MCH 2633 NURSING EXAM 2 QUESTIONS With ANSWERS

MCH 2633 NURSING EXAM 2 QUESTIONS With ANSWERS • Question 1 The perinatal nurse prepares the laboring woman for an epidural anesthesia insertion. In order to prevent maternal hypotension, the nurse: ANSWER: Administer an intravenous infusion of 500 mL of normal saline. • Question 2 At 1 minute after birth the nurse assesses the infant and notes a heart rate of 80 beats/min., some flexion of extremities, a weak cry, slight grimacing, and a pink body but blue extremities. What is the Apgar score the nurse will calculate? ANSWER: 5 • Question 3 A patient with hypertension who is receiving intravenous magnesium sulfate therapy has requested an epidural anesthetic. The perinatal nurse should first review the patient’s complete blood count (CBC) results for: ANSWER: results for evidence of a decreased platelet count • Question 4 After a precipitous birth the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity to do what? ANSWER: Stimulate the uterus to contract • Question 5 Early this morning, an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after what event occurs? ANSWER: The infant voids • Question 6 According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: ANSWER: Administer magnesium sulfate according to agency policy • Question 7 A nurse is assessing a newborn born to a mother who is addicted to drugs. Which assessment finding would the nurse expect to note during the assessment of this newborn? ANSWER: Constant crying * A newborn of a woman using drugs is irritable. The infant is overloaded easily by sensory stimulation. The infant may cry incessantly and be difficult to console. The infant would hyperextend and posture rather than cuddle when being held. • Question 8 A 30-year-old woman is being prepared for an epidural anesthesia. The perinatal nurse assists the anesthesiologist with the procedure and then positions the patient in a supine position. The patient’s blood pressure drops to 90/52 mm Hg and there is a decrease in the fetal heart rate to 110 bpm. The perinatal nurse’s best response is to: ANSWER: Place a wedge under Tanya's left hip. • Question 9 While evaluating an external monitor tracing of woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the deceleration occurring after the peak of the contraction. What is the nurse's first priority? ANSWER: The nurse should Document the finding in the client's record The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention • Question 10 A newborn is jaundiced and receiving phototherapy via ultarviolet bank lights. An appropriate intervention when caring for an infant with hyperbilitubinemia and receiving phototherapy by this method is which of the following? ANSWER: Place eye shields over the newborn's closed eyes. • Question 11 The pediatric nurse sees fracture of the most often in infants as a result of birth trauma. ANSWER: clavicle • Question 12 When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for has increased. ANSWER: Intrauterine infection • Question 13 For a woman at 42 weeks gestation, which finding would require more of an assessment by the nurse? ANSWER: One fetal movement noted in 1 hour of assessment by the mother • Question 14 A young primigravida in latent phase of labor is requesting something for pain. Her BP is 110/70, P 90, R 18, T, 97.6. Fetal heart rate is 140 with moderate variability and is contracting irregularly every 3 - 5 minutes, palpates mild. Vaginal exam is 3cm, 90% effaced and - 2 with intact membranes. What non pharmacological management could you use? (select all that apply:) • Question 15 The pThe perinatal nurse notes a rapid decrease in the fetal heart rate (FHR) that does not recover immediately following an amniotomy. What action should the nurse perform first? ANSWER: Perform a vaginal examination. * The nurse needs to assess the fetal heart rate immediately before and after the artificial rupture of the membranes. Changes such as transient fetal tachycardia may occur and are common. However, other fetal heart rate patterns, such as bradycardia and variable decelerations, may be indicative of cord compression or prolapse. The nurse should perform a vaginal examination to assess for cord prolapse. Administering oxygen may or may not be needed. Maternal temperature is assessed every 2 hours after artificial rupture of membranes but is not related to this situation. The nurse should not wait 30 minutes prior to doing anything • Question 16 A G2 TPAL 2002 patient experienced a precipitous birth 90 minutes ago. Her infant weighed 4200 grams and a repair of a second-degree laceration was needed following the birth. As part of the nursing assessment, the nurse discovers that the patient’s uterus is boggy and deviated to the right. Furthermore, it is noted that the patient’s vaginal bleeding has increased. The nurse’s most appropriate first action is to: ANSWER: Massage the uterine fundus with continual lower-segment support. *As the primary caregiver, the registered nurse may be the first person to identify excessive blood loss and to initiate immediate actions. While another member of the team calls the physician or nurse-midwife, the nurse should first locate the uterine fundus and initiate fundal massage. • Question 17 The nurse caring for the laboring woman should understand that early decelerations are caused by which of the following? ANSWER: Altered fetal cerebral blood flow. Early decelerations are the fetus's response to fetal head compression • Question 18 A client with Diabetes Mellitus gives birth to a 9 pound, 10 ounce neonate at 39 weeks gestation. Which of the neonate's serum levels should be assessed immediately after birth. Answer Feedback: Meconium for drug screen • Question 19 A newborn is place under a radiant heat warmer, and the nurse evaluates the infant's body temperature every hour. Maintaining the newborn's body temperature is important for preventing what risk? ANSWER: Cold stress. • Question 20 What is the most critical nursing action in caring for the newborn immediately after birth? ANSWER: Keeping the airway clear * The care given immediately after the birth focuses on assessing and stabilizing the newborn. Although fostering parent-newborn attachment is an important task for the nurse, it is not the most critical nursing action in caring for the newborn immediately after birth. The care given immediately after birth focuses on assessing and stabilizing the newborn. The nursing activities are (in order of importance) to maintain a patent airway, to support respiratory effort, and to prevent cold stress by drying the newborn and covering him or her with a warmed blanket or placing the newborn under a radiant warmer. After the newborn has been stabilized, the nurse assesses the newborn's physical condition, weighs and measures the newborn, administers prophylactic eye ointment and a vitamin K injection, affixes an identification bracelet, wraps the newborn in warm blankets, and then gives the newborn to the partner or to the mother of the infant. • Question 21 A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? Choose all that apply ANSWER: a. Breast tenderness b. Warmth in the breast c. An area of redness on the breast often resembling the shape of a pie wedge e. Fever and flulike symptoms * Breast tenderness, warmth in the breast, redness on the breast, and fever and flulike symptoms are commonly associated with mastitis and should be included in the nurse's discussion of mastitis. A small white blister on the tip of the nipple generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct. • Question 22 The perinatal nurse understands that certain actions help to decrease the risk of hyperbilirubinemia in the newborn. These actions include