Maternity + Peds

Question 1

The nurse is preparing a client who is prescribed continuous epidural analgesia. Which of the following pre-procedure prescriptions should the nurse be prepared to administer?

A. Lactated Ringers

B. Ondansetron

C. Ketorolac

D. Haloperidol

Answer 1

A. Lactated Ringers

Epidural analgesia has a common adverse reaction of hypotension. It is routine for clients being prepared for epidural analgesia to receive a liter of isotonic fluids to preempt this adverse reaction.

Question 2

A G3P3 client in labor tells the nurse, “I would like to breastfeed, but my breasts got so engorged last time. I could not take it. Do I have to go through that again?” Which of the following responses is most appropriate?

A. “Keeping your baby on an every 4-hours schedule would help slow the milk production and lessen the engorgement.”

B. “You can feed your baby formula milk until your milk comes in. This will reduce stimulation and prevent engorgement.”

C. “You can take Bromocriptine to stop your milk production and prevent engorgement.”

D. “You need to feed your baby as soon as possible. Also, feeding your baby often would prevent breast engorgement.”

Answer 2

D. “You need to feed your baby as soon as possible. Also, feeding your baby often would prevent breast engorgement.”

Choice D is correct. Immediate and frequent breastfeeding is the key to decreasing breast engorgement in breastfeeding women. Also, the first step in treating engorgement is encouraging the mother to immediately breastfeed and continue to do so every 2 hours.

Question 3

Which of the following is the most accurate method used to determine the estimated due date?

A. Nagele’s Rule

B. Embryonic ultrasound

C. Early hCG levels

D. Chadwick’s sign

Answer 3

B. Embryonic ultrasound

An early ultrasound is the most accurate way to determine the estimated due date. One study found that birth occurred within seven days of the estimated due date determined by ultrasound alone.

Question 4

Which of the following statements is true regarding the premature rupture of membranes (PROM)? Select all that applies:

A. PROM is when the membranes rupture before 37 weeks gestation.

B. In a normal delivery, membranes are expected to rupture before labor begins.

C. A priority nursing intervention with PROM is to monitor for infection.

D. When observing the fluid after the rupture of membranes, it should be clear and without odor.

Answer 4

Answer: C, D

A priority nursing intervention with PROM is to monitor for infection. When the membranes are ruptured before labor begins, the baby is then exposed to bacteria and pathogens of the outside world.

One of the most critical observations you must make is of the color, odor, consistency, and amount of the amniotic fluid when the rupture of membranes occurs. Any discolored or malodorous fluid may indicate an infection.

After the breakdown of membranes occurs, the nurse should monitor the mother’s temperature, WBC count, CRP, and other markers of disease

Question 5

You are educating a 25-year-old obese client with a body mass index (BMI) of 31 at 12 weeks gestation, who presents for a routine antenatal check-up. She gained 3 pounds compared to pre-pregnancy weight. Which of the following statements by the client reflect correct understanding regarding recommended weight changes in pregnancy?

Select all that applies:

A. “Since I am obese, I should try to lose weight now to limit my risk of gestational diabetes.”

B. “Typically, there is 3 to 6 pounds of weight gain during the first trimester of pregnancy.”

C. “In the third trimester, a weight gain of 2 pounds or more each week is considered high for me.”

D. “I should aim to gain a total of 25 to 35 pounds during this pregnancy.”

E. “Going forward in my pregnancy, I should aim to gain ½ pound per week.”

Answer 5

Answer: B, C, E

The client in the question has already gained 3 pounds, which is healthy. Going forward, she should aim to gain about 8 to 17 pounds in the next six months (about half a pound per week for the rest of her pregnancy). This is based on the recommended weight gain of 11-20 pounds during the entire pregnancy for someone with a BMI of 30 or above (obese).

Question 6

A mother in her first trimester of pregnancy is very upset that she feels constantly nauseous. You reassure her that the nausea is common in the first trimester. In addition, which of the following advice would you share with her?

Select all that applies:

A. Eat dry crackers before getting out of bed in the morning.

B. Drink small sips of liquids throughout the day rather than large amounts with meals.

C. Eat only three moderate size meals a day.

D. Brush teeth immediately after eating to avoid smells and tastes that trigger nausea.

Answer 6

Answer: A, B

Eating dry crackers in the morning before rising is standard advice to help decrease nausea (Choice A). It is recommended to drink small sips of liquids throughout the day rather than drinking large amounts with meals (Choice B).

Meals can be divided into smaller ones throughout the day to prevent N/V (Choice C).

It is better to avoid brushing teeth immediately after a meal and shortly after getting out of bed in the morning to prevent nausea. (Choice D)

Question 7

The nurse is caring for a prenatal client with some vaginal bleeding. The nurse knows that this client could be experiencing a spontaneous abortion or miscarriage if it is occurring before ________ weeks of gestation.

A. 14

B. 16

C. 18

D. 20

Answer 7

D: A spontaneous abortion or miscarriage occurs before 20 weeks.

Question 8

A postpartum pt who gave birth by cesaren section 5 hours ago is restless, HR of 110/min and admits to recent onset of anxiety. What priority action should the nurse take?

1. Assess for lower extremity warmth and redness
2. Instrct client in relaxation breathing techniques
3. Obtain oxygen saturation
4. Offer client PRN pain med

Answer 8

3. Obtain oxygen saturation

Pregnancy is a hypercoagulable state that provides protection from hemorrhage after birth, but also greatly augments risk of thrombus formation. This invlude DVT, which could lead to PE.

The client had S&S of PE (restless, HR 110, anexity).

So the nurse’s priority is rapidly identifying symptoms, assessing respiratory status, administering supplemental oxygen, and notifying the health care provider (HCP) (Option 3).

Question 9

A client 39 weeks gesttion is brought to the ED in stable condition following a motor vehicle collision. The client is secured supine on a backboard, becomes pale with BP of 88/50. Which action should the nurse take first?

1. admin NS blous
2. Ask about prenatal complications
3. Initiate fetal HR monitoring
4. Tilt backboard to one side

Answer 9

4. Tilt backboard to one side

During stabilization of a pregnant client after trauma (eg, motor vehicle collision, fall), uterine displacement is the first step to address supine hypotension (due to aortocaval compression and decreased venous return to the heart) and promote blood circulation to the fetus. The client should be tilted laterally while strapped on the backboard to promote venous return and protect the client from further potential spinal injury.

Question 10

The GN is caring for a client who gave birth to a baby 30 minutes ago. The client is having difficulty with breastfeeding and requesting assistance. Which action by the GN is incorrect?

1. Check the newborn’s position and sucking behavior during breastfeeding
2. Provide supplemental formula feeding until improved breastfeeding occur
3. Show the mother how to hand epress breastmilk
4. Teach the mother to recognize newborn hunger cues

Answer 10

2. Provide supplemental formula feeding until improved breastfeeding occur

Breastmilk is the best source of nutition for the infant until 6 months old. The graduate nurse should not offer supplemental formula to the mother because it can hinder successful breastfeeding.

If there are no contraindications to breastfeeding, the nurse should provide supplemental formula only if the newborn experiences medical complications (eg, hypoglycemia, hyperbilirubinemia) or if breastfeeding is repeatedly unsuccessful.

Question 11

When is the time frame to administer Rh immune globulin for a Rh (-) mother after giving birth to a Rh (+) child?

Answer 11

Rh immune globulin should be administered within 72 hours of birth to ensure effectiveness.

Question 12

Ruptured ectopic pregnancy signs and symptoms

Answer 12

Delayed or missed menses (period)

Abdominal pain on one side

Vaginal bleed

Hypovolemic shock

Dizziness, hypotension (e.g 82/64), tachycardia
Referred shoulder pain

Question 13

Omphalocele - what is this condition? What are the interventions and things to avoid?

Answer 13

An omphalocele occurs when bowel, usually covered with a peritoneal sac, herniates through the abdominal wall via the umbilical opening.

Immediately after birth, the nurse should cover the herniated bowel to prevent injury, a nonadherent dressing covered to prevent fluid loss and protect bowel from drying.

The nurse should monitor for temperature instability, infection, and fluid loss and initiate IV access to facilitate antibiotic administration and fluid and electrolyte replacement.

The nurse should not apply petrokeum jelly to the bowel.

Question 14

The nurse is caring for a client who has tetralogy of fallot. Which assessment finding is a priority to report to the HCP?

1. Hematocrit level of 67%
2. Murmur on heart auscultation
3. Newborn becomes fatigued during feeding
4. Weight gain of 0.6 lb since birth

Answer 14

1. Hematocrit level of 67%

The client with tetralogy of fallot will have hypoxia due to decreased pulmonary blood flow and circulation of poorly oxygenated blood. So to compensate the hypoxia, the body will produce additional RBCs (Polycythemia), which will increase hematocrit levels.

This puts the client at risk of blood clotting (thrmbus formation) which can cause stroke. Therefore an elevated hematocrit level is the priority.

Question 15

Methylergonovine IM - what is it? When is it contraindicated?

Answer 15

It is a uterotonic drug used to control uterine bleeding.

It is contraindicated for clients with high BP because the primary mechanism of action is vasoconstriction.

If given to a high BP patient it can further elevate BP and cause seizure or stroke.

Question 16

A client in labor is 8 cm dilated, fully effaced and feels urge to push. The nurse observes thick blood tinged mucus duirng vaginal examination. What is the nurse’s best action?

1. Admin IV meperidine for pain
2. Encourage client to bear down with spontaneous urge to push
3. Place client in lithotomy position in prep for birth
4. Provide encouragement and coach breathing techniques

Answer 16

4. Provide encouragement and coach breathing techniques

This client is in the transition phase of stage 1 of labor (8 cm dilation).

This stage is usually the most emotionally challenging phase of labor, marked by increased maternal anxiety.

A mix of blood and mucus (Bloody show) is commonly observed during transition. Nursing priorities include providing emotional support and encouragement, as well as coaching the client in breathing techniques. (Option 4)

Pushing and lithotomy positioning (lying down with legs up) should be introduced after 10 cm dilation.

Question 17

The nurse follow up on phone call to a client who gave birth 5 days ago. Which statement should the nurse be most concerned with?

1. I am really tired all the time since giving birth
2. I saw some bright red blood in my bowel movment yesterday
3. My bleeding is like a really heavy period with some blood clots
4. My hands feel tingly when I hold the baby for a long time

Answer 17

2. I have noticed less kicking movements as the baby grows bigger

As the fetus size increases during gestation, so should the number of fetal movements.

Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired oxygenation), which may precede fetal death (Option 2).

Leg cramps, edema in lower extremeties, and s.o.b are common during third trimester.

Cramps are likely due to the weight of the uterus pressing on the nerves affecting calf muscles.

Edema is due to decreased venous return as the weight of uterus presses against the vena cava.

The s.o.b is caused by uterus rising and pushing against diaphragm.

Question 18

The nurse follow up on phone call to a client who gave birth 5 days ago. Which statement should the nurse be most concerned with?

1. I am really tired all the time since giving birth
2. I saw some bright red blood in my bowel movment yesterday
3. My bleeding is like a really heavy period with some blood clots
4. My hands feel tingly when I hold the baby for a long time

Answer 18

3. My bleeding is like a really heavy period with some blood clots

Postpartum hemorrhage (PPH) may be primary (ie, <24 hours since birth) or secondary/delayed (ie, >24 hours but <6 weeks postpartum).

Birth to 4 days postpartum = Lochia rubra

4 - 14 postpartum day = Lochia serosa

11 postpartum day - 6 weeks postpartum = Lochia alba

The nurse should expect a client >3-4 days postpartum to report a progressive change in lochia from lochia rubra to lochia serosa.

Reports of increased vaginal bleeding, soaking a pad in <1-2 hours, reverting from lochia serosa back to lochia rubra, or passing several/large clots (ie, larger than a nickel) are concerning findings!

Question 19

A client reports severe abdominal pain and vaginal spotting. The client had a postive urine pregnancy test, and her last menstrual period was 8 weeks ago. Which client report to the nurse is most important?

1. Abd pain rated 8/10
2. hx of pelvic inflammatory disease
3. Intermittent nausea and vomiting for the past 7 days
4. R shoulder pain and dizziness

Answer 19

4. R shoulder pain and dizziness

Symptoms of ectopic pregnancy:

Lower abdominal and pelvic pain, amenorrhea, vaginal spotting, bleeding.

The ectopic pregnancy may rupture.

Symptoms of a ruptured ectopic pregnancy include hypotension, tachycardia, dizziness, and referred shoulder pain (Option 4)

Question 20

The nurse assess a 36 week gestation client. Which statement by the client should the nurse investigate first?

1. I am not sleeping as well due to cramps in my calves at night
2. I have noticed less kicking movements as the baby grows bigger
3. Over the last few weeks, I have not been able to wear any of my shoes
4. Sometimes I feel s.o.b after walking up a flight of stairs.

Answer 20

2. I have noticed less kicking movements as the baby grows bigger

As the fetus size increases during gestation, so should the number of fetal movements.

Decreased fetal movement is a potential warning sign of fetal compromise (ie, impaired oxygenation), which may precede fetal death (Option 2).

Leg cramps, edema in lower extremeties, and s.o.b are common during third trimester.

Cramps are likely due to the weight of the uterus pressing on the nerves affecting calf muscles.

Edema is due to decreased venous return as the weight of uterus presses against the vena cava.

The s.o.b is caused by uterus rising and pushing against diaphragm.

Question 21

Trisomy 18 - Edwards syndrome. What is it?

Answer 21

Trisomy 18 (Edwards syndrome) is a life-threatening chromosomal abnormality that affects multiple organ systems. Many fetuses affected by this condition die in utero. Of the newborns that survive birth, half will die in the first week of life and most do not make it to the first birthday.

Question 22

The nurse performs an assessment on an initial newborn and observes bluish discoloration of the hands and feet. Which nursing action is best?

1. Apply blow-by oxygen and count respiration
2. Auscultate heart sounds for a murmur
3. Observe the new born for expiratory grunting
4. Place the newborn skin to skin with the mother

Answer 22

4. Place the newborn skin to skin with the mother

The new born likely has Acrocyanosis (Peripheral cyanosis of hands and feet). Acrocyanosis is a benign finding during a newborn’s transition to extrauterine life. It is especially common during the first 24 hours of life or in the first week if the newborn is cold.

It results from poor perfusion of the body. It is best to promote thermoregulation by placing the newborn skin to skin with the mom or under radiant warmer and assessing axillary temperature.

Question 23

Which of the following puts a client in the first trimester at risk for preterm labor?

1. Age 25
2. Periodontal disease
3. Vegetarian diet
4. White ethnicity

Answer 23

2. Periodontal disease

Preterm birth is < 37 weeks gestation.

Infections (Periodontal disease, UTIs) are strongly associated with preterm labor, particularly when untreated (Option 2).

Question 24

The nurse is educating several first-trimester moms. Which client requires priority anticipatory teaching?

1. Client who gardens and eats home grown vegetables
2. Client who gained 4 lb from prepregnancy weight
3. Client who has noticed thin, milky, white vaginal discharge
4. Client who practices yoga and swims in a pool 3 times a week

Answer 24

1. Client who gardens and eats home grown vegetables

Eatting home grown vegetables exposes the client to Toxoplasmosis.

Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii, which may be acquired from exposure to infected cat feces or ingestion of undercooked meat or soil-contaminated fruits/vegetables.

Pregnant clients who contract toxoplasmosis can transfer the infection to the fetus and potentially cause serious fetal harm (eg, stillbirth, malformations, blindness, mental disability).

Pregnant clients should be advised to take precautions when gardening and thoroughly wash all produce to decrease exposure risk.

Question 25

A nurse is caring for a client who had a vaginal birth 2 hrs ago. The client has saturated a pad in 20 mins. During assessment, the nurse notice that the client has a boggy fundus that is deviated to the right and slightly above the umbilicus. Which intervention should the nurse perform first?

1. Assist the client to use the bedpan to void
2. Begin oxytocin IV infusion
3. Obtain a CBC
4. Start oxygen delivery at 10L/min

Answer 25

1. Assist the client to use the bedpan to void

Based on the nurse’s assessment, the boggy fundus indicates uterine atony. The fundus is also elevated above the umbilicus and deviated to the right, indicating a distended bladder. Bladder distension prevents the uterus from contracting sufficiently to control bleeding at the previous placental site. The client should be assisted to void to correct the bladder distension.

The nurse should then perform fundal massage.

Question 26

Neural tube defect prevention - foods that are rich in what?

Answer 26

To decrease the risk of neural tube defects, foods that are high in folic acids are recommended during pregnancy.

Examples of folic acid foods:

Black beans
Rice
Fortified breakfast cereal and milk
Peanut butter on whole wheat toast

Question 27

1 hour Glucose test - what is it?

Answer 27

Consumption of 50-100 mg of glucose to test the body’s response to glucose. A patient should fast for

The glucose level is normal if <7.8

The glucose level between 7.8 to 10.6 will require the patient to take a 3 hr glucose test to determine gestational diabetes.

The glucose level >10.6 indicates gestational diabetes

Question 28

Shaken baby syndrome - What is it? What are the signs and symptoms?

Answer 28

Shaken baby syndrome (SBS) is a type of abusive head injury and is defined by the Centers for Disease Control and Prevention (CDC) as severe physical child abuse resulting from violent shaking of an infant by the arms, legs, or shoulders.The impact of the shaking causes bleeding within the brain or the eyes.

Clinical findings are often vague and nonspecific—vomiting, irritability, lethargy, inability to suck or eat, seizures, and inconsolable crying.

Question 29

A nurse is caring for a client at 30 weeks gestation who is admitted for preterm labor. Which of the following interventions should the nurse anticipate?

Select all that apply.

1. Administer IM betamethasone
2. Admin penicillin via IV piggyback
3. Assisting with artificial rupture of membranes
4. Initiating IV magnesium sulfate
5. Obtaining fetal heart tones once per shift

Answer 29

Answer: 1, 2, 4

Admin betamethasone to help mature baby’s lungs (Option 1)

Penicillin administered to help with preterm infection (Option 2)

Rupture of membranes should be avoided as we want to delay preterm birth (Option 3)

Initiating an IV magnesium sulfate infusion for fetal neuroprotection if at <32 weeks gestation (Option 4)

Fetal heart tones should be monitored continuously, (NOT once per shift) to assess for increasing frequency and duration of contractions and to evaluate fetal tolerance of labor (Option 5)