PN VATI MATERNAL NEWBORN 2024 WITH QUESTIONS AND ANSWERS, Exams of Nursing

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1.A nurse is reinforcing teaching with a guardian about how to care for the umbilical cord of their newborn infant. Which of the following statements by the guardian indicates a need for further teaching? Ans I will give my newborn a bath once daily." The nurse should reinforce with the guardian to avoid giving the newborn a daily bath because it can damage the integrity of the newborn's skin. 2.A nurse is reinforcing teaching with a client who is at 8 weeks of gestation and has chlamydia. Which of the following statements should the nurse in- clude? Ans "After treatment, you will need another test in 3 weeks and again between 35 and 37 weeks." The nurse should reinforce with the client that they will need to be 1/25 retested for chlamydia 3 weeks after completing the prescribed regimen and again between 35 and 37 weeks of gestation. Most clients who have chlamydia are asymptomatic. Therefore, clients should be retested to identify potential reinfection, which would allow for additional treatment and decrease the risk for harm to the fetus during delivery. 3.A nurse is reinforcing teaching with a client who plans to use a modi- fied-paced breathing technique to relieve labor pain. Which of the following instructions should the nurse include in the teaching? Ans "Begin and end modi- fied-breathing with a deep cleansing breath. The nurse should instruct the client that all breathing patterns begin with a deep, relaxing, cleansing breath to "greet the contraction" and end with an exhaled deep breath to "blow the contraction away." Deep breaths ensure sufficient oxygenation for both the client and fetus. 4.A nurse is reviewing the laboratory reports of four newborns. Which of the following laboratory results should the nurse report to the provider? Ans Hgb 10 g/dL A hemoglobin level of 10 g/dL is below the expected reference range of 14 to 24 g/dL for a newborn. The nurse should report this finding to the 2/25 effect of the medication. Diarrhea can lead to dehydration, which can cause preterm labor. This finding should be reported to the provider. 6.A nurse is collecting data from a client who is 24 hr postpartum. Which of the following findings is the priority for the nurse to report to the provider? Ans - Saturated perineal pad within 15 min A saturated perineal pad within 15 min can indicate a cervical or vaginal tear. Therefore, the nurse should report this finding to the provider immediately. 7. Anurse is collecting data from a newborn who is 6 hr old. Which of the following manifestations should the nurse expect? (Select all that apply.) Ans - Rust-stained urine is correct. A newborn's first void can contain uric acid crystals, which will give the urine a rust-stained appearance. Overlapping cranial sutures is correct. A newborn's cranial sutures should be palpable without evidence of fusion. Overlap- ping sutures can occur during a vaginal birth to allow passage of the fetus through the birth canal. 4/3 Periodic breathing is correct. A newborn's respiratory effort is shallow and irregular and can have periods of 5 to 10 seconds with respiratory effort. 8.A nurse is reinforcing teaching about daily fetal movement count with a client who is at 34 weeks of gestation. Which of the following statements by the client indicates an understanding of the teaching? Ans "I will notify my provider if I do not feel my baby move for 12 hours." The nurse should instruct the client to report absence of fetal movement for 12 hr to the provider. This is known as the fetal alarm signal, which can indicate fetal distress 9.A nurse is collecting data from a newborn whose mother tested positive for cocaine use. Which of the following newborn withdrawal manifestations should the nurse expect? Ans Excessive sucking The neurotoxic effects of cocaine can lead to excessive sucking and poor feeding has a BP of 156/102 mm Hg and is at 36 weeks of gestation. Which of the following labora- tory values should the nurse report to the provider? Ans Platelet count 100,000/mm The nurse should identify that a platelet count of 100,000/mm is below the expected reference range of 150,000 to 400,000/mm during pregnancy. A low platelet count can indicate HELLP syndrome; therefore, the nurse should report this laboratory value to the provider. 13. A nurse is caring for a client who is 1 hr postpartum and has a third-degree perineal laceration. Which of the following actions should the nurse perform? (Select all that apply.) Ans Apply an ice pack to the client's perineum is correct. The nurse should apply an ice pack to the client's perineum to decrease edema and promote comfort. Place witch hazel pads on the client's perineum is correct. The nurse should place witch hazel pads on the client's perineum to promote comfort. Encourage the client to use a squeeze bottle to cleanse the perineum with each void is correct. The nurse should encourage the client to use a squeeze bottle to cleanse the perineum with each void to prevent infection. 14. A nurse is assisting with the admission assessment of a client whose labor is being induced. The client reports using heroin 6 hr ago. For which of the following manifestations of abstinence should the nurse monitor the client? Ans Insomnia Abstinence manifestations begin within 6 hr after the last drug use and might include insomnia, shivering, body aches, vomiting, nausea, body shivers, abdominal pain, muscle jerks, and diarrhea. 15.A nurse is reinforcing teaching with the parents of a newborn who is having a newborn screening test. Which of the following statements should the nurse include in the teaching? Ans The test will check your baby for phenylketonuria." The nurse should reinforce with the parents that the newborn screening test checks for multiple congenital disorders including sickle cell disease. phenylketonuria, galactosemia, and hypothyroidism. Most of these disorders are not symptomatic at birth. 16.A nurse is assisting with discharge teaching about pain 18. A nurse is assisting with the care of a newborn who has hyperbilirubinemia and is receiving phototherapy. Which of the following findings should the nurse identify as a potential complication of phototherapy? Ans Decreased urinary output The nurse should closely monitor urinary output while the newborn is receiving phototherapy. Phototherapy can increase the rate of insensible water loss, which can lead to dehydration. The nurse should ensure the newborn is eating every 2 to 3 hr to promote adequate hydration. 19. A nurse is reinforcing discharge teaching with a parent of a newborn following a circumcision using the Plastibell technique. Which of the following statements by the parent indicates an understanding of the teaching? Ans I will be sure that my babys diaper does not put pressure on his penis." The nurse should identify that this statement indicates an understanding of the teaching. The diaper should be applied loosely to prevent the application of pressure to the circumcision site. 20. A nurse in an antepartum clinic is reinforcing teaching with a client who is at 32 weeks of gestation and is scheduled for a 10/25 nonstress test. Which of the following information should the nurse include in the teaching? Ans "You will be asked to press a button when you feel your baby move during the test. The nurse should instruct the client to press a hand-held button attached to the monitor when they feel the baby move. Pressing the hand-held button will help to accurately correlate fetal movement with the fetal heart rate. 21.A nurse is reinforcing teaching with the guardians of a newborn about the care of the umbilical stump. Which of the following instructions should the nurse include in the teaching? Ans "Sponge bathe your baby until the umbilical stump has fallen off." The nurse should reinforce with guardians that submerging the umbilical stump in water can impede healing and promote infection. Therefore, the guardians should sponge bathe their newborn until the umbilical stump has fallen off. 22. A nurse in an antepartum clinic is collecting data from a client who is at 12 weeks of gestation. Which of the following findings should the nurse report to nurse initiate for the client? Ans Droplet The nurse should initiate droplet precautions for a client who has pertussis. Droplet precautions include a private room or cohorting of clients and the use of a mask when providing client care. Other infections that require droplet precautions include rubella, pneumonia, and influenza, 25. A nurse in a prenatal clinic is reinforcing nutritional teaching with a client who is at 10 weeks of gestation. Which of the following statements by the client indicates an understanding of the instructions? Ans make sure that I get 1,000 milligrams of calcium per day." The client should consume a minimum of 1,000 mg of calcium daily during pregnan- cy to support fetal bone and tooth development. 26. A nurse in a Clinic is assisting with the plan of care for a client who is at 36 weeks of gestation. Which of the following actions should the nurse include in the plan of care? Ans Obtain a culture for group B streptococcus B-hemolytic. The nurse should plan to obtain a rectovaginal culture to screen for group 13/25 [25 gestation. Which of the following manifestations should the nurse report to the provider as potentially indicating a complication of pregnancy? Ans Frequent headaches Manifestations such as frequent headaches, visual disturbances, swelling of the face or fingers, and epigastric pain are manifestations of preeclampsia or hypertensive conditions during pregnancy. The nurse should identify frequent headaches as a potential complication of pregnancy and report this manifestation to the provider. 30. A nurse is reinforcing dietary teaching with a client who is at 10 weeks of gestation. Which of the following foods should the nurse identify as containing the highest amount of folate? Ans 3% oz beef liver The nurse should identify that 3 % oz of beef liver contains 200 mcg of folate. The nurse should instruct the client to consume at least 600 mcg of folate per day during pregnancy to decrease the risk of neural tube defects in the fetus. 31. A nurse in a clinic is caring for a client who tests positive for gonorrhea. Which of the following findings should the nurse expect during data collec- tion? Ans Chronic pelvic pain Female clients who have gonorrhea are often without symptoms. However, they might report increased vaginal discharge, chronic or acute severe pelvic or lower abdominal pain, irregular or more painful menstrual cycles, dysuria, and low back pain. 32. A nurse is contributing to the plan of care for a full-term newborn whose mother has type 1 diabetes mellitus. Which of the following is the priority action for the nurse to include in the plan of care? Ans Obtain the glucose level of the newborn. The newborn is at risk for developing hypoglycemia, If brain cells become completely depleted of glucose, brain damage can occur. Therefore, this is the priority action the nurse should include in the plan of care. 33.A nurse is collecting data from a newborn who has Down syndrome. Which of the following findings should the nurse expect in a term newborn who has Down syndrome? Ans Hypotonic muscle tone This hematocrit level is below the expected reference range of greater than 33% during pregnancy. The nurse should report this finding to the provider. 36. A nurse is contributing to the plan of care for a client who is in labor and tested positive for group B streptococcus B- hemolytic. Which of the following interventions should the nurse include in the plan of care? Ans Administer ampi- cillin via intermittent IV bolus. The nurse should administer ampicillin via intermittent IV bolus to the client who is positive for group B streptococcus B-hemolytic because transmission can occur during a vaginal birth, which can result in serious ilness in or death of the newborn. 37.A nurse is planning to administer phytonadione IM to a newborn shortly after birth. The nurse should identify that this medication is administered to prevent which of the following complications? Ans Hemorrhagic disease The nurse should administer phytonadione because the newborn does not produce vitamin K on their own until 7 days of age, when intestinal 19/25 flora is present in the newborn's gastrointestinal tract. Therefore, this medication is administered to prevent hemorrhagic disease in the newborn until spontaneous production of vitamin K takes place. 38. A nurse is assisting with the care of a client who is in active labor and notes late decelerations in the fetal heart rate, Which of the following actions should the nurse take first? Ans Place the client in a side-lying position. When using the urgent vs. nonurgent approach to client care, the nurse should identify that late decelerations indicate a disruption of oxygen to the fetus. Therefore, the first action the nurse should take is to place the client in a side-lying position to maximize blood flow to the placenta and increase oxygen transfer to the fetus. 39. A nurse in an antepartum clinic is collecting data from a client who is at 28 weeks of gestation. Which of the following findings should the nurse identify as an indication of a _ potential complication? Ans Dysuria The nurse should identify that dysuria is an unexpected finding during pregnancy that can indicate a urinary tract infection. The nurse should report this finding to the provider.