PP
On assessment of a client who is 30 minutes into the fourth stage of labor, the nurse finds the client's perineal pad saturated with blood and blood soaked into the bed linen under the client's buttocks. The nurse's initial action is:
What is Massage the funds
A nurse performs a pelvic exam on a laboring mother. Findings are that the client is 5 cm and at zero station. What does this mean for the fetus?
What is the Fetus is at the Ischial Spines
The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is:
What is Progesterone
The Apgar assessment is performed:
At least twice, 1 minute and 5 minutes after birth.
The nurse caring for the laboring woman should understand that early decelerations are caused by:
Methylergonovine (Methergine) is prescribed for a woman who has just delivered a healthy newborn infant. The priority assessment before administering the medication is to check the clients:
What is BP
The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug?
What is Assessing for chest discomfort and palpitations
A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that:
This is a normal respiratory change in pregnancy caused by elevated levels of estrogen
The nurse administers vitamin K to the newborn for which reason?
Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.
The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:
What is Variable Decelerations
A nurse is caring for a postpartum client who delivered 6 hours ago. The client has a temperature of 100°F. The nurse should mostlikely begin planning care for which condition?
what is Dehydration
Temperatures in the first 12 hours are most often caused by dehydration
A fetus is being born head first, with the occiput facing the right side of the mother’s pelvis, towards the back. What is the fetal presentation?
What is ROP
Physiologic anemia often occurs during pregnancy as a result of:
a. Inadequate intake of iron.
b. Dilution of hemoglobin concentration.
c. The fetus establishing iron stores.
d. Decreased production of erythrocytes.
B
An African-American woman noticed some bruises on her newborn girl’s buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called:
What are Mongolian spots
A 31-year-old patient is brought in to the emergency room after suffering an ectopic pregnancy. Based on the nurse’s understanding of this condition, the nurse knows to look for which signs or symptoms in this patient? Select all that apply.
a. dark red vaginal bleeding
b. abdominal petichiae
c. referred shoulder pain
d. A firm, "board -like" abdomen
e. abdominal pain
A, C, E
A nurse is caring for a postpartum client with an episiotomy. Which of the following orders should the nurse anticipate? Select all that apply.
a. Ice packs to the perineum
b. Urinary catheter
c. NSAIDS
d. sitz baths
e. witch hazel pads
A, C, D
A pregnant woman’s amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority?
What is Placing woman is knee-chest position or trendelenberg position
What laboratory marker is indicative of disseminated intravascular coagulation (DIC)?
a. Bleeding time of 10 minutes
b. Thrombocytopenia
c. Presence of fibrin split products
d. Hyperfibrinogenemia
C
At 1 minute after birth, the nurse assesses the infant and notes a heart rate of 80 beats/minute, some flexion of the extremities, a weak cry, grimacing, and a pink body with blue extremities. The nurse would calculate an Apgar score of:
5
A nurse is providing care for a client who has undergone a D&C for a molar pregnancy. What will be included in the plan of care after discharge?
a. uterine US
b. contraception for 6 weeks
c. frequent hCG levels
d. Methotrexate
C.
After a hydatiform mole has been removed, monitoring hCG levels afterwards is critical. If the hCg levels continue to rise, there may be molar tissue attached to the uterine tissue, and a hysterectomy may be necessary as molar tissue can lead to cancer. hCG levels are monitored weekly until they are back to pre-pregnancy levels, and then monthly for 1 year.
Which woman is at greatest risk for early postpartum hemorrhage (PPH)?
a. A primiparous woman (G 2 P 1 0 0 1) being prepared for an emergency cesarean birth for fetal distress
b. A woman with severe preeclampsia who is receiving magnesium sulfate and whose labor is being induced
c. A multiparous woman (G 3 P 2 0 0 2) with an 8-hour labor
d. A primigravida in spontaneous labor with preterm twins
what is B
Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony.
Complications and risks associated with cesarean births include (Select all that apply):
a. Placental Abruption
b. Wound dehiscence
c. Hemorrhage
d. UTI
e. Fetal injuries
What is B, C, D, E
The diagnosis of pregnancy is based on which positive signs of pregnancy (Select all that apply)?
a. Identification of fetal heartbeat
b. Palpation of fetal outline
c. Visualization of the fetus
d. Verification of fetal movement
e. Positive hCG test
A,C,D
While examining a newborn, the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:
What is Hip Dysplasia
A woman’s obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?
4-1-2-0-4