RN VATI Maternal Newborn
1. A charge nurse is teaching a newly licensed nurse about substance use disorders
during pregnancy.Which of the following statements by the newlylicensed nurse
indicates an understanding of the teaching Answer: Encourage clientwho are
prescribed methadone to breastfeed.
-The nurse should encourage clients who are prescribed methadone during preg-
nancy to breastfeed their newborns to help with withdrawal symptoms.
2. A nurse is caring for a client who received terbutaline subcutaneously.Which
of the following findings is an indication the medication was effec-tive Answer:
Decreased frequency of contractions.
-Terbutaline is a tocolytic medication that is used to halt preterm labor. Terbutaline
cause relaxation of smooth muscle, which decrease uterine activity. Therefore,
thenurse should identify that a decrease in frequency of contractions is an
indicationthat terbutaline was effective.
3. A charge nurse is discussing care of clients who are in labor with a
newlylicensed nurse. Which of the following actions should
,the charge nurse in- clude in the teaching regarding situations requiring an
amniotomy Answer: Placinga fetal scalp electrode.
-A fetal scalp electrode is attached to the presenting part of the fetus in orderto
provide accurate continuous monitoring of the fetal heart rate. If the
client'smembranes are intact, the amniotic sac must be artificially ruptured prior
to attaching the electrode to enable access to the presenting part.
4. A nurse is reviewing the medical record of a client who has preeclampsiaprior
to administering labetalol. For which of the following findings should the nurse
withhold the medication Answer: Heart rate 54/min
-The nurse should identify that a heart rate of 54/min is below the expected
reference range of 60 to 100/min. During pregnancy, the heart rate increases 10
to 15/min due to increased blood volume and increase tissue demands for oxygen.
Bradycardia is a contraindication for the administration of labetalol, an
antihypertensive medication. Therefore, the nurse should withhold the
medicationand notify the provider.
5. A nurse is caring for a client who is at 30 weeks of gestation and observesthe
client choking while eating lunch.The client is unable to speak or cough.Identify
the sequence of steps the nurse should take to clear the airway obstruction.: 1.
Stand posterior to the client.
2. Position arms under the client's axilla and across the client's chest.
,3. Place thumb-side of a clenched fist to the client's mid-sternum area.
4. Initiate chest thrust to the client using a backward motion.
, -If the client becomes unconscious, the nurse should perform CPR and
activateemergency medical services.
6. A nurse is preparing to administer an opioid analgesic to a client who is inactive
labor. Which of the following assessments should the nurse perform ANS(SATA):
Maternal blood pressure.
-Opioid analgesic can cause hypotension. The nurse should assess the clientsblood
pressure before and after administering opioids.
Pain level.
-The nurse should assess the clients baseline pain level prior to administering
pain medication and again after administering pain medication to determine
theeffectiveness of the medication. Opioid analgesic are indicated for the relief of
moderate to sever labor pain. Fetal heart rate.
-Opioid analgesics can cause fetal bradycardia and changes in variability. The nurse
should assess the fetal heart rate prior to administering an opioid analgesicto ensure
the rate is within the expedited reference range and to have a baselinefor future
assessments. The nurse should provide ongoing assessments of fetal heart rate
throughout labor according to facility protocol.
7. A nurse is reviewing the medical records of a client who is at 8 wks. of gestation.
Which of the following findings should the nurse identify
1. A charge nurse is teaching a newly licensed nurse about substance use disorders
during pregnancy.Which of the following statements by the newlylicensed nurse
indicates an understanding of the teaching Answer: Encourage clientwho are
prescribed methadone to breastfeed.
-The nurse should encourage clients who are prescribed methadone during preg-
nancy to breastfeed their newborns to help with withdrawal symptoms.
2. A nurse is caring for a client who received terbutaline subcutaneously.Which
of the following findings is an indication the medication was effec-tive Answer:
Decreased frequency of contractions.
-Terbutaline is a tocolytic medication that is used to halt preterm labor. Terbutaline
cause relaxation of smooth muscle, which decrease uterine activity. Therefore,
thenurse should identify that a decrease in frequency of contractions is an
indicationthat terbutaline was effective.
3. A charge nurse is discussing care of clients who are in labor with a
newlylicensed nurse. Which of the following actions should
,the charge nurse in- clude in the teaching regarding situations requiring an
amniotomy Answer: Placinga fetal scalp electrode.
-A fetal scalp electrode is attached to the presenting part of the fetus in orderto
provide accurate continuous monitoring of the fetal heart rate. If the
client'smembranes are intact, the amniotic sac must be artificially ruptured prior
to attaching the electrode to enable access to the presenting part.
4. A nurse is reviewing the medical record of a client who has preeclampsiaprior
to administering labetalol. For which of the following findings should the nurse
withhold the medication Answer: Heart rate 54/min
-The nurse should identify that a heart rate of 54/min is below the expected
reference range of 60 to 100/min. During pregnancy, the heart rate increases 10
to 15/min due to increased blood volume and increase tissue demands for oxygen.
Bradycardia is a contraindication for the administration of labetalol, an
antihypertensive medication. Therefore, the nurse should withhold the
medicationand notify the provider.
5. A nurse is caring for a client who is at 30 weeks of gestation and observesthe
client choking while eating lunch.The client is unable to speak or cough.Identify
the sequence of steps the nurse should take to clear the airway obstruction.: 1.
Stand posterior to the client.
2. Position arms under the client's axilla and across the client's chest.
,3. Place thumb-side of a clenched fist to the client's mid-sternum area.
4. Initiate chest thrust to the client using a backward motion.
, -If the client becomes unconscious, the nurse should perform CPR and
activateemergency medical services.
6. A nurse is preparing to administer an opioid analgesic to a client who is inactive
labor. Which of the following assessments should the nurse perform ANS(SATA):
Maternal blood pressure.
-Opioid analgesic can cause hypotension. The nurse should assess the clientsblood
pressure before and after administering opioids.
Pain level.
-The nurse should assess the clients baseline pain level prior to administering
pain medication and again after administering pain medication to determine
theeffectiveness of the medication. Opioid analgesic are indicated for the relief of
moderate to sever labor pain. Fetal heart rate.
-Opioid analgesics can cause fetal bradycardia and changes in variability. The nurse
should assess the fetal heart rate prior to administering an opioid analgesicto ensure
the rate is within the expedited reference range and to have a baselinefor future
assessments. The nurse should provide ongoing assessments of fetal heart rate
throughout labor according to facility protocol.
7. A nurse is reviewing the medical records of a client who is at 8 wks. of gestation.
Which of the following findings should the nurse identify
