Newborn
The creamy cheese like substance covering the baby after birth.
What is the vernix caseosa?
A nurse is caring for a client who wants to know if it is possible to have a vaginal birth after a cesarean birth (VBAC). Which of the following statements by the nurse is appropriate?
Rationale: A transverse incision (also known as a horizontal incision) cuts across the lower, thinner part of the uterus. It is used during most cesarean births and makes a VBAC possible. A vertical incision cuts up and down through the uterine muscles that strongly contract during labor and might cause uterine rupture during a VBAC.
A nurse is preparing to administer Cervidil (Dinoprostine) to a client who is pregnant. The client asks the nurse about the purpose of the medication. Which of the following responses should the nurse make?
Dinoprostone promotes softening of the cervix.
Rationale: Dinoprostone is used to prepare or soften the cervix for the induction of labor in pregnant clients who are at or near term.
A nurse is collecting data from a client who is 3 hr postpartum. The nurse notes that the client’s fundus is displaced to the right of midline, is firm, and is two fingerbreadths above the umbilicus. Which of the following actions should the nurse take?
Have the client urinate.
Rationale: A full bladder displaces the uterine fundus and elevates it above the level of the umbilicus. Having the client urinate allows the uterus to settle back to midline below the umbilicus.
Blood test administered to the newborn born post term and SGA.
What is Blood Glucose Level?
A nurse is teaching a new mother about signs of effective breastfeeding of her newborn. Which of the following information should the nurse include in the teaching?
Your baby can lose 5% of body weight during the first 3 days of life.
Rationale: The nurse should instruct the mother that the baby can have a weight loss between 5% and 6% of their birth weight during the first 3 days of life. Breastfed infants usually regain birth weight by their second or third week of life.
The triad of symptoms associated with preeclampsia
What is proteinuria, edema (sacral, face, and perineum), and hypertension?
The drug given to stimulate fetal surfactant production in a preterm labor.
What is Betamethasone?
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?
Heart rate 110/min
Rationale: A rapid or increasing heart rate can be a sign of fluid volume depletion related to hemorrhage. The nurse should further evaluate the client for postpartum hemorrhage.
A nurse is assisting with the care of a newborn following a vaginal delivery. Which of the following actions should the nurse perform first?
Clear the respiratory tract.
Rationale: Using the airway, breathing, circulation (ABC) priority-setting framework, the first action the nurse should take is to open the airway of a newborn who was just delivered.
A nurse reinforcing teaching about vitamin K with a client who is postpartum. Which of the following statements should the nurse include?
Vitamin K decreases the newborn's risk of hemorrhagic disorders.
Rationale: Newborns cannot produce vitamin K until about 8 days after birth. It is administered in the delivery suite to prevent hemorrhagic disorders.
A nurse is assisting in the care of a client who is in active labor. The nurse notes late decelerations on the fetal monitor tracing. Which of the following actions should the nurse take first?
Position the client on her side.
Rationale: Late decelerations are caused by uteroplacental insufficiency. A position change should increase perfusion to, or decrease compression of, the placenta, and is the first intervention the nurse should try.
A 40 week pregnant client is going to have their labor induced. Which of the following medications would the nurse anticipate to give to the client?
Oxytocin
A nurse is caring for a client who is 2 hr postpartum. The client has an IV of lactated Ringer’s with 25 units of oxytocin infusing and large rubra lochia with a hypotonic uterus. Vital signs include blood pressure 146/94 mm Hg, pulse 80/min, and respirations 18/min. Which of the following prescriptions should the nurse clarify with the provider?
Administer methylergonovine 0.2 mg IM now.
A nurse is assisting in the care of a newborn immediately following birth. The nurse notes mucus bubbling out of the newborn’s mouth and nose. Which of the following actions should the nurse take first?
Suction the newborn’s mouth with a bulb syringe.
Rationale: The nurse should first suction the newborn’s mouth with a bulb syringe, followed by the nares. Suctioning the mouth first helps prevent aspiration of mucus into the newborn’s airway.
The physiological change of highest priority in the newborn.
What is spontaneous respirations.
A nurse is assisting with the care of a client who has severe preeclampsia and is receiving magnesium sulfate IV at 2 g/hr. Which of the following findings indicates that it is safe for the nurse to continue the infusion?
Respiratory rate of 16/min
Rationale: The client’s respiratory rate should be at least 12/min as a precaution against excessive depression of impulses at the myoneural junction. Based on this finding, the nurse can continue the infusion.
A nurse is assisting with the admission of a client who is in preterm labor at 30 weeks of gestation and has a new prescription for betamethasone. Which of the following statements should the nurse make?
"The purpose of this medication is to boost fetal lung maturity."
Rationale: Betamethasone is a glucocorticoid that boosts fetal lung maturity by promoting the release of certain enzymes that help produce surfactant.
A nurse is caring for a client who is postpartum and asks, "When will my breast milk come in?" Which of the following responses should the nurse make?
Rationale: By day 3 to 5, most clients who are breastfeeding begin to produce copious amounts of breast milk.
A nurse is collecting data from a newborn and finds an apical pulse of 130/min. Which of the following actions should the nurse take?
Document this as an expected finding.
Rationale: The expected reference range for apical pulse in a newborn is 120 to 160/min. The nurse should document this as an expected finding.
A nurse is collecting data from a newborn immediately after delivery by a client who was at 42 weeks of gestation. Which of the following findings should the nurse expect?
Dry, cracked skin
Rationale: Newborns who are postmature have dry, cracked skin that feels like parchment paper.
The only definitive treatment for HELLP.
What is delivery?
Drug that may cause respiratory depression so not used as first line treatment for stopping contractions in preterm labor.
What is Magnesium Sulfate?
A nurse is caring for a client in the immediate postoperative period following removal of an ectopic pregnancy via salpingostomy. For which of the following indications should the nurse administer Rho(D) immune globulin?
Rationale: Administering Rho(d) immune globulin to the client prevents the formation of antibodies to Rh-positive blood. Exposure can occur following delivery, spontaneous or induced abortion, or amniocentesis involving an Rh-positive fetus.
Cyanosis of the hands and feet in the newborn.
What is acrocyanosis?