Which of the following correctly defines puerperium? 1. The 1st hour after birth 2. The 6 weeks following birth 3. The days spent in the hospital 4. The duration of breast-feeding

A client is 9 days postpartum and breast-feeding her baby. The client experiences pain, redness, and swelling of her left breast and is diagnosed with mastitis. The nurse teaching the client how to care for her infected breast should include which information? 1. Wear a loose-fitting bra to avoid constricting the milk ducts. 2. Stop breast-feeding permanently. 3. Take antibiotics until the pain is relieved. 4. Use a warm moist compress over the painful area.

When assessing the fetal heart rate tracing, the nurse becomes concerned about the fetal heart rate pattern. In response to the loss of variability, the nurse repositions the client to her left side and administers oxygen. These actions are likely to improve which of the following? 1. Fetal hypoxia 2. The contraction pattern 3. The status of a trapped cord 4. Maternal comfort 1. Fetal hypoxia 2. The contraction pattern 3. The status of a trapped cord 4. Maternal comfort

The nurse caring for a 3-day-old neonate notices that he looks slightly jaundiced. Although not a normal finding, it's an expected finding of physiologic jaundice and is caused by which of the following? 1. Poor clotting mechanism 2. High hemoglobin (Hb) levels between 14 and 20 g/100 ml of blood 3. Persistent fetal circulation 4. Large, immature liver

The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce labor. The nurse should be prepared for which maternal adverse reactions? 1. Hypertension 2. Jaundice 3. Dehydration 4. Fluid overload 5. Uterine tetany 6. Bradycardia

A client in her 15th week of pregnancy has presented with abdominal cramping and vaginal bleeding for the past 8 hours. She has passed several clots. What is the primary nursing diagnosis for this client? 1. Deficient knowledge (pregnancy) 2. Deficient fluid volume 3. Anticipatory grieving 4. Acute pain

A client's membranes rupture during the 36th week of pregnancy. Eighteen hours later, the nurse measures the client's temperature at 101.8° F (38.8° C). After initiating prescribed antibiotic therapy, the nurse should prepare the client for: 1. amniocentesis. 2. delivery. 3. sonography. 4. tocolytic therapy.

The nurse is assessing the psychosocial status of a postpartum client. Which finding is most likely to promote parent-neonate attachment? 1. Parental desire to bond with the neonate 2. Sustained parent-neonate contact immediately after delivery 3. Parental understanding of the importance of parent-neonate bonding 4. Previous positive childbirth experience

A client, age 19, has an episiotomy to widen her birth canal. Delivery extends the incision into the anal sphincter. This complication is called: 1. a first-degree laceration. 2. a second-degree laceration. 3. a third-degree laceration. 4. a fourth-degree laceration

Lochia normally progresses in which pattern? 1. Rubra, serosa, alba 2. Serosa, rubra, alba 3. Serosa, alba, rubra 4. Rubra, alba, serosa

A client is admitted to the maternity unit in active labor. Her cervix is dilated 4 cm. The physician prescribes etidocaine (Duranest), 150 mg via epidural catheter. What might account for the physician's choice of etidocaine over other local anesthetic agents? 1. It produces no vasoconstrictor effects. 2. It's least likely to cross the placenta. 3. It has the fastest onset of action. 4. It's least likely to cause cardiac arrhythmias

A client who has been in the latent phase of the first stage of labor enters the transition to the active phase. During the transition, the nurse expects to see which client behavior? 1. A desire for personal contact and touch 2. A full response to teaching 3. Fatigue, a desire for touch, and quietness 4. Withdrawal, irritability, and resistance to touch

After an amniotomy, which client goal should take the highest priority? 1. The client will express increased knowledge about amniotomy. 2. The client will maintain adequate fetal tissue perfusion. 3. The client will display no signs of infection. 4. The client will report relief of pain.

During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which answer should the nurse supply? 1. 7 days after fertilization 2. 14 days after fertilization 3. 21 days after fertilization 4. 28 days after fertilization

What is the most likely reason for a temperature of 99.8° F (37.7° C) during the first 24 hours postpartum? 1. Puerperal infection 2. Mastitis 3. Dehydration 4. Chorioamnionitis

The nurse is doing a neurologic assessment on a 1-day-old neonate in the nursery. Which findings would indicate possible asphyxia in utero? 1. The neonate grasps the nurse's finger when she puts it in the palm of his hand. 2. The neonate does stepping movements when held upright with sole of foot touching a surface. 3. The neonate's toes don't curl downward when soles of feet are stroked. 4. The neonate doesn't respond when the nurse claps her hands above him. 5. The neonate turns toward the nurse's finger when she touches his cheek. 6. The neonate displays weak, ineffective sucking.

During the admission assessment of a female neonate, the nurse notes a large lump on the baby's head. Concerned about making the correct assessment, the nurse differentiates between caput succedaneum and a cephalohematoma based on the knowledge that: 1. a cephalohematoma doesn't cross the suture lines. 2. caput succedaneum occurs primarily with primigravidas. 3. a cephalohematoma occurs with a birth that required instrumentation. 4. caput succedaneum occurs primarily with a prolonged second stage of labor.

A client who admits she uses heroin delivers a neonate at 32 weeks' gestation. Which neonatal assessment is most important for the nurse to perform? 1. Auscultation of breath sounds for signs of pulmonary problems 2. Careful observation of respiratory effort because of the neonate's prematurity 3. Evaluation for signs of drug withdrawal 4. Observation for jaundice

During neonatal resuscitation immediately after delivery, chest compressions should be initiated when the heart rate falls below which of the following? 1. 60 beats/minute 2. 80 beats/minute 3. 100 beats/minute 4. 110 beats/minute

The nurse notices that a client in the first stage of labor seems agitated. When the nurse asks why she's upset, she begins to cry and says, "I guess I'm a little worried. The last time I gave birth, I was in labor for 32 hours." Based on this information, the nurse should include which nursing diagnosis in the client's care plan? 1. Anxiety related to the facility environment 2. Fear related to a potentially difficult childbirth 3. Compromised family coping related to hospitalization 4. Acute pain related to labor contractions

During the active phase of the first stage of labor, a client undergoes an amniotomy. After this procedure, which nursing diagnosis takes the highest priority? 1. Deficient knowledge (testing procedure) related to amniotomy 2. Ineffective fetal cerebral tissue perfusion related to cord compression 3. Acute pain related to increasing strength of contractions 4. Risk for infection related to rupture of membranes

On the 2nd postpartum day, a client tells the nurse she feels anxious and tearful. Which response by the nurse would be appropriate? 1. "It isn't unusual to have those feelings after delivery." 2. "How have you coped with other problems in your life?" 3. "To whom do you usually talk when you have problems?" 4. "Don't worry. You'll be fine."

During a childbirth education class, a nurse-educator discusses pain control techniques used during labor and delivery. Which technique most effectively helps a client cope with the pain of uterine contractions? 1. Controlled breathing 2. Distraction 3. Cutaneous stimulation 4. Hypnosis

At 28 weeks' gestation, a client is admitted to the labor and delivery area in preterm labor. An I.V. infusion of ritodrine (Yutopar) is started. Which client outcome reflects the nurse's awareness of an adverse effect of ritodrine? 1. "The client remains free from tachycardia." 2. "The client remains free from polyuria." 3. "The client remains free from hypertension." 4. "The client remains free from hyporeflexia."

When preparing a postpartum client for discharge, the nurse teaches her about warning signs during the postpartum period. The nurse should instruct her to report: 1. scant lochia alba 2 to 3 weeks after delivery. 2. a temperature of 99.7° F (37.6° C) for 24 hours or more. 3. breast tenderness that is relieved by analgesics. 4. a red, warm, painful area in the breast.

At 32 weeks' gestation, a client is admitted to the facility with a diagnosis of pregnancy-induced hypertension (PIH). Based on this diagnosis, the nurse expects assessment to reveal: 1. edema. 2. fever. 3. glycosuria. 4. vomiting.

A client has progressed through the first stage of labor. Which assessment finding suggests she's in the transition to the second stage? 1. A decreased urge to push 2. Decreased bloody show 3. Fetal heart rate (FHR) accelerations 4. Bulging of the vaginal introitus

During labor, a client tells the nurse that her last baby "came out really fast." The nurse can help control a precipitous delivery by: 1. applying counterpressure to the fetus's head. 2. encouraging the client to push. 3. massaging and supporting the perineum. 4. instructing the client to contract the perineal muscles.

Late in the first stage of labor, a client receives a spinal block to relieve discomfort. A short time later, her husband tells the nurse that his wife feels dizzy and is complaining of numbness around her lips. What do the client's symptoms suggest? 1. Anesthesia overdose 2. Transition to the second stage of labor 3. Anxiety 4. Dehydration

An assisted birth using forceps or a vacuum extractor may be performed for ineffective pushing, for large infants, to shorten the second stage of labor, or for a malpresentation. The nurse caring for the mother following an assisted birth should keep which of the following in mind? 1. A vacuum extractor is safer than forceps because it causes less trauma to the baby and the mother's perineum. 2. The baby will develop a cephalohematoma as a result of the instrumentation. 3. The use of instruments during the birth process is a fairly rare occurrence. 4. Additional nursing interventions are needed to ensure an uncomplicated postpartum.

The nurse is evaluating the external fetal monitoring strip of a client who is in labor. She notes decreases in the fetal heart rate (FHR) that coincide with the client's contractions. What term does the nurse use to document this finding? 1. Prolonged decelerations 2. Early decelerations 3. Late decelerations 4. Accelerations

Which of the following hormones is responsible for the let-down reflex? 1. Oxytocin 2. Prolactin 3. Estrogen 4. Progesterone

A client who's a gravida 1 para 0 has been admitted to the perinatal admission unit and is in early labor. The client's cervical examination would reveal which of the following? 1. 2 cm dilated; 100% effaced at 0 station 2. 4 to 5 cm dilated; 80% effaced at –1 station 3. 2 cm dilated; 50% effaced at +1 station 4. 3 cm dilated; 50% effaced at 0 station

A nurse in the neonatal nursery is preparing to perform phenylketonuria (PKU) testing. Which baby is ready for the nurse to test? 1. A 3-day-old baby who has been fed I.V. since birth 2. A 2-day-old baby who has been breast-fed 3. A 1-day-old baby receiving formula 4. A breast-fed baby being discharged within 24 hours of birth

The nurse should tell new mothers who are breast-feeding that breast milk is produced when: 1. the placenta is delivered, causing the secretion of prolactin. 2. the newborn begins to suckle and stimulates the anterior pituitary to produce prolactin. 3. oxytocin is released from the posterior pituitary gland. 4. relaxin is released from the ovary.

When caring for a client who has had a cesarean section, which action is not appropriate? 1. Removing the initial dressing for incision inspection 2. Monitoring pain status and providing necessary relief 3. Supporting self-esteem concerns about delivery 4. Assisting with parental newborn bonding

A client is in the third stage of labor. Which finding indicates impending placental separation? 1. Increased maternal anxiety 2. Severe rectal pressure 3. Increased bloody show 4. Umbilical cord lengthening

The nurse is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client? 1. Risk for deficient fluid volume related to hemorrhage 2. Risk for infection related to the type of delivery 3. Acute pain related to the type of incision 4. Urinary retention related to periurethral edema

The nurse is assessing a neonate. Health history findings indicate that the mother drank 3 oz (89 ml) or more of alcohol per day throughout pregnancy. Which characteristic should the nurse expect to find? 1. Prominent nasal bridge 2. Thick upper lip 3. Upturned nose 4. Large for gestational age

For a client in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied? 1. The membranes must rupture. 2. The fetus must be at 0 station. 3. The cervix must be dilated fully. 4. The client must receive anesthesia.

When assessing a neonate who was born at 30 weeks' gestation, the nurse notes bounding femoral pulses, a palpable thrill over the suprasternal notch, tachycardia, tachypnea, and crackles. The nurse suspects: 1. ventricular septal defect. 2. patent ductus arteriosus. 3. tetralogy of Fallot. 4. atrial septal defect.

A client has meconium-stained amniotic fluid. Fetal scalp sampling indicates a blood pH of 7.12; fetal bradycardia is present. Based on these findings, the nurse should take which action? 1. Administer amnioinfusion. 2. Prepare for cesarean delivery. 3. Reposition the client. 4. Start I.V. oxytocin infusion as prescribed.

Which of the following describes a preterm neonate? 1. A neonate weighing less than 2,500 g (5 lb, 8 oz) 2. A low-birth-weight neonate 3. A neonate born at less than 37 weeks' gestation regardless of weight 4. A neonate diagnosed with intrauterine growth retardation

The nurse is teaching a client how to perform perineal care to reduce the risk of puerperal infection. Which activity indicates that the client understands proper perineal care? 1. Using a peri bottle to clean the perineum after each voiding or bowel movement 2. Cleaning the perineum from back to front after a bowel movement 3. Spraying water from peri bottle into the vagina 4. Changing perineal pads every 8 hours

Which of the following describes how the nurse interprets a neonate's Apgar score of 8 at 5 minutes? 1. A neonate who's in good condition 2. A neonate who's mildly depressed 3. A neonate who's moderately depressed 4. A neonate who needs additional oxygen to improve the Apgar score

A client, 7 months pregnant, is admitted to the unit with abdominal pain and bright red vaginal bleeding. Which action should the nurse take first? 1. Place the client on her left side and start supplemental oxygen, as ordered, to maximize fetal oxygenation. 2. Administer I.V. oxytocin, as ordered, to stimulate uterine contractions and prevent further hemorrhage. 3. Ease the client's anxiety by assuring her that everything will be all right. 4. Massage the client's fundus to help control the hemorrhage.

The certified nurse midwife places the neonate under the radiant heat unit for the nurse's initial assessment. The initial assessment includes heart rate 110 beats/minute and an irregular respiratory effort. The neonate is moving all extremities and his body is pink. He also has a vigorous cry. The nurse notes copious amounts of clear mucus present both orally and nasally. Based on these assessment findings, what should the nurse do next? 1. Assign an Apgar score of 7, place the neonate in modified Trendelenburg position, and begin artificial respirations. 2. Assign an Apgar score of 6, place in the neonate in modified Trendelenburg position, and initiate a code to gain assistance from the code team. 3. Assign an Apgar score of 9, place the neonate in modified Trendelenburg position, and suction the neonate's nose and oropharynx. 4. Assign an Apgar score of 10, place in the neonate in modified Trendelenburg position, and suction the neonate's nose.

At 5 minutes of age, a neonate is pink with acrocyanosis, has his knees flexed and fists clinched, has a whimpering cry, has a heart rate of 128, and withdraws his foot when slapped on the sole. What 5-minute Apgar score would the nurse record for this neonate? Sign Apgar Score 0 1 2 Heart rate Absent Less than 100 beats/minute (slow) More than 100 beats/minute Respiratory effort Absent Slow, irregular Good crying Muscle tone Flaccid Some flexion and resistance to extension of extremities Active motion Reflex irritability No response Grimace or weak cry Vigorous cry Color Pallor, cyanosis Pink body, blue extremities Completely pink

When assessing a postpartum client, the nurse notes a continuous flow of bright red blood from the vagina. The uterus is firm and no clots can be expressed. Which action should the nurse take? 1. Apply an ice pack to the perineum. 2. Massage the uterus every 15 minutes. 3. Notify the physician. 4. Reassure the client that such bleeding is normal.

One day after a client delivers a neonate, the nurse performs a postpartum assessment. At this time, the nurse expects to find: 1. lochia nigra. 2. lochia alba. 3. lochia serosa. 4. lochia rubra.

When assessing a neonate 1 hour after delivery, the nurse measures an axillary temperature of 95.6° F (35.3° C), an apical pulse of 110 beats/minute, and a respiratory rate of 64 breaths/minute. Which nursing diagnosis takes highest priority at this time? 1. Hypothermia related to heat loss 2. Impaired parenting related to the addition of a new family member 3. Risk for deficient fluid volume related to insensible fluid losses 4. Risk for infection related to transition to the extrauterine environment

The nurse brings a new mother her baby for the first time approximately 1 hour after the baby's birth. After checking the identification, the nurse hands the baby to the mother. Within a few minutes, the mother begins to undress her baby. Which of the following should the nurse do? 1. Call the pediatrician and report the behavior. 2. Anticipate and support the behavior as a normal part of bonding. 3. Encourage the mother to rewrap the baby because the room is cold. 4. Take the baby back to the nursery and recheck the baby's temperature.

A 2-day-old neonate hasn't been eating well, is irritable, and has a temperature of 101° F axillary. The nursery nurse anticipates that the physician will most likely prescribe which tests? 1. Cerebrospinal fluid (CSF) and blood cultures and a complete blood count (CBC) 2. Urinalysis 3. Blood culture and a throat culture 4. CBC and arterial blood gas analysis

A gravida 5 para 2 client delivers a 3,000-gram neonate at 38 weeks' gestation. During the assessment, the nurse notes that the neonate is hyperactive, jittery, and has a hyperactive rooting reflex combined with inconsolable crying. She also notes intrauterine growth retardation and suspect facial characteristics, such as short palebral fissures, flattened midfacies, short upturned nose, thin upper lip, and smooth philtrum. Based on these findings, what information should the nurse include in the mother's discharge plan? 1. Referral to an alcohol treatment counselor 2. Client education on isotretinoin (Retin-A) 3. Instructions on dietary sources of folic acid 4. Referral to cocaine treatment counselor