VATI Maternal Newborn Assessment Quiz & Flashcards

Questions and Answers

Which of the following statements by the client indicated an understanding of anticipated body changes during the second trimester?

I will lose weight during this trimester.

I will not experience any body changes.

My body will feel the same throughout the pregnancy.

I might notice a change in my skin coloring. (correct)

Which of the following vaccines should the nurse discuss with the client who is at 8 weeks of gestation?

Varicella vaccine

Influenza vaccine

Hepatitis B vaccine

Tetanus-diphtheria-acellular pertussis (Tdap) vaccine. (correct)

Which of the following information should the nurse identify as a contraindication for the use of a combined oral contraceptive (COC)?

Age over 18.

History of migraine with aura. (correct)

Having regular menstrual cycles.

Prior use of contraceptives.

Which of the following actions should the nurse take for a client in the second stage of labor experiencing shoulder dystocia?

Position the client using the McRoberts maneuver. Signup and view all the answers

Which of the following findings is an indication of a potential prenatal complication for a client at 32 weeks of gestation?

Epigastric pain. Signup and view all the answers

Which of the following actions should the nurse plan to take for a newborn with hyperbilirubinemia who is prescribed phototherapy?

Change the newborn's position every 2 hours. Signup and view all the answers

Which of the following interventions should the nurse include in the plan of care for a client at 35 weeks of gestation with mild vaginal bleeding due to placenta previa?

Initiate continuous monitoring of the FHR. Signup and view all the answers

Which of the following statements should the charge nurse make about syphilis?

A chancre lesion appears within 90 days after infection during the primary stage. Signup and view all the answers

Which of the following actions should the nurse take for a newborn who was born 15 minutes ago with an axillary temperature of 36.1C (97F)?

Place the newborn skin to skin on the mother's chest. Signup and view all the answers

Which of the following findings is the best indication of adequate perfusion and oxygenation for a client who gave birth 4 hours ago and is receiving 2 units of packed RBCs due to postpartum hemorrhage?

Urinary output. Signup and view all the answers

Which of the following laboratory results for a client at 29 weeks of gestation should be reported to the provider?

Hct 31% Signup and view all the answers

Which of the following results should the nurse expect for a client with preeclampsia with severe features?

Increased BUN. Signup and view all the answers

Which of the following actions should the nurse take when preparing to obtain a blood specimen from a newborn via a heel stick?

Warm the newborn's heel for 10 minutes prior to the puncture. Signup and view all the answers

Which of the following laboratory results for a client at 31 weeks of gestation with gestational hypertension should be reported to the provider?

Platelet count 99,000/mm3. Signup and view all the answers

Which of the following laboratory results for a term newborn who is 24 hours old should be reported to the provider?

Glucose 35 mg/dL. Signup and view all the answers

Which of the following actions should the nurse take when assessing a newborn who was born 15 minutes ago?

Count the respiratory rate for 60 seconds. Signup and view all the answers

Which of the following findings should the nurse expect when assessing a client who has genital herpes?

Ulcerated lesions on the labia. Signup and view all the answers

Which of the following statements by the newly licensed nurse indicates an understanding of the teaching regarding substance use disorders during pregnancy?

Encourage clients who are prescribed methadone to breastfeed. Signup and view all the answers

Which of the following findings indicates that terbutaline was effective?

Decreased frequency of contractions Signup and view all the answers

Which of the following actions should the charge nurse include in the teaching regarding situations requiring an amniotomy?

Placing a fetal scalp electrode Signup and view all the answers

For which finding should the nurse withhold labetalol in a client with preeclampsia?

Heart rate of 54/min Signup and view all the answers

Identify the sequence of steps the nurse should take to clear the airway obstruction for a choking pregnant client.

<ol> <li>Stand posterior to the client. 2. Position arms under the client's axilla and across the client's chest. 3. Place thumb-side of a clenched fist to the client's mid-sternum area. 4. Initiate chest thrust using a backward motion. If unconscious, perform CPR and activate emergency medical services.</li> </ol> Signup and view all the answers

Which assessments should the nurse perform before administering an opioid analgesic to a client in active labor? (Select all that apply)

Pain level Signup and view all the answers

Identify a risk factor for developing preeclampsia in a client at 8 weeks of gestation.

Rheumatoid Arthritis Signup and view all the answers

Which laboratory test should the nurse monitor for a postpartum client receiving warfarin?

International normalized ratio (INR) Signup and view all the answers

What should the nurse expect when monitoring a client in the active phase of labor with an intrauterine pressure catheter and fetal scalp electrode?

Montevideo units (MVU) of 220 mm Hg Signup and view all the answers

What should the nurse do first for a patient 1 hour postpartum with a respiratory rate of 10/min?

Administer oxygen by nonrebreather face mask Signup and view all the answers

What clinical finding should the nurse expect in a client with placenta previa?

Painless vaginal bleeding Signup and view all the answers

Which finding should the nurse report when assessing a client at 33 weeks of gestation?

Episodes of blurred vision Signup and view all the answers

Which findings are associated with hyperemesis gravidarum? (Select all that apply)

Poor skin turgor Signup and view all the answers

Identify an indication of a prenatal complication in a client at 29 weeks of gestation.

BUN 30 mg/dL Signup and view all the answers

What should the nurse do first for a client who has saturated a perineal pad with blood in 15 minutes?

Firmly massage the fundus. Signup and view all the answers

Identify the priority adverse effect to report for a client who has received two doses of terbutaline.

Heart rate: 132/min Signup and view all the answers

What should the nurse instruct a client with mastitis to do?

Apply moist heat to the affected breast. Signup and view all the answers

What indicates that a client understands prenatal care teachings regarding visit frequency?

I will have monthly prenatal visits for the first 28 weeks of pregnancy. Signup and view all the answers

Which statements about IUD teaching should the nurse include? (Select all that apply)

You might experience irregular spotting the first few months after placement of the device. Signup and view all the answers

Identify a finding that should be reported for a client at 33 weeks of gestation.

Epigastric pain. Signup and view all the answers

What should be done for a client who is postpartum, tachycardic, and experiences excessive bleeding?

Initiate an infusion of oxytocin. Signup and view all the answers

What should the nurse recognize as the potential cause of late decelerations on a fetal monitor tracing?

Fetal hypoxia Signup and view all the answers

Which instruction should the nurse include to facilitate sibling acceptance of a newborn?

The parent should plan to spend individual time with the older sibling. Signup and view all the answers

What is the first action for a nurse caring for a newborn with meconium-stained amniotic fluid?

Begin suctioning of mouth and nose. Signup and view all the answers

What indicates understanding of dietary modifications in hyperemesis gravidarum?

I will eat small, frequent meals throughout the day. Signup and view all the answers

Which client is at increased risk for a fall in the postpartum period?

A client who has an indwelling urinary catheter. Signup and view all the answers

What should the nurse do for a client who is 3 days postpartum?

Obtain a vaginal culture. Signup and view all the answers

What is the priority action for a client in active labor receiving epidural anesthesia who feels nauseated?

Turn the client to a lateral position. Signup and view all the answers

What should the nurse first check for a client admitted with ruptured membranes and breech presentation?

Check fetal heart tones. Signup and view all the answers

What nonpharmacological intervention should the nurse provide for back labor pains?

Encourage the support person to apply sacral counterpressure. Signup and view all the answers

What interpretation should the nurse make for a client with increased perineal pain and swelling postpartum?

A hematoma. Signup and view all the answers

What indicates understanding of discharge teaching after receiving rubella immunization?

I can breastfeed my baby even though I received this immunization. Signup and view all the answers

What finding in a 1-hour-old newborn should the nurse report?

Generalized petechiae. Signup and view all the answers

How many mL of methotrexate should the nurse administer to a client weighing 110 lbs?

2 Signup and view all the answers

What should the nurse monitor when a newborn begins phototherapy for bilirubin levels?

Monitor intake and output. Signup and view all the answers

What is the nurse's priority when observing a pattern of late decelerations on the fetal monitor?

Position the client laterally. Signup and view all the answers

Which finding indicates calcium gluconate was effective for magnesium sulfate toxicity?

Respiratory rate 12/min. Signup and view all the answers

What intervention should a nurse include for managing pain in a client in the latent phase of labor?

Encourage the client to listen to music. Signup and view all the answers

What indicates understanding of newborn care regarding bathing instructions?

We will wash our newborn's face first. Signup and view all the answers

What statement by a client at 10 weeks of gestation should the nurse investigate further?

I just want to stay in bed all day because nothing interests me anymore. Signup and view all the answers

What should the nurse do when using a Doppler device to auscultate fetal heart tones?

Count the radial pulse of the client while auscultating FHTs. Signup and view all the answers

What indicates understanding of car seat safety for infants?

I will use a rear-facing car seat for my baby for the first 2 years. Signup and view all the answers

Study Notes

Substance Use Disorders During Pregnancy

Encourage clients prescribed methadone to breastfeed.

Terbutaline Administration

Effective indication: decreased frequency of contractions.

Amniotomy Indicators

Action requiring amniotomy: placing a fetal scalp electrode.

Preeclampsia Management

Withhold labetalol if heart rate is 54/min.

Airway Obstruction in Pregnant Client

Initial steps: stand behind, position arms, perform chest thrusts, and initiate CPR if unconscious.

Opioid Analgesic Assessment

Assess: maternal blood pressure, pain level, and fetal heart rate before administration.

Preeclampsia Risk Factors

Identify rheumatoid arthritis as a risk factor for preeclampsia.

Warfarin Monitoring

Monitor international normalized ratio (INR) in postpartum clients receiving warfarin for DVT.

Intrauterine Pressure Monitoring

Expected finding in active labor: Montevideo units (MVU) of 220 mm Hg.

Post-Cesarean Respiratory Assessment

First action for a respiratory rate of 10/min: administer oxygen using a nonrebreather mask.

Placenta Previa Findings

Expect painless vaginal bleeding in clients with placenta previa.

Reporting Gestational Symptoms

Report episodes of blurred vision in clients at 33 weeks of gestation.

Hyperemesis Gravidarum Symptoms

Identify findings: tachycardia, dry mucous membranes, poor skin turgor.

Prenatal Complications

BUN of 30 mg/dL indicates a potential prenatal complication in a client at 29 weeks gestation.

Postpartum Hemorrhage Response

First action for a client saturating a perineal pad in 15 min: firmly massage the fundus.

Terbutaline Side Effects

Heart rate of 132/min is a priority adverse effect to report after terbutaline administration.

Mastitis Postpartum Care

Instruct applying moist heat to the affected breast.

Routine Prenatal Care

Understand monthly prenatal visits are required for the first 28 weeks of pregnancy.

Intrauterine Device (IUD) Teaching

Mention the need for STI cultures, potential for irregular spotting, and signing informed consent prior to IUD placement.

Reporting Abdominal Symptoms

Report epigastric pain in clients at 33 weeks of gestation.

Postpartum Hemorrhage Management

Initiate a continuous infusion of oxytocin for clients with tachycardia and excessive bleeding.

Fetal Monitoring Deceleration Patterns

Recognize potential cause of late decelerations: fetal hypoxia.

Facilitating Sibling Acceptance

Encourage individual time with older siblings for better newborn acceptance.

Newborn Meconium Care

First action for newborn with meconium-stained fluid: suction mouth and nose.

Iron Supplementation Education

Include the consumption of 29 grams of fiber daily as part of iron supplementation teaching.

Negative Contraction Stress Test

Allow labor to progress naturally if CST results are negative.

APGAR Score Interpretation

Newborn exhibiting grimacing, irregular respiratory effort, and a heart rate of 92/min has an APGAR score of 5 at 1 min.

Uterus Postpartum Assessment

Fundus should be palpated at approximately 2 cm below the umbilicus immediately after birth.

Methotrexate Handling Protocol

Wear two pairs of gloves while handling methotrexate for ectopic pregnancy.

Presumptive Signs of Pregnancy

Amenorrhea is a presumptive sign of pregnancy.

Epidural Anesthesia Preparation

Administer a 500 mL bolus of lactated Ringer's prior to epidural placement.

Group B Streptococcus (GBS) Management

Expect to administer IV antibiotics for clients positive for GBS at 36 weeks.

Reactive Nonstress Test Results

Fetal heart rate accelerations occurring with fetal movement indicate a reactive nonstress test.

Nifedipine Adverse Effects

Instruct clients to notify due to irregular heartbeat while using nifedipine for gestational hypertension.

Labor Expectation

Expect a decrease in blood glucose levels in laboring clients.

Newborn Circumcision Assessment

Yellow exudate covering the glans indicates healing 48 hours after circumcision.

Nagele's Rule Application

Calculate expected date of birth using Nagele's rule; last menstrual period April 22 results in EDB.

Newborn Hypoglycemia Indicator

Hypotonia indicates the need for blood glucose level check.

Cesarean Birth Education

Include management of postpartum pain, advantages of early ambulation, and indwelling urinary catheter necessity in teaching.

Newborn Abduction Prevention Strategies

Advise bringing the newborn in the bassinet while using the bathroom.

Postpartum Hemorrhagic Shock Management

Accurate indication of organ perfusion: client's urine output.

Breastfeeding Concerns

Report depressed fontanels in a 1-hour-old breastfeeding newborn experiencing weight loss.

Sore Nipples Management

Suggest applying colostrum to sore, cracked nipples post-feeding to promote healing.

Newborn Temperature Assessment

Prioritize assessment of a newborn with an axillary temperature of 36°C (96.8°F).

Rear-Facing Car Seat Guidelines

Maintain newborn in a rear-facing car seat until they are 2 years old.

Blood Specimen Collection from Newborns

Cleanse the heel puncture site with alcohol prior to blood collection.

Dietary Modifications for Hyperemesis Gravidarum

Recommend eating small, frequent meals throughout the day.

Fall Risk in Postpartum Clients

Identify clients with indwelling urinary catheters as increased fall risk.

Vaginal Cultures in Postpartum Clients

Obtain vaginal cultures for clients who are 3 days postpartum.

Epidural Anesthesia Response

First intervention for blood pressure drop and nausea: position the client laterally.

Breech Presentation Response

First action after water breaks in a breech presentation: check fetal heart tones.

Pain Management in Back Labor

Suggest using sacral counterpressure from a support person for back labor pain relief.

Perineal Pain Assessment Post-Vaginal Delivery

Findings of purplish discoloration and swelling indicate a hematoma.

Rubella Immunization and Breastfeeding

Clients can breastfeed after receiving the rubella immunization.

Reporting Newborn Conditions

Report generalized petechiae in a 1-hour-old newborn.

Methotrexate Dosage Calculation

For a client weighing 110 lbs, administer 2 mL of methotrexate at a concentration of 25 mg/mL.

Bilirubin Level Monitoring

Monitor intake and output for a 2-day-old newborn starting phototherapy with a bilirubin level of 14 mg/dL.

Late Decelerations Management

Position the client laterally if observing late decelerations while administering oxytocin.

Calcium Gluconate Effectiveness

A respiratory rate of 12/min indicates effectiveness of calcium gluconate for magnesium sulfate toxicity.

Pain Management in Latent Phase of Labor

Encourage listening to music for pain management during the latent phase.

Newborn Bathing Instructions

Wash the newborn's face first during bathing.

Investigation of Maternal Behavior

Investigate further if a client at 10 weeks expresses a desire to stay in bed all day with no interest in activities.

Fetal Heart Tones Assessment

Count the client's radial pulse while auscultating fetal heart tones with a Doppler device at 12 weeks of gestation.

Understanding Newborn Car Seat Safety

Confirm understanding of car seat safety by using a rear-facing seat for the first 2 years.

Second Trimester Changes

Expect skin color changes during the second trimester of pregnancy.

Recommended Vaccines During Pregnancy

Discuss Tdap vaccination for the client at 8 weeks of gestation.

Combined Oral Contraceptive Contraindications

History of migraine with aura is a contraindication for combined oral contraceptives.

Shoulder Dystocia Management

Apply the McRoberts maneuver for clients experiencing shoulder dystocia in labor.

Prenatal Complications Indications

Epigastric pain in clients at 32 weeks gestation may indicate a prenatal complication.

Newborn Hyperbilirubinemia Care

Change a newborn's position every 2 hours during phototherapy for hyperbilirubinemia.

Monitoring Protocols for Mild Vaginal Bleeding

Initiate continuous fetal heart rate monitoring for clients with mild vaginal bleeding due to placenta previa.### Primary Chancre Lesion
A chancre lesion appears within 90 days of infection during the primary stage of syphilis.

Newborn Assessment

For a newborn with an axillary temperature of 36.1°C (97°F), skin-to-skin contact on the mother's chest is recommended to maintain warmth.

Postpartum Hemorrhage

In assessing a client who just gave birth and receiving packed RBCs for postpartum hemorrhage, urinary output is the best indicator of adequate perfusion and oxygenation.

Laboratory Results in Pregnancy

A hemoglobin and hematocrit (Hct) of 31% in a client at 29 weeks of gestation should be reported to the provider as it indicates anemia.

Preeclampsia Monitoring

In clients with preeclampsia with severe features, expect to see increased BUN levels indicating potential renal impairment.

Blood Specimen Collection

Before performing a heel stick on a newborn, warming the heel for 10 minutes enhances blood flow, facilitating easier blood collection.

Gestational Hypertension

A platelet count of 99,000/mm³ in a client at 31 weeks of gestation should be reported, as it suggests thrombocytopenia.

Newborn Glucose Levels

In a term newborn who is 24 hours old, a blood glucose level of 35 mg/dL is low and should be reported to the provider for evaluation.

Respiratory Rate Assessment

For a newborn assessed 15 minutes after birth, counting the respiratory rate for a full 60 seconds ensures accuracy in monitoring respiratory function.

Genital Herpes Findings

In clients with genital herpes, expect to find ulcerated lesions on the labia as a common symptom of the infection.

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Test your knowledge on maternal newborn care with these flashcards. Focus on substance use disorders during pregnancy and medication effects on clients. Perfect for newly licensed nurses aiming to enhance their understanding in the clinical setting.

VATI RN Maternal Newborn Assessment Flashcards