MCN 273 Final Exam | Q & A (Complete Solutions)

MCN 273 Final Exam | Q & A (Complete Solutions) The nurse understands that the endometrium is prepped for egg implantation by the corpus luteum, which secretes: A. Progesterone B. Estrogen C. Luteinizing hormone D. Prolactin Angie Young is a 32-year-old African-American female who is in excellent health. She has been happily married to her husband Steve for 8 years, and they have two children, Kelsey and Marcus What is Angie's G/P (TPAL)? G2P2002 What is the most fertile time for conception during a cycle? Ovulation: follicle releases ovum (egg) and have 24hr window after ovulation to conceive. typically occurring on day 14 of menstrual cycle What should one teach about at home pregnancy tests? they are most reliable 14 days after conception It is important that nurses include a discussion about teratogens in their prenatal discussions to help prevent deformities or abnormalities. Teratogens may include which of the following? (Select all that apply.) A. Multivitamin supplement B. Certain medications C. Alcohol D. Infections When discussing the various risks to the mother and infant, the nurse should include that which of the following is the leading cause of cognitive impairment in the United States? A. Maternal drug addiction B. Pregnancy category X medications C. Fetal alcohol spectrum disorder D. Genetic anomalies Rachel is a healthy, happily married 38 year old, Hispanic woman. She and her husband Angelo have been married for 3 years and have been attempting to conceive a child ever since. Does Rachel meet the criteria for being infertile? Yes, infertility is the inability to conceive after 1 year of unprotected sex. Rachel has been documenting basal temperature pattern and her doctor notices a lack of a biphasic temperature curve. What may be contributing to her infertility? Ovarian dysfunction, due to the absence of a temperature increase during ovulation. A 19 year old female client has been diagnosed with pelvic inflammatory disease due to untreated chlamydia. Which of the following instructions should the nurse offer when caring for the client? Select all that apply. A. Use an intrauterine device (IUD) for contraception. B. Complete antibiotic therapy. C. Increase fluid intake. D. Limit the number of sex partners. Which baby is most likely to have a difficult respiratory transition? A. 38wk vaginal delivery B. 34wk pre-mature C-section C. 40wk C-section D. 36wk pre-mature vaginal delivery Pre-mature and no vaginal squeeze to stimulate the lungs Baby has HR of 90 and regular RR of 40, tight flexion, a grimace when stimulated and acrocyanosis. APGAR score?? A. 6 B. 7 C. 8 D. 9 HR1 (under 100bpm), RR2 (within normal limits), Muscle Tone2 (within normal limits), Reflex irritability1(no vigorous cry), color1 (typical) Which would alter the nurse to suspect that a newborn is experiencing respiratory distress? A. Asymmetrical chest movement B. Apnea periods lasting 10 seconds C. Acroncyanosis D. Respiratory rate of 50 breath per minute May have an irregular breathing pattern, but should always have symmetrical movement Nurse preparing a teaching plan for new parents about why newborns experience heat loss, what should she include? A. Limited voluntary muscle activity B. Expanded stores of glucose and glycogen C. Thick skin with deep lying blood vessel D. Enhanced shivering ability B, C, D are all false (decreased glucose stores, thin skin with superficial blood vessels, and muscularly immature so no shivering ability) Angie Young tells the nurse her last period was May 18. The nurse uses Nagele's rule to compute the client's expected date of birth, and tells the client that the correct date of birth will be: A. February 11 (of the next year) B. February 18 (of the next year) C. February 25 (of the next year) D. February 28 (of the next year) Minus 3 months, plus 7 days, plus one year. A nurse assesses four clients at 32 weeks GA in the prenatal clinic. Which client will present with the most accurate fundal height related to gestational age? A. The client who develops polyhydramnios B. The client with obesity C. The client who develops hypertension D. The client with a 70-pound weight gain Complication but does not effect fundal height Angie is seen for a 16 week ultrasound. What do you want to discuss with her prior to/after the procedure? Positioned in a left tilt/ semi fowlers position: to increase perfusion Talk through procedure and what to expect No need for a full bladder in second trimester (as we did for the first) Where would you place an EFM ultrasound to assess fetal heart tones for a baby in LOA position? LLQ of the abdominal wall During the day, Angie begins contracting and calls her provider's office. She tells the nurse she believes she is in labor. What questions might the nurse ask to determine if Angie is in true labor? What prenatal history should the nurse obtain during the call? How long/ frequent she's been contracting: do the contractions stop when you walk around? BOW break? if so TACO questions Is your baby moving? How far along (GA) Are you bleeding? What number baby is this--Effects assessment finding (maybe shorter birth process) Which of the following, if reported by Angie, might be a sign of labor onset? A. Sudden loss of energy from epinephrine release B. "Nagging" but constant pain in the lower back C. Urinary urgency from increased bladder pressure D. "Show" or release of the cervical mucus plug B is false because you expect an increase of energy or "nesting" and C is common in the third trimester of pregnancy Angie describes her contractions and discomfort as mild. You examine her report VSS, FHR 135 with moderate variability, UCs q 6-7 min, SVE 3/50/-2, membranes intact. What phase and stage of labor is she in? And what positions/ activities are appropriate for Angie at this time latent phase of stage one & getting up and walking as able in order to assist with discomfort and dilation Angie is not ready to be admitted for labor just yet. You teach her about the differences between true and false labor. Your teaching is effective when she states: A. When I am contracting every 5 minutes, I am in true labor B. The presenting part is engaged and not floating C. Progressive cervical change occurs in true labor D. In true labor, my bag of water will break As you admit Angie, she reveals that she and Steve have written a birth plan. Which statement would help assure you that she has a workable plan? A. "I've written down everything I have to have to make labor a success." B. "I didn't include anything Steve wanted; I'm the one having the baby." C. "My mother strongly suggested I ask for morphine like she did, so I'm going to add that." D. "I've tried to keep it flexible because I know circumstances can change." Angie wishes for an unmedicated labor. What if she refuses to have any electronic fetal monitoring? How should you handle this request? if she is not on any medication (Pitocin) intermittent monitoring (q30min) is probably ok, but dependent on hospital policy After another hour, Angie is feeling pressure and a strong urge to push. Her SVE is now 10/100/3. Is Angie a good candidate for laboring down? No, she is still at a +3 station, in addition to no medication At 1 minute, he is crying vigorously and is flexed, however he is still blue. What APGAR would he get? 8: lost both points for color Angie and Steve name their new son, Eric. What nursing interventions will promote bonding? skin to skin breastfeeding protecting the golden hour You complete your BBUBBLE-EE assessment on Angie who is now 12-hours postpartum. Findings include lochia rubra, with a firm fundus at the level of the umbilicus. What nursing action is indicated? A. Massage the fundus to prevent early postpartum hemorrhage. B. Administer uterotonic medications to stop the bleeding. C. Call the physician/CNM and prepare for a pelvic exam. D. Document findings and continue to monitor. You are caring for Angie and Baby Eric on the postpartum floor. She is breastfeeding when she says to you, "I don't remember feeling cramping this bad the last two times." Explain to her why after pains are more acute in multiparous women After pains are pain that happens after from breastfeeding due to oxytocin, which is released while breastfeeding to stimulate the uterine contractions. Happens more intensely in multiparous woman because the uterine is a little more stretched with each pregnancy so little more work with each pregnancy to get uterus to pre pregnancy size. Administer Ibuprofen to help with pain Angie has some perineal edema and reports some discomfort from a second degree perineal laceration. Which intervention is most appropriate to implement? A. Application of warm compresses to the perineum B. Application of an ice pack to the perineum C. Administration of Hemabate 250 mcg D. Contacting the physician/CNM for new orders C would be used for PP Hemorrhage Angie tells you that her milk supply was, "not that great" with Kelsey and Marcus. What instructions should you give her to improve milk supply? A. Take cold baths B. Apply ice packs to the breasts C. Empty the breasts frequently D. Be sure to increase caloric intake C. Empty the breasts frequently: On demand system, when you empty it the body makes more. D is appropriate, but not the best way to increase supply Ever the overachiever, at 24 hours Angie, asks you when she can begin exercising to regain her pre-pregnancy shape. Which response is correct? A. "Simple abdominal and pelvic exercises can begin right now." B. "You will need to wait until after your 6-week postpartum checkup." C. "Once your lochia has stopped you can begin exercising." D. "You should not exercise while you are breastfeeding." Such as keagles or walking around. Full weight training routine is contraindicated until 6wk check up A 33 y/o G2P0 at 8 weeks' gestation has a history of type 1 DM. When explaining about the importance of glucose control in pregnancy, which should the nurse expect to occur regarding the client's insulin needs in the third trimester? A. They will increase. B. They will decrease. C. They will remain constant. D. They will be unpredictable. Insulin needs decrease during the first trimester due to estrogen and progesterone naturally increasing insulin production. The insulin requirements then increase up to 4X the normal amount due to hPl being an insulin antagonist. At labor insulin will then decrease again due to it being a major form of exercise. A patient with gestational diabetes is seen for an ultrasound at 39 weeks. The fetus is estimated to be 4500 gms (10 lbs). The patient asks, "What causes the baby to be so large?" The nurse's best response is: A. Family history of large infants B. Fetal anomalies C. Maternal hyperglycemia D. Maternal hypertension A neonate was born at 41 weeks GA, weighing 4082 gms (9 lbs). Assesing for signs and symptoms of which of the following conditions should be a priority? A. Anemia B. Hypoglycemia C. Delayed meconium D. Elevated bilirubin Less glucose to the brain (big concern- priority), baby is at risk because it is used to getting a lot of sugar form mom, therefore they have a lot of insulin to deal with sugar. But, once removed from environment with all that sugar they have excess insulin and BGL can drop. Which of the following should the nurse identify as a risk associated with anemia during pregnancy? A. Newborn with heart problems B. Fetal asphyxia C. Low birthweight D. Polyhydramnios People who have anemia usually have nutritional deficiencies A primigravid client has completed the lab work from her first prenatal visit. Her blood work reveals she is HBsAg positive. What should the nurse anticipate in the plan of care at delivery? Select all that apply. A. Series of 3 hepatitis B vaccines for the newborn started before discharge B. Isolation of the infant during hospitalization C. Universal precautions for mother and infant D. Formula feeding for the infant A G2 P0101 at 32 weeks is complaining of UCs q 6-8 minutes for the past hour. She will have several assessments completed, including Fetal Fibronectin, SVE, Transvaginal ultrasound, and a speculum exam. Which test must be performed first? A. fFN B. SVE C. TVUS D. SSE Fetal "glue" that holds the fetal sac to the uterine lining. You don't want to be a cause for positive test due to other invasive procedures--- Cannot have an fFN done you have had an SVE or intercourse in last 24hr. If absent during the 20th and 34th week it is a strong predictor for no preterm labor. Prior to initiation of Indocin therapy for a patient in preterm labor at 28 weeks, which of the following assessments would be appropriate? A. Non-stress test B. Amniotic fluid index C. Contraction stress test D. Amniocentesis Get a baseline, already low on fluid will get a different category of a drug because it can cause oligohyramosis C/D. are contraindicated at 28wk Which of the following S/S might indicate a patient with preterm, premature ROM has developed an infection? Select all that apply. A. Maternal tachycardia B. Fetal tachycardia C. Uterine tenderness D. Leukocytosis E. Foul-smelling amniotic fluid A patient with placenta previa at 37.4 weeks gestation presents with active, ongoing bleeding. Her VS are T 98.2 F, HR 88, RR 20, BP 136/80. Which diet is most appropriate for her? A. NPO B. Clear liquid diet C. Low sodium diet D. General diet She might be going into labor, but more likely c-section due to placenta previa, so always NPO with surgery A patient with abruptio placenta is entering DIC as a result of significant placental separation. You are reviewing her labs and would expect her PT/PTT to be: A. Unaffected B. Reduced C. Prolonged decrease in clotting factors because they have already been used up A nurse is admitting a full-term pregnant client presenting with active vaginal bleeding and intense abdominal pain. Her VS on admission are T 98.0 F, HR 109, RR 22, BP 150/96. Which problem should the nurse suspect that the client is likely experiencing? A. Placenta previa B. Placenta abruption C. Placenta accreta D. Succenturiate placenta Due to pain, active bleeding, and BP A G2 P0010 at 16 weeks GA presents with vaginal bleeding. In order to assess her, which intervention(s) is/are appropriate? Select all that apply. A. SVE B. Speculum exam C. Ultrasound D. Laparoscopy E. Non-stress test Cannot do an NST until 28wk and SVE is contraindicated in a patient who has bleeding from an unknown source A 21 year old woman presents to the ED with complaint of acute L lower abdominal pain and no c/o vaginal discharge. Her last normal menstrual period was approximately 8 weeks ago. Which of the following is the most appropriate diagnostic test? A. Abdominal-pelvic CT scan B. Abdominal radiograph C. CBC D. hCG level E. Progesterone level Want to confirm pregnancy first Which assessment finding might be expected with hyperemesis gravidarum? A. Spec grav 1.025 B. Decreased hematocrit C. 3+ edema D. 5 lb Weight gain for first trimester urine is very concentrated due to dehydration B. is false because you would expect the hematocrit to increase because plasma (fluid) is lowered so delusional increase in hematocrit You will know that the magnesium sulfate treatment for preeclampsia is successful if your patient: A. Decreases her blood pressure B. Remains afebrile C. Maintains a respiratory rate of 18 bpm D. Does not experience a seizure A is just an advantageous side effect As a result of magnesium sulfate treatment, your patient is most at risk for: A. Jitteriness B. Increased after pains C. Uterine atony D. Bladder spasticity due to decrease in the muscle tone Upon completing your assessment, which patient are you most concerned will experience a seizure? A. RR 12 and decreased hand grasp B. Complaint of headache and 4+ DTRs C. 3+ edema and rales on auscultation D. Oliguria and elevated BUN E. Elevated ALT/AST and epigastric pain neurological symptom is always a priority A nurse is assessing a client 2 hours postpartum. Her blood pressure is 98/60, pulse is 90, and she has saturated one pad in the last hour. What should be the immediate nursing action? A. Massage fundus until firm B. Prepare the patient for a manual removal of placental fragments C. Administer Methergine D. Administer platelets A nurse is caring for four postpartum clients who each have an order for Methergine (methylergonovine maleate). Based on the data collected during the nurse's initial shift assessment, which client would not receive the medication? A. The client with a temperature of 101ºF B. The client with a respiratory rate of 20