NR 228 CHAMBERLAIN COLLEGE OF NURSING OB PROCTORED FINAL EXAM 1 → 2021. GRADED A

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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 pre... senting 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- 150000,300000 2. WBC count 10,000mm3 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 16. A nurse is planning care for a full term newborn who is receiving phototherapy. Which of the following actions should the nurse include in the plan of care? P. 336 ch 27 1. Avoid using lotion or ointment on the newborn’s skin- absorbs too much heat and can burn baby! 2. Dress the newborn in lightweight clothing- keep new born undressed but cover males genitalia to prevent testicular damage. 3. Keep the newborn supine throughout treatment (reposition the newborn every 2 hr to expose all of the body surfaces to the phototherapy lights and prevent pressure sores.) 4. Measure the newborns temp q8hrs - check new brons axiallry temp every 4 hours. -cover eyes.newborn undressed but cover genitals. No lotion! Remove baby from phototherapy every 4 hours. Reposition every 2 hrs. Bronze discoloration of baby is normal. 17. A nurse is caring for a preterm newborn immediately after delivery. Which of the following actions should the nurse take first? 1. Dry the infant under a radiant warmer- Maintain thermoregulation in newborn who is preterm by using heat warmer. Manifestation of hypothermia:apnea, cyanosis, hypoglycemia, feeding intolerance, lethargy 2. Weigh the infant 3. Take the infant’s temp 4. Obtain the infants blood glucose level Preterm newborn- birth occurs within week 20-37 18. A nurse is providing prenatal teaching to a group of clients who are in their trimester of pregnancy. Which of the following statements by a client indicates an understanding of the teaching? 1. I should lie on my back as much as possible during the labor process (PDF p.80: 4 stages of labor = all with different nonpharmacological interventions for pain) 2. I will be allowed to start to push once my cervix is dilated to 5 cm (PDF p.73: wait for complete dilation of 10cm) 3. Once my water has broken, I will not be able to have epidural anesthesia (PDF p.82: Administered when the client is in active labor and dilated to at least 4 cm) 4. Panting will help me control the urge to push when my cervix is not completely dilated (PDF p.110: Encourage the client to pant with an open mouth between contractions to control the urge to push) 19. A nurse is providing teaching about increasing dietary fiber to an antepartum client who reports constipation. Which of the following food selections has the highest fiber content per cup? (Answers based on Google) 1. Asparagus (3.6g--boiled) 2. Lentils (16g--boiled) 3. Oatmeal (4g--cooked) 4. Cabbage (2.8g--boiled) 20. A nurse is assessing a client who is 1 hr postpartum. The nurse notes a large amount of vaginal bleeding with several large blood clots on the client’s peripad. The clients bp is 70/42 mmHg and her heart rate is 150/min. Which of the following actions should the nurse take first? 1. Apply O2 at 10-12 L/min (#3 priority-- Provide oxygen at 2 to 3 L/min per nasal cannula) 2. Elevate the legs (#4 priority-- Elevate legs to a 20° to 30° angle to increase venous return) 3. Administer an IV bolus of oxytocin (#2 priority-- To promote uterine contraction, a faster action than massaging the fundus) 4. Massage the fundus (#1 priority--PDF p.136: Firmly massage the uterine fundus to promote uterine contractions.Uterine atony causes pooling of blood leading to postpartum hemorrhage (blood clots larger than a quarter; perineal pad saturation in 15 min or less; constant oozing, trickling, or frank flow of bright red blood from the vagina; tachycardia and hypotension) 21. A nurse manager on the labor and delivery unit is teaching a group of newly licensed nurses about maternal cytomegalovirus. Which of the following information should the nurse manager include in the teaching? 1. Transmission can occur via the saliva and urine of the newborn (PDF p.48: Cytomegalovirus is part of the TORCH infections that can cross the placenta and have teratogenic effects on the fetus. Latent virus can be reactivated and cause disease to the fetus in utero or during passage through the birth canal. Transmitted by droplet infection from person to person, a virus found in semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and blood) 2. Mothers will receive prophylactic treatment with acyclovir prior to delivery (PDF p.48: Treatment of toxoplasmosis includes sulfonamides or a combination of pyrimethamine and sulfadiazine) 3. Lesions are visible on the mothers genitalia (PDF p.48: Cytomegalovirus: asymptomatic or mononucleosis-like manifestations; Herpes simplex infection: symptoms consisting of painful blisters 4. This infection requires airborne precautions are initiated for the newborn (PDF p.48: Transmitted by droplet infection) 22. A nurse is caring for a client who is in the second stage of labor. Which of the following manifestations should the nurse expect? 1. The client delivers the newborn (PDF p.73: 2nd stage--birth) 2. The client expels the placenta (3rd stage) 3. The client beings having regular contractions (1st stage, active phase) 4. The client experiences gradual dilation of the cervix (1st stage, active phase) [Show More]

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