RN maternal-newborn online practice 2013 B

Question 1

Caring for p. Rx’d Rh immune globulin. WOTF p. statements indicates correct understanding?

a. this med prevents blood incompatibilities in my next pregnancy.
b. the med will make sure that I do not become anemic
c. my baby will receive a dose of the med after birth
d. I will receive two doses of the med after my baby is born

Answer 1

a. Women who are Rh-negative should receive Rh immune globulin within 72 hours after giving birth to a newborn who is Rh-positive to prevent Rh-positive antibodies from developing (which will kill subsequent Rh-pos fetuses). Txmt requires only one dose, and is not given to the baby.

Question 2

RN caring for NB immediately following delivery. WOTF actions should RN take 1st?

a. assign Apgar scores to the newborn
b. weigh the newborn
c. place identification bracelets on the newborn
d. dry the newborn

Answer 2

d. dry the NB. One of greatest risks to the NB is cold stress. Therefore, the 1st action should be to dry the NB. Drying and promoting clear airway are priorities. Apgar scores are taken at 1 and 5 minutes after birth. Obtaining weights (for baseline) is done after drying… and so are identification bracelets

Question 3

Breastfeeding teaching, wotf indicates an understanding of the teaching?

a. I will let my baby nurse 10 minutes on each breast
b. I will feed my baby every 3 hours
c. I will make sure that my baby latches onto just the nipple
d. I will hold my baby tummy to tummy when I’m feeding her.

Answer 3

d. To facilitate feedings and correct latching-on, the mom should hold her NB tummy to tummy. The recommended avg times for breastfeeding is 15 to 20 min per breast. Infants who are breastfed should feed on demand (not at intervals). Infants should latch onto the nipple and areola to prevent breast soreness

Question 4

Caring for p. who is 25 weeks and in PTL. WOTF is the purpose of giving betamethasone to the p?

a. improve fetal cardiac function
b. increase fetal lung maturity
c. decrease maternal anxiety
d. reduce the contraction rate of the mother

Answer 4

b. The purpose of betamethasone (corticosteroid) is to increase the release of lung surfactant, which improves fetal lung maturity to prevent/decrease resp. distress syndrome in preterm NBs b/w 24-34 wks gestation. The p. should receive two doses of betamethasone 12mg IM, 24 hours apart.

Question 5

Caring for p who expresses concern w/ toddler’s acceptance of NB. WOTF strategies should RN suggest?

a. have toddler give NB a gift
b. wait to introduce the toddler to NB at home
c. Give toddler a t-shirt that says, I’m a big brother
d. Ensure toddler isn’t present when bathing NB

Answer 5

c. Giving the toddler a shirt that encourages his status, as well as giving the toddler gifts will promote acceptance. The toddler and NB should be introduced at the hospital, and the toddler should participate in caring for the NB (like w/baths) to promote acceptance

Question 6

Charge nurse in L&D receiving report on 4 ps. Should plan to first assess p who is exp. WOTF decels?

a. Early
b. Variable
c. Late
d. Prolonged

Answer 6

d. Prolonged decels may result in fetal death if there is no response to intrauterine resuscitation. The RN should notify the HCP immediately and prepare for a C-section if the pattern isn’t corrected. Early decels r/t fetal head compression during UCs and are benign. Variable decels r/t cord compression, which are typically transient and respond well to nrs interventions. Late decels r/t uteroplacental insufficiency, which requires maternal position change, increasing IVFs, d/c-ing oxytocin, giving O2, and delivering the NB if HR pattern is persistent.

Question 7

P. at 9 wks in ER c/o blurred vision and headache. Her HR is 110 and skin is cold/clammy. Place the following steps of action in order:

a. Offer the p 120 ml of OJ
b. allow the p to rest for 15 min
c. check the p’s BS
d. document the findings

Answer 7

The correct order of action for the RN is to first check the p’s BS (c) to assess for hypoglycemia. Then the RN should offer the p. 15g of a simple carbohydrate (like OJ) to raise the BS. Then the RN should allow the p to rest for 15 minutes, then document the findings to provide for continuity of care.

Question 8

P. received epidural anesthesia during labor. While monitoring VS, RN notes that p is hypotensive. After positioning p on left side, wotf is the priority?

a. Give ephedrine 5 mg IV
b. increase the IV infusion rate
c. Elevate the p’s legs
d. apply O2 10L/min via face mask

Answer 8

b. Increasing the rate of IVFs will stabilize the p’s BP, thus is the priority. Elevating the p’s legs can help stabilize BP, but isn’t priority. O2 improves perfusion but not priority. Ephedrine will increase the p’s BP, but isn’t necessary unless other interventions are unsuccessful

Question 9

P. on Oxytocin to augment labor and fetus has HR decels that begin and end suddenly and are V-shaped. WOTF is the priority action?

a. prep p for amnioinfusion
b. give O2
c. D/C oxytocin
d. change the p’s position

Answer 9

d. Greatest risk to fetus is decreased uteroplacental perfusion r/t umbilical cord compression; therefore, the priority action is for the RN to change the p’s position to relieve the pressure on the umbilical cord. D/C-ing the oxytocin and giving O2 are priorities if position change doesn’t affect the variable decels. Amnioinfusion may be necessary IF the p’s amniotic fluid is low

Question 10

Wotf is an appropriate intervention to promote maternal postpartum adjustment during the taking-hold phase?

a. discussing contraceptive options w/ the p
b. repeating info to ensure p understanding
c. listening to the p and her partner review the birth process
d. demonstrating to the p. how to perform a NB bath

Answer 10

d. During the taking-hold phase, the new mother is focusing on care of the NB and acquiring parenting skills so she needs instructions on proper NB care. Discussing contraception doesn’t promote adjustment. Listening to p talk about birth experience is appropriate during the taking-in phase when the new mother is focused on herself and meeting her basic needs

Question 11

NB care instructions should include?

a. cleanse the NB’s skin with mild soap b/w baths
b. keep the temp of bath water b/w 36.0 and 36.5 (96.8 and 97.7 F)
c. immerse the NB in a tub bath once the cord is dry and shriveled
d. bathe the NB q other day

Answer 11

d. Instructions should include avoid bathing the NB qday bc it can cause dryness and alters the acid mantle of the NBs skin. Use warm water b/w baths to cleanse skin. Keep bath water temp 36.6 and 37.2 (98 and 99 F). Wait for the cord to fall off before immersing the NB in a tub bath.

Question 12

Expected findings for p w/ severe preeclampsia?

a. 2+ DTR
b. urine protein 20mg/dL
c. polyuria
d. blurred vision

Answer 12

d. blurred vision is expected w/ severe preeclampsia along with 3+ DTRs, urine protein greater than 0.3g in a 24 hr urine specimen, and oliguria (less than 20ml/hr or less than 400mL/hr in a 24 hour period)

Question 13

Plastibell device circumcision, teaching should include?

a. cleanse the circumcision site w/soap and water each diaper change
b. change the diaper at least q4h
c. gently wipe away any yellow exudate
d. the plastic rim should fall off in about 2 days

Answer 13

b. the parent should change the diaper q4h to prevent the diaper from sticking to the penis. Soap and water can be irritating to the healing circumcision, yellow exudate should not be wiped off as it is part of the healing process, and the plastibell rim should fall off in about 2 days

Question 14

27 wks w/ elevated 1-hr, 50g glucose screening result. RN should plan to?

a. begin diabetes dietary teaching
b. instruct the p to obtain serial blood glucose levels for 24 hr
c. request a prescription for a 3 hr glucose tolerance test (GTT)
d. inform the p the test will need to be repeated

Answer 14

c. An elevated 1 hour, 50-g glucose screening is not diagnostic of diabetes and requires a prescription for a 3 hr glucose tolerance test. Obtaining serial blood glucose levels for 24 hours will not confirm gestational diabetes either.

Question 15

Postpartum adolescent, wotf findings should RN address first?

a. inability to diaper NB correctly
b. absence of emotional support systems
c. misinterpretation of infant feeding cues
d. reports of fatigue

Answer 15

c. this places the NB at risk for inadequate nutritional intake and is the priority.

Question 16

Preeclampsia, on 2g mag sulfate IV bolus. Need to call HCP for?

a. facial flushing
b. resp rate 14
c. UOP 150 mL over 4h
d. absence of DTRs

Answer 16

d. absent DTRs= mag toxicity and requires immediate intervention.
resp rate below 12= mag toxicity
facial flushing = expected SE, UOP is nml

Question 17

Type 1 DM (on insulin) management during preg. Wotf = need for more tching?

a. I should have a goal of maintaining my fasting BS at 60-90mg/dL
b. I should eat 3-5 times a day
c. I should include foods high in fiber
d. I should eat most of my carbs at breakfast

Answer 17

d. the p should eat fewer carbs at breakfast compared to other meals for better BS control. Other statements are correct

Question 18

NB car seat safety, further teaching needed?

a. I should position my baby forward facing
b. I should turn the air bag off if my baby has to ride in the front seat
c. I should secure my baby’s seat w/ the vehicle seat belt
d. I should keep my baby’s car seat at a 45 degree angle

Answer 18

a. The parent should position the NB rear-facing until 2 yrs of age, or until the child reaches the max ht and wt.

Question 19

Sequence for leopold maneuvers?

a. ID the attitude of the head
b. palpate fundus to ID fetal part
c. Determine the location of the fetal back
d. palpate for the fetal part presenting at the inlet

Answer 19

b. the RN should first palpate the fundus to ID the fetal part. c. Then determine the location of the fetal back. d. then palpate for the fetal part presenting at the inlet. a. Finally the RN should palpate the cephalic prominence to ID the attitude of the head

Question 20

D/C instructions for breastfeeding, wotf is true?

a. I will wake my baby q4h during the day for feedings
b. I will schedule a f/u visit in 1wk at my doctor’s office for my baby’s vaccinations
c. I will notify my HCP if my baby’s skin begins to turn yellow
d. I will wear gloves at home to change the baby’s diaper

Answer 20

c. Serum bilirubin lvls continue to rise until the 5th day of life. If the infant develops jaundice, it is important to call HCP.
Bst feeds should be q2-3 hours, after receiving the hep b vaccine before discharge, the NB doesn’t need any more vaccines until 2 months of age.

Question 21

P. is 2 weeks postpartum from C-section. Wotf = infection?

a. persistent abd striae
b. wbc count 10,000 mm3
c. unilateral bst pain
d. lochia alba

Answer 21

c. unilateral bst pain is a symptom of mastitis (along w/ chills, fever, malaise), an infection of the breast tissue. Postpartum WBC counts can rise as high as 25,000, especially 10-12 days after delivery, w/out an infection. Lochia alba is expected at 2 wks pp and can persist up to 6 wks.

Question 22

Wotf findings in a p’s history is a CI to receiving nalbuphine?

a. GDM
b. opioid dependency
c. allergy to hydromorphone
d. cigarette smoker

Answer 22

b. nalbuphine is CI’d for p’s w/ opioid dependency, because the antagonist activity of the med can cause w/drawal symptoms.

Question 23

EDD using Nagele’s rule. P’s LMP began august 9. WOTF= EDD?

a. April 2
b. April 16
c. May 2
d. May 16

Answer 23

d. may 16 (subtract 3 mths and add 7 days to)

Question 24

NB w/ hyperbilirubinemia and receiving phototherapy. Wotf= complication?

a. yellowed mucous membranes
b. maculopapular skin rash
c. brown or gold urine
d. irritability

Answer 24

d. irritability can be a sign of encephalopathy r/t acute bilirubinemia. Yellowed mucous membranes and brown/gold urine are expected signs of hyperbilirubinemia. A maculopapular skin rash is an expected finding in NBs, whether or not they have hyperbilirubinemia.

Question 25

Just delivered and about to receive oxytocin. Wotf are indications for oxytocin? (MM)

a. flaccid uterus
b. cervical laceration
c. excess vaginal bleeding
d. increased cramping
e. increased maternal temp

Answer 25

a. flaccid uterus- oxytocin increases UCs
c. excess bleeding - oxytocin decreases bleeding by increasing UCs.
Oxytocin will not decrease bleeding r/t cervical lacerations, it will increase postpartum cramping, and will have no effect on mom’s temp

Question 26

Preg p. exercising. Wotf p. statements is true?

a. I will lie supine for at least 5 minutes after exercising
b. I will take my pulse after 30 min of exercise
c. I will continue to swim throughout my pregnancy
d. I will sit in a hot tub after exercising

Answer 26

c. The RN should teach preg p’s to perform non-wt bearing exercises like swimming, cycling, and stretching. Preg p’s should take their pulse q15 minutes and slow down if HR > 140, should lie on their side for 10 min after exercising to improve circulation to fetus, and avoid hot tubs bc body T should not exceed 100 F

Question 27

Relaxation techniques to use during painful contractions?

a. hypnosis
b. effleurage
c. biofeedback
d. music therapy

Answer 27

b. effleurage- the slow massaging of the abd will help distract the p. from the UC pain. All of the other techniques require preparation

Question 28

P. 41 wks and about to undergo a biophysical profile (BPP). Test determine wotf?

a. fetal blood flow
b. fetal breathing movement
c. fetal hemolytic disorder
d. fetal chromosome analysis

Answer 28

b. fetal breathing movement. A BBP evaluates multiple parameters including fetal breathing movement, FHR, gross fetal movements, fetal muscle tone, and amniotic fluid volume and scores each parameter from 0 (absent) to 2 (present). A score of 8-10 is normal unless oligohydramnios is detected (which could indicate chronic hypoxia)

Question 29

Wotf= inappropriate p. identifier for medication administration?

a. p’s room number
b. p’s phone #
c. p’s birth date
d. p’s medical record #

Answer 29

a. p’s room # is inappropriate and places p at risk for med error

Question 30

Apgar score if NB’s HR is 120, is crying vigorously w/ limbs flexed, has a pink trunk, and has cyanotic hands and feet?

a. 7
b. 8
c. 9
d. 10

Answer 30

c. 9, the RN should score the NB’s HR as 2, resp effort as 2, muscle tone as 2, reflex irritability as 2, and color as 1.

Question 31

Apgar scores

Answer 31

HR- 0 (absent), 1 (below 100), 2 (above 100)
Resp effort- 0 (no spontaneous resps), 1 (slow resps, weak cry), 2 (spontaneous resps, strong cry)
muscle tone- 0 (limp), 1 (minimal flexion, sluggish movement), 2 (flexed body posture, vigorous movement)
reflex response- 0 (no response to suction or slap on soles), 1 (minimal response to suction), 2 (responds promptly to suction or gentle slap)
color- 0 (pallor/cyanosis), 1 (bluish hands/feet), 2 (pink )

Question 32

Preparing to care for NB that was exposed to herpes simplex virus during delivery. WOTF = correct precautions?

a. standard
b. contact
c. droplet
d. airborne

Answer 32

b. contact precautions is appropriate and includes use of gown and gloves

Question 33

early labor, tensing w/UCs, breathing technique?

a. cleansing breath
b. slow-paced breathing
c. patterned breathing
d. modified paced breathing

Answer 33

a. cleansing breath

Question 34

Abnormal alpha-fetoprotein at 18 wks, elects to have amniocentesis. Post-test complication?

a. I am really tired
b. I am really thirsty
c. I feel my baby moving
d. my stomach feels tight

Answer 34

d. PTL and miscarriage are potential complications after an amniocentesis, tightness in the abd may = onset of UCs

Question 35

32 weeks and experiencing painless, vaginal bleeding. Wotf is CI’d?

a. vaginal exam for cervical dilation
b. uterine palpation
c. axmt of amt and color of bleeding
d. insertion of IV

Answer 35

a. vaginal exam is CI’d to avoid placenta abruptio

Question 36

hyperemesis gravidarum at 8 wks. 1st action?

a. give antiemetic
b. start IVFs
c. give TPN
d. Give small amts of low-fat foods

Answer 36

b. start IVFs to prevent F&E imbalances

Question 37

NB expected findings

a. hr 154
b. temp 36 degrees (96.8)
c. resp 58
d. length 16.9 inches
e. wt 2.6 kg (5 lb 12 oz)

Answer 37

a, c, and e are all expected. temps should range from 36.5 to 37.2. Nml NB length = 19-21 inches (48-53 cm)

Question 38

Serum alpha-fetoprotein results are high. RN action?

a. request a Rx for an US
b. offer grief counseling
c. prep p. for an infant w/ down’s syndrome
d. obtain a Rx for folate supplements

Answer 38

a. AFP is a screening tool for fetal neural tube defects done at 15-22 weeks. High levels require f/u w/ US examination and amniocentesis

Question 39

34 wks teaching about possible complications?

a. 3-4 contractions/hour
b. increased anxiety
c. interrupted sleep pattern
d. dull, intermittent back pain

Answer 39

d. dull back pain= sign of PTL

Question 40

IV hep for DVT. RN action?

a. give aspirin
b. maintain p on bed rest
c. massage affected LE
d. apply cold compresses

Answer 40

b. p should be on bed rest to prevent risk of PE. Rn should apply warm compresses, not cold, and should avoid giving aspirin and avoid massaging

Question 41

Nonstress test, shows a 15 bpm increase above baseline, lasting at least 15 seconds in response to fetal movement two times a 20 min period. RN action?

a. tell p this is reassuring
b. prep p for emergency C-section
c. conduct a CST
d. continue to test for another 10 min

Answer 41

a. Two or more accelerations in a 20 min period = a reassuring nonstress test. NST monitors the fetal HR in response to fetal movement. An increase like that above is reassuring r/t fetal movement and indicates adequate oxygenation. The absence of accels with movement should alert RN to hypoxemic and acidotic concerns.

Question 42

26 wks, finding that needs to be reported?

a. leukorrhea
b. supine hypotension
c. periodic numbness in fingers
d. pitting edema of the ankles

Answer 42

d. pitting edema = sign of preeclampsia. Leukorrhea is expected r/t hormone secretion causing an increased amt of mucus, b. and c. are expected too

Question 43

breastfeeding and has engorgement. Wotf comfort measures appropriate?

a. breast binder
b. cold compresses after feeds
c. colostrum on nipples
d. breast shells inside bra

Answer 43

b. cold compresses

Question 44

Full-term NB, lab findings that need to be reported?

a. total serum bilirubin 14mg/dL
b. Blood glucose 45 mg/dL
c. Hct 60%
d. WBC 10,000

Answer 44

a. This bilirubin level is too high. A NB w/ a total serum bilirubin level of 8mg/dL or higher at day 1 should receive phototherapy

Question 45

20 hr pp and fundus to right?

Answer 45

assist p to void

Question 46

38 wks and in labor w/ fetal head in a posterior position. Appropriate non-pharm action?

a. back rub
b. counter-pressure
c. playing music
d. foot massage

Answer 46

b. counter pressure lifts the occiput off the spinal nerves and provides pain relief for the p.