Mat 2 Which task could be appropriately

Mat 2 Which task could be appropriately delegated to the unlicensed assistive personnel (UAP) working with the nurse at the obstetric clinic? Checking the blood pressure of a patient who is 36 weeks’ pregnant and reports a headache Removing the adhesive skin closure strips of a patient who had a cesarean section 2 weeks ago Giving community resource information and emergency numbers to a prenatal patient who may be experiencing domestic violence 4 A 19-year-old gravida 1, para 0 patient at 40 weeks’ gestation who is in labor is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are priority assessments with this medication? Select all that apply. Check deep tendon reflexes. Observe for vaginal bleeding. Check the respiratory rate. Note the urine output. Monitor for calf pain. 11 A pregnant woman at 12 weeks’ gestation tells the nurse that she is a vegetarian. What would be the first appropriate nursing action? Recommend vitamin B12 and iron supplementation. Recommend consumption of protein drinks daily. Obtain a 24-hour diet recall history. Determine the reason for her vegetarian diet. 12 A 26-year-old gravida 1, para 1 patient who underwent cesarean section 24 hours ago tells the nurse that she is having some trouble breast feeding. Which tasks could be appropriately delegated to the unlicensed assistive personnel (UAP) on the postpartum floor? Select all that apply. Providing the mother with an ordered abdominal binder Assisting the mother with breast feeding Taking the mother’s vital signs Checking the amount of lochia present Assisting the mother with ambulation 13 Which action by a newly graduated RN during a delivery complicated by shoulder dystocia would require immediate correction by the nurse who is orienting her? Applying fundal pressure Applying suprapubic pressure Requesting immediate presence of the neonatologist Flexing the maternal legs back across the maternal abdomen 14 Which statements by a new father indicate that additional discharge teaching is needed for this family, who had their first baby 24 hours ago? Select all that apply. “We have a crib ready for our baby with lots of stuffed animals and two quilts that my mother made.” “My wife wants to receive the flu shot before she goes home.” “We will bring our baby to the pediatrician in 3 weeks.” “I will give the baby formula at night so my wife can rest. She will breast feed in the daytime.” “We will always put our baby to sleep in a face-up position.” 15 The charge nurse in the labor and delivery unit needs to assign two patients to one of the RNs because of a staffing shortage. Normally the unit has nurse-patient ratio of 1:1. Which two patients should the charge nurse assign to the RN? A 30-year-old gravida 1, para 0 (G1P0) woman, 40 weeks, 2 cm/90% effaced/-1 station A 25-year-old G3P2 woman, 38 weeks, 8 cm/100% effaced/0 station A 26-year-old G1P1 woman who delivered via normal vaginal delivery 15 minutes ago A 17-year-old G1P0 woman with premature rupture of membranes, no labor at 35 weeks A 40-year-old G6P5 woman with contractions at 28 weeks who has not yet been evaluated by the health care provider 16 While assessing a 29-year-old gravida 2, para 2 patient who had a normal spontaneous vaginal delivery 30 minutes ago, the nurse notes a large amount of red vaginal bleeding. What would be the first priority nursing action? Check vital signs. Notify the health care provider. Firmly massage the uterine fundus. Put the baby to breast. 17 A 30-year-old gravida 1, para 0 woman at 39 weeks’ gestation experienced a fetal demise and has just delivered a female infant. Her husband is at the bedside. Which are appropriate nursing actions at this time? Select all that apply. Offer the option of autopsy to the parents. Stay with the parents and offer supportive care. Place the infant on the maternal abdomen. Clean and wrap the baby and offer the infant to the parents to view or hold when desired. Ask the parents if there are any special rituals in their religion or culture for a baby who has died that they would like to have done. 18 A 27-year-old patient underwent a primary cesarean section because of breech presentation 24 hours ago. Which assessment finding would be of the most concern? Small amount of lochia rubra Temperature of 99°F (37.2°C) Slight redness of the left calf Pain rated as 3 of 10 in the incisional area 19 A 22-year-old gravida 1, para 0 woman is being given an epidural anesthetic for pain control during labor and birth. Which are appropriate nursing actions when epidural anesthesia is used during labor? Select all that apply. Request the anesthesiologist to discontinue the epidural anesthetic when the patient’s cervix is completely dilated to allow the patient to sense the urge to push. Insert an indwelling catheter because the woman is likely to be unable to void. Encourage pushing efforts when the cervix is completely dilated in the absence of an urge to push. Encourage the patient to turn from side to side during the course of labor. Teach the patient that pain relief can be expected to last 1 to 2 hours. 20 A 36-year-old gravida 1, para 0 patient has received an epidural anesthetic. Her cervix is 6 cm dilated. Her blood pressure is currently 60/38 mm Hg. Which would be appropriate priority nursing actions? Select all that apply. Place the patient in high Fowler position. Turn the patient to a lateral position. Notify the anesthesiologist. Prepare for emergency cesarean section. Decrease the IV fluid rate. 22 A 25-year-old gravida 2, para 1 patient has come to the obstetric triage room at 32 weeks’ gestation reporting painless vaginal bleeding. The nurse is providing orientation for a new RN on the unit. Which statement by the new RN to the patient would require the nurse to promptly intervene? “I’m going to check your vital signs.” “I’m going to apply a fetal monitor to check the baby’s heart rate and to see if you are having contractions.” “I’m going to “I’m going to perform a vaginal examination to see if your cervix is dilated.”perform a vaginal examination to see if your cervix is dilated.” “I’m going to feel your abdomen to check the position of the baby.” 23 A 30-year-old gravida 6, para 5 woman at 12 weeks’ gestation has just begun prenatal care, and her initial laboratory work reveals that she has tested positive for human immunodeficiency virus (HIV) infection. What would be priority evidence-based nursing education for this patient today? Medication for HIV infection is safe and can greatly reduce transmission of HIV to the infant. Breast feeding is still recommended due to the great benefits to the infant. Pregnancy is known to accelerate the course of HIV disease in the mother. Cesarean section is not recommended because of the increased risk of HIV transmission with the bleeding at surgery. 24 A 22-year-old woman is 6 weeks postpartum. In the clinic, she admits to crying every day, feeling overwhelmed, and sometimes thinking that she may hurt the baby. What would be the priority nursing action at this time? Advise the patient of community resources, parent groups, and depression hotlines. Counsel the mother that the “baby blues” are common at this time and assess her nutrition, rest, and availability of help at home. Contact the health care provider to evaluate the patient before allowing her to leave the clinic. Advise the woman that she cannot use medication for depression because she is breast feeding. 25 A 23-year-old gravida 1, para 0 patient at 10 weeks’ gestation states that she exercises 5 days a week. The nurse has discussed exercise in pregnancy with her. Which statement by the patient indicates that more teaching of evidence-based principles is needed? “I will continue to exercise 5 days a week.” “I will reduce my exercise at this time in my pregnancy to reduce the risk of miscarriage but will increase it in the second trimester.” “I will drink more fluid before and after exercising.” “I will stop playing football while I am pregnant.” 26 A 3-day-old breast-fed infant is brought to the clinic by his parents for routine assessment following a normal full-term delivery without complications. Which statement by the parents suggests an abnormal finding on a newborn of this age? “The baby urinated only three times yesterday.” “The bowel movement of the baby was dark at first, but yesterday it was greenish yellow.” “The baby cried for 2 hours last night.” “The baby ate four times in the past 24 hours.” 27 A full-term newborn is at the clinic with his parents. He is 4 days old. His birth weight was 7 lb (3.2 kg). Which assessment made by the RN is most significant? The infant’s weight today is 6 lb 9 oz (3 kg). The infant’s skin is peeling. The infant’s breast tissue is swollen. There is a yellow discharge from the infant’s right eye. 31 A same-sex couple are in the delivery room, and a healthy baby boy has just been born to one of the women. She breast fed the baby with a good latch, and now the baby has fallen asleep. She tells the nurse that both she and her partner are planning to breast feed the baby. What should the nurse do next? Wake the baby and help the baby to latch on to the other woman’s breasts. Alternate the baby between the two women for nursing. Inquire as to what preparation the partner has done for breast feeding. Let her know you will work with their plan while also assuring adequate intake for the baby Explain that the baby must first suck 20 minutes on each of the birth mother’s breasts and then can be placed on the other mother’s breasts. Suggest that the birth mother breast-feed the infant and the partner supplement the baby with formula. 32 A patient in labor had a positive QuantiFERON-TB gold tuberculosis (TB) test during pregnancy. A chest x-ray examination was done and showed no active TB in the lungs. How should the nurse care for this patient during the maternity stay? Isolate the mother, initiate droplet precautions, separate the mother and baby, and do not allow breast feeding at this time.ing at this time. The mother and infant can room together in isolation from the other maternity patients, and breast feeding should be encouraged. The patient requires no isolation procedures at this time and should be encouraged to breast feed. The patient should be encouraged to follow up postpartum for possible initiation of medication for latent TB treatment. Place a face mask on the mother while transporting her outside her room. Isolate her from the baby but encourage her to pump milk, which can be fed to the baby by a healthy family member. 33 The charge nurse is orienting a new nurse on the postpartum floor. What action by the new nurse would require intervention by the charge nurse? Telling a patient with active varicella that she may breast-feed her newborn Telling a patient with active varicella that she should pump her milk and a healthy family member may feed her milk to the infant Telling a patient with active varicella that other family members should be vaccinated against varicella Telling a patient with active varicella that she must wear a face mask when being transported from her room 34 The health care provider has ordered a flu vaccine for a patient in the prenatal clinic. As the nurse prepares to give it, the patient states she does not want the vaccine as she never gets it and never had the flu. How can the nurse best respond to the patient? Respect the patient’s preference and offer education on how to avoid getting the flu by good hand washing, good nutrition, and adequate rest. Inform the patient that changes in the heart, lungs, and immune system in pregnancy puts her in a higher risk group for complications of flu and that the flu in pregnancy is also associated with pregnancy complications such as premature delivery. Inform the patient that it is acceptable to defer the vaccine until the postpartum period if she is worried about vaccine’s effects in pregnancy. Explain that the vaccine is mandatory in pregnancy. Maternal newborn remediation 2 Which task could be appropriately delegated to the unlicensed assistive personnel (UAP) working with the nurse at the obstetric clinic? Checking the blood pressure of a patient who is 36 weeks’ pregnant and reports a headache Removing the adhesive skin closure strips of a patient who had a cesarean section 2 weeks ago Giving community resource information and emergency numbers to a prenatal patient who may be experiencing domestic violence 4 A 19-year-old gravida 1, para 0 patient at 40 weeks’ gestation who is in labor is being treated with magnesium sulfate for seizure prophylaxis in preeclampsia. Which are priority assessments with this medication? Select all that apply. Check deep tendon reflexes. Observe for vaginal bleeding. Check the respiratory rate. Note the urine output. Monitor for calf pain. 11 A pregnant woman at 12 weeks’ gestation tells the nurse that she is a vegetarian. What would be the first appropriate nursing action? Recommend vitamin B12 and iron supplementation. Recommend consumption of protein drinks daily. Obtain a 24-hour diet recall history. Determine the reason for her vegetarian diet. 12 A 26-year-old gravida 1, para 1 patient who underwent cesarean section 24 hours ago tells the nurse that she is having some trouble breast feeding. Which tasks could be appropriately delegated to the unlicensed assistive personnel (UAP) on the postpartum floor? Select all that apply. Providing the mother with an ordered abdominal binder Assisting the mother with breast feeding Taking the mother’s vital signs Checking the amount of lochia present Assisting the mother with ambulation 13 Which action by a newly graduated RN during a delivery complicated by shoulder dystocia would require immediate correction by the nurse who is orienting her? Applying fundal pressure Applying suprapubic pressure Requesting immediate presence of the neonatologist Flexing the maternal legs back across the maternal abdomen 14 Which statements by a new father indicate that additional discharge teaching is needed for this family, who had their first baby 24 hours ago? Select all that apply. “We have a crib ready for our baby with lots of stuffed animals and two quilts that my mother made.” “My wife wants to receive the flu shot before she goes home.” “We will bring our baby to the pediatrician in 3 weeks.” “I will give the baby formula at night so my wife can rest. She will breast feed in the daytime.” “We will always put our baby to sleep in a face-up position.” 15 The charge nurse in the labor and delivery unit needs to assign two patients to one of the RNs because of a staffing shortage. Normally the unit has nurse-patient ratio of 1:1. Which two patients should the charge nurse assign to the RN? A 30-year-old gravida 1, para 0 (G1P0) woman, 40 weeks, 2 cm/90% effaced/-1 station A 25-year-old G3P2 woman, 38 weeks, 8 cm/100% effaced/0 station A 26-year-old G1P1 woman who delivered via normal vaginal delivery 15 minutes ago A 17-year-old G1P0 woman with premature rupture of membranes, no labor at 35 weeks A 40-year-old G6P5 woman with contractions at 28 weeks who has not yet been evaluated by the health care provider 16 While assessing a 29-year-old gravida 2, para 2 patient who had a normal spontaneous vaginal delivery 30 minutes ago, the nurse notes a large amount of red vaginal bleeding. What would be the first priority nursing action? Check vital signs. Notify the health care provider. Firmly massage the uterine fundus. Put the baby to breast. 17 A 30-year-old gravida 1, para 0 woman at 39 weeks’ gestation experienced a fetal demise and has just delivered a female infant. Her husband is at the bedside. Which are appropriate nursing actions at this time? Select all that apply. Offer the option of autopsy to the parents. Stay with the parents and offer supportive care. Place the infant on the maternal abdomen. Clean and wrap the baby and offer the infant to the parents to view or hold when desired. Ask the parents if there are any special rituals in their religion or culture for a baby who has died that they would like to have done. 18 A 27-year-old patient underwent a primary cesarean section because of breech presentation 24 hours ago. Which assessment finding would be of the most concern? Small amount of lochia rubra Temperature of 99°F (37.2°C) Slight redness of the left calf Pain rated as 3 of 10 in the incisional area 19 A 22-year-old gravida 1, para 0 woman is being given an epidural anesthetic for pain control during labor and birth. Which are appropriate nursing actions when epidural anesthesia is used during labor? Select all that apply. Request the anesthesiologist to discontinue the epidural anesthetic when the patient’s cervix is completely dilated to allow the patient to sense the urge to push. Insert an indwelling catheter because the woman is likely to be unable to void. Encourage pushing efforts when the cervix is completely dilated in the absence of an urge to push. Encourage the patient to turn from side to side during the course of labor. Teach the patient that pain relief can be expected to last 1 to 2 hours. 20 A 36-year-old gravida 1, para 0 patient has received an epidural anesthetic. Her cervix is 6 cm dilated. Her blood pressure is currently 60/38 mm Hg. Which would be appropriate priority nursing actions? Select all that apply. Place the patient in high Fowler position. Turn the patient to a lateral position. Notify the anesthesiologist. Prepare for emergency cesarean section. Decrease the IV fluid rate. 22 A 25-year-old gravida 2, para 1 patient has come to the obstetric triage room at 32 weeks’ gestation reporting painless vaginal bleeding. The nurse is providing orientation for a new RN on the unit. Which statement by the new RN to the patient would require the nurse to promptly intervene? “I’m going to check your vital signs.” “I’m going to apply a fetal monitor to check the baby’s heart rate and to see if you are having contractions.” “I’m going to “I’m going to perform a vaginal examination to see if your cervix is dilated.”perform a vaginal examination to see if your cervix is dilated.” “I’m going to feel your abdomen to check the position of the baby.” 23 A 30-year-old gravida 6, para 5 woman at 12 weeks’ gestation has just begun prenatal care, and her initial laboratory work reveals that she has tested positive for human immunodeficiency virus (HIV) infection. What would be priority evidence-based nursing education for this patient today? Medication for HIV infection is safe and can greatly reduce transmission of HIV to the infant. Breast feeding is still recommended due to the great benefits to the infant. Pregnancy is known to accelerate the course of HIV disease in the mother. Cesarean section is not recommended because of the increased risk of HIV transmission with the bleeding at surgery. 24 A 22-year-old woman is 6 weeks postpartum. In the clinic, she admits to crying every day, feeling overwhelmed, and sometimes thinking that she may hurt the baby. What would be the priority nursing action at this time? Advise the patient of community resources, parent groups, and depression hotlines. Counsel the mother that the “baby blues” are common at this time and assess her nutrition, rest, and availability of help at home. Contact the health care provider to evaluate the patient before allowing her to leave the clinic. Advise the woman that she cannot use medication for depression because she is breast feeding. 25 A 23-year-old gravida 1, para 0 patient at 10 weeks’ gestation states that she exercises 5 days a week. The nurse has discussed exercise in pregnancy with her. Which statement by the patient indicates that more teaching of evidence-based principles is needed? “I will continue to exercise 5 days a week.” “I will reduce my exercise at this time in my pregnancy to reduce the risk of miscarriage but will increase it in the second trimester.” “I will drink more fluid before and after exercising.” “I will stop playing football while I am pregnant.” 26 A 3-day-old breast-fed infant is brought to the clinic by his parents for routine assessment following a normal full-term delivery without complications. Which statement by the parents suggests an abnormal finding on a newborn of this age? “The baby urinated only three times yesterday.” “The bowel movement of the baby was dark at first, but yesterday it was greenish yellow.” “The baby cried for 2 hours last night.” “The baby ate four times in the past 24 hours.” 27 A full-term newborn is at the clinic with his parents. He is 4 days old. His birth weight was 7 lb (3.2 kg). Which assessment made by the RN is most significant? The infant’s weight today is 6 lb 9 oz (3 kg). The infant’s skin is peeling. The infant’s breast tissue is swollen. There is a yellow discharge from the infant’s right eye. 31 A same-sex couple are in the delivery room, and a healthy baby boy has just been born to one of the women. She breast fed the baby with a good latch, and now the baby has fallen asleep. She tells the nurse that both she and her partner are planning to breast feed the baby. What should the nurse do next? Wake the baby and help the baby to latch on to the other woman’s breasts. Alternate the baby between the two women for nursing. Inquire as to what preparation the partner has done for breast feeding. Let her know you will work with their plan while also assuring adequate intake for the baby Explain that the baby must first suck 20 minutes on each of the birth mother’s breasts and then can be placed on the other mother’s breasts. Suggest that the birth mother breast-feed the infant and the partner supplement the baby with formula. 32 A patient in labor had a positive QuantiFERON-TB gold tuberculosis (TB) test during pregnancy. A chest x-ray examination was done and showed no active TB in the lungs. How should the nurse care for this patient during the maternity stay? Isolate the mother, initiate droplet precautions, separate the mother and baby, and do not allow breast feeding at this time.ing at this time. The mother and infant can room together in isolation from the other maternity patients, and breast feeding should be encouraged. The patient requires no isolation procedures at this time and should be encouraged to breast feed. The patient should be encouraged to follow up postpartum for possible initiation of medication for latent TB treatment. Place a face mask on the mother while transporting her outside her room. Isolate her from the baby but encourage her to pump milk, which can be fed to the baby by a healthy family member. 33 The charge nurse is orienting a new nurse on the postpartum floor. What action by the new nurse would require intervention by the charge nurse? Telling a patient with active varicella that she may breast-feed her newborn Telling a patient with active varicella that she should pump her milk and a healthy family member may feed her milk to the infant Telling a patient with active varicella that other family members should be vaccinated against varicella Telling a patient with active varicella that she must wear a face mask when being transported from her room 34 The health care provider has ordered a flu vaccine for a patient in the prenatal clinic. As the nurse prepares to give it, the patient states she does not want the vaccine as she never gets it and never had the flu. How can the nurse best respond to the patient? Respect the patient’s preference and offer education on how to avoid getting the flu by good hand washing, good nutrition, and adequate rest. Inform the patient that changes in the heart, lungs, and immune system in pregnancy puts her in a higher risk group for complications of flu and that the flu in pregnancy is also associated with pregnancy complications such as premature delivery. Inform the patient that it is acceptable to defer the vaccine until the postpartum period if she is worried about vaccine’s effects in pregnancy. Explain that the vaccine is mandatory in pregnancy. SCIENCE HEALTH SCIENCE NURSING NURS 4343

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