Rasmussen College:NUR 2513 ATI Maternal Newborn LATEST 2021/2022,100% CORRECT

Rasmussen College:NUR 2513 ATI Maternal Newborn LATEST 2021/2022 Main topics covered on proctored & need to know information* PLUS PROCTORED EXAM 2020 QUESTIONS Contraception: ◊ Diaphragms o Must be refit every 2 years, if client has gained more than 15 lbs, and if becomes pregnant o You must use spermicide with every act of coitus interruptus; every time you withdrawal, more spermicide should be instilled o Do not remove diaphragm for 6 hours following sexual intercourse ◊ Oral contraceptives o Side effects: chest pain, SOB, leg pain, increased risk for DVT, headache, vision problems, stroke, hypertension o Contraindicated in women with histories of blood clots, stroke, cardiac conditions, smoking, breast or estrogen related cancers ◊ Depo- Provera AKA Medroxyprogesterone o Injectable progestin; key piece of information to know – can cause decreased bone mineral density and/or loss of calcium ****** Presumptive signs of pregnancy: other conditions may cause these signs to occur ♥ Amenorrhea Fatigue Nausea, vomiting Urinary frequency Quickening (“stomach flutter”) Probable signs of pregnancy: Hegar’s sign Chadwick’s sign Ballottement Braxton hicks contractions Positive pregnancy test Positive signs of pregnancy: Fetal heart sounds heard Baby seen via ultrasound Fetal movement felt GTPAL: G = gravidity: number of times a woman has been pregnant, including current pregnancy* (don’t forget) T = Term births: numbers of babies delivered at 37 weeks+ P = Preterm births: number of babies born before 37 weeks A = Abortion: spontaneous or miscarriages L = Living children Routine lab tests: Blood type, Rh factor, CBC with differential, hgb, and hbt - anemia Rubella titer Hep B screening Group B strep – 35-37 weeks gestation Urinalysis – identifies pregnancy, DM, gestational HTN, renal disease, infection 1 hr glucose tolerance test! o 24-28 weeks o 140 mg/dl = follow up with 3 hr glucose tolerance test 3 hr glucose tolerance test o Screening tool for DM; diagnosis is based on two elevated glucose readings MSAFP – between 15 and 22 weeks o Used to rule out down syndrome (low levels) and neural tube defects (high) Biophysical Profile (BPP): ◊ (5) variables o Reactive FHR o Fetal breathing movements o Gross body movements o Fetal tone o Qualitative amniotic fluid volume (2 = adequate, 0 = not) ◊ Score of 8-10 = normal; low risk for chronic fetal asphyxia Amniocentesis: ◊ Aspiration of amniotic fluid w/ needle into client’s uterus & amniotic sac with use of an ultrasound ◊ May be performed after 14 weeks gestation** ◊ Alfa-fetoprotein (AFP): 16-18 weeks gestation – neural tube defects or chromosomal disorders o High levels = neural o Low levels = down syndrome ◊ Fetal lung maturity: 37 weeks gestation; obtains lecithin/sphingomyelin (L/S) Ratio (normal = 2:1) Chorionic villus sampling: ◊ Assessing portion of developing placenta; 1st trimester, 10-12 weeks ◊ Determines genetic chromosome abnormalities Quad marker and alpha-fetoprotein screening: ◊ Likelihood of fetal birth defects; 16-18 weeks gestation Vaginal bleeding during pregnancy = ALWAYS ABNORMAL!! Occurring in 1st trimester: spontaneous abortion, ectopic pregnancy Occurring in 2nd trimester: gestational trophoblastic disease Occurring in 3rd trimester: placenta previa, abruptio placentae Preterm labor: Uterine contractions & cervical changes occurring between 20-37 weeks Diagnosis: fetal fibronectin between 24-24 weeks*** Medications o Nifedipine – monitor for ortho hypotension Magnesium sulfate (#1!!!) o Tocolytic that relaxes smooth muscle, thus inhibiting uterine activity o Discontinue if signs of pulmonary edema present Betamethasone (another really important one!!) o Administered IM in two injections 24 hours apart; given to increase fetal lung maturity Stages of Labor: Δ First stage – onset to complete dilation o Latent phase ▪ Irregular; 0-3 cm o Active phase ▪ 4-7 cm, q 5-30 minutes o Transition phase ▪ Shortest; contractions q 2-3 minutes Δ Second stage – full dilation to birth (contractions q 1-2 minutes) Δ Third stage – delivery of neonate to delivery of placenta Ch. 21 - Uterine infection aka endometritis • Pelvic pain, chills, loss of appetite • Uterine tenderness and enlargement • Dark, profuse lochia may be purulent or malodorous (bad smelling) • 100.4 temp, tacky Mastitis • Breast infection, unusually unilateral • Caused by milk stasis, engorgement, improper latching, bra with underwire • Enlarged axillary lymph nodes • Edu - frequent changes of breast pads, allow nipples to air dry, release infants grasp before removing from nipple, completely empty breasts with each feeding to prevent stasis, continue breastfeeding, especially on affected side, • Flu like s/s, anorexia • Elevated temp 100.4, tachycardia, UTI • Suprapubic pain • Urinary retention • Pain at costovertebral angle (pyelonephritis) chp. 12 - Gate control pain theory: • Assists in understanding how non pharm therapy can alleviate pain experienced with the birthing process Nonpharm pain management: • Aromatherapy • Breathing techniques • Use of focal points • Therapeutic touch and massage • Walking • Effleurage - light stroking of abdomen in rhythm with breathing during contractions • Sacral counter pressure - heel of hand or fist against sacral area to reduce lower back pain Pharm therapy: ** ANALGESIA aka pain • Sedatives (barbiturates) o During early or latent phase, not for patients who are expected to give birth within 24 hours o Neonatal resp. Depression • Opioid analgesics (usually early part of active labor) o Butorphanol & nalbuphine ‣ Do not cause significant resp. depression to mother or fetus ‣ Will cause drowsiness ‣ Have naloxone readily available o Ondansetron & metoclopramide ‣ Given for nausea and anxiety ‣ May cause dry mouth and sedation • Epidural and spinal regional anesthesia o Analgesics administered as motor blocks o Pt can still sense contractions and still has ability to bear down Before administering, complete a vaginal exam (to determine if labor is well established) PHARM ANESTHESIA (regional blocks and general anesthesia) • Regional blocks (4 types) o Epidural block • ‣ Pain eliminated from umbilicus to thighs • ‣ AEs - maternal hypotension*, fetal bradycardia, loss of ability to bear down, inability to feel urge to void • ‣ Manage hypotension via IV fluid bolus o Spinal block ‣ Eliminates pain from nipples to feet, common in c-sections ‣ AEs: maternal hypotension*, fetal bradycardia ‣ Manage hypotension via IV fluid bolus • General anesthesia o Only used if there or complications or in emergencies o Produces unconsciousness o Assess postpartum for dec. uterine tone, which can cause hemorrhage Chapter 17: Postpartum Physiological Adaptations • Involution • Lochia • Dec. in vaginal discharge • Dec. in hormones, causing low blood sugar • Breast engorgement • Diaphoresis, diuresis • Dec. in vaginal lubrication, discomfort during intercourse • ^ in muscle tone • Lactating - ovulation occurs approx. 6 mo later • Non lactating - ovulation at 6-9 wks, menses 12 wks Greatest risk factors: hemorrhage, shock, infection BP & pulse assessed q 15 minutes for 1st 2 hours after birth Temperature q 4 hours (for 1st 8 hours) then q 8 hours Focused postpartum assessment includes: o Breasts o Uterus o Bowel o Bladder o Lochia o Episiotomy o Uterus (assess fundal height, uterine placement, and uterine consistency q 8 hours) Considerations: • Involution: decrease in size • Fundus should be at umbilicus 1 hour after labor • Should descend 1-2 cm q 24 hours • Encourage early breastfeeding (which will stimulate oxytocin and prevent hemorrhage) . • Encourage emptying of the bladder to prevent uterine displacement and atony . Lochia: 3 stages - o Rubra - dark red, clotty, 1-3 days o Serosa - pink-brown, 4-10 days o Alba - yellow-white, day 10 - 8 weeks • Assess frequently to determine amount of bleeding • Abnormal = excessive spurting, many large clots, foul odor, persistent/heavy lochia ruby beyond day 3 • Teaching - do not use tampons d/t increased risk for infection Cervix: • Directly after - soft, bruised, small lacerations • Within 2-3 days, regains form, shortens, becomes firm vagina Perineum • Can be erythematosus or edematous • Hematomas & hemorrhoids may be present • Pelvic floor muscles can be overstretched and weak • Cervix, vagina, and perineum healing - initial occurs in 2 -3 weeks, complete within 4-6 months • Perineal tenderness, lacerations, episiotomy Cold packs for 1st 24 hours (not directly) to reduce edema • Heat to increase circulation Breasts: • Colostrum - occurs during pregnancy and 2-3 days immediately after birth (milk 3-5 days after birth) • Engorgement (fullness) • Promote early breastfeeding within 1-2 hr after birth • Encourage early demand feeding • Proper latch techniques - takes areola and nipple, not just tip (to prevent nipple soreness) CV: • Blood loss, diaphoresis, diuresis, weight loss during 1st 5 days, • During 1st 4-7 days, wbc values between common/normal • Elevated pulse, SV, CO during 1st hr postpartum, causing hr to be low • Elevated temp due to dehydration during first 24 hrs after labor GI: • Increased appetite after birth • Bowel movement might not occur until 2-3 days later • Urinary retention d/t loss of tone, causing distention - atony • Assist to void 6-8 hours after. If can't, Cath may be needed • Increased output occurs within 12 hours postpartum • Distended bladder may mean fundal height above baseline, displaced to the side, excess lochia, Chapter 18: baby-friendly care • Baby-friendly care can be promoted by dialing nursing procedures during 1st hr after birth Phases of maternal roles attainment (3) Dependent: taking-in phase ◦ First 24-48 hr, focus on meeting personal needs, excited, rely on Others - Dependent-independent: taking-hold Day 2 or 3, lasts 10 days to several weeks, focus on baby care and improving caregiving competency, baby blues Interdependent: letting-go ◦ Focus on family as a unit, resumption of role Assess for behaviors that indicate parent-infant bonding ◦ Names infant, maintains close proximity, smiles and talks to Assess for behaviors that impair and indicate a lack of bonding ◦ Apathy when infant cries, turns away from, ignores Assess for mood swings, conflict about maternal role, insecurity ◦ Feelings of being down, feelings of being unable to care for infant, insecure Nursing interventions: • Place infant in skin-to-skin contact immediately after birth • Promote rooming in as a quiet and private environment • Early initiation of breastfeeding • Encourage bonding, provide praise Fatherhood transition: - Expectations and intentions - desires to deeply connect with infant Confronting reality - Creating role of involved father - Reaping rewards - including fetal smiles Sibling adaption: • Assess for positive responses from the sibling ◦ Interest and concern* • Assess for adverse responses from the sibling ◦ Regression, increased attention-seeking behaviors Nursing interventions - take sibling on tour of nursing unit, encourage parents to do the following: ◦ Let sibling be one of first to see baby, provide gift from infant to sibling, arrange for one parent to spend time with infant while other is with baby, allow older siblings to help in providing care, give preschool siblings a doll to care for *** Chapter 20: postpartum disorders DVT • Assessment o Leg pain/tenderness, unilateral area of swelling, warmth • Prevention o Antiembolism stockings until ambulation established, bed rest 8 hr - perform AROM and PROM, initiate early and frequent postpartum ambulation, elevate legs when sitting, avoid crossing legs and standing/sitting in same position for prolonged periods • Management ◦ Encourage rest, elevate extremity above heart, warm compresses, do not massage area, anticoagulants • Medication tx o Heparin - given iv to prevent formation of other clots and prevent enlargement of existing. Have protamine sulfate (antitdote) readily available, monitor aPTT. Tell patient to report any bleeding or bruising o Warfarin - antidote (phytonadione), monitor PT, watch for bleeding and bruising, use bc to prevent pregnancy bc of warfarin's teratogenic effects o or both - avoid aspirin and ibuprofen Pulmonary embolus • Assessment o Apprehension, pleuritic chest pain, dyspnea, hypoxia, • Management - high fowlers position, HOB elevated, admin O2 by mask, same meds listed under DVT • Thrombolytic therapy to break up clots may be prescribed - alteplase, streptokinase Coagulopathies - ITP & DIC □ ITP o Life span of platelets is decreased o Risk factors - genetic DIC □ DIC o Clotting and anti-clotting mechanisms occur at same time • Risk factors - abruptio placentae, severe preeclampsia, eclampsia, gest. Hypertension Δ Assessment of both - spontaneous nose/gum bleeding, oozing/ trickling flow of blood from incisions, petechiae and ecchymosis, oliguria, tachycardia, hypotension Postpartum hemorrhage* (KNOW ALL THE BELOW) • 500 mL of blood after vaginal or 1000 mL after c-section • Assessment • Increase or change in lochia pattern, uterine atony, constant oozing/trickling, tachycardia and hypotension, pale/cool/clammy skin, oliguria Uterine atony : inability of the uterine muscle to contract adequately after birth, which may lead to hemorrhage • Nursing care • Ensure bladder is empty!!! Subinvolution of the uterus : when the uterus remains enlarged with continued lochia discharge and may result in hemorrhage • Causes - retained placental fragments not completely expelled • Assessment o Enlarged uterus that is higher than expected o Boggy uterus o Prolonged lochia discharge o Increased vaginal bleeding • Treatment - D&C to remove retained fragments • Encourage activities that can enhance involution, such as breastfeeding, early ambulation, frequent voiding • Oxytocin Inversion of uterus • Turning inside out, emergency situation • Assessment • Lower abdomen pain, large/red/round mass that protrudes outside the introitus • Stop oxytocin • Will require surgical replacement by physician • Medication • Terbutaline (tocolytic) - to relax uterus prior to provider's attempt to replace the uterus • C-section will be required for future pregnancies Retained placenta • Can lead to uterine atony or subinvolution Lacerations and hematomas • Episiotomy can extend and become a laceration • Lacerations - noticeable bleeding • Hematomas - pain chp. 22: • Postpartum blues o Feelings of sadness, feeling inadequate, lack of appetite, crying easily for no apparent reason • Physical crying = postpartum depression • Feelings of guilt or inadequacies, fatigue persisting longer than it should, feeling of loss, persistent feelings of sadness, intense mood swings • Physical - weight loss, flat affect, rejection of infant Postpartum psychosis • Pronounced sadness, disorientation, confusion, paranoia • Physical - behaviors indicating hallucinations/delusions, thoughts of harming self or infant • Nursing care o Reinforce that feeling down in the postpartum period is normal o Encourage the client to communicate their feelings o Assess for self-harm, suicide, or harm to infant Chapter 23: Newborn Assessment APGAR score: based on a quick ROS performed 1 minute and 5 minutes after birth 0 - 3 = severe distress 4 - 6 = moderate difficulty 7 -10 = minimal or no difficulty • Heart rate • Respiratory rate • Muscle tone • Reflex irritability • Color ◦ Gestational age assessment performed 48 hours after delivery ‣ Includes newborn measurements and the use of the new New Ballard score: o Assesses newborn maturity (neuromuscular and physical) o Neuromuscular o Physical • Small for gestational age - 10th percentile • Large for gestational age - 90th percentile • Low birth weight - weight of 2500 g or less Vital signs checked in following sequence - respiratory rate, heart rate, blood pressure, and temperature KNOW NEWBORN VITALS • RR – 30 – 60/min with short periods of apnea • HR - 110 - 160 • BP - 60-80/40-50 • Temp - 97.7 - 99.5 Then more extensive H-T • Posture o lying in curled up position with arms and legs in moderate flexion o Resistant to extension of extremities • Skin o initially deep red-purple with acrocyanosis on hands and feet o Jaundice can appear on 3rd day but spontaneously disappear o Dry, soft, smooth. Cracks on hands and feet and peeling common o Quick turgor o Vernix caseosa o Lanugo - ears, forehead, and shoulders • Normal deviations o Milia - small raised white spots on the nose, chin, forehead. Go away on their own. Don't squeeze o Mongolian spots - bluish purple spots of pigmentation o Telangiectatic nevi - stork bites that are flat pink or red marks that blanch, usually fade by second year o Nevis flamm. o Erythema toxicuum - pink rash that disappears during first 3 weeks, referred to as newborn rash, no interventions needed • Head o Should be 2-3 cm larger than chest circumference o Hydrocephalus - excess fluid surrounding the brain cavity o Microcephaly - circumference less than or equal to 32 cm o Sutures should be palpable, separated, and can be overlapping o Frontals soft and flat, can bulge when baby cries/coughs and are flat at rest. Depressed fontanelles can indicate dehydration**** o Caput succedaneum - localized swelling of the scalp, usually resolves within 3-4 days ◦ Cephalohematoma - collection of blood, appears 1-2 days after birth and resolves within 2-3 weeks • Eyes o Usually blue-grey following birth o Minimal or no tears o Pupillary and red reflex present o Random jerky eyeball movement • Ears o Should be even, low can indicate chromosomal abnormality o Cartilage well formed o Should respond to voices and other noises • Nose o Newborns = nose breathers, don't develop response of opening mouth until 3 weeks o They sneeze to clear nasal passage • Mouth o Symmetrical lip movements, scant saliva o Epstein's pearls suspected - small white cysts on gums o Tongue should not protrude o Grey/white patches can indicate thrush (caused by Candida albicans) • Neck Chest o Should have head control, no webbing, should move freely • o Barrel-shaped, diaphragmatic, no retractions, nodules • Abdomen o Round, dome-shaped, no distention o Bowel sounds present a few minutes after breathing • Anogenital o Anus patent, meconium passed within 24-48 hours o Male - rugae on scrotum o Female - hymeneal tag present o Urine passed within 24 hours - rust color first couple days Reflexes • Sucking and rooting reflexes o Elicit by stroking cheek or edge of mouth, should turn head towards stimulus and start to suck o Usually disappears after 3-4 months • Palmar grasp o Place finger in newborn palm, should curl around finger o Lessens by 3-4 months • Plantar grasp o Finger at base of newborns toes, curls toes down o Birth - 8 mo • Moro reflex o Elicit by allowing head and trunk in semi sitting position to fall backwards. Newborn will symmetrically extend and then abduct arms at the elbows & fingers to form a c o Birth - 6 mo • Tonic neck reflex - in supine position, quickly turns head to one side; arm and leg on that side extend and other side flex. Birth - 3/4 mo • Babinski reflex o Stroke outer edge of sole of foot, moving up to toes. Toes should fan outward and out. Birth - 1 yr • Stepping o Hold upright with feet on flat surface. Newborn responds with stepping movements. Birth to 4 weeks Senses Vision • Should be able to focus 8-12 in from face • Sensitive to light • Can discriminate colors within 2-3 months Hearing • Similar to adult hearing once amniotic fluid drains Touch • Mouth is most sensitive to touch in newborn Complications • Hypothermia o If unstable, place in radiant warmer o Healthy = 96.5 - 98.6 o Assess axillary temp q hour o Skin to skin contact with mother Expected labs • Hbt 14-24 • hct 44-64% • Platelets - • Glucose 40-60 • rbc • Wbc Ch. 24: Nursing care of newborns Circumcision: • Not to be performed immed. following birth • Assess for bleeding q 15- 30 min after for 1st hour • Acetaminophen after (45mg/day max) • Can't bottle feed before, can breastfeed • No baths until healed • Don't wash off yellow mucus film that will form after • Complications - hemorrhage, cold stress/hypoglycemia ◊ Each time infant given to parents, their identification band must be verified ◊ Do not give to anyone without photo id badge ◊ Temp stabilizes within 12 hr after birth ◊ Best method for stabilizing is skin to skin contact Bathing: • Can be initiated after temp stabilizes Feeding: • Can be started immediately Cord care: clamp stays in place for 24-48 hours Medications: • Erythromycin ◦ Eye prophylaxis • Vitamin k (phytonadione) o Prevents hemorrhagic disorders o Administered IM into vests lateralis • Hep B immunization o Reach dosage schedule is at birth, 1 month, 6 months o Don't give hep b and vit k in same thigh! Neonate complications: • Cold stress • Hypoglycemia • Hemorrhage (ensure clamp is tight) Ch 25: Nutrition for newborn • Fetal weight loss after delivery is normal o Loss of 5-10% after birth (regain within 10-14 days) o Gain of 110-200g/week for first 3 months • Caloric intake o First 3 months: 110kcal/day o 3-6 months: decreases to 100kcal/day • 9g/day of protein for first 6 months • Infants who breastfeed should receive vitamin D daily • Breast milk and commercial formula lacks iron and fluoride • Solids not introduced until 6 months Breastfeeding: • Should occur q 2-3 hours • Encourage through first 12 months • Benefits to neonate and mom o Maternal benefits: decreased postpartum bleeding and more rapid involution o Initiate as soon as possible or within 30 minutes following birth, explain let down reflex, teach to insert finger inside of side of infants mouth to break suction/prevent nipple trauma, uterine cramps normal during breastfeeding, signs of latched on = nose, cheeks, and chin touching the breast, breastfeed at least 15-20 min per breast • Let down reflex - nipple stim. Causes oxytocin release, which initiates the let down of milk • Hunger cues - hand to mouth or hand to hand movements, sucking motions, and rooting reflex. Newborns will nurse on demand once pattern is established o Don't offer other things like pacifier/formula until breast feeding established to prevent nipple confusion o Place neonate on back after feeding, always o Burp b/t alternating breasts o Milk can be stored in room temp for 8 hrs, refrigerator for 8 days, frozen in freezer compartment for 6 mo. thawing refrigerated milk preserves immunoglobulins in it (thaw by running under lukewarm water, do not microwave), do not refreeze thawed, unused portions must be discarded after thawing Bottle feeding: • Prepared formula can be refrigerated for up to hr, always hold bottle (never prop) Ch. 26: Discharge teaching - • Newborns sleep 16-19 hours a day • For the first 6 months, only breastfeeding recommended • Sleep in supine position/on back to prevent SIDS • When awake, place on abdomen to promote muscle strength • Support head when lifting • Keep cord dry and keep top of diaper folded underneath it to prevent infection, falls off b/w 10-14 days and sponge baths given until this occurs (no immersion) • Never place on soft surface to sleep on, should be firm • Rear-racing car seat in middle until age 2 Ch. 27: Neonatal substance withdrawal: • LT complications - feeding problems, cos dysfunction, attention deficit, microcephaly Neonatal abstinence syndrome: • CNS (hyperactivity, increases moro reflex) • Metabolic, vasomotor, and respiratory (nasal congestion, yawning, retractions, tachypnea) • GI (poor feeding) • Cardinal signs ** - increased incidence of seizures, sleep pattern disturbances, still birth, SIDS, higher birth weights (compared to heroin exposure) Nursing care: • Assess newborns reflexes • Swaddle newborn with legs flexed • Offer non-nutritive sucking • Reduce environmental stimuli* • Meds - morphine sulfate, phenobarbital • Frequent, small, high-cal feedings. Elevate fetal head before and after • For infants withdrawing from cocaine - avoid eye contact and and use vertical rocking and a pacifier Hypoglycemia: (Normal - 30-60) • Jitters, hypothermia, flaccid muscle tone, seizures, cyanosis • Nursing care - IV dextrose for symptomatic infant, skin to skin contact to treat hypothermia Neonatal respiratory distress syndrome: • Tachypnea, retractions, nasal flaring, cyanosis, unresponsive flaccidity • Nursing care ◦ Suction as needed, maintain adequate oxygenation, monitor pulse ox Preterm newborns: • Complications - respiratory distress, bronchopulmonary dysplasia, necrotizing enterocolitis • Assessment o Low birth weight, minimal fat deposits, macrosomia, abundance of lanugo, wrinkled features, weak grasp reflex, soft skull SGA: • Below 10th percentile • Complications - asphyxia, meconium aspiration, hypoglycemia, instability of thermoregulation • Assessment • Normal skull but reduced body dimensions, sparse hair on scalp LGA/Macrocosmic: • More than 8.8 lb/4000g/above 90th percentile • Leading cause = uncontrolled hyperglycemia QQQQQQQ’s A nurse is caring for a client who is in active labor and has gonorrhea. Which of the following should the nurse monitor for? - chorioamnionitis A nurse is caring for a client who has placenta previa. WOTF should the nurse expect? - painless vaginal bleeding A nurse is assessing a client who is 6 hours postpartum and has endometritis. Which of the following signs should the nurse expect? - uterine tenderness Priority to report for client who is 27 weeks gestation and is preeclamptic. - platelet count 60 A nurse is planning care for a newborn who is scheduled to start phototherapy using a lamp. What should the nurse include in the plan? - ensure the newborns eyes are closed beneath the shield A nurse is assessing four newborns. Which of the following clinical findings should the nurse report to the provider? - 2 hr old infant who has respiratory rate of 70 A nurse on a postpartum unit is caring for four clients. Which of the following clients should receive Rh immunoglobulin? - the mother is Rh negative and baby is Rh positive Two days after delivery – teaching about lochia flow - lochia flow normally lasts for about 21 days, and changes from bright red, to pinkish brown, to creamy white Which site is preferred for giving an IM injection to a newborn? - the middle third of the vastus lateralis Which assessment finding indicates that placental separation has occurred during the 3rd stage of labor? - lengthening of the umbilical cord A nurse is assessing a full term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider? - transient circumoral cyanosis In which position should the nurse place the laboring client in order to increase the intensity of contractions and improve oxygenation to the fetus? - squatting A breastfeeding mother is complaining of cramping. Which is the main cause of the client’s afterpains? - contractions of the uterus A nurse is teaching a client and her partner about the technique of counter pressure during labor. Which of the following instructions should the nurse include? - apply pressure using a tennis ball to the lower back A nurse is assessing a client who is 32 weeks gestation and is receiving magnesium sulfate via IV. Which of the following findings should the nurse report to the provider? - loss of deep tendon reflexe A nurse is providing discharge teaching to a client who is breastfeeding her newborn. Which of the following instructions should the nurse include? - allow the baby to feed at least every 3 hours