RN Maternal Newborn Online Practice 2016 A, latest Upload (Set-2), Verified And Correct Answers
Maternal Newborn
1. A nurse is planning discharge
... [Show More] for a client who is 3 days postpartum. Which of the following nonpharmacological interventions should the nurse include in the plan of care for lactation suppression?
A. Place warm, moist packs on the breasts.
The client can use cold compresses to decrease breast discomfort during lactation suppression.
B. Apply cabbage leaves to the breasts.
Plant sterols and salicylates from cabbage leaves can help to relieve swelling and discomfort caused by breast engorgement.
C. Wear a loose-fitting bra.
A tight-fitting bra will provide support to the breasts during engorgement, which can decrease pain.
D. Put green tea bags on the breasts.
Tea bags are used to relieve nipple soreness in breastfeeding clients.
2. A nurse is performing a physical assessment of a newborn. Which of the following clinical findings should the nurse expect? (Select all that apply.)
-Heart rate 154/min
-Axillary temperature 36° C (96.8° F)
-Respiratory rate 58/min
-Length 43 cm (16.9 in)
-Weight 2.6 kg (5 lb 12 oz)
• • A heart rate of 154/min is correct. The expected reference range for a newborn's heart rate is from 110/min to 160/min while awake.
• • An axillary temperature of 36° C (96.8° F) is incorrect. A healthy newborn's temperature averages 37° C (98.6° F), with a range of 36.5° to 37.5° C (97.7° to 99.5° F).
• • A respiratory rate of 58/min is correct. The expected reference range for a newborn's respiratory rate is from 30/min to 60/min.
• • A length of 43 cm (16.9 in) is incorrect. The expected reference range for a newborn's length is from 45 to 55 cm (17.7 to 21.7 in).
• • A weight of 2.6 kg (5 lb 12 oz) is correct. The expected reference range for a newborn's weight is from 2.5 to 4 kg (5.5 lb to 8.8 lb).
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3. A nurse is caring for a client and her partner who have experienced a fetal death. Which of the following actions should the nurse take?
• A. Take photos of the newborn to give to the parents.
The nurse should create a memory box that includes mementos of the newborn (for example, photos, the newborn's ID bands, the newborn's hat, and the newborn's blanket).
• B. Tell the parents that they can consider organ donation.
Organ donation can be considered if a newborn is delivered alive.
• C. Encourage the parents to avoid allowing older children to visit them in the hospital.
The nurse should encourage the client to allow older children to come to the hospital as a beneficial part of the grieving process.
• D. Explain to the parents the need to name the newborn.
RN Maternal Newborn Online Practice 2016 A
The nurse should explain to the client that naming the baby can be helpful during the grieving process, but it is not a requirement.
4. A nurse is caring for a client who is at 36 weeks of gestation and has a prescription for an amniocentesis. For which of the following reasons should the nurse prepare the client for an ultrasound?
A. To estimate the fetal weight
This is not an indication for an ultrasound prior to an amniocentesis.
• B. To locate a pocket of fluid
An ultrasound is done to locate a pocket of amniotic fluid and the placenta prior to an amniocentesis. This decreases the risk of injury to the fetus.
• C. To determine multiparity
This is not an indication for an ultrasound prior to an amniocentesis.
• D. To prescreen for fetal anomalies
This is not an indication for an ultrasound prior to an amniocentesis.
5. A nurse in the antepartum clinic is assessing a client's adaptation to pregnancy. The client states that she is, "happy one minute and crying the next." The nurse should interpret the client's statement as an indication of which of the following?
A. Emotional lability
The nurse should recognize and interpret the client's statement as an indication of emotional lability. Many women experience rapid and unpredictable changes in mood during pregnancy. Intense hormonal changes may be responsible for mood changes that occur during pregnancy. Tears and anger alternate with feelings of joy or cheerfulness for little or no reason.
• B. Focusing phase
The focusing phase is the third phase of the father's emotional response to the pregnancy. It is characterized by his active involvement in the pregnancy and his relationship with the child.
• C. Cognitive restructuring
Cognitive restructuring is accepting the idea of pregnancy and assimilating it into the woman's life. The degree of acceptance is shown in the mother's emotional responses.
• D. Couvade syndrome
Couvade syndrome is pregnancy-like manifestations experienced by the expectant father. Manifestations include nausea, weight gain, and other physical manifestations of pregnancy.
6. 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."
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.
• B. "Collect at least 1 milliliter of urine for the test."
The nurse should collect a capillary blood sample via heel stick for the newborn screening. Urine is not collected for this test.
• C. "Ensure that the newborn has been receiving feedings for 24 hours prior to obtaining the specimen."
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