Podcast
Questions and Answers
Which of the following findings should the nurse report to the provider? (Select all that apply)
Which of the following findings should the nurse report to the provider? (Select all that apply)
- Condom usage (correct)
- Dyspareunia (correct)
- Vaginal discharge (correct)
- Heart rate
- Abdominal assessment (correct)
- Temperature (correct)
Which of the following conditions should the nurse identify as being consistent with the adolescent's assessment findings? (Select all that apply)
Which of the following conditions should the nurse identify as being consistent with the adolescent's assessment findings? (Select all that apply)
- Diabetes - candidiasis
- Absence of condom use - trichomoniasis and gonorrhea (correct)
- Greenish discharge - trichomoniasis and gonorrhea (correct)
- Pain on urination - trichomoniasis, gonorrhea and candidiasis (correct)
- Abdominal pain - gonorrhea (correct)
Which condition is the client most likely developing?
Which condition is the client most likely developing?
PID
Which of the following prescriptions should the nurse expect the provider to prescribe?
Which of the following prescriptions should the nurse expect the provider to prescribe?
The nurse is reviewing the provider's prescriptions in the adolescent's medical chart. Complete the following sentence: The nurse is responsible for ______
The nurse is reviewing the provider's prescriptions in the adolescent's medical chart. Complete the following sentence: The nurse is responsible for ______
Which statement indicates that the adolescent understands the discharge instructions?
Which statement indicates that the adolescent understands the discharge instructions?
What indicates the first step of Leopold maneuvers?
What indicates the first step of Leopold maneuvers?
After calling for assistance, which action should the nurse take when observing the umbilical cord protruding from the vagina?
After calling for assistance, which action should the nurse take when observing the umbilical cord protruding from the vagina?
Which actions are the nurse's priorities? (Select the 4 actions that the nurse should take immediately)
Which actions are the nurse's priorities? (Select the 4 actions that the nurse should take immediately)
Which manifestation is an indication of hypoglycemia in a late preterm newborn?
Which manifestation is an indication of hypoglycemia in a late preterm newborn?
For which complication should the nurse assess in a client who has admitted to recent cocaine use?
For which complication should the nurse assess in a client who has admitted to recent cocaine use?
Which instruction should the nurse include in the teaching for a client at 40 weeks of gestation with a new prescription for misoprostol?
Which instruction should the nurse include in the teaching for a client at 40 weeks of gestation with a new prescription for misoprostol?
Which manifestation should the nurse report to the provider for a newborn assessed 12 hours after birth?
Which manifestation should the nurse report to the provider for a newborn assessed 12 hours after birth?
Which finding should the nurse report to the provider for a client at 26 weeks of gestation?
Which finding should the nurse report to the provider for a client at 26 weeks of gestation?
Which manifestation should the nurse expect in a client who is 1 day postpartum with a vaginal hematoma?
Which manifestation should the nurse expect in a client who is 1 day postpartum with a vaginal hematoma?
Which client should the nurse see first?
Which client should the nurse see first?
Which findings should the nurse report to the provider? (Select all that apply)
Which findings should the nurse report to the provider? (Select all that apply)
Which technique should the nurse use to help minimize the pain of the heel stick procedure for the newborn?
Which technique should the nurse use to help minimize the pain of the heel stick procedure for the newborn?
In which order should the nurse perform the following actions when bathing a newborn?
In which order should the nurse perform the following actions when bathing a newborn?
Which of the following actions should the nurse include in the plan of care for a newborn undergoing phototherapy for hyperbilirubinemia?
Which of the following actions should the nurse include in the plan of care for a newborn undergoing phototherapy for hyperbilirubinemia?
Which outcome should the nurse expect after administering betamethasone to a client who is anemic and in preterm labor?
Which outcome should the nurse expect after administering betamethasone to a client who is anemic and in preterm labor?
Which client statement indicates an understanding of newborn safety teaching?
Which client statement indicates an understanding of newborn safety teaching?
Which finding is an adverse effect of carboprost for postpartum hemorrhage?
Which finding is an adverse effect of carboprost for postpartum hemorrhage?
Which finding should the nurse identify as a risk factor for the development of preeclampsia?
Which finding should the nurse identify as a risk factor for the development of preeclampsia?
For what reason should the nurse prepare a client for an ultrasound before amniocentesis?
For what reason should the nurse prepare a client for an ultrasound before amniocentesis?
Which manifestations should the nurse expect upon assessing a newborn? (Select all that apply)
Which manifestations should the nurse expect upon assessing a newborn? (Select all that apply)
What should the nurse do immediately after turning a client’s head during a seizure?
What should the nurse do immediately after turning a client’s head during a seizure?
How many mL/hr should the nurse set the IV infusion pump for magnesium sulfate?
How many mL/hr should the nurse set the IV infusion pump for magnesium sulfate?
Which suggestion should the nurse make to help a 7-year-old child accept a new sibling?
Which suggestion should the nurse make to help a 7-year-old child accept a new sibling?
Which statement indicates a client's understanding of nutritional needs during pregnancy?
Which statement indicates a client's understanding of nutritional needs during pregnancy?
Which client statement about physiological changes during pregnancy indicates understanding?
Which client statement about physiological changes during pregnancy indicates understanding?
Which finding should the nurse report to the provider during a prenatal visit?
Which finding should the nurse report to the provider during a prenatal visit?
Which medication should the nurse administer for respiratory depression following IV morphine?
Which medication should the nurse administer for respiratory depression following IV morphine?
What should the nurse include in teaching about universal newborn screening?
What should the nurse include in teaching about universal newborn screening?
Which laboratory finding should the nurse report for a client in the first trimester?
Which laboratory finding should the nurse report for a client in the first trimester?
What should the nurse expect when assessing a newborn who experienced a tight nuchal cord?
What should the nurse expect when assessing a newborn who experienced a tight nuchal cord?
Which finding should the nurse report for a client receiving IV fluids for hyperemesis gravidarum?
Which finding should the nurse report for a client receiving IV fluids for hyperemesis gravidarum?
What condition should the nurse prioritize following an amniocentesis for a Rh-negative client?
What condition should the nurse prioritize following an amniocentesis for a Rh-negative client?
Which prescription should the nurse anticipate regarding a newborn's status?
Which prescription should the nurse anticipate regarding a newborn's status?
Which action should the nurse take when transporting a newborn?
Which action should the nurse take when transporting a newborn?
Which finding is expected when assessing a newborn using the New Ballard Score?
Which finding is expected when assessing a newborn using the New Ballard Score?
Which finding should the nurse report to the provider when assessing newborns?
Which finding should the nurse report to the provider when assessing newborns?
Which findings should the nurse report to the provider? (Select all that apply)
Which findings should the nurse report to the provider? (Select all that apply)
Which laboratory test should the nurse expect for a client with suspected placental abruption?
Which laboratory test should the nurse expect for a client with suspected placental abruption?
Which finding should the nurse include as an adverse effect of combined oral contraceptives?
Which finding should the nurse include as an adverse effect of combined oral contraceptives?
What action should the nurse take prior to applying an external transducer for fetal monitoring?
What action should the nurse take prior to applying an external transducer for fetal monitoring?
Which item should the nurse recommend for nonpharmacological pain management during breastfeeding engorgement?
Which item should the nurse recommend for nonpharmacological pain management during breastfeeding engorgement?
What is the priority intervention when a client states, 'my water just broke'?
What is the priority intervention when a client states, 'my water just broke'?
Which discharge instruction should the nurse include for a client who had a cesarean birth?
Which discharge instruction should the nurse include for a client who had a cesarean birth?
Which finding contraindicates the initiation of oxytocin infusion?
Which finding contraindicates the initiation of oxytocin infusion?
Which cultural practice should the nurse include in the plan of care for a postpartum client adhering to traditional Hispanic beliefs?
Which cultural practice should the nurse include in the plan of care for a postpartum client adhering to traditional Hispanic beliefs?
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Study Notes
Bathing a Newborn
- Perform eye wiping from the inner canthus outward.
- Wash the neck by lifting the newborn's chin.
- Cleanse the skin around the umbilical cord stump.
- Wash the legs and feet last.
- Always clean the diaper area last.
Newborn Phototherapy Care
- Remove all clothing from the newborn except for the diaper during phototherapy.
- Avoid feeding the newborn water; focus on breast milk or formula.
Betamethasone Administration
- Expect a reduction in respiratory distress in the newborn following betamethasone administration.
Newborn Safety Teaching
- Confirm understanding by stating the personnel will wear ID badges, especially when taking pictures.
Carboprost Side Effects
- Monitor for hypertension as a potential adverse effect after carboprost administration.
Preeclampsia Risk Factors
- Preegestational diabetes mellitus is a notable risk factor for developing preeclampsia.
Amniocentesis Preparation
- An ultrasound is needed to locate the pocket of fluid before performing amniocentesis.
Newborn Assessment Findings
- Expect acrocyanosis, a positive Babinski reflex, and the presence of two umbilical arteries in a newborn assessment.
Seizure Management in Pregnancy
- Administer oxygen via a nonrebreather mask immediately following a seizure event.
Magnesium Sulfate Calculation
- For magnesium sulfate administration, set the IV infusion pump to 50 mL/hr.
Bonding with Adopted Newborn
- Suggest the 7-year-old receive a gift from the newborn to facilitate bonding.
Nutritional Needs During Pregnancy
- Folic acid intake should be 600 micrograms daily for pregnant clients.
Newborn Care Protocols
- Indicated actions include beginning range of motion exercises, assessing for grasp reflex, and immobilizing the arm if needed.
Understanding Pregnancy Changes
- Expect to need alternative positions for sexual intercourse during pregnancy.
Prenatal Visit Findings to Report
- A weight gain of 2.2 kg (4.8 lb) in a week should be reported to a healthcare provider.
Morphine Reaction Monitoring
- Administer naloxone for respiratory rate at 8/min during morphine administration.
Newborn Screening Procedures
- Ensure the newborn has been fed for at least 24 hours prior to specimen collection for screening.
Anemia in Pregnancy
- A hemoglobin level of 10 g/dL should be reported immediately.
Effects of Nuchal Cord
- Expect petechiae over the head in newborns who experienced a tight nuchal cord.
Hyperemesis Gravidarum Monitoring
- Report a BUN level of 25 mg/dL for clients with hyperemesis gravidarum.
Endometritis Nursing Interventions
- Prepare to obtain a culture of vaginal fluid and administer IV antibiotics for suspected endometritis.
Positive Parenting Behaviors
- A parent laying the newborn across their lap and gently swaying is a positive behavior.
Fetal Heart Rate during Assessment
- Normal FHR at 18 weeks of gestation is approximately 152/min.
Magnesium Sulfate Adverse Effects
- Notify providers for a respiratory rate of 10/min when administering magnesium sulfate.
Hyperglycemia in Gestational Diabetes
- Increased urinary output is an expected finding for clients experiencing hyperglycemia.
Parvovirus B19 Management
- Schedule an ultrasound examination for clients with parvovirus B19.
Nonstressing Testing Implications
- Prepare for a Biophysical profile (BPP) after a positive contraction stress test.
Magnesium Toxicity Intervention
- Calcium gluconate is the antidote for magnesium toxicity.
Rh-negative Client Post-amniocentesis
- Monitor fetal heart rate (FHR) after amniocentesis for Rh-negative clients.
Newborn Status Monitoring
- Administer scheduled oral morphine and maintain a low stimulus environment for assessing newborns at risk.
Identification Protocol post-Nursery Visit
- Verify that the parent's identification band matches the newborn's identification band when transporting from the nursery.
New Ballard Score Assessment
- Expect minimal arm recoil in a newborn assessed at 26 weeks gestation.
Newborn Follow-up Findings
- Report an axillary temperature of 37.7 C (99.9 F) for a newborn older than 18 hours.
Essential Findings to Report
- Uterine contractions, gestational age, and vaginal examination results should be reported during assessment.
Placental Abruption Tests
- A Kleihauer-Betke test is expected for a suspected placental abruption case.
Combined Oral Contraceptive Side Effects
- Depression can be an adverse effect of combined oral contraceptives.
Fetal Monitoring Preparation
- Perform Leopold's maneuvers to assess fetal position before applying external transducers.
Nonpharmacological Pain Management
- Cold cabbage leaves can relieve breast engorgement effectively.
Priority Following Water Break
- Begin fetal heart rate monitoring immediately following water breaking.
Cesarean Birth Discharge Teaching
- Advise that it's possible to become pregnant while breastfeeding.
Oxytocin Contraindications
- Report late decelerations before initiating oxytocin infusions.
Pregnancy Cultural Practices
- Include cultural beliefs like protecting the client's head and feet from cold air in postpartum care.
Adolescent Assessment Findings
- Report findings like abdominal pain related to gonorrhea or greenish discharge regarding STIs.
Adolescent Treatment Prescription
- Anticipate ceftriaxone and doxycycline prescriptions for adolescents suspected of STI infections.
Adolescent Education and Medication Administration
- Includes educating adolescents about medications and administering prescribed treatments.### Medication Continuation and Health Monitoring
- Continue all medications regardless of symptom presence to prevent complications and future issues like infertility.
- Immediate medical attention is necessary if urine appears dark.
- Use of condoms is not required if an IUD is kept in place.
- Increased risk of sunburn noted while on certain medications.
Labor and Delivery Procedures
- First step in Leopold maneuvers involves placing hands on the fundus.
- In labor scenarios with umbilical cord prolapse, insert two gloved fingers and apply upward pressure on the presenting part is critical.
Immediate Nursing Actions in Labor
- Administer a bolus of IV fluids to maintain hydration.
- Reposition the client for optimal fetal positioning.
- Apply oxygen at a high flow rate via nonrebreather mask.
- Elevate the client's legs to reduce venous pooling.
Newborn Assessments
- Respiratory distress in late preterm newborns may indicate hypoglycemia.
- Cocaine use during pregnancy increases the risk of abruptio placenta.
- Following misoprostol insertion, oxytocin can be administered after four hours.
Postpartum Assessment
- Jaundice in newborns within the first 12 hours post-birth requires provider notification.
- Abnormal fundal height measurements are significant and should be reported from medical records.
- Vaginal pressure is an expected symptom of a hematoma.
Prioritizing Client Assessments
- Clients who report abdominal cramping in early pregnancy should be prioritized for assessment.
Reporting Critical Findings
- Central nervous system and gastrointestinal findings are key indicators that need prompt reporting.
Pain Management in Newborn Procedures
- Skin-to-skin contact with the mother can minimize pain during heel stick blood specimen collection.
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