Download 2024 MATERNAL NEWBORN ATI TEST BANK | 450 LATEST QUESTIONS AND CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity!
2024 MATERNAL NEWBORN ATI TEST BANK |
450 LATEST QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES (ALREADY
GRADED A+) | PROFESSOR VERIFIED | LATEST
VERSION (JUST RELEASED)
- When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion? A. Sperm count B. Sperm motility C. Sperm maturity D. Semen volume ------CORRECT ANSWER---------------B. Although all of the factors listed are important, sperm motility is the most significant criterion when assessing male infertility. Sperm count, sperm maturity, and semen volume are all significant, but they are not as significant sperm motility.
- A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, "We know several friends in our age group and all of them have their own child already, Why can't we have one?". Which of the following would be the most pertinent nursing diagnosis for this couple? A. Fear related to the unknown B. Pain related to numerous procedures. C. Ineffective family coping related to infertility. D. Self-esteem disturbance related to infertility. ------CORRECT ANSWER---------------D. Based on the partner's statement, the couple is verbalizing feelings of inadequacy and negative feelings about themselves and their capabilities. Thus, the nursing diagnosis of self-esteem disturbance is most appropriate. Fear, pain, and ineffective family coping also may be present but as secondary nursing diagnoses.
- Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester? A. Dysuria
B. Frequency C. Incontinence D. Burning ------CORRECT ANSWER---------------B. Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. Dysuria, incontinence, and burning are symptoms associated with urinary tract infections.
- Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following? A. Increased plasma HCG levels B. Decreased intestinal motility C. Decreased gastric acidity D. Elevated estrogen levels ------CORRECT ANSWER---------------. During the second trimester, the reduction in gastric acidity in conjunction with pressure from the growing uterus and smooth muscle relaxation, can cause heartburn and flatulence. HCG levels increase in the first, not the second, trimester. Decrease intestinal motility would most likely be the cause of constipation and bloating. Estrogen levels decrease in the second trimester.
- On which of the following areas would the nurse expect to observe chloasma? A. Breast, areola, and nipples B. Chest, neck, arms, and legs C. Abdomen, breast, and thighs D. Cheeks, forehead, and nose ------CORRECT ANSWER---------------D. Chloasma, also called the mask of pregnancy, is an irregular hyperpigmented area found on the face. It is not seen on the breasts, areola, nipples, chest, neck, arms, legs, abdomen, or thighs.
- A pregnant client states that she "waddles" when she walks. The nurse's explanation is based on which of the following as the cause? A. The large size of the newborn B. Pressure on the pelvic muscles C. Relaxation of the pelvic joints D. Excessive weight gain ------CORRECT ANSWER---------------C. During pregnancy, hormonal changes cause relaxation of the pelvic joints, resulting in the typical "waddling" gait. Changes in posture are related to the growing fetus. Pressure on
signs are subjective signs and include amenorrhea; nausea and vomiting; urinary frequency; breast tenderness and changes; excessive fatigue; uterine enlargement; and quickening.
- Which of the following would the nurse identify as a presumptive sign of pregnancy? A. Hegar sign B. Nausea and vomiting C. Skin pigmentation changes D. Positive serum pregnancy test ------CORRECT ANSWER---------------B. Presumptive signs of pregnancy are subjective signs. Of the signs listed, only nausea and vomiting are presumptive signs. Hegar sign,skin pigmentation changes, and a positive serum pregnancy test are considered probably signs, which are strongly suggestive of pregnancy.
- Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester? A. Introversion, egocentrism, narcissism B. Awkwardness, clumsiness, and unattractiveness C. Anxiety, passivity, extroversion D. Ambivalence, fear, fantasies ------CORRECT ANSWER---------------D. During the first trimester, common emotional reactions include ambivalence, fear, fantasies, or anxiety. The second trimester is a period of well-being accompanied by the increased need to learn about fetal growth and development. Common emotional reactions during this trimester include narcissism, passivity, or introversion. At times the woman may seem egocentric and self-centered. During the third trimester, the woman typically feels awkward, clumsy, and unattractive, often becoming more introverted or reflective of her own childhood.
- During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during pregnancy, and nutrition? A. Prepregnant period B. First trimester C. Second trimester D. Third trimester ------CORRECT ANSWER---------------B. First-trimester classes commonly focus on such issues as early physiologic changes, fetal development, sexuality during pregnancy, and nutrition. Some early classes may include
pregnant couples. Second and third trimester classes may focus on preparation for birth, parenting, and newborn care.
- Which of the following would be disadvantage of breast feeding? A. Involution occurs more rapidly B. The incidence of allergies increases due to maternal antibodies C. The father may resent the infant's demands on the mother's body D. There is a greater chance for error during preparation ------CORRECT ANSWER----- ----------C. With breast feeding, the father's body is not capable of providing the milk for the newborn, which may interfere with feeding the newborn, providing fewer chances for bonding, or he may be jealous of the infant's demands on his wife's time and body. Breast feeding is advantageous because uterine involution occurs more rapidly, thus minimizing blood loss. The presence of maternal antibodies in breast milk helps decrease the incidence of allergies in the newborn. A greater chance for error is associated with bottle feeding. No preparation is required for breast feeding.
- Which of the following would cause a false-positive result on a pregnancy test? A. The test was performed less than 10 days after an abortion B. The test was performed too early or too late in the pregnancy C. The urine sample was stored too long at room temperature D. A spontaneous abortion or a missed abortion is impending ------CORRECT ANSWER---------------A. A false-positive reaction can occur if the pregnancy test is performed less than 10 days after an abortion. Performing the tests too early or too late in the pregnancy, storing the urine sample too long at room temperature, or having a spontaneous or missed abortion impending can all produce false- negative results.
- FHR can be auscultated with a fetoscope as early as which of the following? A. 5 weeks gestation B. 10 weeks gestation C. 15 weeks gestation D. 20 weeks gestation ------CORRECT ANSWER---------------D. The FHR can be auscultated with a fetoscope at about 20 week's gestation. FHR usually is ausculatated at the midline suprapubic region with Doppler ultrasound transducer at 10 to 12 week's gestation. FHR, cannot be heard any earlier than 10 weeks' gestation.
- Which of the following prenatal laboratory test values would the nurse consider as significant? A. Hematocrit 33.5% B. Rubella titer less than 1: C. White blood cells 8,000/mm D. One hour glucose challenge test 110 g/dL ------CORRECT ANSWER---------------B. A rubella titer should be 1:8 or greater. Thurs, a finding of a titer less than 1:8 is significant, indicating that the client may not possess immunity to rubella. A hematocrit of 33.5% a white blood cell count of 8,000/mm3, and a 1 hour glucose challenge test of 110 g/dl are with normal parameters.
- Which of the following characteristics of contractions would the nurse expect to find in a client experiencing true labor? A. Occurring at irregular intervals B. Starting mainly in the abdomen C. Gradually increasing intervals D. Increasing intensity with walking ------CORRECT ANSWER---------------D. With true labor, contractions increase in intensity with walking. In addition, true labor contractions occur at regular intervals, usually starting in the back and sweeping around to the abdomen. The interval of true labor contractions gradually shortens.
- During which of the following stages of labor would the nurse assess "crowning"? A. First stage B. Second stage C. Third stage D. Fourth stage ------CORRECT ANSWER---------------B. Crowing, which occurs when the newborn's head or presenting part appears at the vaginal opening, occurs during the second stage of labor. During the first stage of labor, cervical dilation and effacement occur. During the third stage of labor, the newborn and placenta are delivered. The fourth stage of labor lasts from 1 to 4 hours after birth, during which time the mother and newborn recover from the physical process of birth and the mother's organs undergo the initial readjustment to the nonpregnant state.
- Barbiturates are usually not given for pain relief during active labor for which of the following reasons?
A. The neonatal effects include hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. B. These drugs readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. C. They rapidly transfer across the placenta, and lack of an antagonist make them generally inappropriate during labor. D. Adverse reactions may include maternal hypotension, allergic or toxic reaction or partial or total respiratory failure ------CORRECT ANSWER---------------C. Barbiturates are rapidly transferred across the placental barrier, and lack of an antagonist makes them generally inappropriate during active labor. Neonatal side effects of barbiturates include central nervous system depression, prolonged drowsiness, delayed establishment of feeding (e.g. due to poor sucking reflex or poor sucking pressure). Tranquilizers are associated with neonatal effects such as hypotonia, hypothermia, generalized drowsiness, and reluctance to feed for the first few days. Narcotic analgesic readily cross the placental barrier, causing depressive effects in the newborn 2 to 3 hours after intramuscular injection. Regional anesthesia is associated with adverse reactions such as maternal hypotension, allergic or toxic reaction, or partial or total respiratory failure.
- Which of the following nursing interventions would the nurse perform during the third stage of labor? A. Obtain a urine specimen and other laboratory tests. B. Assess uterine contractions every 30 minutes. C. Coach for effective client pushing D. Promote parent-newborn interaction. ------CORRECT ANSWER---------------D. During the third stage of labor, which begins with the delivery of the newborn, the nurse would promote parent-newborn interaction by placing the newborn on the mother's abdomen and encouraging the parents to touch the newborn. Collecting a urine specimen and other laboratory tests is done on admission during the first stage of labor. Assessing uterine contractions every 30 minutes is performed during the latent phase of the first stage of labor. Coaching the client to push effectively is appropriate during the second stage of labor.
- Which of the following actions demonstrates the nurse's understanding about the newborn's thermoregulatory ability? A. Placing the newborn under a radiant warmer. B. Suctioning with a bulb syringe C. Obtaining an Apgar score D. Inspecting the newborn's umbilical cord ------CORRECT ANSWER---------------A. The newborn's ability to regulate body temperature is poor. Therefore, placing the newborn
- When assessing the newborn's heart rate, which of the following ranges would be considered normal if the newborn were sleeping? A. 80 beats per minute B. 100 beats per minute C. 120 beats per minute D. 140 beats per minute ------CORRECT ANSWER---------------B. The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute.
- Which of the following is true regarding the fontanels of the newborn? A. The anterior is triangular shaped; the posterior is diamond shaped. B. The posterior closes at 18 months; the anterior closes at 8 to 12 weeks. C. The anterior is large in size when compared to the posterior fontanel. D. The anterior is bulging; the posterior appears sunken. ------CORRECT ANSWER----- ----------C. The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond shaped, closes at 18 months, whereas the posterior fontanel, which is triangular shaped, closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increased intracranial pressure, or sunken, which may indicate dehydration.
- Which of the following groups of newborn reflexes below are present at birth and remain unchanged through adulthood? A. Blink, cough, rooting, and gag B. Blink, cough, sneeze, gag C. Rooting, sneeze, swallowing, and cough D. Stepping, blink, cough, and sneeze ------CORRECT ANSWER---------------B. Blink, cough, sneeze, swallowing and gag reflexes are all present at birth and remain unchanged through adulthood. Reflexes such as rooting and stepping subside within the first year.
- Which of the following describes the Babinski reflex? A. The newborn's toes will hyperextend and fan apart from dorsiflexion of the big toe when one side of foot is stroked upward from the ball of the heel and across the ball of the foot. B. The newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement or loud noise.
C. The newborn turns the head in the direction of stimulus, opens the mouth, and begins to suck when cheek, lip, or corner of mouth is touched. D. The newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface ------CORRECT ANSWER---------------A. With the babinski reflex, the newborn's toes hyperextend and fan apart from dorsiflexion of the big toe when one side of foot is stroked upward form the heel and across the ball of the foot. With the startle reflex, the newborn abducts and flexes all extremities and may begin to cry when exposed to sudden movement of loud noise. With the rooting and sucking reflex, the newborn turns his head in the direction of stimulus, opens the mouth, and begins to suck when the cheeks, lip, or corner of mouth is touched. With the crawl reflex, the newborn will attempt to crawl forward with both arms and legs when he is placed on his abdomen on a flat surface.
- Which of the following statements best describes hyperemesis gravidarum? A. Severe anemia leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. B. Severe nausea and vomiting leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. C. Loss of appetite and continuous vomiting that commonly results in dehydration and ultimately decreasing maternal nutrients D. Severe nausea and diarrhea that can cause gastrointestinal irritation and possibly internal bleeding ------CORRECT ANSWER---------------B. The description of hyperemesis gravidarum includes severe nausea and vomiting, leading to electrolyte, metabolic, and nutritional imbalances in the absence of other medical problems. Hyperemesis is not a form of anemia. Loss of appetite may occur secondary to the nausea and vomiting of hyperemesis, which, if it continues, can deplete the nutrients transported to the fetus. Diarrhea does not occur with hyperemesis.
- Which of the following would the nurse identify as a classic sign of PIH? A. Edema of the feet and ankles B. Edema of the hands and face C. Weight gain of 1 lb/week D. Early morning headache ------CORRECT ANSWER---------------B. Edema of the hands and face is a classic sign of PIH. Many healthy pregnant woman experience foot and ankle edema. A weight gain of 2 lb or more per week indicates a problem. Early morning headache is not a classic sign of PIH.
A. Placenta previa B. Ectopic pregnancy C. Incompetent cervix D. Abruptio placentae ------CORRECT ANSWER---------------D. Abruptio placentae is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. Placenta previa refers to implantation of the placenta in the lower uterine segment, causing painless bleeding in the third trimester of pregnancy. Ectopic pregnancy refers to the implantation of the products of conception in a site other than the endometrium. Incompetent cervix is a conduction characterized by painful dilation of the cervical os without uterine contractions.
- Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor? A. Weak contraction prolonged to more than 70 seconds B. Tetanic contractions prolonged to more than 90 seconds C. Increased pain with bright red vaginal bleeding D. Increased restlessness and anxiety ------CORRECT ANSWER---------------B. Hyperstimulation of the uterus such as with oxytocin during the induction of labor may result in tetanic contractions prolonged to more than 90seconds, which could lead to such complications as fetal distress, abruptio placentae, amniotic fluid embolism, laceration of the cervix, and uterine rupture. Weak contractions would not occur. Pain, bright red vaginal bleeding, and increased restlessness and anxiety are not associated with hyperstimulation.
- When preparing a client for cesarean delivery, which of the following key concepts should be considered when implementing nursing care? A. Instruct the mother's support person to remain in the family lounge until after the delivery B. Arrange for a staff member of the anesthesia department to explain what to expect postoperatively C. Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth D. Explain the surgery, expected outcome, and kind of anesthetics ------CORRECT ANSWER---------------C. A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either a planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available. Allowing the mother's support person to remain with her as much as possible is an important concept, although doing so depends on many variables. Arranging for necessary explanations by various staff members to be involved
with the client's care is a nursing responsibility. The nurse is responsible for reinforcing the explanations about the surgery, expected outcome, and type of anesthetic to be used. The obstetrician is responsible for explaining about the surgery and outcome and the anesthesiology staff is responsible for explanations about the type of anesthesia to be used.
- Which of the following best describes preterm labor? A. Labor that begins after 20 weeks gestation and before 37 weeks gestation B. Labor that begins after 15 weeks gestation and before 37 weeks gestation C. Labor that begins after 24 weeks gestation and before 28 weeks gestation D. Labor that begins after 28 weeks gestation and before 40 weeks gestation ------ CORRECT ANSWER---------------A. Preterm labor is best described as labor that begins after 20 weeks' gestation and before 37 weeks' gestation. The other time periods are inaccurate.
- When PROM occurs, which of the following provides evidence of the nurse's understanding of the client's immediate needs? A. The chorion and amnion rupture 4 hours before the onset of labor. B. PROM removes the fetus most effective defense against infection C. Nursing care is based on fetal viability and gestational age. D. PROM is associated with malpresentation and possibly incompetent cervix ------ CORRECT ANSWER---------------B. PROM can precipitate many potential and actual problems; one of the most serious is the fetus loss of an effective defense against infection. This is the client's most immediate need at this time. Typically, PROM occurs about 1 hour, not 4 hours, before labor begins. Fetal viability and gestational age are less immediate considerations that affect the plan of care. Malpresentation and an incompetent cervix may be causes of PROM.
- Which of the following factors is the underlying cause of dystocia? A. Nurtional B. Mechanical C. Environmental D. Medical ------CORRECT ANSWER---------------B. Dystocia is difficult, painful, prolonged labor due to mechanical factors involving the fetus (passenger), uterus (powers), pelvis (passage), or psyche. Nutritional, environment, and medical factors may contribute to the mechanical factors that cause dystocia.
A. Epidemic infection from nosocomial sources localizing in the lactiferous glands and ducts B. Endemic infection occurring randomly and localizing in the periglandular connective tissue C. Temporary urinary retention due to decreased perception of the urge to avoid D. Breast injury caused by overdistention, stasis, and cracking of the nipples ------ CORRECT ANSWER---------------D. With mastitis, injury to the breast, such as overdistention, stasis, and cracking of the nipples, is the primary predisposing factor. Epidemic and endemic infections are probable sources of infection for mastitis. Temporary urinary retention due to decreased perception of the urge to void is a contributory factor to the development of urinary tract infection, not mastitis.
- Which of the following best describes thrombophlebitis? A. Inflammation and clot formation that result when blood components combine to form an aggregate body B. Inflammation and blood clots that eventually become lodged within the pulmonary blood vessels C. Inflammation and blood clots that eventually become lodged within the femoral vein D. Inflammation of the vascular endothelium with clot formation on the vessel wall ------ CORRECT ANSWER---------------D. Thrombophlebitis refers to an inflammation of the vascular endothelium with clot formation on the wall of the vessel. Blood components combining to form an aggregate body describe a thrombus or thrombosis. Clots lodging in the pulmonary vasculature refers to pulmonary embolism; in the femoral vein, femoral thrombophlebitis.
- Which of the following assessment findings would the nurse expect if the client develops DVT? A. Midcalf pain, tenderness and redness along the vein B. Chills, fever, malaise, occurring 2 weeks after delivery C. Muscle pain the presence of Homans sign, and swelling in the affected limb D. Chills, fever, stiffness, and pain occurring 10 to 14 days after delivery ------ CORRECT ANSWER---------------C. Classic symptoms of DVT include muscle pain, the presence of Homans sign, and swelling of the affected limb. Midcalf pain, tenderness, and redness, along the vein reflect superficial thrombophlebitis. Chills, fever and malaise occurring 2 weeks after delivery reflect pelvic thrombophlebitis. Chills, fever, stiffness and pain occurring 10 to 14 days after delivery suggest femoral thrombophlebitis.
- Which of the following are the most commonly assessed findings in cystitis? A. Frequency, urgency, dehydration, nausea, chills, and flank pain B. Nocturia, frequency, urgency dysuria, hematuria, fever and suprapubic pain C. Dehydration, hypertension, dysuria, suprapubic pain, chills, and fever D. High fever, chills, flank pain nausea, vomiting, dysuria, and frequency ------ CORRECT ANSWER---------------B. Manifestations of cystitis include, frequency, urgency, dysuria, hematuria nocturia, fever, and suprapubic pain. Dehydration, hypertension, and chills are not typically associated with cystitis. High fever chills, flank pain, nausea, vomiting, dysuria, and frequency are associated with pvelonephritis.
- Which of the following best reflects the frequency of reported postpartum "blues"? A. Between 10% and 40% of all new mothers report some form of postpartum blues B. Between 30% and 50% of all new mothers report some form of postpartum blues C. Between 50% and 80% of all new mothers report some form of postpartum blues D. Between 25% and 70% of all new mothers report some form of postpartum blues ---- --CORRECT ANSWER---------------C. According to statistical reports, between 50% and 80% of all new mothers report some form of postpartum blues. The ranges of 10% to 40%, 30% to 50%, and 25% to 70% are incorrect. A nurse is reviewing the medical record of a client who is one day postpartum. The client had a vaginal birth with a fourth-degree perineal laceration. The nurse should contact the provider regarding which of the following prescriptions? ------CORRECT ANSWER----------------The nurse should not administer a rectal suppository or enema to a client who has a fourth-degree perineal laceration. These can cause separation of the suture line, bleeding, or infection. A nurse is preparing to administer hepatitis B immune globulin to a newborn. The prescription states, "Administer 5 mcg IM once today." Available is a 5 mL vial with 10 mcg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) ------CORRECT ANSWER----------------STEP 8: Reassess to determine whether the amount to administer makes sense. If there are 10 mcg/mL and the prescription reads 5 mcg, it makes sense to administer 0.5 mL. The nurse should administer hepatitis B immunoglobulin 0.5 mL IM.
Increased afterbirth cramping is incorrect. The use of oxytocin will increase, rather than decrease, afterbirth cramping. Increased maternal temperature is incorrect. The use of oxytocin will have no effect on maternal temperature. A nurse is teaching a new mother about newborn safety. Which of the following instructions should the nurse include in the teaching? ------CORRECT ANSWER---------- ------Room-sharing is recommended during the first few weeks. This allows the parents to be readily available to the newborn and learn the newborn's cues. However, the nurse should instruct the parents to avoid placing the newborn in their bed as it increases the risk for sudden infant death syndrome. A nurse is calculating a client's expected date of birth using Naegele's rule. The client tells the nurse that her last menstrual cycle started on November 27th. Which of the following dates is the client's expected date of birth? ------CORRECT ANSWER------------ ----When using Naegele's rule to calculate the estimated date of birth for a client, the nurse should subtract 3 months from the first day of the client's last menstrual cycle and then add 7 days. November 27th minus 3 months equals August 27th. August 27th plus 7 days equals September 3rd. A charge nurse on a labor and delivery unit is teaching a newly licensed nurse how to perform Leopold maneuvers. Which of the following images indicates the first step of Leopold maneuvers? ------CORRECT ANSWER----------------Evidence-based practice indicates the nurse should perform this step first when performing Leopold maneuvers. During this step, the nurse palpates the client's abdomen with her palms to determine which fetal part is in the uterine fundus. This step also identifies the lie (transverse or longitudinal) and presentation (cephalic or breech) of the fetus. A nurse is caring for a client who is at 38 weeks of gestation. Which of the following actions should the nurse take prior to applying an external transducer for fetal monitoring? ------CORRECT ANSWER----------------The nurse should perform Leopold maneuvers to assess the position of the fetus to best determine the optimal placement for the external fetal monitoring transducer
A staff nurse on an obstetric unit is caring for a client who is scheduled for an induced abortion. The staff nurse informs the nurse manager that she has a moral issue with the client's decision. Which of the following actions should the nurse manager take? ------ CORRECT ANSWER----------------The nurse manager should take into account the staff nurse's moral beliefs and recognize that she also has rights and responsibilities concerning the care of a client who is undergoing an induced abortion. Therefore, the nurse manager should reassign the care of the client to another staff nurse. A nurse is caring for a client who is pregnant and is at the end of her first trimester. The nurse should place the Doppler ultrasound stethoscope in which of the following locations to begin assessing for the fetal heart tones (FHT)? ------CORRECT ANSWER- ---------------At the end of the first trimester of pregnancy, the client's uterus is approximately the size of a grapefruit and is positioned low in the pelvis slightly above the symphysis pubis. Therefore, the nurse should begin assessing for FHTs just above the symphysis pubis. A nurse is planning care for a client who is to undergo a nonstress test. Which of the following actions should the nurse include in the plan of care? ------CORRECT ANSWER----------------Fetal movement may not be evident on the fetal monitor and tracing. Instructing the client to press the button when she detects fetal movement will ensure that the fetal movement is noted. A nurse in the antepartum clinic is assessing a client's adaptation to pregnancy. The client states that she is, "happy one minute and crying the next." The nurse should interpret the client's statement as an indication of which of the following? ------ CORRECT ANSWER----------------The nurse should recognize and interpret the client's statement as an indication of emotional lability. Many women experience rapid and unpredictable changes in mood during pregnancy. Intense hormonal changes may be responsible for mood changes that occur during pregnancy. Tears and anger alternate with feelings of joy or cheerfulness for little or no reason. A nurse is caring for a prenatal client who has parvovirus B19 (fifth disease). Which of the following actions should the nurse take? ------CORRECT ANSWER----------------The nurse should schedule serial ultrasound examinations to monitor the fetus during the pregnancy to detect the possible development of fetal hydrops.
