Deck 66: Care of the Normal Newborn

Question 1

A pregnant woman states that she wants to have her baby at home on her "own territory." What type of professional would be most likely to attend a home birth?

A) Nurse practitioner
B) Physician
C) Registered nurse
D) Certified nurse midwife

Answer 1

Certified nurse midwife

Question 2

A nurse is informing a client about different choices available to pregnant women choosing a birth setting. Which birth setting promotes safe, satisfying, and the most cost-effective childbirth?

A) Free-standing birth centers
B) Labor and delivery unit
C) Home setting
D) Birthing room

Answer 2

Free-standing birth centers

Question 3

The certified nurse midwife is discussing the birth plan with a client. Which data would most likely be documented in the plan? Select all that apply.

A) The woman's choice of a partner for support during labor
B) The woman's living will or advance directives
C) The type of pain relief measures desired
D) The parents' choice of baby names
E) The outcome of labor and delivery
F) The woman's feelings about fetal monitoring

Answer 3

The woman's choice of a partner for support during labor
The type of pain relief measures desired
The woman's feelings about fetal monitoring

Question 4

The nurse assessing a laboring client documents that the client is in stage II of labor. What typically occurs during this stage?

A) Dilation of the cervix
B) Movement of fetus to the birth canal
C) Delivery of the baby through the vaginal opening
D) Delivery of the placenta following delivery of the newborn

Question 5

The nurse practitioner examining a pregnant woman in labor notes that the fetal spine is parallel to the woman's spine. What is the term for this relationship of the fetal body to the maternal body?

A) Lie
B) Presentation
C) Station
D) Engagement

Question 6

The nurse assisting with deliveries is aware that which clients are most at risk for having a difficult delivery and possibly cesarean section?

A) A woman whose baby is in a longitudinal lie
B) A woman whose baby has a cephalic presentation
C) A woman whose baby has engaged prior to labor
D) A woman whose baby is in the footling breech position

Question 7

The obstetrical nurse checks the station of a laboring pregnant woman and documents+5 on the client chart. What does this number mean in terms of the delivery?

A) The baby is "floating" above the mother's ischial spines.
B) The fetal head is at the vaginal opening.
C) The lowest part of the fetal skull is at the level of the mother's ischial spines.
D) The presenting part is 5 cm above the level of the ischial spines.

Question 8

A client is in labor, and the nurse palpates her abdomen to assess the presentation of the fetus. Which presentation indicates normal labor?

A) Breech presentation
B) Shoulder presentation
C) Brow presentation
D) Vertex presentation

Question 9

A primigravida who is 2 weeks away from her delivery date tells the obstetrical nurse that she feels like "the baby has dropped." What would be the nurse's best response to this client?

A) "This feeling may be a sign that there is a complication with your pregnancy."
B) "This feeling is called lightening and means that the fetus has settled into the pelvis."
C) "This is a normal feeling at this stage and it is called Braxton Hicks contractions."
D) "This is a normal feeling called lightening signaling that labor has begun."

Question 10

A pregnant client in her 38th week of gestation reports abdominal pains and suspects she is in labor. Which finding is characteristic of true labor contractions?

A) Contractions are short and irregular.
B) Contractions are generally felt low in the abdomen.
C) Contractions help create effacement and dilation of the cervix.
D) Contractions are relieved by change of position or activity.

Question 11

A nurse is caring for a client in labor. During assessment, which should the nurse consider to be a common discomfort of labor?

A) Exaggerated fetal movement
B) Pain in the lower back
C) Prolonged slowing of the fetal heart rate
D) Irregular fetal heartbeat

Question 12

The nurse is caring for a laboring woman who has been given oxytocin to induce labor. She is having contractions at an interval of every 2 minutes with 90 seconds duration in between. What would be the appropriate intervention in this situation?

A) Encourage the woman's coach to help her with breathing exercises.
B) Provide a back rub for the woman when the pain is at its greatest intensity.
C) Check her pain medication preferences and administer an analgesic, if indicated.
D) Report this emergency situation to the birth attendant.

Question 13

The obstetrical nurse is administering oxytocin for her client to induce labor. Which guideline is recommended for administration of the drug?

A) For labor induction: Initial dose of 1 to 2 mU; increased 1 to 2 mU/min until an adequate labor pattern is achieved.
B) For labor augmentation: Initial dose: 1.5 to 2.0 mU; increased 1 to 2 mU/min until an adequate labor pattern is achieved.
C) For labor induction and labor augmentation: Maximum recommended dose is 25 mU/min.
D) For postpartum: 15 to 25 mU IM or IV after delivery of the placenta.

Question 14

A nurse is assessing a pregnant client whose membranes have ruptured. Which finding may indicate an infection?

A) Nitrazine paper remains yellow
B) White or cloudy amniotic fluid
C) Clear and colorless amniotic fluid
D) Nitrazine paper turns blue

Question 15

A pregnant woman is having moderately strong contractions every 3 minutes lasting 50 seconds. Her cervix is dilated 6 cm. What state of labor is she experiencing?

A) Stage I, latent phase
B) Stage I, active phase
C) Stage I, transitional phase
D) Stage II

Question 16

A client in the first stage of labor has an episode of bright-red bleeding. What is the best action for the nurse to take?

A) Perform a vaginal examination per protocol.
B) Report the bright red bleeding at once.
C) Perform an ultrasound examination, as ordered.
D) Inject vitamin K, as ordered, to stop bleeding.

Question 17

A client is in the second stage of labor. The nurse should record the following information in the second stage:

A) The exact time of placental delivery
B) The nature of placental delivery
C) The side of placental presentation
D) The type of episiotomy on the client's chart

Question 18

The obstetrical nurse records the expulsion of the placenta in stage III labor as a Duncan presentation. What does this data represent?

A) The placenta is expelled with the dull side out.
B) The placenta is expelled with the shiny side out.
C) The placenta is not fully expelled.
D) The placenta contains placental fragments.

Question 19

The nurse is caring for a client who just delivered a healthy 7 lb 9 oz baby girl. What is the priority nursing intervention for this new mother?

A) Giving the mother a bed bath to assess for vaginal discharge.
B) Allow the mother a period of rest with no distractions.
C) Encourage bonding with the infant.
D) Perform a comprehensive assessment.

Question 20

What sign of fetal distress observed on the fetal monitor should the nurse report immediately?

A) Accelerations of 15 bpm
B) Early decelerations
C) Decreased variability
D) Fetal heart rate above 100 bpm

Question 21

A fetus is experiencing variable decelerations in the fetal heart rate during contractions. What is the appropriate nursing intervention for this situation?

A)
Have the pregnant woman walk around the room.
B) Change the woman's position and give oxygen.
C) Notify the healthcare practitioner immediately.
D) Administer prescribed pain medications.

Question 22

The nurse caring for a postpartum client explains the occurrence of lochia following delivery. Which statement accurately describes a characteristic of this process?

A) "Lochia rubra, which is mostly red and bloody, is seen for the first week after delivery."
B) "Lochia serosa, which is pink or brown tinged, starts after the bleeding diminishes."
C) "Lochia alba, which is yellow or white, starts on about day 15."
D) "Lochia alba has a pungent, foul odor."

Question 23

Following delivery, a client feels the urge to void, but is unable to do so after an extended period of time. What immediate action should the nurse take?

A) Report the situation to the practitioner.
B) Catheterize the client's bladder.
C) Apply suprapubic pressure.
D) Reassure the client.

Question 24

A nurse is performing fundal massage for a client. What precaution should the nurse take when giving a fundal massage?

A) Never massage a contracted fundus.
B) Avoid placing a hand over the symphysis pubis.
C) Report cramps immediately to physician.
D) Avoid applying heat to relieve cramps.

Question 25

The nurse performing a postpartum assessment on a client to elicit the Homans sign. For what condition is the nurse assessing?

A) Thrombophlebitis
B) Urinary distention
C) Soft, boggy uterus
D) Hematoma

Question 26

The nurse is providing teaching to a new mother regarding changing her perineal pad. Which client statement indicates effective teaching?

A) "I will pull my underwear down and to the front."
B) "I will always unhook my pad from the front first."
C) "I will remove the pad from the back to the front."
D) "I will apply the new pad by hooking it to the back first."

Question 27

The nurse is teaching a new mother breastfeeding techniques. What should the nurse teach to help relieve engorgement?

A) Do not wear a bra or other constricting clothing.
B) Apply cold packs to the breast for 15 minutes before nursing.
C) Increase fluid intake by 30%.
D) Avoid manual expression or pumping breasts.

Question 28

The nurse is teaching a new mother about the advantages/disadvantages of breastfeeding versus formula feeding. Which statements accurately describe the process? Select all that apply.

A) Breast milk is readily available and convenient.
B) Breast milk is always the right temperature.
C) Breastfeeding slows involution.
D) Breast milk contains antibodies.
E) Breast milk is more likely to cause allergic reactions.
F) Breastfeeding ensures another pregnancy will not occur.

Question 29

The nurse is discharging a new mother from the hospital. Which recommended teaching guideline should be discussed?

A) Tell the client to return for a follow-up examination in 1 month.
B) Advise the client to resume sexual intercourse as soon as it feels comfortable.
C) Tell the nonnursing client that menstruation should resume in 6 to 8 weeks.
D) Tell the nursing mother that contraception is not necessary until her period returns.