Maternal newborn practice B With Rationale
A charge nurse on the postpartum unit is observing a newly licensed nurse who
is preparing o administer pain medication to a client. The charge nurse should
intervene when the newly licensed nurse uses which of the following secondary
id to identify the client?
The client's room number
R: is not acceptable identifier and places the client at risk for a med error
A nurse is providing discharge teaching to a patient whose newborn has just had
a circumcision. Which of the following instructions should the nurse include?
Apply slight pressure with a sterile gauze pad for mild bleeding
R: Nurse should instruct client to attempt to stop mild bleeding by applying pressure
with sterile gauze. If bleeding continues the client should notify the provider.
A nurse is teaching about effective breastfeeding to a client who is 3 days
postpartum. Which of the following information should the nurse include?
Your newborn should appear content after feeding
R: If the baby is not content after feeding signs of hunger are rooting, sucking on the
hands or crying because they might not be emptying the breasts during feeding
completely
A nurse planning care for a client who is in labor and is requesting epidural
anesthesia for pain control. Which of the following actions should the nurse
include in the plan of care?
Monitor the clients B/P every 5 min following the first dose of anesthetic solution
B: The nurse should plan to obtain a baseline blood pressure prior to the initiation of
anesthetic solution. The nurse should then continue to monitor the client's blood
pressure every 5 to 10 min to assess for maternal hypotension caused by the anesthetic
solution
A nurse is teaching a new mother how to use a bulb syringe to suction her
newborn's secretions. Which of the following instructions should the nurse
include?
Stop suctioning when the newborn cry sounds clear
R: nurse should instruct client to stop suctioning when cry no longer sounds like it is
coming through a bubble of fluid or mucus
A nurse is assessing a client who is 12hr postpartum. The client's fundus is two
finger breadths above the umbilicus deviated to the right of the midline, and less
firm than previously noted. Which of the following actions should the nurse take?
Assist the client to the bathroom to void
R: a dissented bladder can cause the uterus from contracting and can cause uterine
atony. Therefore, the nurse should assist the client to void.
A nurse is reviewing the medical record at 1800 for a client who is at 34wks
gestation. Based in the chart findings and documentation the nursing plan of care
should include which of the following actions?
Administer terbutaline
R: administer terbutaline to stop contractions because the lab results indicate that the
fetus's lungs are not mature enough for delivery
A nurse is assessing a full-term newborn 15min after birth. Which of the following
findings requires intervention by the nurse?
, Respiratory rate of 18/min
R: first 30 min's of a newborns life the rest rate can range from 20-100/min. A resp. rate
this low at the time requires further evaluation and intervention by the nurse
A nurse us assessing a client who is at 26wks gestation. Which of the following
clinical manifestations should the nurse report to the provider?
Decreased urine output
R: increased B/P, proteinuria and decreased fetal activity can be indication of
preeclampsia and should be notified to the provider
A nurse is providing teaching to a client about the physiological changes that
occur during preg. The client is at 10 wks of gestation and has a BMI w/in the
expected reference range. Which of the following client statements indicate an
understanding of the teaching?
"I will likely need to use alternative positions for sexual intercourse"
R: The weight of the preg will change positions of sexual intercourse therefore
understanding physiological changes during preg
A nurse in a woman health clinic is providing teaching about nutritional intake to
a client who is at 8wks of gestation. The nurse should instruct the client to
increase her daily intake of which of the following nutrients?
Iron
R: for the woman who are pregnant, it is 27 mg/day. the recommendations for woman
not preg is 15/mg day, for women younger than 19 yr old and 18 mg/day for women
between the ages of 19 and 50 years old.
A nurse is assessing a client who is in active labor and notes early decelerations
in the FHR on the monitor tracing. The client is at 39 wks of gestation and is
receiving a continuous IV infusion of oxytocin. Which of the following actions
should the nurse take?
Continue monitoring the client
R: early decelerations are due to fetal head during contractions, vaginal examinations
and pushing during the second stage of labor. They are ok and normal
A nurse is caring for a newborn who was transferred to the nursery 30 min after
delivery. Which of the following actions should the nurse take first?
Verify the newborn's ID
R: for safety / risk reduction
A nurse is providing education about the family bonding to parents who recently
adopted a newborn. The nurse should make which of the following suggestions
to aid the family 7-yr old in accepting the new family member?
Obtain a gift from the newborn to present to the sibling
A nurse is teaching a client who has pre-gestational type 1 DM about
management during preg. Which of the following statements by the client
indicates an understanding of the teaching?
"I will continue to take my insulin if I experience n/v"
R: Teach the client to continue to take insulin as prescribed during illness to prevent
hypoglycemic and hyperglycemic episodes
A nurse is providing d/c teaching to a client who is postpartum. For which of the
following clinical manifestations should the nurse instruct the client to monitor
and report to the provider?
A charge nurse on the postpartum unit is observing a newly licensed nurse who
is preparing o administer pain medication to a client. The charge nurse should
intervene when the newly licensed nurse uses which of the following secondary
id to identify the client?
The client's room number
R: is not acceptable identifier and places the client at risk for a med error
A nurse is providing discharge teaching to a patient whose newborn has just had
a circumcision. Which of the following instructions should the nurse include?
Apply slight pressure with a sterile gauze pad for mild bleeding
R: Nurse should instruct client to attempt to stop mild bleeding by applying pressure
with sterile gauze. If bleeding continues the client should notify the provider.
A nurse is teaching about effective breastfeeding to a client who is 3 days
postpartum. Which of the following information should the nurse include?
Your newborn should appear content after feeding
R: If the baby is not content after feeding signs of hunger are rooting, sucking on the
hands or crying because they might not be emptying the breasts during feeding
completely
A nurse planning care for a client who is in labor and is requesting epidural
anesthesia for pain control. Which of the following actions should the nurse
include in the plan of care?
Monitor the clients B/P every 5 min following the first dose of anesthetic solution
B: The nurse should plan to obtain a baseline blood pressure prior to the initiation of
anesthetic solution. The nurse should then continue to monitor the client's blood
pressure every 5 to 10 min to assess for maternal hypotension caused by the anesthetic
solution
A nurse is teaching a new mother how to use a bulb syringe to suction her
newborn's secretions. Which of the following instructions should the nurse
include?
Stop suctioning when the newborn cry sounds clear
R: nurse should instruct client to stop suctioning when cry no longer sounds like it is
coming through a bubble of fluid or mucus
A nurse is assessing a client who is 12hr postpartum. The client's fundus is two
finger breadths above the umbilicus deviated to the right of the midline, and less
firm than previously noted. Which of the following actions should the nurse take?
Assist the client to the bathroom to void
R: a dissented bladder can cause the uterus from contracting and can cause uterine
atony. Therefore, the nurse should assist the client to void.
A nurse is reviewing the medical record at 1800 for a client who is at 34wks
gestation. Based in the chart findings and documentation the nursing plan of care
should include which of the following actions?
Administer terbutaline
R: administer terbutaline to stop contractions because the lab results indicate that the
fetus's lungs are not mature enough for delivery
A nurse is assessing a full-term newborn 15min after birth. Which of the following
findings requires intervention by the nurse?
, Respiratory rate of 18/min
R: first 30 min's of a newborns life the rest rate can range from 20-100/min. A resp. rate
this low at the time requires further evaluation and intervention by the nurse
A nurse us assessing a client who is at 26wks gestation. Which of the following
clinical manifestations should the nurse report to the provider?
Decreased urine output
R: increased B/P, proteinuria and decreased fetal activity can be indication of
preeclampsia and should be notified to the provider
A nurse is providing teaching to a client about the physiological changes that
occur during preg. The client is at 10 wks of gestation and has a BMI w/in the
expected reference range. Which of the following client statements indicate an
understanding of the teaching?
"I will likely need to use alternative positions for sexual intercourse"
R: The weight of the preg will change positions of sexual intercourse therefore
understanding physiological changes during preg
A nurse in a woman health clinic is providing teaching about nutritional intake to
a client who is at 8wks of gestation. The nurse should instruct the client to
increase her daily intake of which of the following nutrients?
Iron
R: for the woman who are pregnant, it is 27 mg/day. the recommendations for woman
not preg is 15/mg day, for women younger than 19 yr old and 18 mg/day for women
between the ages of 19 and 50 years old.
A nurse is assessing a client who is in active labor and notes early decelerations
in the FHR on the monitor tracing. The client is at 39 wks of gestation and is
receiving a continuous IV infusion of oxytocin. Which of the following actions
should the nurse take?
Continue monitoring the client
R: early decelerations are due to fetal head during contractions, vaginal examinations
and pushing during the second stage of labor. They are ok and normal
A nurse is caring for a newborn who was transferred to the nursery 30 min after
delivery. Which of the following actions should the nurse take first?
Verify the newborn's ID
R: for safety / risk reduction
A nurse is providing education about the family bonding to parents who recently
adopted a newborn. The nurse should make which of the following suggestions
to aid the family 7-yr old in accepting the new family member?
Obtain a gift from the newborn to present to the sibling
A nurse is teaching a client who has pre-gestational type 1 DM about
management during preg. Which of the following statements by the client
indicates an understanding of the teaching?
"I will continue to take my insulin if I experience n/v"
R: Teach the client to continue to take insulin as prescribed during illness to prevent
hypoglycemic and hyperglycemic episodes
A nurse is providing d/c teaching to a client who is postpartum. For which of the
following clinical manifestations should the nurse instruct the client to monitor
and report to the provider?
