NUR 221 Final Exam
Study online at https://quizlet.com/_989s5l
1. The nurse in a labor room is performing a vaginal assessment on a pregnant
client in labor. The nurse notes the presence of the umbilical cord protruding
from the vagina. What is the firstnursing action with this finding?: Place the client in
Trendelenburg's position.
2. The nurse is monitoring a client in the immediate postpartum period for signs
of hemorrhage. Which sign, if noted, would be an early sign of excessive blood
loss?: An increase in the pulse rate from 88 to 102 beats per minute.
During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15
minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps
faster to compensate for reduced blood volume.
3. The nurse is preparing to care for a newborn receiving phototherapy. Which
interventions should be included in the plan of care? Select all that apply.: Monitor
skin temperature closely.
Reposition the newborn every 2 hours.
Cover the newborn's eyes with eye shields or patches.
4. Methylergonovine is prescribed for a woman to treat postpartum hemor-
rhage. Before administration of methylergonovine, what is the priority assess-
ment?: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting
the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority
assessment before the administration of the medication is to check the blood pressure. The obstetrician needs to be
notified if hypertension is present.
5. Methylergonovine: contraindicated in clients with significant cardiovascular disease, peripheral vascular
disease, hypertension, preeclampsia, or eclampsia.
6. A postpartum client is attempting to breast-feed for the first time. The nurse
notes that the client has inverted nipples. What nursing action should the nurse
take to assist the client in breast-feeding the newborn infant?: Provide breast shells and
assist the mother with using a breast pump before each feeding to make the nipples easier for the newborn infant to
grasp.
7. What is uterine atony?: Failure of the uterus to "cramp down" and tighten after delivery
1/5
, NUR 221 Final Exam
Study online at https://quizlet.com/_989s5l
8. Hemorrahge medication for postpartum mom: Hemabate
methylergine
oxtocin
cytotec
9. Hemabate (Carboprost): do not give if you have asthma!
o Uterine Contraction / prevention of bleeding - smooth muscle contraction
use with caution on woman who have a history of:liver heart lungs disease. asthma hypertension diabetes or uterine
scarring
10. Methylergonovine (Methergine): Acts directly on the uterine muscle to stimulate forceful contrac-
tions. Used for postpartum hemorrhage.
Precautions/interactions: use with extreme caution in clients with hypertension, preeclampsia, heart disease, venoatria
shunts, mitral valve stenosis, sepsis, or hepatic or renal impairment.
Side effects: potential vasoconstriction, hypertension, headache. Interventions: continuously monitor BP, assess uterine
bleeding, and uterine tone.
11. Misoprostol (Cytotec): Contracts the uterus
give rectally, sublingual or PO
12. Coombs test: a test for the presence of anti-Rh factor antibodies in the blood (this is often given to pregnant
women that are Rh- to see if they will mount an immune response against the blood of their fetus)
13. RhoGAM: Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type
14. Rh factor: presence or lack of antigens on the surface of red blood cells, which causes a reaction between
Rh-positive blood and Rh-negative blood
this affects the second baby
15. ABO incompatibility: Mother's blood type is O
Infant's blood type is A, B, or AB
It affects any pregnancy
2/5
Study online at https://quizlet.com/_989s5l
1. The nurse in a labor room is performing a vaginal assessment on a pregnant
client in labor. The nurse notes the presence of the umbilical cord protruding
from the vagina. What is the firstnursing action with this finding?: Place the client in
Trendelenburg's position.
2. The nurse is monitoring a client in the immediate postpartum period for signs
of hemorrhage. Which sign, if noted, would be an early sign of excessive blood
loss?: An increase in the pulse rate from 88 to 102 beats per minute.
During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15
minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps
faster to compensate for reduced blood volume.
3. The nurse is preparing to care for a newborn receiving phototherapy. Which
interventions should be included in the plan of care? Select all that apply.: Monitor
skin temperature closely.
Reposition the newborn every 2 hours.
Cover the newborn's eyes with eye shields or patches.
4. Methylergonovine is prescribed for a woman to treat postpartum hemor-
rhage. Before administration of methylergonovine, what is the priority assess-
ment?: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting
the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority
assessment before the administration of the medication is to check the blood pressure. The obstetrician needs to be
notified if hypertension is present.
5. Methylergonovine: contraindicated in clients with significant cardiovascular disease, peripheral vascular
disease, hypertension, preeclampsia, or eclampsia.
6. A postpartum client is attempting to breast-feed for the first time. The nurse
notes that the client has inverted nipples. What nursing action should the nurse
take to assist the client in breast-feeding the newborn infant?: Provide breast shells and
assist the mother with using a breast pump before each feeding to make the nipples easier for the newborn infant to
grasp.
7. What is uterine atony?: Failure of the uterus to "cramp down" and tighten after delivery
1/5
, NUR 221 Final Exam
Study online at https://quizlet.com/_989s5l
8. Hemorrahge medication for postpartum mom: Hemabate
methylergine
oxtocin
cytotec
9. Hemabate (Carboprost): do not give if you have asthma!
o Uterine Contraction / prevention of bleeding - smooth muscle contraction
use with caution on woman who have a history of:liver heart lungs disease. asthma hypertension diabetes or uterine
scarring
10. Methylergonovine (Methergine): Acts directly on the uterine muscle to stimulate forceful contrac-
tions. Used for postpartum hemorrhage.
Precautions/interactions: use with extreme caution in clients with hypertension, preeclampsia, heart disease, venoatria
shunts, mitral valve stenosis, sepsis, or hepatic or renal impairment.
Side effects: potential vasoconstriction, hypertension, headache. Interventions: continuously monitor BP, assess uterine
bleeding, and uterine tone.
11. Misoprostol (Cytotec): Contracts the uterus
give rectally, sublingual or PO
12. Coombs test: a test for the presence of anti-Rh factor antibodies in the blood (this is often given to pregnant
women that are Rh- to see if they will mount an immune response against the blood of their fetus)
13. RhoGAM: Used to prevent an immune response to Rh positive blood in people with an Rh negative blood type
14. Rh factor: presence or lack of antigens on the surface of red blood cells, which causes a reaction between
Rh-positive blood and Rh-negative blood
this affects the second baby
15. ABO incompatibility: Mother's blood type is O
Infant's blood type is A, B, or AB
It affects any pregnancy
2/5
