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Maternal Newborn ATI Questions 100% accurate answers, graded A+
A nurse in a health clinic is reviewing contraceptive use with a group of adolescent clients. Which of the following statements by an adolescent reflects a... [Show More] n understanding of the teaching? a. "A water-soluble lubricant should be used with condoms." b. "A diaphragm should be removed 2 hours after intercourse." c. "Oral contraceptives can worsen a case of acne." d. "A contraceptive patch is replaced once a month." A. A nurse is instructing a client who is taking an oral contraceptive about danger signs to report to her provider. The nurse determines the client understands the teaching when the client states the need to report which of the following? a. Reduced menstrual flow b. Breast tenderness c. SOB d. Headaches C. A nurse in a OB clinic is teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching? a. "An IUD should be replaced annually during a pelvic exam." b. "I cannot get an IUD until after I've had a child." c. "I should expect intermittent abdominal pain while the IUD is in place." d. "A change in the string length of my IUD is unexpected." D. A nurse is teaching a client about potential adverse effects of implantable progestins. Which of the following adverse effects should the nurse include? (SATA) a. Tinnitus b. Irregular vaginal bleeding c. Weight gain d. Breast changes e. Gingival hyperplasia B., C., D. A nurse in a clinic is teaching a client about her new prescription for medroxyprogesterone. Which of the following information should the nurse include in the teaching? (SATA) a. "Weight loss can occur." b. "You are protected against STIs" c. "You should increase your intake of calcium." d. "You should avoid taking antibiotics." e. "Irregular vaginal spotting can occur." C., E. A nurse in a clinic is caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? a. A client whose sister has alopecia b. A client whose partner has von Willebrand disease c. A client who has an allergy to sulfa d. A client who had rubella 3 months ago B. A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process? a. "You will need to see a genetic counselor as part of the assessment." b. "It is usually the woman who is having trouble, so the man doesn't have to be involved." c. "The man is the easiest to assess, and the provider will usually begin there." d. "Think about adopting first because there are many babies that need good homes." C. A nurse in an infertility clinic is providing care to a couple who has been unable to conceive for 18 months. Which of the following data should be included in the assessment? (SATA) a. Occupation b. Menstrual history c. Childhood infectious diseases d. History of falls e. Recent blood transfusions A., B., C. A nurse in a clinic is caring for a client who is to be seen by the provider for a post-op appointment following a salpingectomy due to an ectopic pregnancy. Which of the following statements by the client requires clarification? a. "It is good to know that I won't have a tubal pregnancy in the future." b. "The doctor said that this surgery can affect my ability to get pregnant again." c. "I understand that one of my fallopian tubes had to be removed." d. "Ovulation can still occur because my ovaries were not affected." A. A nurse is reviewing the health record of a client who is to undergo hysterosalpingography. Which of the following data alert the nurse that the client is at risk for a complication related to this procedure? Vital: temp 98.9 and BMI of 40.3 H&P: radiology technician Lab: glucose 103 and total cholesterol of 265 mg/dL a. Vital signs b. H&P c. Lab findings d. Medications B. A nurse is caring for a client who is pregnant and states that her last menstrual period was April 1st. Which of the following is the client's estimated date of delivery? a. January 8 b. January 15 c. February 8 d. February 15 A. A nurse in a prenatal clinic is caring for a client who is in the first trimester of pregnancy. The client's health record includes this data: G3 T1 P0 A1 L1. How should the nurse interpret this information? (SATA) a. Client has delivered one newborn at term b. Client has experienced no preterm labor c. Client has been through active labor d. Client has had two prior pregnancies e. Client has one living child A., D., E. A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the nurse expect? (SATA) a. Montgomery's glands b. Goodell's sign c. Ballottement d. Chadwick's sign e. Quickening B., C., D. A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following responses should the nurse make? a. "This is due to an increase in blood volume." b. "This is due to pressure from the uterus on the diaphragm." c. "This is due to the weight of the uterus on the vena cava." d. "This is due to increased cardiac output." C. A nurse in a clinic receives a phone call from a client who believes she is pregnant and would like to be tested in the clinic to confirm her pregnancy. Which of the following information should the nurse provide to the client? a. "You should wait until 4 weeks after conception to be tested." b. "You should be off any medications for 24 hours prior to the test." c. "You should be NPO for at least 8 hours prior to the test." d. "You should collect urine from the first morning void." D. A nurse is teaching a group of women who are pregnant about measures to relieve a backache during pregnancy. Which of the following measures should the nurse include in the teaching? (SATA) a. Avoid any lifting b. Perform Kegel exercises twice a day c. Perform the pelvic rock exercise everyday d. Use proper body mechanics e. Avoid constrictive clothing C., D. A nurse is caring for a client who is pregnant and reviewing signs of complications the client should promptly report to the provider. Which of the following complications should the nurse include in the teaching? a. Vaginal bleeding b. Swelling of the ankles c. Heartburn after eating d. Lightheadedness when lying on back A. A client who is at 7 weeks of gestation is experiencing nausea and vomiting in the morning. Which of the following information should the nurse include in the teaching? a. Eat crackers or plain toast before getting out of bed b. Awaken during the night to eat a snack c. Skip breakfast and eat lunch after nausea has subsided d. Eat a large evening meal A. A nurse is teaching a client who is at 6 weeks of gestation about common discomforts of pregnancy. Which of the following findings should the nurse include in the teaching? (SATA) a. Breast tenderness b. Urinary frequency c. Epistaxis d. Dysuria e. Epigastric pain A., B., C. A client who is at 8 weeks of gestation tells the nurse that she isn't sure she is happy about being pregnant. Which of the following responses should the nurse make? a. "I will inform the provider that you are having these feelings." b. "It is normal to have these feelings during the first few months of pregnancy." c. "You should be happy that you are going to bring new life into the world." d. "I am going to make an appointment with the counselor for you to discuss these thoughts." B. A nurse in a prenatal clinic is providing education to a client who is in the 8th week of gestation. The client states that she does not like milk. Which of the following foods should the nurse recommend as a good source of calcium? a. Dark green leafy vegetable b. Deep red or orange vegetable c. White bread and rice d. Meat, poultry, and fish A. A nurse in a prenatal clinic is caring for four clients. Which of the following clients' weight gain should the nurse report to the provider? a. 1.8kg (4 lb) weight gain and is in her first-trimester b. 3.6kg (8 lb) weight gain and is in her first-trimester c. 6.8kg (15 lb) weight gain and is in her second-trimester d. 11.3kg (25 lb) weight gain and is in her third trimester B. A nurse in a clinic is teaching a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency? a. Iron deficiency anemia b. Poor bone formation c. Macrosomic fetus d. Neural tube defects D. A nurse is reviewing a new prescription for iron supplements with a client who is in the 8th week of gestation and has iron deficiency anemia. Which of the following beverages should the nurse instruct the client to take the iron supplements with? a. Ice water b. Low-fat or whole milk c. Tea or coffee d. Orange juice D. A nurse is reviewing postpartum nutrition needs with a group of new mothers who are breastfeeding their newborns. Which of the following statements by a member of the group indicates an understanding of the teaching? a. "I am glad I can have my morning coffee." b. "I should take folic acid to increase my milk supply." c. "I will continue adding 330 calories per day to my diet." d. "I will continue my calcium supplements because I don't like milk." D. A nurse is reviewing the findings of a client's biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test? (SATA) a. Fetal weight b. Fetal breathing movement c. Fetal tone d. Fetal position e. Amniotic fluid volume B., C., E. A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. The nurse should evaluate which of the following tests to assess fetal lung maturity? a. Alpha-feroprotein (AFP) b. Lecithin/sphingomyelin (L/S) ratio c. Kleihauer-Betke test d. Indirect Coombs' test B. A nurse is caring for a client who is pregnant and undergoing a non-stress test. The client asks why the nurse is using an acoustic vibration device. Which of the following responses should the nurse make? a. "It is used to stimulate uterine contractions." b. "It will decrease the incidence of uterine contractions." c. "It lulls the fetus to sleep." d. "It awakens a sleeping fetus." D. A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching? a. "You will lay on your right side during the procedure." b. "You should not eat anything for 24 hours prior to the procedure." c. "You should empty your bladder prior to the procedure." d. "The test is done to determine gestational age." C. A nurse is caring for a client who is pregnant and is to undergo a contraction stress test. Which of the following findings are indications for this procedure? (SATA) a. Decreased fetal movement b. Intrauterine growth restriction c. Postmaturity d. Placenta previa e. Amniotic fluid emboli A., B., C. A nurse in the ED is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnant because she has an intrauterine device. The nurse should suspect which of the following? a. Missed abortion b. Ectopic pregnancy c. Severe pre-eclampsia d. Hydatidiform mole B. A nurse is providing care for a client who is diagnosed with a marginal abruptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (SATA) a. Fetal position b. Blunt abdominal trauma c. Cocaine use d. Maternal age e. Cigarette smoking B., C., E. A nurse is providing care for a client who is at 32 weeks of gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? a. Betamethasone b. Indomethacin c. Nifedipine d. Methylergonovine A. A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? a. Hyperemesis gravidarum b. Threatened abortion c. Hydatidiform mole d. Pre-term labor C. A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? a. No alteration in menses b. Transvaginal ultrasound indicating a fetus in the uterus c. Serum progesterone greater than the expected reference range d. Report of severe shoulder pain D. A nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? (SATA) a. Episiotomy b. Oxytocin infusion c. Forceps d. C-section e. Internal fetal monitoring A., C., E. A nurse in an antepartum clinic is assessing a client who is assessing a client who has a TORCH infection. Which of the following findings should the nurse expect? (SATA) a. Joint pain b. Malaise c. Rash d. Urinary frequency e. Tender lymph nodes A., B., C., E. A nurse is caring for a client who has gonorrhea. Which of the following medications should the nurse anticipate the provider will prescribe? a. Ceftriaxone b. Fluconazole c. Metronidazole d. Zidovudine A. A nurse is caring for a client who is in labor. The nurse should identify that which of the following infections can be treated during labor or immediately following birth? (SATA) a. Gonorrhea b. Chlamydia c. HIV d. Group B strptococcus beta-hemolytic e. TORCH A., B., C., D. A nurse manager is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses. Which of the following statements by a nurse indicates understanding of the teaching? a. "Obtain an immunization against rubella early in pregnancy." b. "Seek prophylactic treatment if cytomegalovirus is detected during pregnancy." c. "A woman should avoid crowded places during pregnancy." d. "A woman should avoid consuming undercooked meat while pregnant." D. A nurse is caring for a client who is at 14 weeks of gestation and has hyperemesis gravidarum. The nurse should identify that which of the following are risk factors for the client? (SATA) a. Obesity b. Multifetal pregnancy c. Maternal age greater than 40 d. Migraine headache e. Oligohydramnios A., B., D. [Show Less]
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ATI Maternal Newborn Posttest questions and answers with top solutions. Latest 2023
A nurse is teaching the parents of a term newborn how to bathe him. Which of the following instructions should the nurse include? Give him a sponge bath u... [Show More] ntil his cord stump falls off A nurse is assessing a patient who is 1 day postpartum and is not breastfeeding. The nurse notes the patient's breasts are engorged. Which of the following actions is appropriate for the patient to take? Applying ice packs 00:49 01:47 A nurse is assessing a patient at a routine antepartum visit. For a rough estimate of the number of gestational weeks the patient is at, the nurse should measure the number of cm between which two anatomical landmarks? The symphysis pubis and the top of the fundus A nurse is caring for a patient who is in labor and has pain in her lower back because the fetal head is in a posterior position. Which of the following nonpharmacological pain management techniques is likely to be most effective in relieving this type of pain? Counterpressure A nurse is assessing a patient who is at 20 weeks of gestation. She instructs the patient to be sure to report headaches, blurred vision, and swelling of her hands because these are indications of which of the following complications of pregnancy? Preeclampsia A nurse is performing a gestational age assessment using the New Ballard Score for newborn maturity rating. Which of the following findings indicates that the newborn is preterm? Flat areola A newborn delivered vaginally at term 1 min ago cried loudly at delivery, has a heart rate of 140/min, has well flexed arms and legs, grimaces when the nurse rubs the soles of his feet, and is pink with mild acrocyanosis. What Apgar score should the nurse assign to this newborn? 8 A patient who is 1 day postpartum tells the nurse that she is concerned about her newborn receiving enough nourishment from breastfeeding. The nurse should explain that she should look for which of the following as a sign of adequate nutrition? The newborn has six wet diapers and three stools per day after day 4. A nurse is performing umbilical cord care for a term newborn. Which of the following findings requires further assessment and intervention Redness at the base A nurse is caring for a term newborn who has just had a circumcision using the Gomco clamp technique. Which of the following instructions should the nurse include when teaching the parents to care for the site? (Select all that apply.) Apply petroleum jelly to the penis for the first 24 hr is correct. Apply gentle pressure from a sterile gauze pad to control slight bleeding is correct. Apply the diaper loosely over the penis is correct. [Show Less]
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Maternal newborn ati proctored exam 1oo% accurate answers, latest 2023
Maternal newborn ati proctored exam 1oo% accurate answers, latest 2023
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ATI Maternal Newborn Practice A with rated top solution. Latest 2023
A nurse is caring for a client who has uterine atony and is experiencing postpartum hemorrhage. Which of the following actions is the nurse's top priority?... [Show More] a) check client's capillary refill b) massage the client's fundus c) insert an indwelling urinary catheter for the client d) Prepare the client for a blood transfusion. b) massage the fundus Uterine atony and postpartum hemorrhage indicate that this client is at the greatest risk for hypovolemic shock. This can compromise the perfusion to the client's vital organs, which can lead to death. Therefore, the nurse's priority is to massage the client's fundus to minimize blood loss. All the other answers are actions the nurse should take, but the priority is massaging the fundus. A nurse is caring for a client who is to receive oxytocin to augment her labor. Which of the following findings contraindicates the initiation of the oxytocin infusion and should be reported to the provider? a) Late decelerations b) Moderate variability of the FHR c) Cessation of uterine dilation d) Prolonged active phase of labor A) Late decelerations Late decelerations are indicative of uteroplacental insufficiency. Therefore, this is a contraindication for the administration of oxytocin and should be reported to the provider. Moderate variability of the FHR is an expected assessment finding associated with normal fetal acid-base balance. It is not a contraindication to the administration of oxytocin. Cessation of uterine dilation is an indication for the initiation of an oxytocin infusion to augment the client's labor progression. A prolonged active phase of labor is an indication for the initiation of an oxytocin infusion to augment the client's labor progression. A nurse is assessing a client who has severe preeclampsia. Which of the following manifestations should the nurse expect? a) 2+ deep tendon reflexes b) Proteinuria of 200 mg in a 24-hr specimen c) Polyuria d) Blurred vision d) Blurred vision The nurse should identify that a client who has severe preeclampsia can have arteriolar vasospasms and decreased blood flow to the retina which can lead to visual disturbances, such as blurred vision, double vision, or dark spots in the visual field. Patient would have 3+ or 4+ DTRs, proteinuria >500 mg, decreased urine output of 20 mL/hr A nurse is assessing a client who is 1 day postpartum and has a vaginal hematoma. Which of the following manifestations should the nurse expect? a) Lochia serosa vaginal drainage b) Vaginal pressure c) Intermittent vaginal pain d) Yellow exudate vaginal drainage b) Vaginal pressure The nurse should expect a client who has a vaginal hematoma to report pressure in the vagina due to the blood that leaked into the tissues. Patient will report persistent, not intermittent pain and lochia rubra. A nurse is caring for a client who is at 36 weeks of gestation and has as positive contraction stress test. The nurse should plan to prepare the client for which of the following diagnostic tests? a) Biophysical profile b) Amniocentesis c) Cordocentesis d) Kleihauer-Betke test a) Biophysical profile A positive contraction stress test indicates that further evaluation of the fetus is necessary. A biophysical profile will provide further evaluation with a real-time ultrasound. An amniocentesis is used to determine lung maturity, detect congenital anomalies, and diagnose fetal hemolytic disease. A cordocentesis is used to identify fetal blood type and RBC when there is a risk of isoimmune hemolytic anemia. The Kleihauer-Betke test is used to determine the amount of fetal blood in the maternal circulation when there is a risk of Rh-isoimmunization. A nurse is providing teaching for a client who has a new prescription for combined oral contraceptives. Which of the following findings should the nurse include as an adverse effect of this medication? a) Depression b) Polyuria c) Hypotension d) Urticaria a) Depression The nurse should instruct the client that depression is a common adverse effect of combined oral contraceptives. Other common adverse effects of the medication include amenorrhea, weight gain, headache, nausea, breakthrough bleeding, and breast tenderness. Fluid retention can occur due to an excess of estrogen. Polyuria is not a common adverse effect of the medication. Hypertension, rather than hypotension, is a common adverse effect of combined oral contraceptives. Urticaria is not a common adverse effect of combined oral contraceptives. A nurse is caring for a postpartum client who is receiving heparin via a continuous IV infusion for thrombophlebitis in her left calf. Which of the following actions should the nurse take? a) Administer aspirin for pain. b) Maintain the client on bed rest. c) Massage the affected leg every 12 hr. d) Apply cold compresses to the affected calf. b) Maintain the client on bed rest. The client should remain on bed rest to decrease the risk of dislodging the clot, which could cause a pulmonary embolism. Elevation of the affected leg is recommended. A client receiving anticoagulant therapy, such as heparin, should not receive aspirin because it can lead to prolonged clotting times and increased risk of bleeding. The nurse should avoid massaging the affected leg to decrease the risk of dislodging the clot, which could cause a pulmonary embolism. The nurse should apply warm compresses to the affected area to promote circulation and decrease edema. A nurse is providing teaching to a client who is at 40 weeks of gestation and has a new prescription for misoprostol. Which of the following instructions should the nurse include in the teaching? a) "I can administer oxytocin 4 hours after the insertion of the medication." b) "You will need a full bladder prior to the insertion of the medication." c) "Remain in a side-lying position for 15 minutes after the medication is inserted." d) "An antacid will be given 20 minutes prior to the insertion of the medication." a) "I can administer oxytocin 4 hours after the insertion of the medication." The nurse can administer oxytocin no sooner than 4 hr after the last dose of misoprostol. Oxytocin can be administered following misoprostol for clients who have cervical ripening and have not begun labor. The nurse should instruct the client to void prior to the administration of the medication. The nurse should instruct the client to remain in a side-lying position for 30 to 40 min after the insertion. The nurse should avoid administering aluminum hydroxide and magnesium-containing antacids with misoprostol. A nurse is assessing four newborns. Which of the following findings should the nurse report to the provider? a) A newborn who is 26 hr old and has erythema toxicum on his face b) A newborn who is 32 hr old and has not passed a meconium stool c) A newborn who is 12 hr old and has pink-tinged urine d) A newborn who is 18 hr old and has an axillary temperature of 37.7° C (99.9° F) d) A newborn who is 18 hr old and has an axillary temperature of 37.7° C (99.9° F) An axillary temperature greater than 37.5° C (99.5° F) is above the expected reference range for a newborn and can be an indication of sepsis. Therefore, the nurse should report this finding to the provider. Pink-tinged urine is an indication of uric acid crystals and is an expected finding for a newborn during the first week following birth. A newborn should pass the first meconium stool within the first 24 to 48 hr following birth. Failure to pass a meconium stool can indicate a bowel obstruction or congenital disorder. This finding is within the expected reference range. Erythema toxicum is a transient rash that can appear anywhere on a newborn's body during the first 24 to 72 hr following birth and can last up to 3 weeks. This finding requires no treatment. A nurse is caring for a client who is at 30 weeks of gestation and has a prescription for magnesium sulfate IV to treat preterm labor. The nurse should notify the provider of which of the following adverse effects? a) Client reports nausea b) Urinary output of 40 mL/hr c) Respiratory rate 10/min d) Client reports feeling flushed c) Respiratory rate 10/min The nurse should report a respiratory rate of less than 12/min to the provider, because this is a manifestation of magnesium toxicity. The nurse should ensure that the antidote, calcium gluconate, is readily available. Oliguria is a manifestation of magnesium toxicity. The nurse should report a urinary output of less than 25 to 30 mL/hr to the provider. Nausea is an expected adverse effect of magnesium sulfate. The nurse should reassure the client and provide comfort measures. Flushing and feeling hot is an expected adverse effect of magnesium sulfate. The nurse should reassure the client and provide comfort measures. A nurse is teaching a client who is at 10 weeks of gestation about nutrition during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a) "I should increase my protein intake to 60 grams each day." b) "I should drink 2 liters of water each day." c) "I should increase my overall daily caloric intake by 300 calories." d) "I should take 600 micrograms of folic acid each day." d) "I should take 600 micrograms of folic acid each day." A client who is pregnant should increase folic acid intake to 600 mcg daily. Folic acid assists with preventing neural tube birth defects. A client who is pregnant should increase protein intake to 71 g each day during the second and third trimesters. A client who is pregnant should consume 3 L of water each day. A client who is pregnant should increase caloric intake by 340 cal during the second trimester and by 452 cal during the third trimester. A nurse is assessing a late preterm newborn. Which of the following manifestations is an indication of hypoglycemia? a) Hypertonia b) Increased feeding c) Hyperthermia d) Respiratory distress d) Respiratory distress Late preterm newborns are at an increased risk for hypoglycemia due to decreased glycogen stores and immature insulin secretion. Respiratory distress is a manifestation of hypoglycemia. Other manifestations of hypoglycemia include an abnormal cry, jitteriness, lethargy, poor feeding, apnea, and seizures. A hypoglycemic newborn can exhibit HYPOtonia, POOR feeding behaviors, and HYPOthermia. A nurse in a prenatal clinic is assessing a group of clients. Which of the following clients should the nurse see first? a) A client who is at 11 weeks of gestation and reports abdominal cramping b) A client who is at 15 weeks of gestation and reports tingling and numbness in right hand c) A client who is at 20 weeks of gestation and reports constipation for the past 4 days d) A client who is at 8 weeks of gestation and reports having three bloody noses in the past week a) A client who is at 11 weeks of gestation and reports abdominal cramping Abdominal cramping can indicate an ectopic pregnancy or manifestations of spontaneous abortion. The nurse should request that the provider see this client first. The other three findings are common discomforts related to pregnancy for their gestation. A nurse is demonstrating to a client how to bathe their newborn. In which order should the nurse perform the following actions? The nurse should demonstrate how to bathe a newborn by using a head to toe, clean to dirty, approach. Therefore, the nurse should first wipe the newborn's eyes from the inner canthus outward using plain water. The nurse should then wash the newborn's neck by lifting the newborn's chin. Next, the nurse should cleanse the skin around the umbilical cord stump followed by washing the newborn's legs and feet. The last step of the bath should be to clean the newborn's diaper area. A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. Which of the following statements should the nurse include in the teaching? a) "Obtain an informed consent prior to obtaining the specimen." b) "Collect at least 1 milliliter of urine for the test." c) "Ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen." d) "Premature newborns may have false negative tests due to immature development of liver enzymes." c) "Ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen." The nurse should ensure that the newborn has been receiving regular feedings for at least 24 hr prior to testing. The universal newborn screening is mandated by law for all newborns. Therefore, the nurse does not need to obtain informed consent prior to obtaining the specimen. The nurse should collect a capillary blood sample via heel stick for the newborn screening. Urine is not collected for this test. Premature newborns have a delayed development of liver enzymes which can cause a false POSITIVE result. A nurse is creating a plan of care for a client who is postpartum and adhere to traditional Hispanic cultural beliefs. Which of the following cultural practices should the nurse include in the plan of care? a) Protect the client's head and feet from cold air. b) Bathe the client within 12 hr following birth. c) Ambulate the client within 24 hr following birth. d) Offer the client a glass of cold milk with her first meal. a) Protect the client's head and feet from cold air. Protecting the client's head and feet from cold air should be included in the plan of care because this is a traditional Hispanic practice during the postpartum period. Bathing the client within 12 hr following birth should not be included in the plan of care because traditional Hispanic practices include delaying bathing for 14 days following birth. Ambulating the client within 24 hr following birth should not be included in the plan of care because traditional Hispanic practices include bed rest for 3 days following birth. Offering the client a glass of cold milk with her first meal should not be included in the plan of care because traditional Hispanic practices include drinking warm beverages following birth. A nurse is assessing a newborn who was born at 26 weeks of gestation using the New Ballard Score. Which of the following findings should the nurse expect? a) Minimal arm recoil b) Popliteal angle of 90° c) Creases over the entire foot sole d) Raised areolas with 3 to 4 mm buds a) Minimal arm recoil The nurse should expect a newborn who was born at 26 weeks of gestation to have decreased muscular tone, or minimal arm recoil. All other findings are indicators of physical maturity with increasing gestational age after 26 weeks. A nurse is caring for a client who is at 15 weeks o gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure? a) Check the client's temperature. b) Observe for uterine contractions. c) Administer Rho(D) immune globulin. d) Monitor the FHR. d) Monitor the FHR. The greatest risk to this client and her fetus is fetal death. Therefore, the priority nursing intervention is to monitor the FHR following an amniocentesis. The check should also check temperature for infection, uterine contractions for preterm labor, and Rhogam to prevent Rh sensitiivation; however, these are not priority interventions. A nurse is assessing a newborn who is 16 hr old. Which of the following findings should the nurse report to the provider? a) Substernal retractions b) Acrocyanosis c) Overlapping suture lines d) Head circumference 33 cm (13 in) a) Substernal retractions The nurse should identify that substernal retractions, apnea, grunting, nasal flaring, and tachypnea are manifestations of neonatal infection or respiratory distress in the newborn. The nurse should report these findings to the provider for immediate intervention. All other options are expected findings/variations/measurements. A nurse is performing a physical assessment of a newborn upon admission to the nursery. Which of the following manifestations should the nurse expect? (Select all that apply.) a) Yellow sclera b) Acrocyanosis c) Posterior fontanel larger than the anterior fontanel d) Positive Babinski reflex e) Two umbilical arteries visible b, d,ee Yellow sclera is incorrect. Yellow sclera is an indication of hyperbilirubinemia and is not an expected manifestation. Acrocyanosis is correct. Acrocyanosis is an expected finding for at least the first 24 hr following birth. Poor peripheral perfusion leads to bluish discoloration in the newborn's hands and feet.Posterior fontanel larger than the anterior fontanel is incorrect. The posterior fontanel is located on the back of the newborn's head and is a small triangular shape. The anterior fontanel is diamond shaped and approximately 5 cm (2 in) long. It is located on the top of the newborn's head and is larger than the posterior fontanel.Positive Babinski reflex is correct. Newborns should exhibit a positive Babinski sign following birth. The nurse should stroke the newborn's foot upward from the heel to the toes. The toes should hyperextend, and dorsal flexion of the big toe should occur. The absence of this finding requires neurological evaluation. The Babinski reflex is no longer present after 1 year of age.Two umbilical arteries visible is correct. The nurse should observe two arteries and one vein in the umbilical cord. The presence of only one artery can indicate a renal anomaly. A nurse is caring for a client who is experiencing preeclampsia and has a new prescription for IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if the client develops magnesium toxicity? a) Calcium gluconate b) Hydraliazine c) Medroxyprogesterone acetate d) Methylergonovine a) Calcium gluconate The nurse should anticipate administering calcium gluconate if the client develops magnesium toxicity. Calcium gluconate is the antidote. Hydralazine is an antihypertensive medication that can be administered to clients who have hypertension during pregnancy, Medroxyprogesterone acetate is an injectable contraceptive hormone Methylergonovine is used to treat postpartum hemorrhage A nurse is teaching a client who is at 37 weeks of gestation and has a prescription for a nonstress test. Which of the following instructions should the nurse include? a) "The test should take 10 to 15 minutes to complete." b) "You will lay in a supine position throughout the test." c) "You should not eat or drink for 2 hours before the test." d) "You should press the handheld button when you feel your baby move." d) "You should press the handheld button when you feel your baby move." The nurse should instruct the client to press the handheld button when the fetus moves. This action will mark the fetal monitor tracing with the client's reports of fetal movement. This will assist in the interpretation of the nonstress test to determine if it is reactive or nonreactive. The nurse should instruct the client that the nonstress will take approximately 20 to 30 min, but more time might be required if the fetus is in a sleep state when the testing begins. The client is not required to be NPO before or during the procedure. The nurse can suggest the client drink orange juice to increase her blood glucose level which will stimulate fetal movements. A nurse is providing education about family bonding to parents who recently adopted a newborn. The nurse should make which of the following suggestions to aid the family's 7-year-old child in accepting the new family member? a. Allow the sibling to hold the newborn during a bath. b. Make sure the sibling kisses the newborn each night. c. Obtain a gift from the newborn to present to the sibling. d. Switch the sibling's room with the nursery. c. Obtain a gift from the newborn to present to the sibling. Presenting a gift from the newborn to the sibling is a strategy to facilitate a school-age sibling's acceptance of a new family member. This ensures that the sibling does not feel left out and that they understand their role in the family. Allowing the sibling to hold the newborn during a bath is not an appropriate activity for a school-age child because of the safety risk. However, the parents could let the sibling assist with other things in regard to caring for the newborn. Forcing interactions between the sibling and the adoptive newborn can cause anger on the part of the sibling. It is more important to allow feelings to evolve naturally as the family unit bonds. Switching the sibling's room with the newborn's room might cause jealousy of the newborn or cause the sibling to feel that the newborn is taking their belongings. A nurse is caring for a client who is at 35 weeks gestation and is undergoing a nonstress test that reveals a variable deceleration in the FHR. Which of the following actions should the nurse take? a. Give the client orange juice. b. Elevate the client's legs. c. Have the client change position. d. Establish IV access. c. Have the client change position. Having the client change position is an appropriate intervention for a variable deceleration to relieve umbilical cord compression. Giving the client orange juice is not an appropriate intervention for a variable deceleration in the FHR. Elevating the client's legs is an acceptable intervention for late decelerations associated with maternal hypotension. Establishing IV access is not indicated at this time. A nurse is assessing a client who is at 38 weeks of gestation during a weekly prenatal visit. Which of the following findings should the nurse report to the provider? a. Blood pressure 136/88 mm Hg b. Report of insomnia c. Weight gain of 2.2 kg (4.8 lb) d. Report of Braxton Hicks contractions c. Weight gain of 2.2 kg (4.8 lb) A weight gain of 2.2 kg (4.8 lb) in a week is above the expected reference range and could indicate complications. Therefore, this finding should be reported to the provider. A blood pressure of 136/88 mm Hg is within the expected reference range for a client who is at 38 weeks of gestation. Therefore, this finding does not need to be reported to the provider. A regular occurrence of insomnia can be expected for a client who is at 38 weeks of gestation. Therefore, this finding does not need to be reported to the provider. Braxton Hicks contractions can be expected for a client who is at 38 weeks of gestation. Therefore, this finding does not need to be reported to the provider. A nurse is providing teaching for a client who gave birth 2 hr ago about the facility policy for newborn safety. Which of the following client statements indicates an understanding of the teaching? a. "My sister will be able to carry my baby from the nursery to my room when she arrives." b. "The nurse will match my wrist band to my baby's crib card when they bring him to me." c. "The person who comes to take my baby's pictures will be wearing a photo identification badge." d. "My baby doesn't need to wear the electronic security bracelet when he's in my room." c. "The person who comes to take my baby's pictures will be wearing a photo identification badge." All personnel working on the unit should be wearing a photo identification badge. The nurse should instruct the parent to never allow anyone who is not wearing an identification badge to come in contact with the newborn. A newborn should always be transported in a bassinet when outside the parent's room. The nurse will match the newborn's identification number with the parent's identification number when they bring the newborn to the parent's room. The newborn should wear the electronic security bracelet at all times. The bracelet is set to alarm if anyone removes the bracelet or if the newborn is brought near an exit door. [Show Less]
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ATI: Maternal Newborn Practice Assessment test rated A+
A nurse in a provider's office is reinforcing teaching for a client with mild pre-eclampsia. Which of the following should the nurse include in the teachin... [Show More] g? A. Rest in bed in the supine postion B. Limit sodium intake to 1,200 mg/day C. Limit fluid intake to 1,000 mL/day D. Test urine once a day for protein D. Test urine once a day for protein A nurse on the postpartum unit is caring for a client who experienced abruptio placenta. The nurse observes petechiae and bleeding around the IV access site. The nurse recognizes this client is at risk for which of the following postpartum complications? A. Amniotic fluid embolism B. Disseminated intravascular coagulation C. Preeclampsia D. Puerperal infection B. Disseminated intravascular coagulation A nurse is caring for a client who is pregnant and has iron-deficiency anemia. To enhance the client's iron absorption, which of the following beverages should the nurse recommend? A. Milk B. Orange juice C. Tea D. Hot chocolate B. Orange juice A nurse is completing a newborn gestational age assessment. Which of these findings is recorded as part of this assessment? A. Acrocyanosis of hands and feet B. Anterior fontanel soft and level C. Plantar creases cover 2/3 of sole D. Vernix caseosa in inguinal creases C. Plantar creases cover 2/3 of sole A nurse is reinforcing teaching about contraceptives for a group of female clients. Which of the following client statements reflects appropriate knowledge regarding proper use of a diaphragm? A. "Remove the diaphragm promptly following intercourse and then douche." B. "Leave the diaphragm in for at least 6 hr after vaginal intercourse." C. "Never use creams or jellies so the diaphragm will fit snugly." D. "Insert the diaphragm at least 4 hr prior to vaginal intercourse to allow for a protective seal." B. "Leave the diaphragm in for at least 6 hr after vaginal intercourse." A nurse is preparing to administer RHO immunoglobulin (RhoGAM). An Rh incompatibility can lead to which of the following? A. Hydrops fetalis B. Hypobilirubinemia C. Congenital hypothermia D. Transient clotting difficulties A. Hydrops fetalis A nurse is assisting with the admission of a client who is at 30 weeks of gestation and is in preterm labor. The provider prescribes betamethasone (Celestone) stat. When the client asks the nurse about the purpose of the medication, the nurse should reply that it will help A. Stop preterm labor contractions B. Halt cervical dilation C. Boost fetal lung maturity D. Increase the fetal heart rate C. Boost fetal lung maturity A nurse is caring for a client who is admitted in preterm labor at 32 weeks of gestation. Which of the following prescriptions should the nurse question? A. Folic acid B. Ritodrine C. Misoprostol D. Trebutaline Sulfate C. Misoprostol This medication can cause abortion, premature labor, and birth defect. A nurse performing a non-stress test for a pregnant client. After 20 min, the client reported having felt four fetal movements. The nurse notes that each fetal movements was accompanied by an increase in the fetal heart rate of 10 to 15 beats per minute lasting approximately 15 to 20 seconds before returning to the baseline FHR of 130 to 136 beats per minute. The nurse interprets the results as indicating which of the following? A. Impaired perfusion of the placenta B. Neurological immaturity of the fetus C. A health fetal response to activity D. Poor response of the fetus to movement C. A health fetal response to activity A nurse is assisting with the care of a client who is at 38 weeks of gestation, in early labor with membranes intact, and has an oral temperature is 38.9 degrees C (102 degrees F). Besides notifying the provider, which of the following is an appropriate nursing action? A. Recheck the client's temperature in 4 hr B. Administer acetaminophen C. Prepare to suppress uterine activity D. Prepare the client for membrane rupture C. Prepare to suppress uterine activity A nurse is caring for a client who might have a hydatidiform mole. The nurse should monitor the client for which of the following findings? A. Fetal heart rate irregularities B. Whitish vaginal discharge C. Excessive uterine enlargement D. Rapidly dropping human chronic gonadotropin levels C. Excessive uterine enlargement A nurse is caring for a client who has just learned that she is pregnant. The nurse should reinforce to the client to call her provider if she experiences which of the following? A. Decreased energy B. Urinary frequency C. Facial edema D. Mood swings C. Facial edema A nurse is reinforcing teaching to a class of pregnant women about fetal development. Which of the following statements should the nurse include in her teaching? A. "The baby's heart beat is audible by a Doppler stethoscope at 12 weeks of pregnancy." B. "The sex of the baby is determined by week 8 of pregnancy." C. "Very fine hairs, called lanugo, cover your baby's entire body by week 36 of pregnancy." D. "You will first feel your baby move by week 24 pregnancy." A. "The baby's heart beat is audible by a Doppler stethoscope at 12 weeks of pregnancy." A client who has a body mass index of 26.5 has just found out that she is pregnant. She asks the nurse how much weight she should gain over the course of her pregnancy. Which of the following is the appropriate nursing response? A. "It would be best if you gained about 11 to 20 pounds." B. "The recommendation for you is about 15 to 25 pounds." C. "A gain of about 25 to 35 pounds is best for you and for your baby." D. "It really doesn't matter exactly how much weight you gain, as long as your diet is healthful." B. "The recommendation for you is about 15 to 25 pounds." A client who is postpartum and is breastfeeding her newborn tells the nurse that her nipples are sore. Which of the following interventions should the nurse suggest to the client? A. Apply a light coating of mineral oil to the nipples between feedings B. Keep the nipples covered in between breastfeeding sessions C. Increase the time between feedings until the nipples are less sore D. Change the newborn's position on the nipples with each feeding D. Change the newborn's position on the nipples with each feeding A nurse is planning care for an infant that has been diagnosed with phenylketonuria. Which of the following is an appropriate action for the nurse to take? A. Initiate a controlled diet eliminating protein B. Educate parents on blood glucose monitoring C. Administer thyroid hormone replacement D. Obtain a blood sample for blood type A. Initiate a controlled diet eliminating protein A client at 40 weeks gestation is about to undergo a biophysical profile. The nurse should explain that this profile focuses on which of the following parameters? A. Fetal breathing B. Fetal motion C. Nuchal translucency D. Amniotic fluid volume E. Fetal gender A. Fetal breathing B. Fetal motion D. Amniotic fluid volume A nurse is preparing to administer vitamin K by intramuscular injection to a newborn. Into which of the following muscles should the nurse inject the medication? A. Vastus laterails B. Ventrogluteal C. Dorsogluteal D. Deltoid A. Vastus laterails A nurse is caring for a client who visits the prenatal clinic stating that she thinks she may be pregnant because she is able to feel the baby move. Which of the following statements by the nurse is an appropriate response? A. "This is a presumptive sign of pregnancy." B. "This is probable sign of pregnancy." C. "This is a possible sign of pregnancy." D. "This is a positive sign of pregnancy." A. "This is a presumptive sign of pregnancy." A nurse is caring for a client in the prenatal clinic who is at 7 weeks of gestation. The client reports urinary frequency and asks the nurse if this will continue throughout her pregnancy. Which of the following is an appropriate response? A. "Yes, it will, but if you decrease your fluid intake, especially at bedtime, it won't be so bothersome." B. "No, in most cases it only lasts until about the 12th week, but it will continue if you have poor bladder tone." C. "There is no way to predict how long it will last for each individual client, so you'll just have to wait and see." D. "No, it should only last until about your 12th week, but it will return near the end of the pregnancy." D. "No, it should only last until about your 12th week, but it will return near the end of the pregnancy." A nurse places the newborn under a radiant heat warmer after birth. The purpose of this action is to prevent which of the following in the newborn? A. Cold stress B. Shivering C. Thermogenesis D. Brown fat production A. Cold stress A client who is postpartum and is breastfeeding her newborn asks the nurse about dietary precautions. The client states that food allergies "run in her family." The nurse should tell the mother to avoid eating A. Peanuts B. Asparagus C. Lamb D. Blueberries A. Peanuts The nurse is administering dinoprostone gel to a client being seen in the prenatal clinic. The client asks the nurse what the medication is for. Which of the following is an appropriate response for the nurse to make? A. Stimulate uterine contractions B. Cause the client to abort the pregnancy C. Promote softening of the cervix D. Relax uterine contractions C. Promote softening of the cervix A nurse is assisting with the care of a client who is in labor. When monitoring the uterine contractions the nurse is aware that relaxation between contractions should be greater than A. 30 seconds B. 45 seconds C. 60 seconds D. 75 seconds A. 30 seconds A nurse is caring for a client immediately after delivery. After assuring a patent airway, which action would be the nurse's priority in the care of the infant? A. Dry the infant and place him in a radiant heat warmer B. Administer Vitamin K intramuscular C. Perform a complete physical assessment and document findings D. Implement identification procedures A. Dry the infant and place him in a radiant heat warmer Immediately after a cesarean delivery, a nurse is caring for a newborn who weighs 5,160 g (11 lb 6 oz) and whose mother has diabetes mellitus. The priority data collection for this newborn is for A. Hypoglycemia B. Hypomagnesemia C. Hyperbilirubinemia D. Hypocalcemia A. Hypoglycemia A nurse is caring for a client who has had a dilation and curettage following a spontaneous abortion. The client tells the nurse that she is hungry. Which of the following initial actions by the nurse is appropriate? A. Auscultate the client's abdomen B. Offer clear liquids C. Ask the client if she is experiencing pain D. Check the client's chart for a diet prescription A. Auscultate the client's abdomen A nurse is collecting data from a client who is postpartum. Which of the following findings should alert the nurse to the possibility of a postpartum complication? A. Chills shortly after delivery B. Fundus at umbilicus level C. Urinary output 3,000 mL per 12 hour D. Pulse rate 110 beats/minute D. Pulse rate 110 beats/minute A pregnant client tells the nurse she has constipation. What is the appropriate nursing recommendation for the client? A. Regular use of laxative B. Maintenance of good posture C. Increased cellulose and fluid in the diet D. Regular use of glycerine suppositories C. Increased cellulose and fluid in the diet A nurse is assisting with the monitoring of a client who is in the first stage of labor, with an external fetal monitor place and IV fluid infusing. The nurse notes variable deceleration in the fetal heart rate on the monitoring strip. The nurse knows that the probable cause of this pattern is A. umbilical cord compression B. uteroplacental insufficiency C. maternal opioid administration D. fetal head compression A. umbilical cord compression A nurse is collecting data from an infant with Trisomy 21 (Down's Syndrome). Which of the following are common characteristics? A. Transverse palmar creases B. Large ears C. Muscular hypertonicity D. Protruding tongue E. Low birth weight A. Transverse palmar creases D. Protruding tongue A nurse in the prenatal clinic is reinforcing teaching to a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which statement by the client indicates a need for further teaching? A. "I should limit my carbohydrates to 50% of caloric intake." B. "I will reduce my exercise schedule to 3 days a week." C. "I will take my glyburide daily with breakfast." D. "I know I am at increased risk to develop type 2 diabetes." B. "I will reduce my exercise schedule to 3 days a week." A nurse in a prenatal clinic is reviewing the record of a client at 28 weeks of gestation. The woman's history reveals one pregnancy, terminated by elective abortion at 9 weeks; the birth of twins at 36 weeks; and a spontaneous abortion at 15 weeks. According to the GTPAL system, which of the following describes her present parity? A. 2-0-1-2-2 B. 1-0-2-2-2 C. 2-0-0-2-2 D. 0-2-0-2-2 A. 2-0-1-2-2 2 pregnancies that have reached 20 weeks or more of gestation (G) NO term births (T) ONE birth given in the preterm (P) TWO pregnancies ended in abortion (A) TWO living children (2) A nurse is caring for a client who is receiving oxytocin IV following a normal vaginal delivery. To evaluate the effectiveness of this medication, the nurse needs to check the client's A. urinary output B. blood pressure C. fundal consistency D. pulse rate C. fundal consistency A nurse is caring for a client who has a suspected placenta previa. Which of the following is an appropriate nursing action? A. Complete a vaginal exam B. Perform a rectal exam C. Apply ice to the peri area D. Apply an external fetal monitor D. Apply an external fetal monitor A nurse is caring for a client during a non-stress test. The nurse observes two deceleration of 15 beats/min in the fetal heart rate during a period of fetal movement. Each deceleration lasts 20 seconds. This indicates which of the following findings? A. A negative test B. A nonreactive test C. A positive test D. A reactive test B. A nonreactive test A nurse is reinforcing teaching to a group of postpartum clients about nutritional requirements during lactation. The nurse recommends increased intake of which of the following nutrients? A. Calcium B. Zinc C. Folic acid D. Iron B. Zinc A nurse is caring for a client who is 2 days postpartum, is breastfeeding, and reports nipple soreness. Which of the following measures should the nurse suggests to help lessen discomfort during breastfeeding? A. Apply breast milk to her nipples before each feeding B. Alternate breasts at the beginning of each feeding C. Let the newborn sleep for long periods do the nipples can heal D. Start breastfeeding with the nipple that is less sore E. Change the infant's position on the nipples A. Apply breast milk to her nipples before each feeding B. Alternate breasts at the beginning of each feeding D. Start breastfeeding with the nipple that is less sore E. Change the infant's position on the nipples A nurse is speaking to a client on the phone who is pregnant and taking iron supplements for iron-deficiency anemia. The client reports that her stools are black but she has no abdominal pain or cramping. Which of the following is an appropriate response by the nurse? A. "Come to the office and we sill check things out." B. "Go to the emergency room and your provider will meet you there." C. "This expected because of the way iron is broken down during digestion." D. "What else have you been eating?" C. "This expected because of the way iron is broken down during digestion." A nurse is assisting a client who is 8 hr postpartum and multiparous. Which of the following findings should alert the nurse to the client's need to urinate? A. Moderate lochia rubra B. Fundus three finger breaths above the umbilicus C. Moderate swelling of the labia D. Blood pressure 130/84 mm Hg B. Fundus three finger breaths above the umbilicus A nurse in a provider's office is reinforcing teaching to a client who is 34 weeks of gestation and at risk for placenta abruption. The nurse recognizes that which of the following is the most common risk factor for abruption? A. Maternal cocaine use B. Maternal hypertension C. Maternal battering D. Maternal cigarette smoking B. Maternal hypertension A nurse is assisting a newborn the day after delivery. The nurse notes a raised bruised area on the left side of the scalp that does not cross the suture line. The nurse should document this findings as A. caput succedaneum B. cephalhematoma C. molding D. cradle cap B. cephalhematoma Swelling of the subcutaneous tissue of the newborn's scalp with blood [Show Less]
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ATI- Maternal Newborn Final questions and answers with graded A solution
A nurse is caring for a client who desires an intrauterine device (IUD) for contraception. Which of the following findings is a contraindication for the us... [Show More] e of this device? Mennorhagia A nurse is reinforcing teaching with a client with a client who is pregnant. Which of the following instructions should the nurse include? "You should use floride-based toothpaste to prevent dental caries." A nurse is assisting with the plan of care for a client who is pregnant and is Rh-negative. In which of the following situations should the nurse administer Rh(D) immune globulin? At 28 weeks of gestation A nurse is caring for a newborn who was born to a client who was a narcotic use disorder. Which of the following nursing actions should the nurse identify as a contraindication for the care of the newborn? Frequent stimulation A nurse is assisting with the plan of care for a client who is at 35 weeks of gestation. Which of the following laboratory tests should the nurse obtain? Group B Streptococcus B-hemolytic culture A nurse is assisting in the plan of care for a newborn who requires phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan of care? Ensure the newborn's eyes are closed before applying the eye shield A nurse is caring or a client who is at 34 weeks of gestation and has a prescription for terbutaline for preterm labor. Which of the following statements by the client is the nurse's priority? "My heart feels as if it is racing." A nurse is assisting with caring for a client who is at 36 weeks of gestation and has pre-eclampsia. Which of the following should the nurse identify as the priority? Nonreactive nonstress test A nurse is caring for a newborn who was irregular respirations of 52/min with several periods of apnea lasting approximately 5 seconds. The newborn is pink with acrocyanosis. Which of the following actions should the nurse take? Continue to routinely monitor the newborn A nurse is reinforcing teaching with a client who is postpartum and breastfeeding. Which of the following nutrients should the nurse include in the teaching as a nutrient for the client to increase the intake of while breastfeeding? Vitamin C A nurse is caring for a client who reports that her last menstrual period (LMP) began on July 8. Based on Nagele's rule, which of the following is the client's expected date of birth (EDB)? April 15 A nurse is caring for a client who is 2 hr postpartum. The nurse notes that the client's perineal pad has a large amount of lochia rubra with severe clots. Which of the following actions should the nurse take first? Massage the fundus A nurse is reinforcing discharge instructions with a client following the removal of a hydatiform mole. Which of the following statements should the nurse include in the teaching? "Do not become pregnant for at least 1 year." A nurse is preparing a client who is pregnant for an ultrasound. Which of the following information is the most important for the nurse to collect? The time of the client's last void A nurse is reinforcing teaching with a client about a nonstress test. Which of the following statements by the client indicates an understanding of the teaching? "I should press the button on the hand held marker when my baby moves." A nurse is assisting with the care of a newborn who has a myelomeningocele. Which of the following actions should the nurse take? Initiate a latex free environment A nurse is reinforcing teaching with a client who is breastfeeding. Which of the following information should the nurse include? "Your baby should have bursts of 15 sucks or swallows at a time." A nurse is caring for a client who has trichomoniasis and a prescription for metronidazole. Which of the following instructions should the nurse reinforce with the client about the treatment plan? "You and your partner need to take the medication and use a condom during intercourse until cultures are negative." A nurse is reinforcing teaching about oxytocin with a client who is in the third trimester of pregnancy and has pre-eclampsia. Which of the following is a contraindication for the use of this medication? Active genital herpes A nurse is speaking with an expectant father who says that he feels resentful of the added attention others are giving to his wife since the emergency was announced several weeks ago. Which of the following responses should the nurse make? "These feelings are common for expectant fathers in early pregnancy." A nurse is reinforcing teaching with a client who has active genital herpes simplex virus, type 2. Which of the following statements by the nurse should be included in the teaching? "You will have a cesarean birth prior to the onset of labor." A nurse is caring for four newborns. Which of the following findings should the nurse report to the provider? A 12-hour-old newborn who has a heart rate of 70/min while sleeping A nurse is assisting with the care of a preterm newborn who is receiving oxygen therapy. Which of the following findings should the nurse identify as a potential complication from the oxygen therapy? Retinopathy A nurse is reinforcing teaching about formula feeding with a parent of a newborn. Which of the following statements by the parent indicates understanding of the teaching? "I will warm the bottle of formula by placing it in a pan of hot water." A nurse is collecting data for a newborn who is 12 hr old and notes mild jaundice of the face and trunk. Which of the following actions should the nurse take/ Obtain a stat prescription for a bilirubin level A nurse is caring for four newborns. Which of the following newborns is a greatest risk for hypoglycemia? A newborn who is large for gestational age A nurse administers betamethasone to a client who is at 33 weeks of gestation to stimulate fetal lung maturity. When assisting with care for the newborn. Which of the following conditions should the nurse identify as an adverse effect of this medication? Decreased blood glucose A nurse is collecting data on a client who is at 8 weeks of gestation. Which of the following findings should the nurse report to the provider? Small amount of brown vaginal discharge A nurse is caring for a client who is at 16 weeks of gestation and has severe iron-deficiency anemia. The provider prescribes an injection of iron IM. Which of the following methods should the nurse use to administer the medication? Use a 20-gauge needle, and administer the medication using the Z-track method A nurse is caring for a client who is at 8 weeks of gestation with twins and is primigravida. The client states that even though she and her planned this pregnancy, she is experiencing many ambivalent feelings about it. Which of the following responses should the nurse make? "These feelings are normal at the beginning of pregnancy." A nurse in a prenatal clinic is caring for a client who is within the recommended guideline for weight. The client asks the nurse how much weight is safe for her to gain during her pregnancy. Which of the following responses should the nurse make? "A weight gain of about 25 to 35 pounds is good." A nurse is caring for a newborn who has a neonatal abstinence syndrome. Which of the following clinical findings should the nurse expect? Exaggerated reflexes A nurse is contributing to the plan of care for a client who plans to formula feed her newborn. Which of the following actions should the nurse include in the plan? Have the client place ice packs on her breasts four times per day A nurse is discussing diaphragm use with a client. Which of the following statements by the client indicates an understanding of the teaching? "I should replace my diaphragm every 2 years." [Show Less]
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Maternal Newborn Practice 2023 A+ with graded solutions
A nurse is assessing a client who has gestational diabetes mellitus and is experiencing hyperglycemia. Which of the following findings should the nurse exp... [Show More] ect? Reports increased urinary output A nurse is caring for a client who is at 22 weeks of gestation and is HIV positive. Which of the following actions should the nurse take? Report the client's condition to the local health department A nurse is providing teaching for a client who has a new prescription for combined oral contraceptives. Which of the following findings should the nurse include as an adverse effect of this medication? Depression A nurse is providing teaching to a client who is at 40 weeks of gestation and has a new prescription for misoprostol. Which of the following instructions should the nurse include in the teaching? "I can administer oxytocin 4 hours after the insertion of the medication" A nurse is caring for a prenatal client who has parvovirus B19 (fifth disease). Which of the following actions should the nurse take? Schedule an ultrasound examination A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn Place the newborn skin to skin on the mothers chest A nurse is performing a vaginal exam on a client who is in labor and observes the umbilical cord protruding from the vagina. After calling for assistance, which of the following actions should the nurse take? Insert two gloved fingers into the vagina and apply upward pressure to the presenting part A nurse is caring for a client who is at 24 weeks of gestation and has a suspected placental abruption. Which of the following laboratory tests should the nurse expect the provider to prescribe? Kleihauer-Betke test A nurse is admitting a client who is in labor. The client admits to recent cocaine use. For which of the following complications should the nurse assess? Abruptio placenta A nurse is assessing a client who has severe preeclampsia. Which of the following manifestations should the nurse expect? Blurred Vision A nurse is providing education about family bonding to parents who recently adopted a newborn. The nurse should make which of the following suggestions to aid the family's 7-year-old in accepting the new family memeber? Obtain an gift from the newborn to present to the sibling A nurse is assessing a client who is receiving morphine via IV bolus for pain following a C-section. The nurse notes a respiratory rate of 8/min. Which of the following medications should be administered? Naloxone A nurse is teaching a client who is at 10 weeks of gestation about nutrition during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? "I should take 600 micrograms of folic acid every day" A nurse is assessing a newborn 12 hr after birth. Which of the following manifestations should the nurse report to the provider? Jaundice A nurse is observing a new parent caring for her crying newborn who is bottle feeding. Which of the following actions by the parent should the nurse recognize as a positive parenting behavior? Lays the newborn across her lap and gently sways A nurse is teaching a newly licensed nurse about collecting a specimen for the universal newborn screening. Which of the following statements should the nurse include in the teaching? "Ensure that the newborn has been receiving feeding for 24 hours prior to obtaining the specimen" A nurse is caring for a client who has uterine atony and is experiencing postpartum hemorrhage. Which of the following actions is the nurse priority? Massage the client's fundus A nurse is performing a physical assessment of a newborn upon admission to the nursery. Which of the following manifestations should the nurse expect? Acrocyanosis Positive Babinski reflex Two umbilical arteries visible is correct A nurse is demonstrating to a client how to bathe their newborn. In which order should the nurse perform the following actions? Wipe eyes Wash Neck Cleanse skin around umbilical cord stump Wash legs and feet Clean diaper area A nurse is assessing a client who received carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication? Hypertension A nurse is caring for a client who is at 35 weeks of gestation and is undergoing a nonstress test that reveals a variable deceleration in the FHR. Which of the following actions should the nurse take? Have the client change positions A nurse is caring for a client who is at 38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring? Perform Leopold Maneuvers A nurse in a prenatal clinic is assessing a group of clients. Which of the following clients should the nurse see first? A client who is at 11 weeks of gestation and reports abdominal cramping A nurse is caring for a client who is at 32 weeks of gestation and has gonorrhea. The nurse should identify that the client is at an increased risk for which of the following complications? Premature rupture of membranes A nurse is assessing four newborns. Which of the following findings should the nurse report to the provider? A newborn who is 18 hr old and has an axillary temperature of 99.9° F A nurse is caring for a postpartum client who is receiving heparin via a continuous IV infusion for thrombophlebitis in her left calf. Which of the following actions should the nurse take? Maintain the client of bed rest A nurse is providing discharge teaching to a client who had a cesarean birth 3 days ago. Which of the following instructions should the nurse include? "You can still become pregnant if you are breastfeeding" A nurse is performing a physical assessment of a newborn. Which of the following clinical finding should the nurse expect? Heart Rate 154/ min Respiratory rate 58/ min Weight 2,600 g (5lb 12 oz) A nurse is performing a routine assessment on a client who is at 18 weeks of gestation. Which of the following findings should the nurse expect? FHR 152/min A nurse is reviewing the prenatal laboratory value for a client who is at 12 weeks of gestation following an initial prenatal visit. Which of the following laboratory findings should the nurse report to the provider Hemoglobin 10 g/dL A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbillirubinemia. Which of the following actions should the nurse include in the plan? Remove all clothing form the newborn except the diaper A nurse is caring for a client who is at 15 weeks gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure? Monitor the FHR A nurse in an antepartum clinic is assessing a client who is at 32 weeks of gestation. Which of the following findings should the nurse report to the provider? Reports of decreased fetal movement A nurse is admitting a client to the labor and delivery unit when the client states, "My water just broke". Which of the following interventions is the nurse's priority? Begin FHR monitoring A nurse is caring for a client who is at 36 weeks of gestation and has a positive contraction stress test. The nurse should plan to prepare the client for which of the following diagnostic test? Biophysicial profile A nurse is preparing to administer magnesium sulfate 2g/hr IV to a client who is in preterm labor. Available is 20 g magnesium sulfate in 500 mL of dextrose 5% in water (D5W). The nurse should set the IV infusion pump to administer how many mL/hr? 50 ml/hr A nurse is caring for a client who has hyperemesis gravidarum and is receiving IV fluid replacement. Which of the following findings should the nurse report to the provider? BUN 25 mg/dL A nurse is assessing a late preterm newborn. Which of the following manifestations is an indication of hypoglycemia? Respiratory distress A nurse in a provider's office is reviewing the medical record of a client who is in the first trimester of pregnancy. Which of the following should the nurse identify as a risk factor for the development of preeclampsia Pregestational Diabetes Mellitus A nurse in an antepartum clinic is providing care for a client who is at 26 weeks of gestation. Upon reviewing the client's medical record, which of the following findings should the nurse report to the provider? Fundal Height Measurement A nurse is assessing a newborn who is 16 hr old. Which of the following findings should the nurse report to the provider? Substernal Retractions A nurse is caring for a client who is at 26 weeks of gestation and has epilepsy. The nurse enters the room and observes the client having a seizure. After turning the client head to the side, which of the following actions should the nurse take immediately after the seizure? Administer oxygen via a nonrebreather mask A nurse is providing teaching about nonpharmological pain management to a client who is breastfeeding and has engorgement. The nurse should recommend the application of which of the following items? Cold cabbage leaves A nurse is assessing a client who is 1 day postpartum and has a vaginal hematoma. Which of the following manifestations should the nurse expect? Vaginal pressure A nurse is assessing a newborn who was born at 26 weeks of gestation using the New Ballard Score. Which of the following findings should the nurse expect? Minimal arm recoil A nurse is providing teaching for a client who have birth 2 hr ago about the facility policy for newborn safety. Which of the following client statements indicates an understanding of the teaching? the person who comes to take my baby's pictures will be wearing a photo identification badge A nurse is assessing a client who is at 36 weeks of gestation. Which of the following findings should the nurse report to the provider? Report of visual disturbances A nurse is providing teaching to a client about the physiological changes that occur during pregnancy. The client is at 10 weeks of gestation and has a BMI within the expected reference range. Which of the following client statements indicates an understanding of the teaching? "I will likely need to use alternative positions for sexual intercourse". A nurse is caring for a client who is anemic at 32 weeks of gestation and is in preterm labor. The provider prescribed bethamethasone 12 mg IM. Which of the following outcomes should the nurse expect? A reduction in respiratory distress in the newborn A nurse is caring for a client who is experiencing preeclampsia and has a new prescription for IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if the client develops magnesium toxicity? Calcium Gluconate A nurse is caring for a client who is at 30 weeks of gestation and has a prescription for magnesium sulfate IV to treat preterm labor. The nurse should notify the provider of which of the following adverse effects? Respiratory rate 10/min A nurse is caring for a client who is to receive oxytocin to augment her labor. Which of the following findings contraindicates the infusion of the oxytocin infusion and should be reported to the provider? Late Decelerations A nurse is teaching a client who is at 37 weeks of gestation and has a prescription for a non-stress test. Which of the following instructions should the nurse include? "You should press the handheld button when you feel your baby move." A nurse is assessing a newborn who was delivered vaginally and experienced a tight nuchal cord. Which of the following findings should the nurse expect? Petechiae over the head [Show Less]
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ATI PRACTICE B MATERNAL NEWBORN 100% correct answers. latest 2023
A nurse is teaching a client who has a new prescription for combined oral contraceptives about potential adverse effects of the medication. For which of th... [Show More] e following findings should the nurse instruct the client to notify the provider? A. Shortness of breath B. Breakthrough bleeding C. Vomiting D. Breast tenderness A. Shortness of breath A nurse is caring for a client following an amniocentesis at 18 weeks of gestation. Which of the following findings should the nurse report to the provider as a potential complication? A. Increased fetal movement B. Leakage of fluid from the vagina C. Upper abdominal discomfort D. Urinary frequency B. Leakage of fluid from the vagina A nurse is calculating a client's expected date of birth using Nagele's rule. The client tells the nurse that her last menstrual cycle started on November 27th. Which of the following dates is the client's expected date of birth? September 3rd A nurse is caring for a client who is at 41 weeks of gestation and has a positive contraction stress test. For which of the following diagnostic tests should the nurse prepare the client? A. Percutaneous umbilical blood sampling B. Amnioinfusion C. Biophysical profile (BPP) D. Chorionic villus sampling (CVS) C. Biophysical profile (BPP) A nurse is teaching a new parent about newborn safety. Which of the following instructions should the nurse include in the teaching? A. "You can share your room with your baby for the next few weeks." B. "Cover your baby with a light blanket while sleeping." C. "Check the temperature of your baby's bath water with your hand." D. "Your baby can nap in the car seat during the daytime." A. "You can share your room with your baby for the next few weeks." A nurse is caring for a client who is in labor and whose fetus is in the right occiput posterior position. The client is dilated to 8 cm and reports back pain. Which of the following actions should the nurse take? A. Apply sacral counterpressure. B. Perform transcutaneous electrical nerve stimulation (TENS). C. Initiate slow-paced breathing. D. Assist with biofeedback. A. Apply sacral counterpressure. A nurse is caring for a newborn who is undergoing phototherapy to treat hyperbilirubinemia. Which of the following actions should the nurse take? A. Cover the newborn's eyes while under the phototherapy light. B. Keep the newborn in a shirt while under the phototherapy light. C. Apply a light moisturizing lotion to the newborn's skin. D. Turn and reposition the newborn every 4 hr while undergoing phototherapy A. Cover the newborn's eyes while under the phototherapy light. A nurse is performing a vaginal examination on a client who is in labor and observes the umbilical cord protruding from the vagina. After calling for assistance, which of the following actions should the nurse take next? A. Place a rolled towel beneath one of the client's hips. B. Apply internal upward pressure to the presenting part using two gloved fingers C. Administer oxygen to the client via a nonrebreather mask at 10 L/min D. Increase the IV infusion rate. B. Apply internal upward pressure to the presenting part using two gloved fingers A nurse is preparing to administer oxytocin to a client who is postpartum. Which of the following findings is an indication for the administration of the medication? (SATA) A. Flaccid uterus B. Cervical laceration C. Excess vaginal bleeding D. Increased afterbirth cramping E. Increased maternal temperature A. Flaccid uterus. C. Excess vaginal bleeding A nurse is teaching a postpartum client about steps the nurses will take to promote the security and safety of the client's newborn. Which of the following statements should the nurse make? A. "The nurse will carry your newborn to the nursery for procedures." B. "We will document the relationship of visitors in your medical record." C. "Your baby will stay in the nursery while you are asleep." D. "Staff members who take care of your baby will be wearing a photo identification badge." D. "Staff members who take care of your baby will be wearing a photo identification badge." A nurse is assessing the newborn of a client who took selective serotonin reuptake inhibitor (SSRI) during pregnancy. Which of the following manifestations should the nurse identify as an indication of withdrawal from an SSRI? A. Large for gestational age B. Hyperglycemia C. Bradypnea D. Vomiting D. Vomiting A nurse is assessing fetal heart tones for a client who is pregnant. The nurse has determined the fetal position as left occipital anterior. To which of the following areas of the client's abdomen should the nurse apply the ultrasound transducer to assess the point of maximum intensity of the fetal heart? A. Left upper quadrant B. Right upper quadrant C. Left lower quadrant D. Right lower quadrant C. Left lower quadrant A nurse is teaching a new mother how to use a bulb syringe to suction her newborn's secretions. Which of the following instructions should the nurse include? A. Insert the syringe tip before compressing the bulb. B. Suction each of the nares before suctioning the mouth. C. Insert the tip of the syringe into the center of the newborn's mouth. D. Stop suctioning when the newborn's cry sounds clear. D. Stop suctioning when the newborn's cry sounds clear. A nurse is reviewing the medical record of a client who is postpartum and has preeclampsia. Which of the following laboratory results should the nurse report to the provider? A. Hct 39% B. Serum albumin 4.5 g/dL C. WBC 9,000/mm3 D. Platelets 50,000/mm3 D. Platelets 50,000/mm3 A nurse is performing a newborn assessment. Which of the following images should the nurse identify as an indication of spina bifida occulta? ... A nurse on an antepartum unit is caring for four clients. Which of the following clients should the nurse identify as the priority? A. A client who has gestational diabetes and a fasting blood glucose level of 120 mg/dL B. A client who is at 34 weeks of gestation and reports epigastric pain C. A client who is at 28 weeks of gestation and has an Hgb of 10.4 g/dL D. A client who is at 39 weeks of gestation and reports urinary frequency and dysuria B. A client who is at 34 weeks of gestation and reports epigastric pain A nurse is providing dietary teaching to a client who has hyperemesis gravidarum. Which of the following statements by the client indicated an understanding of the teaching? A. "I will eat foods that taste good instead of balancing my meals." B. "I will avoid having a snack before I go to bed each night." C. "I will have a cup of hot tea with each meal." D. "I will eliminate products that contain dairy from my diet." A. "I will eat foods that taste good instead of balancing my meals." A nurse is planning care for a client who is 2 hr postpartum. Which of the following interventions should the nurse plan to implement during the taking-hold phase of postpartum behavioral adjustment? A. Discuss contraceptive options with the client and her partner. B. Repeat information to ensure client understanding. C. Listen to the client and her partner as they reflect upon the birth experience. D. Demonstrate to the client how to perform a newborn bath. D. Demonstrate to the client how to perform a newborn bath. A nurse is assessing a client who is at 30 weeks of gestation during a routine prenatal visit. Which of the following findings should the nurse report to the provider? A. Swelling of the face B. Varicose veins in the calves C. Nonpitting 1+ ankle edema D. Hyperpigmentation of the cheeks A. Swelling of the face A nurse is assessing a newborn for manifestations of hypoglycemia. Which of the following findings should the nurse expect? A. Jitteriness B. Hypertonia C. Abdominal distention D. Mottling A. Jitteriness A nurse is teaching a client who is in preterm labor about terbutaline. Which of the following statements by the client indicates an understanding of the teaching? A. "I will get injections of the medication once daily until my labor stops." B. "My blood sugar may be low while I'm on this medication." C. "I will have blood tests because my potassium might decrease." D. "My blood pressure may increase while I'm on this medication." C. "I will have blood tests because my potassium might decrease." A nurse is planning care for a client who is in labor and is having an amniotomy. Which of the following assessments should the nurse identify as the priority? A. O2 saturation B. Temperature C. Blood pressure D. Urinary output B. Temperature A nurse is planning discharge for a client who is 3 days postpartum. Which of the following non-pharmacological interventions should the nurse include in the plan of care for lactation suppression? A. Place warm, moist packs on the breasts. B. Apply cabbage leaves to the breasts. C. Wear a loose-fitting bra. D. Put green tea bags on the breasts. B. Apply cabbage leaves to the breasts. A nurse is caring for a client who becomes unresponsive upon delivery of the placenta. Which of the following actions should the nurse take first? A. Determine respiratory function. B. Increase the IV fluid rate. C. Access emergency medications from cart. D. Collect a maternal blood sample for coagulopathy studies. A. Determine respiratory function A nurse is teaching a client who has pregestational type 1 diabetes mellitus about management during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? A. "I should have a goal of maintaining my fasting blood glucose between 100 and 120." B. "I should engage in moderate exercise for 30 minutes if my blood glucose is 250 or greater." C. "I will continue taking my insulin if I experience nausea and vomiting." D. "I will ensure that my bedtime snack is high in refined sugar." C. "I will continue taking my insulin if I experience nausea and vomiting." [Show Less]
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ATI: Maternal/Newborn : NEWBORN 100% accurate answers
Normal neonate weight range 2,500 - 4,000g Normal neonate length range 45 to 55cm Normal neonate head circumference 32 to 36.8cm No... [Show More] rmal neonate chest circumference 30 to 33cm What is a passing APGAR score? 7-10 Preterm anything before 37 weeks Term 38-42 weeks Postterm anything over 42 weeks What sequence are vitals to be taken on a newborn? RR, HR, BP, and temp Respiratory rate for a newborn 30-60/min What is a normal length of apnea in a newborn? 15 sec What are signs of newborn respiratory distress grunting and nasal flaring What is a normal newborn heart rate range? 100-160/min What is a normal newborn blood pressure range? Systolic: 60-80mmHg Diastolic: 40-50mmHg What is a normal newborn temperature range? 36.5-37.2 Posture of a newborn -curled up position extremities flexed -resistant to extension of extremities Skin color pink or acrocynotic with no jaundice present Skin texture dry, soft, and smooth Desquamation normal peeling of skin occurring a few days after birth Vernix caseosa protective, thick, cheesy covering found in creases and folds most commonly Lanugo fine downy hair usually found on pinnas, forehead, and shoulders Milia small raised white spots usually around the nose and mouth Mongolian Spots bluish purple spots of pigmentation usually found on the shoulders, back, and butt Telangiectatic nevi flat pink or red marks that easily blanch and are found on the back of the neck, nose and upper eyelids. Usually fade by second year of life Nevus flammeus capillary angioma below the surface of the skin that is purple or red, varies in shape or size. does not blanch or disappear Erythema toxicum pink rash that appears suddenly anywhere on the body during the first 3 weeks. Head circumference should be 2 to 3 cm larger than the chest circumference Fontanels should be soft and flat Bulging fontanels may indicate intracranial pressure, infection, or hemorrhage Depressed fontanels may indicate dehydration Sutures should be palpable and separated Overlapping sutures molding Caput localized swelling of the soft tissues of the scalp caused by pressure on the head. may cross over the suture line. resolves in 3-4 days Cephalohematoma collection of blood between periosteum and the skull bone. does not cross suture line. resolves in 2 to 3 weeks When is permanent eye color established? within 3-12 months Why are baby cries tearless? the lacrimal glands have not developed If ears are low-set what can that be an indicator of? down syndrome or a kidney disorder Cartilage should be firm and well formed How long are babies obligated nose breathers for? the first 3 weeks after birth Signs of Down syndrome when assessing a baby -eye placement too close or too far away -low-set ears -protruding tongue -absence of head control What shape should the chest be? barrel-shaped What size should the breast nodules be? about 6mm When should bowel sounds be heard? present 1 to 2 hours after birth What should the abdomen look like? round, dome-shaped, and non distended When should meconium and urine be passed Within the first 24 hours after birth sucking and rooting reflex elicited by stroking cheek or edge of mouth and baby turns head to that side and starts to suck. (birth to 4 months) palmar reflex elicited by placing finger into the newborn's palm. (birth to 6 months) plantar reflex elicited touching the soles of the feet. toes curl downward. (birth to 8 months) moro reflex elicited by (dropping) the babies crib or lowering them from semisitting to 30degree angle and baby legs extend and abduct. (birth to 4 months) startle reflex elicited by clapping hands/loud noise. baby arms abduct ( birth to 4 months) tonic neck reflex elicited when baby head turned to a side, the extremities on that side extend ( birth to 4 months) babinski reflex elicited by stroking outer edge of sole of foot and toes will fan upward and out. (birth to 1 year) stepping elicited by holding newborn upright and touching feet to a flat surface. (birth to 4 months) which part of the baby is most sensitive to touch? the mouth Hgb for newborn 14-24 Hct for newborn 44-64% RBC for newborn 4,800 to 7,100,000 Leukocytes for newborn 9,000 to 30,000 Platelets in newborn 150,000 to 300,000 Glucose in newborn 40-60 Bilirubin in newborn day 1: 0-6 day 2: 8 or less day 3: 12 or less How often should newborn vitals be taken? every 30min x2 every 1 hour X 2 then every 8 hours How often should newborn weight be checked? daily, at the same time, with the same scale What is the first period of reactivity? newborn is alert, exploring activity, makes sucking noises, rapid hr and rr (15-30 min after birth) What is the period of relative inactivity? newborn becomes quiet and begins rest and sleep. hr and rr decrease (30 min to 2 hour after birth) What is the second period of reactivity? newborn reawakens, may gag or choke on mucus in mouth (2 - 8 hour after birth) how often should pain assessment be done on the baby? every 8-12 hours what is PKU a defect in protein metabolism in which the accumulation of the amino acid phenylalanine can result in mental retardation (tx in the first 2 months of life can prevent retardation) Collecting blood samples on newborn: -don clean gloves -warm the heel -cleanse the area and allow to dry -lancet should not go further than 2.4mm into heel -use gauze to stop bleeding -hold and comfort newborn after procedure Bradypnea in newborn RR less than 25/min Tachypnea in newborn RR greater than 60/min abnormal breath sounds expiratory grunting, crackles, and wheezes signs of respiratory distress nasal flaring, retractions, grunting, and labored breathing. Understanding the bulb syringe technique -compress bulb before insertion -insert into one side of the mouth (avoid middle of the mouth to prevent activating gag reflex) -aspirate mouth, then one nostril, then the other nostril what to monitor for hypothermia in newborn -temp less than 36.5 -cyanosis -increased RR Four mechanisms of heat loss conduction, convection, evaporation, radiation conduction loss of body heat from direct contact with cooler surface. [Show Less]
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Maternal Newborn Pretest questions and answers with verified content
A nurse is providing teaching about danger signs during pregnancy to a client who is at 20 weeks of gestation. The nurse should instruct the client to repo... [Show More] rt headaches, blurred vision, and epigastric pain because these are indications of which of the following complications of pregnancy? Gestational diabetes Preeclampsia Hyperemesis gravidarum Abruptio placentae Preeclampsia A nurse is caring for a patient who is in early labor and has a fetus in the occipitoposterior presentation. The client reports pain in their lower back with contractions. Which of the following pain management techniques is most likely to be effective in relieving low back pain caused by this type of fetal presentation? Counterpressure Effleurage Therapeutic touch Breathing techniques Counterpressure A nurse is assigning a 1-minute Apgar score to a newborn who is crying loudly. The newborn has a heart rate of 140/min, has well flexed arms and legs, grimaces when the nurse rubs the soles of their feet, and is pink with mild acrocynosis. What Apgar score should the nurse assign to this newborn? 8 A nurse is assessing the fundal height for a client who is at 28 weeks of gestation. The nurse should measure the distance in centimters between which two anatomicall landmarks? the mons pubis and the xiphoid process The top of the fundus and the umbilicus The symphysis pubis and the top of the fundus The mons pubis and the umbilicius The symphysis and the top of the fundus A nurse is teaching the parents of a newborn about bathing techniques. Which of the following instructions should the nurse include? Bathe the newborn once per day. Bathe the newborn after a feeding. Clean the newborn's face first using plain water. Clean the newborn's ears and nose with cotton swabs. Clean the newborn's face first using plain water. A nurse is providing teaching about breastfeeding to a client who gave birth 8 hours ago. Which of the following information should the nurse include? The newborn should be fed six times in 24 hr. The newborn should have six wet diapers per day after day 4. The breasts will become engorged within 24 hr of the first feeding. The newborn should be breastfed on a set schedule The newborn should have six wet diapers per day after day 4. A nurse is providing discharge teaching to a client who is 3 days postpartum and is formula feeding their newborn. Which of the following instructions should the nurse include when discussing engorgement? Apply ice packs to the breasts for 15 min to relieve swelling and discomfort. Wear a loose-fitting bra for 1 week to minimize pressure on the breasts. Manually express small amounts of breastmilk three times per day. Allow warm water from a shower to run over the breasts twice a day. Apply ice packs to the breasts for 15 min to relieve swelling and discomfort. The nurse is teaching circumcision care to the parents of a newborn who was circumcized using the Gomco clamp method. Which of the following instructions should the nurse include? (Select all that apply). Apply petroleum jelly to the penis with each diaper change for one week. Cleanse the penis with warm water and mild soap twice a day. Apply gentle pressure from a sterile gauze pad to control slight bleeding. Gently remove any yellow exudate that forms on the circumcision site. Apply the diaper loosely over the penis. Apply petroleum jelly to the penis with each diaper change for one week. Apply gentle pressure from a sterile gauze pad to control slight bleeding. Apply the diaper loosely over the penis. A nurse is assessing a newborn who was born 2 days ago. Which of the following findings should the nurse report to the provider? Blackening of the stump of the umbilical cord Redness of the skin at the base of the umbilical cord stump Scant amount of dried blood on the skin around the umbilical cord stump Hardening of the umbilical cord stump Redness of the skin at the base of the umbilical cord stump A nurse is performing a gestational age assessment using the New Ballard Score. Which of the following findings should indicate to the nurse that the newborn is preterm? Flexion of the extremities at rest Creases over the entire plantar surface Leathery skin Flat areola Flat areola [Show Less]
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