Deck 68: The High-Risk Newborn

Question 1

A 33-year-old pregnant woman at 22 weeks' gestation is undergoing an amniocentesis to test for intrauterine growth restriction. Which condition may cause this concern?

A) Maternal diabetes
B) Maternal age > 30 years
C) Maternal smoking
D) Fetal cardiac defects

Answer 1

Maternal diabetes

Question 2

The nurse is preparing a 38-year-old pregnant woman for an amniocentesis to determine if there are any congenital disorders or fetal abnormalities present. Which should the nurse consider before and during the testing?

A) Instruct the client not to empty her bladder before the test.
B) Monitor the woman's vital signs during the test and for one day afterward.
C) Use an external fetal heart monitor to ensure fetus is not in distress.
D) Instruct the woman that minor bleeding and cramping normally occur within 24 hours.

Answer 2

Use an external fetal heart monitor to ensure fetus is not in distress.

Question 3

The birth attendant has ordered an ultrasound for a pregnant woman to determine the gestational age of the fetus. What other information may be obtained by this test? Select all that apply.

A) Location of the placenta
B) Oxygen supply to fetus
C) Fetal heart rate related to fetal activity
D) Gender of the fetus
E) Fetal neural tube defects
F) Fetal head size

Answer 3

Location of the placenta
Gender of the fetus
Fetal head size

Question 4

The birth attendant administers dinoprostone (Prostin E2) to a woman who is having a spontaneous abortion to expel the fetus. In which types of abortion would this drug be used? Select all that apply.

A) Inevitable
B) Threatened
C) Complete
D) Septic
E) Incomplete
F) Missed

Question 5

A 25-year-old client has been diagnosed with a tubal pregnancy. Which factor predisposes a woman to this type of pregnancy? Select all that apply.

A) Diabetes mellitus
B) History of abortions
C) IUD use
D) Pelvic infections
E) Endocrine imbalances
F) Maternal tobacco use

Question 6

The nurse is performing a physical assessment of a pregnant woman at 18 weeks' gestation and documents the following: vaginal bleeding, a uterus that is larger than expected for the weeks of pregnancy, anemia, excessive nausea and vomiting, and signs of pregnancy-induced hypertension. What complication is associated with these symptoms?

A) Ectopic pregnancy
B) Hydatidiform mole
C) Hyperemesis gravidarum
D) Preeclampsia

Question 7

A pregnant woman is diagnosed with pregnancy-induced hypertension. Which condition characterizes this disorder?

A) Hypotension
B) Dehydration
C) Hypokalemia
D) Proteinuria

Question 8

The nurse is assessing a pregnant woman who is in her third trimester and documents the following data: weight gain: 1 lb/week during 2nd and 3rd trimesters, 2+ proteinuria (0.3 g/L in 2-hour urine), BP: 150/95 mm Hg, edema in fingers, face, legs, feet, and hyperreflexia-no clonus. What condition is associated with this assessment data?

A) Mild preeclampsia
B) Severe preeclampsia
C) Eclampsia
D) Normal pregnancy values

Question 9

The HELLP syndrome indicates a potentially life-threatening complication of pregnancy-induced hypertension. Which finding represents a defining characteristic of this acronym?

A) H = High blood pressure
B) E = Elevated gastrointestinal enzymes
C) L = Low liver enzymes
D) P = Low platelet count

Question 10

A primipara client at 30 weeks of pregnancy is diagnosed with severe preeclampsia. What should the nurse keep in mind when caring for such a client?

A)
Room should be well-lit and ventilated.
B) Client should be sedated and kept on bed rest.
C) Client should be made to lie on the right lateral side.
D) Client should receive a low-protein diet.

Question 11

A pregnant woman at 4 weeks' gestation visits her primary care provider for a check-up to monitor her preexisting diabetes mellitus. Which fetal complications might occur because of this maternal condition? Select all that apply.

A) Congenital malformations
B) Macrosomia (oversized fetus)
C) Fetus with juvenile diabetes
D) Smaller than gestational age baby
E) Polyhydramnios
F) Preeclampsia or eclampsia

Question 12

The nurse is assessing a pregnant woman with a history of malignant hypertension. Which teaching intervention is the priority for this client?

A)
Avoid activities that result in shortness of breath.
B) Add more sodium and calcium to the diet.
C) Get occasional rest and frequently exercise.
D) Limit fluid intake for the first and third trimesters.

Question 13

The nurse delivering babies on an obstetrical unit checks the mother's blood type to assess for ABO incompatibility. Which client would be at risk for this hemolytic disease?

A) The mother is type A and the fetus is type A.
B) The mother is type B and the fetus is type B.
C) The mother is type AB and the fetus is type AB.
D) The mother is type A, and the fetus is type AB.

Question 14

A pregnant client who is at term has painless vaginal bleeding and is diagnosed as having placenta previa. What are the predisposing factors for placenta previa?

A) Old cesarean scar
B) Substance abuse
C) Poor placental circulation
D) Systemic hypertension

Question 15

A nurse is caring for a client who had placenta previa delivery. Which is a nursing consideration for this client?

A) Monitor client for sudden extreme pain.
B) Observe for aberrations in uterine shape.
C) Monitor the client for hemorrhage.
D) Measure abdominal girth with a measuring tape.

Question 16

The nurse is caring for a client who is diagnosed with abruptio placentae based on the client's history, physical examination, and laboratory studies. What nursing interventions should be initiated immediately?

A) Continuously monitor the fetus even if a fetal heart rate is not present.
B) Identify the lower limit of the fundus and mark it on the woman's abdomen.
C) Observe the fundus for changes in shape or movement upward.
D) Monitor and report decrease in, or movement downward, of abdominal girth.

Question 17

The nurse explains to the student nurse what is meant by a client's diagnosis of placenta accreta. Which is a characteristic of this emergency situation?

A) The placenta separates.
B) The placenta fails to be expelled.
C) The placenta is expelled too soon.
D) The placenta leaves remnants in the fallopian tubes.

Question 18

The delivery nurse immediately takes action when a client experiences postpartum hemorrhage. Which symptom would the nurse report immediately?

A) A boggy uterus that does not respond to massage
B) A thin trickle of blood
C) A uterus that is low in the abdomen
D) Signs of septic shock

Question 19

During a precipitous delivery, the client had a laceration, which the nurse documents as a second-degree laceration. What does a second-degree laceration indicate?

A) Laceration that involves the perineal skin
B) Laceration that involves the perineal body
C) Laceration that involves the anal sphincter
D) Laceration that extends to the anal canal

Question 20

A client delivers a child by breech presentation with both the feet as the presenting part. What type of breech presentation should the nurse document on the record?

A) Complete breech
B) Footling breech
C) Frank breech
D) Kneeling breech

Question 21

A nurse is assisting a client who is in labor and does not have enough time to get to the healthcare facility for delivery. What is the role of the nurse in assisting an emergency delivery?

A) Attempt to postpone delivery as much as possible.
B) Cut the umbilical cord after delivery of newborn.
C) Have the mother hold the newborn and initiate breastfeeding.
D) Examine for retained placental tissue and lacerations.

Question 22

A nurse is caring for a client in labor with a prolapsed cord. What action should the nurse take?

A) Cover the cord prolapsed outside the vagina with a dry towel.
B) Place the client in the left lateral or supine position.
C) Notify the physician and prepare for resuscitation of the newborn.
D) Perform a sterile vaginal examination immediately.

Question 23

The nurse is preparing a client who is receiving medication to induce labor. Which medication might be given?

A) Magnesium Sulfate
B) Ritodrine HCl
C) Nifedipine
D) Oxytocin

Question 24

The nurse is assisting in the delivery of a baby using forceps owing to maternal exhaustion. When documenting the use of forceps, how are these deliveries classified?

A) The station
B) The presentation
C) The lie
D) The length of labor

Question 25

A client has had an elective cesarean delivery. What postoperative care should the nurse offer this client?

A) Intake and output should be recorded for 12 hours only.
B) Client should be put on bed rest for 8 hours.
C) Fundal assessment should be avoided.
D) Lochia and the incision should be observed.

Question 26

A client develops postpartum hematoma because of prolonged pressure during labor. What are the initial nursing considerations for postpartum hematoma?

A) Avoid giving an analgesic to the client.
B) Apply warm compresses at the perineal area.
C) Perform incision and ligation of a blood vessel.
D) Assess perineal area for discoloration and swelling.

Question 27

Following delivery, a client has postpartum hemorrhage. What action should the nurse take?

A) Place the client in a left lateral position.
B) Massage the uterus gently but firmly.
C) Perform a sterile vaginal examination.
D) Apply a vaginal pack to stop bleeding.

Question 28

The nurse is ambulating a new mother after a cesarean section to reduce the risk of postoperative complications. For what condition does this intervention decrease the risk?

A) Thrombophlebitis
B) Uterine atony
C) Puerperal infection
D) Cystitis

Question 29

A woman 4 weeks postpartum tells her nurse that she is "not able to cope with her baby crying all the time and that all she can think of is getting out of her home." She further states that her family is "going to kill me if I doesn't take this baby where I found her." What is the medical term for this mood disorder?

A) Postpartum blues
B) Postpartum depression
C) Postpartum psychosis
D) Postpartum paranoia

Question 30

Which guideline is recommended for care of a client and family who experienced a stillbirth?

A) Allow the client/family time to grieve before approaching them.
B) Provide the client/family with support and allow them to express their feelings.
C) Call a chaplain or family worker and set up a visit for the client/family.
D) Collect mementoes of the baby and send them to the client/family in the mail.