RN Maternal Newborn Online Practice 2023

Questions and Answers

Which of the following are risk factors for gestational diabetes mellitus? (Select all that apply)

Maternal age older than 25 years (correct)

Maternal age younger than 25 years

Previous stillbirth (correct)

Previous birth of an infant who was large (correct)

Which risk factors should the nurse include when teaching about gestational hypertension? (Select all that apply)

Maternal age younger than 40 years

Maternal age older than 40 years (correct)

First pregnancy (correct)

History of high blood pressure

What medication should be administered if magnesium sulfate toxicity is suspected?

Calcium gluconate

Which findings should the nurse identify and report as magnesium sulfate toxicity? (Select all that apply)

Urine output less than 30 mL/hr Signup and view all the answers

A prophylactic cervical cerclage is a surgical reinforcement of the cervix with a heavy ligature (suture) placed ______ around the cervix.

submucosally Signup and view all the answers

What client education should the nurse include regarding prophylactic cervical cerclage? (Select all that apply)

Refrain from sexual intercourse Signup and view all the answers

Which client should the nurse see first?

Client at 11 weeks of gestation reporting abdominal cramping Signup and view all the answers

What should a client do when they feel their baby move during a nonstress test?

Press the handheld button. Signup and view all the answers

Which of the following findings indicate a need for administering oxytocin?

Flaccid uterus Signup and view all the answers

What should a nurse expect when assessing a newborn born at 26 weeks of gestation?

Minimal arm recoil. Signup and view all the answers

Identify the signs associated with hypoglycemia in a newborn.

Lethargy Signup and view all the answers

What should a nurse report for a 70-hour-old newborn showing CNS findings?

Manifestations of Neonatal Abstinence Syndrome (NAS). Signup and view all the answers

What is the priority action for a newborn undergoing phototherapy?

Remove all clothing except the diaper. Signup and view all the answers

What indicates proper management for a client with type 1 diabetes during pregnancy?

Continue taking insulin despite nausea and vomiting. Signup and view all the answers

What condition might a newborn with a heart rate of 174/min and respiratory rate of 88/min be experiencing?

Cold stress. Signup and view all the answers

Can substernal retractions in a newborn indicate respiratory distress or infection?

True Signup and view all the answers

What finding post-amniocentesis should be reported?

Leakage of fluid from the vagina. Signup and view all the answers

What should a nurse do for a postpartum client receiving heparin?

Maintain the client on bed rest. Signup and view all the answers

Identify risk factors for hyperemesis gravidarum.

Diabetes Signup and view all the answers

Which conditions should a nurse monitor in a client diagnosed with gestational diabetes?

Family history, maternal age, and previous large babies. Signup and view all the answers

Is a headache that is unrelieved by analgesia a significant manifestation to report?

True Signup and view all the answers

What is a common complication for a newborn who is 16 hours old?

Substernal retractions. Signup and view all the answers

What are considered contraindicated actions in managing vaginal bleeding in a client?

Assess cervical dilation Signup and view all the answers

What are the expected findings during the initial assessment of a newborn in the first 24 hours?

Acrocyanosis. Signup and view all the answers

Which of the following findings should the nurse report to the provider for a client who is pregnant?

Vaginal examination Signup and view all the answers

What action should the nurse take for a client who is at 22 weeks of gestation and is HIV positive?

Report to the local health department Signup and view all the answers

What finding should a nurse expect in a client who has idiopathic thrombocytopenia purpura (ITP)?

Decreased platelet count Signup and view all the answers

What does it indicate if a client states they are 'happy one minute and crying the next' during pregnancy?

Emotional lability Signup and view all the answers

Which of the following is an indication of withdrawal from a selective serotonin reuptake inhibitor (SSRI) in a newborn?

Vomiting Signup and view all the answers

What finding should the nurse report for a newborn who is 18 hours old with an axillary temperature of 37.7° C (99.9° F)?

Report to the provider Signup and view all the answers

What fetal heart rate (FHR) should the nurse expect at 18 weeks of gestation?

152/min Signup and view all the answers

What positive parenting behavior should the nurse recognize when observing a guardian caring for their crying newborn?

Lays the newborn across their lap and gently sways Signup and view all the answers

What should the nurse's first action be when caring for a newborn with mild respiratory distress?

Verify the newborn's identification Signup and view all the answers

What is a common adverse effect that should be mentioned to a client starting combined oral contraceptives?

Depression Signup and view all the answers

What assessment should the nurse prioritize after an amniotomy?

Temperature Signup and view all the answers

What is the priority intervention for a client whose water just broke?

Begin FHR monitoring Signup and view all the answers

What should a client be instructed about taking levonorgestrel contraception?

Take the medication within 72 hours following unprotected sexual intercourse Signup and view all the answers

What condition indicates the need for fetal assessment using electronic fetal monitoring at 32 weeks of gestation?

Oligohydramnios Signup and view all the answers

What should a nurse have ready for a client on magnesium sulfate IV?

Calcium gluconate Signup and view all the answers

What phase of labor is indicated by a client in labor with a cervical dilation of 9 cm?

Active phase Signup and view all the answers

What finding in a fundal height measurement at 26 weeks of gestation should be reported?

Fundal height 30 cm Signup and view all the answers

What should a nurse communicate about staff identification for the security of a newborn?

Staff members will wear a photo identification badge. Signup and view all the answers

What should a client at 10 weeks of gestation do regarding folic acid intake?

Take 600 micrograms of folic acid each day Signup and view all the answers

What finding should be reported for a client with hyperemesis gravidarum receiving IV fluid replacement?

Blood pressure 105/64 mm Hg Signup and view all the answers

Match the steps of performing Leopold maneuvers:

1 = Palpate the client's fundus to identify the fetal part. 2 = Determine the location of the fetal back. 3 = Palpate for the fetal part presenting at the inlet. 4 = Palpate the cephalic prominence to identify the attitude of the head. Signup and view all the answers

What should clients with hyperemesis gravidarum focus on regarding their diet?

Eat foods that taste good instead of balancing meals. Signup and view all the answers

What should the nurse ensure before leaving a newborn with their parent?

Ensure that the parent's identification band number matches the newborn's identification band number. Signup and view all the answers

What manifestation should the nurse report for a newborn 12 hours after birth?

Jaundice Signup and view all the answers

Which findings should the nurse report for the 16-year-old adolescent? (Select all that apply)

Greenish vaginal discharge Signup and view all the answers

Which conditions are consistent with trichomoniasis, gonorrhea, or candidiasis? (Select all that apply)

Diabetes Signup and view all the answers

What condition is the client most likely developing if there is an elevated C-reactive protein?

Pelvic inflammatory disease Signup and view all the answers

What medications should the nurse expect the provider to prescribe for pelvic inflammatory disease?

Ceftriaxone and doxycycline Signup and view all the answers

What should the nurse prioritize when reviewing the provider's prescriptions?

Providing education on medications Signup and view all the answers

The adolescent should go to the emergency department if their urine turns dark.

False Signup and view all the answers

Which findings indicate a contraindication to oral contraceptives? (Select all that apply)

Cholecystitis Signup and view all the answers

What intervention should the nurse perform if the uterus is palpated to the right above the umbilicus?

Assist the client to empty their bladder Signup and view all the answers

Which client should the nurse prioritize who is at 34 weeks of gestation and reports epigastric pain?

Client with epigastric pain Signup and view all the answers

What is a manifestation of hypoglycemia in late preterm newborns?

Respiratory distress Signup and view all the answers

What indicates a possible hyperemesis gravidarum in a client at 10 weeks of gestation?

Frequent vomiting with weight loss of 3 lb in 1 week Signup and view all the answers

What diagnostic test should the nurse prepare for a client at 41 weeks of gestation with a positive contraction stress test?

Biophysical profile (BPP) Signup and view all the answers

What action should the nurse include in the nonstress test plan of care?

Instruct the client to press the provided button each time fetal movement is detected Signup and view all the answers

What maneuver should the nurse perform prior to applying an external transducer for fetal monitoring?

Perform Leopold maneuvers Signup and view all the answers

What finding contraindicates the initiation of an oxytocin infusion?

Late decelerations Signup and view all the answers

What is the priority nursing intervention following an amniocentesis for an Rh-negative client?

Monitor the FHR Signup and view all the answers

How many azithromycin tablets should be administered for a 1 g dose?

4 Signup and view all the answers

What finding indicates that a newborn is experiencing pain following a circumcision?

Chin quivering Signup and view all the answers

What is the expected action a nurse should take regarding the client's blood pressure after administering epidural anesthesia?

Monitor the client's blood pressure every 5 min Signup and view all the answers

What indicates gestational hypertension or preeclampsia during a prenatal visit?

Swelling of the face Signup and view all the answers

Study Notes

Antepartum Care

Report findings indicative of preterm labor such as regular uterine contractions, cervical dilation, and gestational age at 32 weeks.
For HIV-positive clients at 22 weeks, report to local health department and ensure antiretroviral treatment to reduce infection transmission risk to the newborn.

Postpartum Assessments

In cases of idiopathic thrombocytopenia purpura (ITP), expect decreased platelet counts indicative of autoimmune responses.
Emotional lability in pregnant clients can manifest as rapid mood swings due to intense hormonal changes.

Newborn Assessments

Withdrawal symptoms from SSRIs in newborns include irritability, agitation, diarrhea, and vomiting, usually lasting up to 2 days.
An axillary temperature of 37.7°C (99.9°F) in a newborn is concerning and can indicate sepsis.
Expected findings at 18 weeks of gestation include a fetal heart rate (FHR) around 152 bpm.

Parenting and Infant Care

Positive parenting behavior includes gentle tactile stimulation techniques to soothe newborns.
Before administering medications such as calcium gluconate, ensure it is readily available when managing magnesium sulfate for preeclampsia.

Labor and Delivery Care

Assess fetal heart rate (FHR) first when a client’s water breaks to check for umbilical cord prolapse risk.
Following a rupture of membranes, document fluid characteristics and check cervical dilation.

Nutrition and Medication in Pregnancy

Pregnant clients should ingest 600 mcg of folic acid daily to prevent neural tube defects.
Be aware that combined oral contraceptives can cause depression and other side effects; educate clients accordingly.

Monitoring During Pregnancy Complications

Oligohydramnios necessitates electronic fetal monitoring for thorough assessment.
For hyperemesis gravidarum, observe urine for ketones as an indicator of hydration status; report any decreased blood pressure.

Identity and Safety Measures for Newborns

Always verify matching identification bands between parents and newborns before release.
Jaundice in a newborn within the first 24 hours post-birth should prompt immediate reporting due to possible serious underlying issues.

Adolescent Health Considerations

Report abnormal findings in adolescents such as abdominal tenderness, greenish vaginal discharge (indicating infection), and elevated temperature (potential infection or inflammation).

Differential Diagnosis in STIs

Gonorrhea often presents with abdominal pain, while greenish discharge is characteristic of both gonorrhea and trichomoniasis.### Candidiasis and Related Conditions
Candidiasis leads to thick, white, lumpy vaginal discharge.
Diabetes predisposes individuals to candidiasis due to high glucose levels facilitating yeast growth.
Dysuria, or pain on urination, can occur in candidiasis, trichomoniasis, and gonorrhea.
Lack of condom use increases the risk for trichomoniasis and gonorrhea; candidiasis is not sexually transmitted.

Pelvic Inflammatory Disease (PID)

PID results from untreated infections, often caused by Neisseria gonorrhoeae and Chlamydia trachomatis, affecting the pelvic reproductive organs.
Symptoms include fever, nausea, vomiting, and increased C-reactive protein (CRP).
A nurse suspects PID when CRP levels are elevated.

Treatment of PID

Anticipated treatment includes ceftriaxone as a single IM dose and doxycycline for 14 days orally.

Education on Medications

Clients must be educated about medications to understand their purpose and potential side effects.
Ceftriaxone must be administered as a NOW prescription within 90 minutes, following patient education.

Discharge Understanding

Patients should continue medication even if asymptomatic to prevent recurrence.
Frequent PID can impact fertility.
Doxycycline can increase sun sensitivity, requiring protective measures.
Dark urine may result from metronidazole; patients shouldn't be alarmed.
IUDs prevent pregnancy but do not protect against STIs; condoms should still be used.

Contraindications for Oral Contraceptives

Contraindicated conditions include:
- Cholecystitis
- Hypertension
- Migraines

Postpartum Assessment

If a uterus is palpated above the umbilicus, assist the client in emptying their bladder to prevent increased bleeding.

Priority Assessments in Antepartum Care

A client at 34 weeks with epigastric pain may indicate preeclampsia and should be prioritized.
Nonurgent conditions include elevated fasting blood glucose (gestational diabetes) and anemia in pregnancy.

Newborn Assessments

Respiratory distress in late preterm newborns may indicate hypoglycemia.
Monitor for signs like lethargy, jitteriness, and abnormal crying.

Monitoring During Pregnancy

Frequent vomiting with weight loss may suggest hyperemesis gravidarum, requiring reporting.
A positive contraction stress test suggests potential uteroplacental insufficiency, warranting preparation for a biophysical profile (BPP).

Nonstress Test Procedure

Clients should press a button during fetal movements to aid in interpreting results.
Proper positioning enhances fetal monitoring, and hydration is encouraged.

Labor and Delivery Considerations

Monitor blood pressure closely after administering epidural anesthesia to detect hypotension.
Indications for oxytocin postpartum include a flaccid uterus and excess vaginal bleeding.

Assessment of Newborns

Newborns at 26 weeks of gestation may show minimal arm recoil, indicating immature muscular tone. Other maturity indicators include breast bud development and creases on the soles of the feet.### Newborn Care and Conditions
Hypoglycemia in newborns is characterized by decreased temperature, poor feeding, respiratory distress, and lethargy.
Hyperbilirubinemia presents with yellow sclera and oral mucosa, poor feeding, and an increased risk in newborns with ecchymotic caput succedaneum.
Sepsis shows similar symptoms to hypoglycemia but includes yellow sclera and oral mucosa.

Newborn Assessment and Intervention

Inconsolable newborns with high-pitched cries and increased muscle tone may indicate Neonatal Abstinence Syndrome (NAS), requiring prompt reporting.
Newborns typically have oxygen saturation above 94%, respiratory rates of 30-60/min, and temperatures between 36.5° and 37.5° C.
The Moro reflex is a normal defensive reaction in infants; its absence may indicate injury.

Phototherapy Protocols

During phototherapy for hyperbilirubinemia, only the diaper should be left on the newborn to maximize skin exposure to UV light.
Do not apply lotions or creams on newborns undergoing phototherapy as they can retain heat and cause burns.
Hydration should be maintained through breastfeeding or formula; water and glucose water do not aid bilirubin excretion.

Diabetes Management in Pregnancy

Clients with type 1 diabetes must continue insulin during illness to prevent severe blood sugar fluctuations.
It's crucial to avoid foods high in refined sugars, emphasizing a low-carbohydrate and high-protein diet.
Blood glucose control may require less insulin during the first trimester due to enhanced insulin response.

Cold Stress in Newborns

Symptoms indicating cold stress include low temperature, elevated respiratory rate, and hypoglycemia.
Immediate actions involve skin-to-skin contact and encouraging breastfeeding, while monitoring temperature and glucose levels is crucial for assessing recovery.

Erb's Palsy Management

Range of motion exercises for the affected arm should begin after about one week post-injury, along with assessing for a grasp reflex to evaluate function.
Passive ROM exercises are essential to restore movement after Erb's palsy caused by brachial plexus injury.

Antepartum Care

For a client with vaginal bleeding in the third trimester, insert a large bore IV catheter for potential fluid resuscitation and monitor blood loss accurately by weighing perineal pads.
Avoid assessing cervical dilation in cases of vaginal bleeding, as this could pose risks to both mother and fetus.

Complications to Report

Unrelieved headache during pregnancy may indicate preeclampsia and should be reported.
For potential complications after amniocentesis, report vaginal fluid leakage, as it may suggest premature membrane rupture.

Magnesium Sulfate Considerations

Monitor clients on magnesium sulfate for signs of toxicity, including absence of patellar reflexes, decreased urine output, and respiratory depression.
Calcium gluconate should be readily available to counteract magnesium sulfate toxicity.

Cervical Cerclage Education

Prophylactic cervical cerclage involves surgically reinforcing the cervix to prevent premature dilation, requiring strict activity restrictions and hydration post-procedure.
Report contractions, membrane rupture, or other signs of preterm labor or infection immediately after the procedure.

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Description

This quiz focuses on nursing care for pregnant clients in antepartum settings. It covers key indicators such as uterine contractions and other critical findings that nurses must report. Prepare yourself for essential maternal-newborn nursing concepts and practice scenarios.