Nursing Practice Questions: Obstetrics | Exams Nursing

OB PROCTORED 1 → 2016

1. A nurse is performing an initial assessment of a newborn who was delivered with a nuchal cord. Which of the following

clinical findings should the nurse expect?

Facial petechiae- seen over the presenting part with soft tissue injuries

-nuchal cord: umbilical cord around fetal neck. Will cause variable deceleration of FHR. Intervention: repositi on client from side to

side or into knee chest, discontinue oxytocin if being infused, oxygen

2. A nurse is monitoring a newborn whose mother reports recent opiate use for neonatal abstinence syndrome. Which of the

following findings indicates narcotic withdrawal?

1. Respiratory rate 50/min

2. Unequal pupils

3. Hypotonia

4. Excessive crying

•Substance withdrawal in the newborn occurs when the mother uses drugs during pregnancy.

•Hitch pitch shrill cries, incessant crying, tremors, increae deep tendon reflexes, disturbed sleep pattern,

hypertonicity, convulsions

•Nasal congestion w/ flaring, apnea, tachypnea <60/min

3. A nurse is caring for a client who is in the second stage of labor. The nurse observes the fetal head retract against the

clients perineum immediately following emergence . Which of the following actions should the nurse take?

1. Assess fetal position using Leopold maneuvers

2. Reposition the client in a left lateral position??? Not sure

3. Apply pressure to the clients suprapubic area

4. Empty the client’s bladder using Crede’s maneuver

•Pg 189) Prepare to apply suprapubic pressure to aid in the delivery of the anterior shoulder, which is located inferior

to the maternal symphysis pubis.

4. A client and her partner ask the nurse for information about permanent contraception. Which of the following statements should

the nurse include in the counseling?

1. “A man is usually sterile immediately after a vasectomy”- must use birth control after procedure. Is not effective until

20 ejaulations or 1 week to several months to allow all sperm to clear

2. “The menstrual cycle is shorter after a tubal ligation”

3. “Most sterilization procedures are considered irreversible”

4. “A woman should use contraception for 1-2 months after a tubal ligation”

5. A nurse is providing education to a client who is to receive misoprostol for induction of labor. Which of the following

instructions should the nurse include in the teaching?

1. “ I will insert a urinary catheter before I administer the medication” -??

2. “I will begin an oxytocin infusion w/in 2 hrs of your last dose of medication”

3. “You will like on your side for 40 minutes after I administer the medication

4. “You will receive an antacid containing magnesium before the medication”

-uterine stimulant. Controls postpartum hemorrhage. Assess uterine tone and vaginal bleeding

-postpartum hemorrhage nursing care: massage fundas. Insert urinary catheter to assess kidney functions to obtain accurate urinary

output for bladder distention. Elevate legs.

6. A nurse is assessing a client who is in her second trimester for common physiological changes during pregnancy. The nurse notes

a blotchy discoloration on the client’s forehead, nose & cheeks. Which of the following changes should the nurse document p.

17 chapter 3

1. Linea nigra-dark line pigmentation from umbilicus to the pubic area.

2. Epulis- not found on ati book, but it is a tumor on the mouth caused by gingervitis.

3. Striae gravidarum - stretch marks found on abdomen and thigh

4. Chloasma -increase pigmentation on the face

7. A charge nurse is discussing STIs w/ a newly licensed nurse. Which of the following infections should the nurse include in

the teaching as an indication for a cesarean birth p . 50 ch 8

1. Gonorrhea- spread genital to genital

2. Chlamydia

3. HIV

4. Syphilis

- INDICATIONS for C-Section

::::::: Malpresentation, Non-reassuring fetal heart tones

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1. A nurse is performing an initial assessment of a newborn who was delivered with a nuchal cord. Which of the following clinical findings should the nurse expect? Facial petechiae- seen over the presenting part with soft tissue injuries -nuchal cord: umbilical cord around fetal neck. Will cause variable deceleration of FHR. Intervention: repositi on client from side to side or into knee chest, discontinue oxytocin if being infused, oxygen 2. A nurse is monitoring a newborn whose mother reports recent opiate use for neonatal abstinence syndrome. Which of the following findings indicates narcotic withdrawal? 1. Respiratory rate 50/min 2. Unequal pupils 3. Hypotonia 4. Excessive crying - Substance withdrawal in the newborn occurs when the mother uses drugs during pregnancy. - Hitch pitch shrill cries, incessant crying, tremors, increae deep tendon reflexes, disturbed sleep pattern, hypertonicity, convulsions - Nasal congestion w/ flaring, apnea, tachypnea <60/min 3. A nurse is caring for a client who is in the second stage of labor. The nurse observes the fetal head retract against the clients perineum immediately following emergence. Which of the following actions should the nurse take? 1. Assess fetal position using Leopold maneuvers 2. Reposition the client in a left lateral position??? Not sure 3. Apply pressure to the clients suprapubic area 4. Empty the client’s bladder using Crede’s maneuver - Pg 189) Prepare to apply suprapubic pressure to aid in the delivery of the anterior shoulder, which is located inferior to the maternal symphysis pubis. 4. A client and her partner ask the nurse for information about permanent contraception. Which of the following statements should the nurse include in the counseling? 1. “A man is usually sterile immediately after a vasectomy”- must use birth control after procedure. Is not effective until 20 ejaulations or 1 week to several months to allow all sperm to clear 2. “The menstrual cycle is shorter after a tubal ligation” 3. “Most sterilization procedures are considered irreversible” 4. “A woman should use contraception for 1-2 months after a tubal ligation” 5. A nurse is providing education to a client who is to receive misoprostol for induction of labor. Which of the following instructions should the nurse include in the teaching? 1. “ I will insert a urinary catheter before I administer the medication” - ?? 2. “I will begin an oxytocin infusion w/in 2 hrs of your last dose of medication” 3. “You will like on your side for 40 minutes after I administer the medication 4. “You will receive an antacid containing magnesium before the medication” -uterine stimulant. Controls postpartum hemorrhage. Assess uterine tone and vaginal bleeding -postpartum hemorrhage nursing care: massage fundas. Insert urinary catheter to assess kidney functions to obtain accurate urinary output for bladder distention. Elevate legs. 6. A nurse is assessing a client who is in her second trimester for common physiological changes during pregnancy. The nurse notes a blotchy discoloration on the client’s forehead, nose & cheeks. Which of the following changes should the nurse document p. 17 chapter 3 1. Linea nigra-dark line pigmentation from umbilicus to the pubic area. 2. Epulis- not found on ati book, but it is a tumor on the mouth caused by gingervitis. 3. Striae gravidarum - stretch marks found on abdomen and thigh 4. Chloasma - increase pigmentation on the face 7. A charge nurse is discussing STIs w/ a newly licensed nurse. Which of the following infections should the nurse include in the teaching as an indication for a cesarean birth p. 50 ch 8 1. Gonorrhea- spread genital to genital 2. Chlamydia 3. HIV 4. Syphilis - INDICATIONS for C-Section ::::::: Malpresentation, Non-reassuring fetal heart tones

Placental abnormalities, Placenta previa, Abruptio placentae, active genital herpes, DM, eclampsia, previous C-birth, dystocia, multiple gestations, umbilical cord prolapse

8. A nurse is planning care for a newborn who has neonatal abstinence syndrome. Which of the following interventions should the nurse include in the plan of care? Ch 27 p. 318 1. Increase the newborn’s visual stimulation 2. Swaddle the newborn in a flexed position - to reduce self stimulation and protect skin from abrasions. 3. Weigh the newborn every other day 4. Discourage prenatal interaction until after a social service evaluation Interventions-offer small feedings, swaddle newborn with legs flexed, reduce environmental stimuli, 9. A nurse is providing discharge instructions to a client who is breastfeeding her newborn. Which of the following instructions should the nurse include? 1. Offer the newborn 30mL (1 oz) of water between feedings 2. Allow the baby to feed at least every 2 hrs 3. Feed the newborn 5-10 mins per breast - 15-20 minutes per breast 4. Expect 2 -4 wet diapers every 24 hrs -6-8 a day -should breastfeed every 2-3 hours for the first 6 months. Should occur 8-12 times a day. And feed on demand. Cramps are normal during breastfeeding. Stimulating the nipple causes let down reflex of milk. 10. A nurse is assessing a client immediately following the placement of an epidural. The nurse obtains a maternal blood pressure of 96/54 mmHg and a fetal heart rate of 102/min. Which of the following actions should the nurse take? 1. Administer naloxone to the client 2. Position the client in a lateral position- is this the same as side lying? 3. Place the client in knee chest position - do this for variable deceleration od FHR 4. Prepare the client for an amnioinfusion 11. A nurse is caring for a client who is in labor and is prescribed an amnioinfusion. Which of the following findings is an indication for this procedure p. 102 ch 15 1. Fetal macrosomia 2. Variable decelerations - process of instilling normal saline in amniotic cavity into the uterus to supplement the amount of fluids to reduce variable decelerations causs by cord compression 3. Early decelerations- slowing of the FHR with the start of contraction with return of the FHR to baseline at the end of contraction 4. Increased uterine tone 12. A nurse is providing discharge instructions to a client who delivered a newborn via cesarean birth 4 days ago. The nurse should instruct the client to contact the provider for which of the following findings. 1. Newborn has fewer than 4 wet diapers in 24hrs-6-8/day 2. The newborns cord stump will detach after 1 week- falls off around 10-14 days 3. The newborn sleeps 16hrs a day- normal 16-19 hours/day 4. The newborn has loose stools - normal from milk 13. A nurse is caring for a client who has had a pudendal nerve block. The nurse should monitor for which of the following findings as an adverse effect p. 81 chapter 12 1. Maternal hypertension 2. Decreased ability to bear down 3. Fetal bradycardia 4. Uterine hyperstimulation - Is a local anesthesia to the perineum, vulva, rectal areas during delivery. Given in 2nd stage of labor. 20 minutes before delivery. Provides analgesia before expulsion of the fetus. ADVERSE effects: broad ligament hematoma,, compromise of material of bearing down reflex 14. A nurse is reviewing the laboratory findings of a client who is at 10 wks gestation. Which of the following findings should the nurse report to the provider? 1. Platelets 100,000 mm3- 150000, 2. WBC count 10,000mm 3. Hgb 12g/dL 4. Creatinine 0.5mg/dL 15. A nurse is reviewing the medication prescriptions for a newborn who is 6 hr old and who's mother is HBsAg-positive. The nurse should anticipate administering which of the following medications? 1. Hep A vaccine 2. Haemophilus influenzae type B vaccine 3. Hep B immune globulin- newborn born to infected mothers should receive hep B immune globulin within 12 hours after birth 4. Hep A immune globulin

23. A nurse is teaching a client who is breastfeeding and has mastitis. Which of the following statements by the client indicates an understanding of the teaching? 1. I should a nipple shield while breastfeeding (PDF p.129: Use a breast shield between feedings) 2. I should apply lanolin to the infection site daily (PDF p.129: Have the client apply breast creams as prescribed and wear breast shields in her bra to soften her nipples if they are irritated and cracked. Sore nipples with cracks & fissures are indication of mastitis which is an infection in the milk duct) (WebMD: Lanolin is a medication fused as a moisturizer to treat or prevent dry & irritated skin) 3. I should apply warm compresses aker the feeding (PDF p.144: Encourage the client to use ice packs or warm packs on affected breasts for discomfort ) 4. I should stop breastfeeding until the infection has healed (PDF p.144: Instruct the client to continue breastfeeding frequently q2-4 hr especially on the affected side completely emptying her breasts with each feeding to prevent milk stasis, which provides a medium for bacterial growth) 24. A nurse in a provider’s office is caring for a 20 y/o client who is at 12 weeks of gestation and requests an amniocentesis to determine the gender of the fetus. Which of the following responses should the nurse make? 1. We can schedule the procedure for later today if you’d like (PDF p.33: performed after 14 weeks of gestation) 2. You can’t have an amniocentesis until you're at least 35 y/o 3. Your provider will schedule a chorionic villus sampling to determine the sex of your baby (first-trimester alternative to amniocentesis to determine any abnormality) 4. This procedure determines if your baby has genetic or congenital disorders (PDF p.33: The aspiration of amniotic fluid for analysis of chromosomal & congenital anomalies, lung maturity, meconium in amniotic fluid, etc) 25. A nurse is assessing a client who is at 37 weeks of gestation. Which of the following statements by the client requires immediate intervention by the nurse? 1. My feet are really swollen today (PDF p.22: lower-extremity edema can occur during the second and third trimesters) 2. I have been seeing spots this morning ( PDF p.60: Visual disturbances (blurring of vision, flashes of lights or dots before the eyes) are s/s of severe preeclampsia & can lead to seizure activity aka eclampsia) 3. I didn't have lunch today but I had breakfast this morning 4. It burns when I urinate (s/s of UTI--not as urgent) 26. A nurse is teaching a client who is postpartum about car seat safety. Which of the following statements indicates an understanding of the instructions? 1. I will adjust the angle of the carseat so that my baby is at a 90 degree angle (30-45 degrees) 2. I will position the car seat in the front passenger seat facing the front of the car (PDF p.179: rear-facing in the back seat) 3. I will place the shoulder harness slightly below my baby’s shoulders 4. I will make sure the retainer clip is at the level of my baby’s abdomen (should be chest!) 27. A nurse is performing a physical examination of a term newborn upon admission to the nursery. In which order should the nurse perform the following assessments? 1. Observe the newborns respirations (PDF p.156: Vital signs are checked in the following sequence: respirations, heart rate, blood pressure, and temperature. The nurse observes the respiratory rate first before the newborn becomes active or agitated by use of the stethoscope, thermometer, and/or blood pressure cuff) 2. Auscultate the newborn’s heart rate 3. Auscultate the newborns abdomen 4. Test the newborn’s reflexes 28. A nurse is monitoring a client who has preeclampsia and is receiving magnesium sulfate by continuous IV infusion. Which of the following findings should the nurse report to the provider? 1. Respiratory rate 14/min 2. Urinary output 20 ml/hr (PDF p.60: Magnesium sulfate toxicity = absent tendon reflex, urine output <30ml/hr, RR <12/min, decreased LOC, cardiac dysrhythmias) 3. BP 148/94 mmHg 4. 2+ deep tendon reflexes :::: Magnesium sulfate = relaxes the smooth muscle of the uterus and inhibits uterine activity by suppressing contractions. 29. A nurse is assessing a full term newborn 1 hr following a vaginal birth. Which of the following is an expected assessment finding? 1. The newborn’s head circumference is greater than the chest circumference (PDF p.157: Head should be 2 to 3 cm larger than chest circumference) 2. The newborn exhibits apnea episodes of 30 seconds (PDF p.126: Too long; RR varies from 30 to 60 breaths/min with short periods of apnea (less than 15 seconds) 3. The newborn has a heart rate of 70/min while sleeping (PDF p.126: Too low; HR ranges from 110 to 160/min with brief fluctuations above and below this range depending on activity level) 4. The newborn’s anterior fontanelle bulges when he is quiet (PDF p.157: Fontanels can bulge when the newborn cries, coughs or vomits, and are flat when the newborn is quiet)

30. A nurse in a postpartum unit is caring for several clients. Which of the following tasks should the nurse delegate to assistive personnel? 1. Help the client with perineal care (CNA=hygiene, ADLs) 2. Check the saturation of the perineal pad (RN=Assess) 3. Provide the client with a dose of magnesium hydroxide (RN=Medication administration) 4. Demonstrate to a client how to change a diaper (RN=Teach) 31. A nurse if caring for a client who is postpartum following repair of a vaginal laceration. The client has a firm fundus, moderate lochia rubra & reports moderate perineal discomfort & pressure. Which of the following actions should the nurse take? 1. Check the perineal area (PDF p.119: Assess first! Assess episiotomy and lacerations for approximation, drainage, quantity, and quality) 2. Perform deep fundal massage (Unnecessary b/c fundus is firm & no need for assistance for uterine contraction) 3. Administer methylergonovine 0.2 mg IM (PDF p.118: An oxytocic given after the placenta is delivered to promote uterine contractions and to prevent hemorrhage. Unnecessary b/c fundus is firm) 4. Obtain a vaginal culture (PDF p.119: Lacerations can delay the production of estrogen-influenced cervical mucus and are a predisposing factor to infection. But assess area first for s/s of infection) 32. A nurse is assessing a full term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider? 1. Single palmar creases (PDF p.194: characteristics of Down Syndrome= short broad hands with a fifth finger that has one flexion crease instead of two, a deep crease across the center of the palm aka simian crease) 2. Rust stained urine (PDF p.159: Uric acid crystals will produce a rust color in the urine the first couple of days of life) 3. Subconjunctival hemorrhage (PDF p.158: Subconjunctival hemorrhages can result from pressure during birth) 4. Transient circumoral cyanosis (r/t respiratory distress; ABC circulation priority) 33. A nurse at an antepartum clinic is caring for four clients. Which of the following clients should the nurse assess first? 1. A client who is at 8 weeks of gestation and reports severe vomiting (PDF p.58: Hyperemesis gravidarum is excessive nausea and vomiting that is prolonged past 12 weeks of gestation and results in a 5% weight loss from prepregnancy weight, electrolyte imbalance, acetonuria, and ketosis. There is a risk to the fetus for intrauterine growth restriction or preterm birth if the condition persists) 2. A client who is at 36 weeks of gestation and reports back pain following intercourse 3. A client who is at 24 weeks of gestation and reports periodic tingling of the fingers (PDF p.59 & 80: Decreased O circulation r/t hypoglycemia or hyperventilation; ABC priority) 4. A client who is at 10 weeks gestation and reports frequent urination (PDF p.16: Urinary frequency is common during pregnancy. Filtration rate increases secondary to the influence of pregnancy hormones and an increase in blood volume and metabolic demands. The amount of urine produced remains the same) 34. A nurse is conducting a class for a group of clients about birth control. Which of the following information should the nurse include in the teaching? 1. You should have an annual exam to assess your diaphragm (PDF p.5: Replaced every 2 years and refitted for a 20% weight fluctuation, after abdominal or pelvic surgery, and after every pregnancy) 2. Your fertility will return 6 months after your provider removes your IUD (PDF p.8: Contraception can be reversed with immediate return to fertility) 3. You should use spermicide 3 hrs prior to sexual intercourse (PDF p.5: Up to 6 hours before intercourse) 4. You will not need to use birth control for 1 month after receiving emergency contraception (PDF p.6: Does not provide long-term contraception so still need to use contraception regularly after) 35. A nurse is assessing the results of a nonstress test for an antepartal client at 35 wks of gestation. Which of the following findings should indicate to the nurse the need for further diagnostic testing? 1. Three fetal movements perceived by the client in a 20 min testing period (PDF p.31: occurs two or more times during a 20-min period) 2. No late decelerations in the fetal heart rate noted with three uterine contractions of 60 seconds in duration w/in a 10 min testing period (PDF p.32: Contraction Stress Test (CST) = nipple or oxytocin-stimulated contraction test; Negative CST is a normal finding which is indicated if within a 10-min period, with three uterine contractions, there are no late decelerations of the FHR) 3. Irregular contractions of 10-20 secs in duration that are not felt by the client (possible Braxton Hicks contraction?) 4. An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40 min testing period (PDF p.31: NST is interpreted as reactive if the FHR is a normal baseline rate with moderate variability, accelerates at least 15/min for at least 15 seconds and occurs two or more times during a 20- min period; Nonreactive NST is a test that does not demonstrate at least two qualifying accelerations in a 20-min window) 36. A nurse is providing discharge teaching to a client following tubal ligation. Which of the following statements by the client indicates an understanding of the teaching? 1. Premenstrual tension will no longer be present → menstruation still remain the same as before the sterilization. 2. Ovulation will remain the same → you may feel pain at ovulation

Lowdermilk PDF 841 Infants born to mothers with diabetes are at increased risk for complications such as congenital anomalies, macrosomnia, birth trauma, pernatal asphyxia, stillbirth, preterm birth, respiratory distress syndrome (RDS), HYPOGLYCEMIA , hypocalcemia, hypomagnesemia, cardiomyopathy, HYPERBILIRUBINEMIA , and POLYCETHEMIA****.

45. A nurse is caring for a client following a vaginal delivery of a term fetal demise. Which of the following statements should the nurse make? 1. If you don’t hold the baby it will make letting go much harder 2. I'm sure you will be able to have another baby when you are ready 3. You should name the baby so she can have an identity 4. You can bath and dress your baby if you’d like so Fetal demise- stillbirth or neonatal death; process of CLOSURE 46. A nurse is discussing family planning with a client who has a history of DVT. The nurse should inform the client that this condition is a contraindication for which of the following birth control methods? 1. Intrauterine device 2. Cervical cap 3. Oral contraceptive 4. Diaphragm ATI OB PG. 7 DISADVANTAGES: Women with HX of blood clots, stroke, cardiac problems, breast or estrogen-related cancers, pregnancy, or smoking (if over 35 years of age- advised NOT to take Oral contra. 47. A nurse is teaching a client who is pregnant about a new prescription for iron supplements. Which of the following instructions should the nurse include in the teaching. 1. Take an extra pill if you miss a dose 2. Drink 8oz of milk with each pill 3. Increase intake of foods rich in vitamin C 4. Report black stools to the provider It enhances body’s absorption of iron by drinking or eating foods rich in vitamin C. 48. A nurse is caring for a newborn. Which of the following assessment findings should indicate to the nurse that suctioning of the nasopharynx is needed? 1. The newborns respiratory rate is 32/min → normal RR 30- 60 2. The newborn’s pulse ox is 91% 3. The newborn is beginning to cough → airway; suction mouth and nose 4. The newborn’s respiratory rate is irregular → breathing is irregular and shallow, can have periods of apnea, no longer than 20 seconds. 49. A nurse is providing teaching to the parents of a newborn about the plastibell circumcision technique. Which of the following info should the nurse include 1. Yellow exudate will form at the surgical site in 24 Hours 2. Notify the provider if the end of your baby penis appears dark red 3. Make sure the newborn’s diaper is snug 4. The Plasticbell will be removed 4 hrs after the procedure :::: For Gomco (Yellen) or Mogen Clamp = petroleum gauze to prevent infection and control bleeding :::: For Plastibell device = After 5-7 days, the plastibell drops off, leaving a clean, healed excision. NO petroleum

Lowdermilk 588 Box 24- 7

50. A nurse is a caring for a client who is at 24 wks of gestation and has a glucose screening test result of 150 mg/dL. Which of the following actions should the nurse take? 1. Perform a urine screen for ketones 2. Repeat the glucose screening test in 15mins to verify results 3. Schedule the client for a 3 hr oral glucose tolerance test 4. Determine if the client has fasted ATI OB 98 A glucola screening test/1-hr glucose tolerance test (50 g oral glucose load, followed by plasma glucose analysis 1 hr. later performed at 24-48 weeks of gestation- fasting not necessary; a positive blood glucose screening is 130-140 mg/dl or greater; additional testing within a 3-hr. oral glucose test (OGTT) is indicated. 51. A nurse in a prenatal clinic is discussing quickening with a client who is in the first trimester of her first trimester of her first pregnancy. Which of the following statements by the client indicates understanding of the teaching 1. I will begin scheduling appointments every 2 wks 2. I will feel movement at about 16-20 wks 3. I will take 2 ibuprofen capsules for the discomfort 4. I will plan to have a blood test when quickening occurs ATI OB 24 Quickening- slight fluttering movements of the fetus felt by a woman, usually between 16-20 weeks of gestation. 52. A nurse on the postpartum unit is reviewing prevention of new diaper rash with a client. Which of the following statements indicates an understanding of the teaching? 1. I will allow the diaper area to dry before applying clean diaper 2. I will clean the diaper area with a scented baby wipe 3. I will apply a thin layer of tail to the diaper area twice a day 4. I will wash the diaper area with an antibacterial soap with each diaper change → mild soap and water only Lowdermilk PDF PG 594 The infant skin should be allowed to dry completely before applying another diaper. ATI OB 305 To avoid diaper rash, the newborn’s diaper area should be kept clean and dry. Diapers should be changed frequently, and the perineal area cleaned with warm water or wipes and dried thoroughly to prevent skin breakdown. 53. A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate by continuous IV infusion. The nurse should monitor for which of the following adverse effects? 1. Elevated BP 2. Hypertonia 3. Absence of deep tendon reflexes 4. Polyuria ATI Pharm 398 Assess for depressed or absent deep tendon reflexes as a sign of toxicity. Calcium gluconate is given for magnesium sulfate toxicity.also output < 30 ml/hr

61. A nurse is caring for a client who is 1 day postpartum and breastfeeding her newborn. The client reports sore nipples. Which of the following actions should the nurse take? P. 120 ch 17 1. Offer supplemental formula between the newborn’s feedings- baby must only be with breat milk for first year. 2. Assess the newborn’s latch while breastfeeding 3. Instruct the client to wait 4 hrs between daytime feedings 4. Have the client limit the length of breastfeeding to 5 min per breast 62. A nurse is reviewing a client’s rubella titer or 1:8 at her second prenatal visit. Which of the following statements by the nurse is appropriate? 1. Because rebel is a live vaccine you will not be able to breastfeed your newborn- it is not communicable in breast milk. However the virus is shed in urine and other body fluids so it should not be given to other members who are immunocompromised. 2. Your titer indicates you are susceptible to rubella- titers of less than 1:8 mean 3. During your third trimester you will need to repeat blood test for the tite r- 4. You will need a rubella immunization at your next prenatal visit 63. A nurse is caring for a client who is active labor & is receiving oxytocin vis IV infusion. The nurse has applied an internal fake heart monitor & recognizes an early deceleration of the fetal heart rate tracing. Which of the following actions should the nurse take? P . 88 ch 13 1. Continue to monitor the client 2. Discontinue oxytocin 3. Administer 8L/min per mask 4. Assists the client to lay on her right side OB ati pg 88: early decelerations are slowing of FHR w/start of contraction w/return of FHR to baseline at end of contraction. Likely caused by fetal head compression resulting from uterine contraction. No intervention is required. Early decels are always good. Theres is no intervention needed to use when there is early decels. HOWEVER, whenever there is LATE DECELERATIONS, or ABSENT VARIABLITIY, then thats when you need to WORRY, because that is when UNTEROPLACENTAL INSUFFIENCY kicks in. 64. A nurse is caring for 4 clients. Which of the following clients should the nurse auscultate the fetal heart rate during the prenatal visit? 1. Client who has positive urine pregnancy test 1 week after missed menses (not urgent, normal) 2. A client who has a crown rump length of 7 wks gestation (normal) 3. A client who has an ultrasound that confirms molar pregnancy (URGENT) 4. A client who ha felt quickening of the first time (Normal, its a presumptive sign of pregnancy) Rationale: Molar Pregnancy Appears when tissue that normally becomes a fetus instead becomes an abnormal growth in your uterus. Even though it isn't an embryo, this growth triggers symptoms of pregnancy. A molar pregnancy should be treated right away. This will make sure that all of the tissue is removed. 65. A nurse is caring for a cline who Is in the first stage of labor & the fetal head is in a posterior position. The client reports pressure and pain in her lower back. Which of the following non pharmacological comfort measure should nurse suggest first? P. 80 chapter 12 1. Effleurage → light, gentle circular stroking on pt’s belly w/ fingertips in rhythm w/ breathing during contractions 2. Patterned breathing 3. Couterpressure- - counteracts lower back pain by consistently applying pressure to the pt’s sacral area using the heel of your hand or fist 4. Guided imagery 66. A nurse is caring for a client who is receiving oxytocin to induce labor. The nurse should discontinue the oxytocin if which of the following occurs p. 805 lowdermilk 1. Six contractions in 10 mins- MORE than 5 in 10 minutes or contractions occuring more than 1 minute of each other is risk for uterine tachysystole aka uteroplacental insuffiency 2. Moderate variability of the fetal heart rate 3. Nonprepetive.early decals 4. Contractions last 60 secs- contractions are bad if they last for more than 90 seconds. 67. A nurse is providing discharge teaching to the parent of a newborn about surgical site care following circumcision using a clamp technique. Which of the following statements by the parent indicates understanding? 1. I will check the site hourly for bleeding 2. I will apply petroleum jelly to area with each diaper change 3. I will remove the crust with each diaper change - DO NOT wipe of yellow mucous 4. I will twas the penish with soap and water daily 68. A charge nurse is teaching newly licensed nursing about fetal monitoring. The newly licensed nurse should identify that which of following images indicates prolonged decelerations?

Nursing Practice Questions: Obstetrics, Exams of Nursing

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