Maternal/Newborn: Exam 3 with complete solutions latest 2024 graded A, Exams of Nursing

Download Maternal/Newborn: Exam 3 with complete solutions latest 2024 graded A and more Exams Nursing in PDF only on Docsity!

complete solutions latest 2024 graded A

List some categories of postpartum complications: - correct answer- shock

• hemorrhage
• thromboembolic disorders
• puerperal infections
• sub-involution of the uterus
• mood disorders Define shock: - correct answera condition in which the cardiovascular system fails provide essential oxygen and nutrients to the cells What are the different types of shock: - correct answer- hypovolemic
• anaphylactic
• septic
• cardiogenic Describe postpartum preeclampsia: - correct answer- may take several days to a week for symptoms to resolve following birth
• treatment must continue until the blood pressure and reflexes return to normal ranges Describe postpartum hemorrhage: - correct answer- uncontrolled bleeding can become a life-threatening event and excessive bleeding must be reported immediately to the RN and primary care provider
• 10 point decrease in hematocrit between admission and post birth, excessive blood loss has occurred
• saturation of a sanitary pad within 1 hour signals excessive bleeding and must be reported Things to note about postpartum hemorrhage: - correct answer- EBL (estimated blood loss) of 500 mLs for a vaginal birth and 1000 mLs for a cesarean birth are the criteria used for this
• women of asian or hispanic heritage have a higher chance of developing this What are the 4 causes of immediate postpartum hemorrhage: - correct answer- uterine atony
• lacerations
• retained placental fragments
• hematomas What is the most common cause of delayed postpartum hemorrhage: - correct answerfailure of the uterus to return to its normal size due to retained placental fragments What is usually the first sign of hypovolemic shock: - correct answertachycardia

complete solutions latest 2024 graded A

Postpartum infections: - correct answer- mastitis (infection of the breast occur most commonly in lactating women)

• lacerations
• episiotomies
• cesarean incisions What is a puerperal infection: - correct answer- is a postpartum infection that is rare, following childbirth
• infection usually begins in the vagina and migrates upward into the uterus (endometritis), pelvic lymph nodes, peritoneum (peritonitis), and circulation
• report temperatures of 100.4 (38.4C) and above
• once the organisms are growing in the blood, the disease has progressed to septicemia What are some risk factors for puerperal infection: - correct answer- cesarean delivery
• prolonged rupture of membranes
• multiple vaginal examinations during labor
• compromised health status of the mother
• obstetric trauma (lacerations, episiotomy)
• intrauterine monitoring equipment
• instrument-assisted delivery
• manual removal of placenta
• pre-existing vaginal infections (STI's) Psychological Risks: Postpartum blues - correct answer- occur in most women
• characterized by mild depression interspaced with happy feelings
• finds overall pleasure in life and in her new role as a mother
• begins within a few days after birth and lasts a few hours to approx 2 weeks
• is self-limiting
• depression (profound, overwhelming, persists)
• lack of enjoyment in life
• disinterest in others
• feelings of inadequacy, unworthiness, guild, inability to cope
• loss of mental concentration, inability to make decisions
• disturbed sleep and appetite
• constant fatigue and feelings of ill health Risk factors for postpartum depression: - correct answer- primipara
• contradictory feelings about the pregnancy
• history of postpartum depression
• history of depression or bipolar illness
• family history of psychiatric disorders
• lack of staple relationships
• lack of social support

complete solutions latest 2024 graded A

• body image disorders including eating disorders
• history of drug and or alcohol abuse Psychological risks: psychosis - correct answeris considered an emergency because of the risk of suicide and infanticide
• primary symptom is an impaired sense of reality Risk factors for postpartum psychosis: - correct answer- previous puerperal psychosis
• history of bipolar disorder (manic-depressive)
• history of major depression
• prenatal stressors (lack of support, lack of partner, low socioeconomic status)
• obsessive personality
• family history of mood disorders Nursing care: - correct answer- refer to a multidisciplinary team
• be a sympathetic listener for the woman
• elicit feelings
• observe for complaints of sleeplessness or chronic fatigue
• provide support
• help woman identify her support system
• determine if the mother is getting enough exercise, sleep, and nutrition
• help the woman identify ways to meet her own needs
• refer new mother to support groups Homeless mother and newborn: - correct answer- lack of permanent home
• often have difficulty accessing care
• follow up is difficult
• prior to discharge, ensure mother has a place to go and a way of accessing help
• facilitate referrals to outreach programs, support services within the community The nurse uses which of the following to most accurately indicate blood loss by the postpartum client during delivery? - correct answerhct level The nurse is caring for a postpartum client who reportedly delivered a fragmented placenta. The nurse recognizes that this client is at increased risk for: - correct answerpostpartum hemorrhage A woman delivered a full-term infant vaginally with her feet elevated in stirrups for 2 hours while pushing, and sustained a fourth degree perineal laceration. Postpartum, the client is reluctant to get out of bed secondary to pain. This client is at increased risk for:
• correct answerthromboembolic disease

complete solutions latest 2024 graded A

The nurse teaches the postpartum client who delivered vaginally to perform which of the following to reduce the risk of infection of the episiotomy? - correct answerchange the perineal pad at least every 2 hours Describe a high-risk neonate: - correct answer- is born prior to 28 weeks or after 42 weeks

• who has alterations in intrauterine growth
  • SGA
  • LGA
  • CDC growth chart
• who has a medical condition that requires frequent monitoring and treatment
• drug addiction
• being too large or too small for gestational age What are some priorities for the care of high-risk newborns: - correct answer- maintenance
• promoting tissue perfusion
• managing pain What is the newborn assessed for: - correct answer- vital signs
• pain
• intake/output
• blood glucose What does the nurse assist with when it comes to medical treatments: - correct answer- drug therapy
• diagnostic exams
• surgery
• ventilation
• nutrition List things that are on the neonatal infant pain scale: - correct answer- facial expression (relaxed/grimace)
• cry (no cry/whimper/ vigorous crying)
• breathing patterns (relaxed/change in breathing)
• arms (restrained, relaxed, flexed, extended)
• legs (restrained, relaxed, flexed, extended)
• state of arousal (sleeping, awake, fussy) Congenital anomalies: - correct answer- most require surgical repair beginning in the newborn period
• defects of the gastrointestinal system are the most common (they require surgical correction, but many are not life threatening)

complete solutions latest 2024 graded A

List some common congenital anomalies: - correct answer- cleft palate and lip

• club foot
• intestines are in the umbilical cord or outside the body
• heart issues How to deal with a drug-exposed newborn: - correct answer- the infant is at extreme risk of being born addicted to the drugs
• the newborn, withdrawing from the addiction can experience pain, tremors, seizures, lethargy, and failure to thrive
• the newborn may have permanent neurologic damage and could die What are some drugs used and abused by the pregnant woman: - correct answer- tobacco
• cocaine
• meth
• marijuana
• heroin
• methadone
• alcohol What is the term used to describe the behavior of the infant exposed to chemical substances in utero: - correct answerneonatal abstinence syndrome List some effects of tobacco in the womb: - correct answer- increased chance of birth defects
• increased change of placental abruption
• increased chance of miscarriage
• increased chance of stillbirth
• increased chance of premature birth
• increased chance of low birth weight
• increased chance of weak lungs upon birth List some effects of alcohol in the womb: - correct answer- increased chance of cerebral palsy
• increased chance of miscarriage
• increased chance of low birth weight
• increased chance of fetal alcohol syndrome
• increased chance of stillbirth List some effects of cocaine in the womb: - correct answer- increased chance of kidney defects
• increased chance of placental abruption
• increased chance of low birth weight
• increased chance of heart defects and arrhythmias

complete solutions latest 2024 graded A

• increased chance of smaller head circumference
• increased chance of premature birth List some effects of heroin in the womb: - correct answer- increased chance of intrauterine growth restrictions
• increased chance of neonatal abstinence syndrome
• increased chance of low birth weight
• increased chance of disease from needle sharing
• increased chance of premature birth List some infections that can occur after the rupture of membranes: - correct answer- group B strep
• genital herpes
• gonorrhea List some infections that can occur during transfer across the placenta and infect the developing fetus: - correct answer- cytomegalovirus (CMV)
• rubella
• syphilis
• HIV/AIDS Care of the newborn with respiratory conditions: - correct answer- establish and maintain a patent airway is highest priority
• nurse should suction the airway as needed with a bulb syringe or suction catheter
• oxygen can be administered by nasal catheter or mask Care of the newborn with cardiovascular conditions: - correct answer- focus your care on promoting respiratory effectiveness and reducing workload
• give oxygen as ordered and assess the infants color frequently
• auscultate lung sounds every hour and report changes
• help keep infant comfortable to decrease crying, which can lead to SOB
• monitor intake and output for fluid overload The nurse, working in the newborn nursery, receives report on a 4-hour-old baby who has not yet voided. At what age of life would the nurse need to notify the physician if the child still has not voided? - correct answer24 hours of age The nurse is assigned to care for a mother who delivered her baby at 26 weeks gestation and is in the NICU. The nurse will reinforce to the mother that all of the following are important nursing actions for her premature baby except: - correct answertalking to the infant and providing frequent stimulation The nurse is assigned to care for a mother-baby couplet. The newborn was born at 39 5/7 weeks and weighs 5 lbs 2 oz. Which of the following nursing implementations would

complete solutions latest 2024 graded A

be indicated for the small-for-gestational-age neonate but not for the large-for- gestational-age infant? - correct answermonitor for temperature instability The nurse is assisting the RN with the care of a newly born infant and discovers that the infant has an imperforate anus. The nurse anticipates surgical repair: - correct answerwill occur within 24 hours with creation of an ostomy A neonate is from when to when: - correct answerfrom delivery through the first month of life Neonatal transition to extrauterine life: - correct answerphase 1: period of reactivity (0- 30 minutes after birth) phase 2: decreased responsiveness (30 minutes to 2 hours after birth) phase 3: second period of reactivity (2-8 hours after birth) What are the foundations of neonate care: - correct answer- airway

• breathing
• circulation
• thermoregulation Birthing room care: - correct answer- apgar testing done at 1 min and 5 minutes
• skin to skin for first hour
• proper identification (wristbands, neonate footprints, umbilical alarm)
• vital signs every 30 minutes for 2 hours Phase 2 nursing care of the newborn: - correct answer- Supporting thermoregulation (evaporation, conduction, convection, radiation)
• observing bowel and urinary fx
• security measures
• identifying the infant ( gestation age, skin, vernix, hair, ears, breast tissue, genitalia, sole creases)
• observing for injuries and anomalies
• obtaining vital signs
• weighing and measuring length and head circumference
• umbilical cord care
• screening tests (blood glucose, cardiac screen, hearing, bilirubin, metabolic screen) What are normal vital signs for a newborn? - correct answertemp: 36.5-37. HR: 110-160 (regular and strong, may have soft murmur) Resp: 40-60 (lusty cry, color pink and even tone for race, clear lungs bilaterally, rate may be irregular) What are some priorities for nursing care of the normal neonate involve: - correct answer- maintaining the airway, breathing, and circulation

complete solutions latest 2024 graded A

• maintain body temperature
• teaching parents to provide care for their neonate
• providing nutrition
• ensuring elimination
• teaching safety measures to the parents What does routine care of the neonate involve: - correct answer- sponge baths
• feeding
• cord care
• circumcision care
• diapering in a warm, calm environment neonate should only be transported in a bassinet, not held in the arms Neonatal screeing tests: - correct answeraccomplished through heel sticks for blood draw to test for:
• hypoglycemia
• phenylketonuria (PKU)
• bilirubin Circumcision - correct answer- surgical removal of the foreskin of the penis
• informed consent must be signed by parents
• penis should be washed with warm water with each diaper change
• glans may be kept covered with a petroleum jelly gauze until healing has occured
• LPN may assist with male circumcision and post procedure care Sleep: neonate - correct answer- generally sleeps 20-22 hours a day
• newborn likes security and warmth by swaddling
• infant should be placed on his/her back for sleeping
• no objects in the crib to prevent suffocation What are some risks for neonatal hypoglycemia: - correct answer- preterm/postterm
• diabetic mother
• LGA/SGA
• IUGR
• asphyxiated
• cold stress
• mother had tocolytics during labor process Signs and symptoms of hypoglycemia in a newborn: - correct answer- jitteriness
• poor muscle tone
• sweating
• respiratory difficulty
• low temperature
• poor suck

complete solutions latest 2024 graded A

• high-pitched cry
• lethargic
• seizures Define bonding: - correct answerstrong emotional tie that forms soon after birth between parents and newborn Define attachment: - correct answeraffectionate tie occurring over time with increased interaction What are some nursing interventions to aid in bonding and attachment: - correct answer- calling the infant by name
• holding the infant en face
• providing skin-to-skin contact
• talking in gentle, high-pitched tones Neonate nutrition: - correct answer- full term needs 50-55 kcal/lb (20oz) per day
• at birth, newborns stomach will hold 5-20 mmL or less slightly less than an ounce
• stomach is the size of a marble
• by the end of the first week of life the newborn can retain 60-90 mL with each feeding
• need to be fed every 2-4 hours
• breast milk recommended for the first year of birth hormonal stimulation: - correct answer- prolactin
• ocytocin composition of milk: - correct answer- foremilk
• hindmilk Phases of milk production: - correct answer- colostrum
• transitional
• mature Assisting the mother to breastfeed: advantages - correct answer- promotes mother- infant bonding
• maintains infant temperature
• sucking stimulates oxytocin release to contract mother's uterus
• cultural use of galactagogues What are breastfeeding techniques: - correct answer- positions of the mother's hands
• latch-on
• suckling patterns
• removing the infant from the breast

complete solutions latest 2024 graded A

Preventing problems when breastfeeding: - correct answer- typically ever 2-3 hours during early weeks

• sleepy infant
• fussy infant
• flat or inverted nipples
• supplemental feeding
• nipple confusion of the infant
• breast engorgement
• nipple trauma
• breast hygiene A woman with flat nipples will not be able to breastfeed: T/F - correct answerFalse How to recognize hunger in the newborn: - correct answer- hand-to-mouth movements
• mouth and tongue movements
• sucking motions
• rooting movements
• clenched fists
• kicking of legs
• crying (late sign) Storing and Freezing breast milk facts: - correct answer- milk at room temp for more than 4 hours increases potential for bacterial contamination
• container size should hold no more than one feeding
• safely stored or frozen in glass or hard plastic containers
• milk can be stored in refrigerator at 4'C (38'F) for 24 hours or in the freezer at -4'C` -can be thawed in refrigerator for 24 hours prior to using
• microwaving of breast milk is not advised because it destroys immune factors in the milk What are the different types of formulas: - correct answer- ready to feed
• concentrated liquid
• powdered Things to know with nonbreast milk: - correct answer- feed every 3-4 hours because formula is digested more slowly than breast milk
• do not microwave formula
• do not prop bottle
• involve partner and family in bottle feeding of infant Newborn discharge care: - correct answer- discharge planning for the newborn begins shortly after birth
• if discharged before 72 hours old, a follow-up visit with the pediatrician is recommended within 2 days of discharge

complete solutions latest 2024 graded A

• well baby checks starts around 6-8 weeks
• immunization information may be provided
• guidelines of when and who to call for questions or concerns
• all caregivers should know how to take baby's temp List of things new parents are taught prior to discharge: - correct answer- nutrition
• diapering
• hygiene
• clothing/blankets
• placing infant on back to sleep
• general safety
• care seat is rear facing until 2 years of age
• skin care
• circumcision care
• umbilical cord care When does the nurse apply antibiotic eye drops to the infant's eyes: - correct answerwithin an hour of delivery The nurse, working in the admission nursery, anticipates the newborn who adapts well to extrauterine life will breathe: - correct answerirregularly at 30-60 breaths per minute The nurse observes a new mother breastfeeding her newborn and recognizes that further teaching is needed when she: - correct answerattempts to breastfeed for 2 minutes then gives formula The nurse suspects that the newborn was born prematurely when which of the following characteristics is noted: - correct answerundescended testicles in boys and prominent clitoris in girls