractions.

mineral oil

The nurse should not recommend a daily intake of ________ because it is high in iron and contributes to constipation.

red meat

A nurse is caring for a client in active labor whose membranes have ruptured. The fetal monitor tracing reveals late decelerations. What action should the nurse take first?

Turn the client onto her left side

The nurse should turn the client onto her left side since late decelerations indicate _____________. The client might be experiencing pressure on the ____________, which decreases the oxygen to the placenta and thus to the fetus. Turning the client onto her left side will relieve the pressure and facilitate better blood flow to the _________, thereby increasing the fetal oxygen supply.

uteroplacental insufficiency

inferior vena cava

placenta

What do late decelerations indicate? What is the priority action for the client?

uteroplacental insufficiency

turn the client onto her left side

Late decelerations indicate uteroplacental insufficiency. What causes this?

Pressure on the inferior vena cava which decreases the oxygen to the placenta and thus to the fetus

Turning the client onto her left side will relieve the pressure and facilitate better blood flow to the placenta, thereby increasing the fetal oxygen supply.

The nurse should administer oxygen at 8 to 10 L/min by nonrebreather facemask to enhance ___________.

placental perfusion

A nurse is caring for a client in labor whose cervix is dilated to 9 cm. She is experiencing strong contractions every 2 min lasting 75 sec. The nurse should recognize that the client is in which of the following phases or stages of labor?

Transition phase of first stage

The first stage ends with the transition phase in which the cervix dilates to 8 to 10 cm. Uterine contractions are strong, occurring every _____ to _____ minutes and lasting 45 to 90 seconds.

2 - 3

Which stage and/or phase of labor is characterized by some cervical effacement and dilation from 0 to 3 cm, with little progress in the descent of the presenting part?

Latent phase of the first stage of labor

The _________ within the first stage of labor is characterized by cervical dilation from 4 to 7 cm and significant descent of the presenting part. In this phase, the client has moderate to strong uterine contractions every 3 to 5 min that last 40 to 70 seconds.

C. The second stage begins with complete cervical dilation and ends with the birth of the newborn.

active phase

During the active phase of labor, describe the frequency and duration of uterine contractions.

every 3-5 minutes

lasting 40-70 seconds

What are the characteristics of the active phase of labor? Include cervical dilation, descent, and contractions.

Cervical dilation from 4 to 7 cm

Significant descent of the presenting part

Moderate to strong uterine contractions every 3 to 5 min that last 40 to 70 seconds

The second stage of labor begins with ___________ and ends with the _________.

complete cervical dilation

birth of the newborn

A nurse is assessing a newborn. For which of the following findings should the nurse notify the provider?

A. Heart rate 136/min

B. Acrocyanosis

C. Mottling

D. Respiratory rate 60/min

The nurse should report mottling to the provider as an indication of hypothermia or respiratory distress.

A bluish discoloration of the hands and feet, known as ________, is an expected finding in a newborn

acrocyanosis

When assessing a newborn, the nurse should notify the provider if the newborn's respiratory rate is under ____/min or above ____/min.

< 25/min

> 60/min

When assessing a newborn, the nurse should notify the provider if the newborn's heart rate is below ____/min while asleep or above ____/min while crying.

80/min

180/min

A nurse is assessing a client who delivered vaginally 8 hours ago. The nurse notes that the client's fundus is 2 fingerbreadths above the umbilicus and has shifted to the left, and there is a large amount of lochia rubra on the perineal pad. Which of action should the nurse take first?

Assist the client to the toilet

A nurse is assessing a client who delivered vaginally 8 hours ago. The nurse notes that the client's fundus is 2 fingerbreadths above the umbilicus and has shifted to the left, and there is a large amount of lochia rubra on the perineal pad. Why is helping the client to the toilet a priority action?

The client should first empty her bladder

Displacement of the fundus to the left indicates that the cause of the excessive bleeding is uterine atony due to bladder distention, so this action is the nurse's priority

A nurse is caring for a client who is in labor. What method will determine the frequency of the client's contractions?

Evaluating the time from the beginning of a contraction to the beginning of the next contraction

To calculate the frequency of contractions at any given point in time, measure the time from the _______ of one contraction to the _________ of the next.

beginning

beginning

Palpating the firmness of the uterus during a contraction measures the _________ or ________ of the contraction.

intensity

strength

How would the nurse determine the resting period between contractions?

Measuring the time from the end of one contraction to the beginning of the next

How would the nurse determine the duration of the contraction?

Measure the length of a contraction from beginning to end

A nurse is caring for a primigravid client who is at 8 weeks gestation with twins. The client states that even though she and her husband planned this pregnancy, she is experiencing ambivalent feelings about it. How should the nurse respond?

These feelings are quite normal at the beginning of pregnancy.

A nurse is caring for a client at 12 weeks gestation who has a BMI of 45. What piece of information should the nurse provide for the client regarding the recommended weight gain during her pregnancy?

You should plan to gain no more than 20 pounds during your pregnancy

Women who have a BMI above 30 should limit their weight gain to ____ to ____ pounds during pregnancy.

11 - 20

A nurse is performing a physical assessment of a male newborn. What finding should the nurse report to the provider?

There is decreased abdominal movement with breathing.

The nurse should expect the newborn to have diaphragmatic breathing with synchronous abdominal and chest movements.

Decreased abdominal movement with breathing is a deviation from an expected finding and could indicate ___________ or a ______________.

phrenic nerve palsy

congenital diaphragmatic hernia

Slightly thickened skin on the hands and feet with superficial cracking and peeling is ___________ in a newborn.

an expected finding

A palmar grasp that occurs spontaneously when sucking or when the palm is stroked is __________ in a newborn.

an expected finding

The testes should be palpable on each side and can present as a palpable bulge in the inguinal canal. This is ___________ in a newborn.

an expected finding

A nurse is assessing a client who reports that she might be pregnant. Which of the following findings should the nurse identify as a presumptive sign of pregnancy?

Nausea in the morning

Positive home pregnancy test

Increased sensitivity of the cervix noted upon examination

Gestational sac observed by transvaginal ultrasound

Nausea in the morning

Nausea is a presumptive sign of pregnancy—that is, a(n) _________ reported by the mother that could have a cause other than pregnancy.

subjective symptom

A home pregnancy test assesses for the presence of human chorionic gonadotrophin in the client's urine. The test is a(n)__________.

objective finding

A positive home pregnancy test could have other causes such as the presence of a hydatiform mole or certain cancers. Therefore, a positive home pregnancy test is considered a(n) ___________ of pregnancy.

probable sign

An increase in sensitivity of the cervix and vagina is a(n) ___________ noted by the examiner and a(n) ___________ of pregnancy.

objective finding

probable sign

Visualization of the gestational sac is a(n) ___________ that can only be attributed to pregnancy.

positive sign

A nurse is teaching the guardian of a newborn about caring for the newborn's umbilical cord. Why should the nurse instruct the guardian to avoid using antimicrobial agents on the cord?

They can cause delayed cord separation.

Swelling around the cord is indicative of what?

infection

A nurse is assessing a newborn who was circumcised 24 hours ago. What finding should the nurse report to the provider?

The newborn has urinated once since the circumcision.

A newborn should void ____ to ____ times a day the first 24 to 48 hours after birth and then ___ to ___times per day starting on the third day.

2 - 6

6 - 8

A scant amount of serosanguineous drainage is a(n) __________ 24 hours following a circumcision. __________ should be reported to the provider.

expected finding

Bright red bleeding

A ___________ forms on a circumcision site 24 hours after the procedure. This should not be removed and will remain for 2 to 3 days. ____ or _____ at the site should be reported to the provider.

yellow exudate

edema

odor

A newborn may fuss or cry during diaper changes and cleaning of the circumcision site until the site is healed. __________ should be reported to the provider.

Inconsolable crying

A nurse is assessing a newborn 1 min after birth and notes a heart rate of 136/min and respiratory rate of 36/min. The newborn has well-flexed extremities, responds to stimuli with a cry, and has blue hands and feet. Which Apgar score should the nurse assign to the newborn?

9

The nurse should use the Apgar scoring system to perform a quick assessment of the newborn at ________ and _______ after birth.

1 minutes

5 minutes

Apgar has ____ categories?

5

Regarding Apgar scoring, the nurse should assign a score of ___, ___, or ___ to each of 5 categories.

0, 1, or 2

Regarding Apgar scoring, the nurse should assign:

- a score of 2 for a heart rate ________

- a score of 2 for a _______ which shows normal respiratory effort

- a score of 2 for ________, which shows normal muscle tone

- a score of 2 for responding to stimulation with a ____, _____ or _____

- a score of 1 for ________, which is known as acrocyanosis

>100/min

good, strong cry

well-flexed extremities

cry, cough, or sneeze

blue hands and feet

A nurse is assessing a client who missed 2 menstrual cycles and reports that she might be pregnant. What would be a positive sign of pregnancy?

A. Quickening

B. Breast tenderness

C. Uterine enlargement

D. Auscultation of a fetal heart rate

Auscultation of a fetal heart rate

Quickening is the mother's report of feeling fetal movement. This is a(n) ____________ of pregnancy because it is client-reported and could have other causes.

presumptive sign

Breast tenderness is a(n) ___________ of pregnancy because it is client-reported and could have other causes.

presumptive sign

Uterine enlargement is a(n)__________ of pregnancy when detected by an examiner.

probable sign

While strongly suggestive of pregnancy, __________ are not conclusive.

probable signs

A nurse is assessing a 2-day-old newborn and notes an egg-shaped, edematous, bluish discoloration that does not cross the suture line. What information should the nurse provide to the mother when she asks about this finding?

This will resolve in 3 to 6 weeks without treatment.

This discoloration is a cephalhematoma, resulting from a collection of blood between the skull and periosteum.

A nurse is providing discharge teaching to a client following the removal of a hydatidiform mole. Which of the following statements should the nurse include in the teaching?

Do not become pregnant for at least 1 year.

_____________ are uncontrolled growths in the uterus arising from placental or fetal tissue in early pregnancy.

Hydatidiform moles

A baseline human chorionic gonadotropin (hCG) level should be obtained following the evacuation of the hydatidiform mole and then _________ until levels are normal for __________.

weekly

3 consecutive weeks

A baseline human chorionic gonadotropin (hCG) level should be obtained following the evacuation of the hydatidiform mole and then weekly until levels are normal for 3 consecutive weeks. Then, additional hCG levels should be obtained every ____ weeks for the next ____ to ____ months.

4

6 - 12

Although the exact cause of molar pregnancies is unknown, it is not believed to be ________.

genetic

There is an increased incidence of ____________ associated with molar pregnancies.

choriocarcinoma

Molar pregnancies tend to cause ___________. However, this manifestation usually disappears once the abnormal products of conception are evacuated.

hypertension

A nurse is evaluating a client who has just received instructions about breastfeeding. What statement should the nurse identify as an indication that the client understands how to prevent mastitis?

I should avoid waiting too long between feedings.

The inflammation or infection of the breast is known as ________.

Mastitis

Identify 7 factors that can increase the risk of developing mastitis.

insufficient emptying of the breasts during breastfeeding

stress

illness

poor nutrition

fatigue

underwire bras

abruptly stopping breastfeeding

For cracked nipples, the client should ____________ after breastfeeding and then ______________ to prevent infection.

rinse the nipples with water

apply a thin coating of an antibiotic ointment

The nurse should recommend applying a ______ compresses for a client who has mastitis.

warm

A nurse is caring for a client who is in labor. The nurse decides to switch from intermittent auscultation to continuous fetal monitoring. What type of data can only be obtained from continuous electronic fetal monitoring?

Determination of variability

______________ is required to determine variability since the nurse needs a monitor tracing to quantify variability.

Continuous electronic fetal monitoring

A nurse is caring for a client who is in labor. The client speaks a different language than the nurse and is grimacing. What action should the nurse take while waiting for an interpreter?

Change the client's position

A nurse is providing discharge instructions for a client who had a cesarean birth 4 days ago. The client's hemoglobin level is 9.2 g/dL, and the provider has prescribed an iron supplement. Which foods should the nurse recommend to help increase absorption of the iron supplement at the time of administration?

Foods that have a high vitamin C content help to increase the absorption of iron supplements. These foods include citrus fruits, strawberries, melons, and tomatoes.