The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the

maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the
nurse expect to note if this condition is present?
1. Soft abdomen
2. Uterine tenderness
3. absence of abdominal pain
4. painless, bright red vaginal bleeding

The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is
experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the
health care provider's prescriptions and should question which prescription?
1.Prepare the client for an ultrasound.
2.Obtain equipment for a manual pelvic examination.
3.Prepare to draw a hemoglobin and hematocrit blood sample
4. Obtain equipment for external electronic fetal heart rate monitor

An ultrasound is preformed on a client at term gestation who is experiencing moderate vaginal bleeding.
The results of the ultrasound indicate that abruption placentae is present. On the basis of these findings,
the nurse should prepare the client for which anticipated prescription?
1.Delivery of the fetus.
2. Strict monitoring of intake and output
3.Complete bed rest for the remainder of the pregnancy
4. The need for weekly monitoring of coagulation studies until the time of delivery

The nurse is preforming an initial assessment on a client who has just been told that a pregnancy test is
positive. Which assessment finding indicates that the client is at risk for preterm labor?
1.The client is a 35 year old primigravida
2. The client has a history of cardiac disease
3. The client's hemoglobin level is 13.5 g/dL
4. The client is a 20 year old primigravida of average weight and height

The nurse is monitoring a client in active stage of labor. The client has been experiencing contractions
that are short, irregular, and weak. The nurse documents that the client is experiencing which type of
labor dystocia?
1. Hypotonic
2. Precipitous
3. Hypertonic
4. Preterm labor

After a precipitous delivery, the nurse notes that the new mother is passive and only touches her
newborn infant briefly with her fingertips. What should the nurse do to help the woman process the
delivery?
1.Encourage the mother to breastfed soon after birth
2. Support the mother in her reaction to the newborn infant
3.Tell the mother that it is important to hold the newborn infant.
4. document a complete account of the mother's reaction on the birth record.

The nurse in a labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal
compromise. Which assessment finding would alert the nurse to a compromise?
1. Maternal fatigue
2. coordinated uterine contractions
3. Progressive changes in the cervix
4. Persistent nonreassuring fetal heart rate

The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is
beginning the second stage of labor?
1. The contractions are regular.
2. The membranes have ruptured
3. The cervix is completely dilated
4. The client starts to expel clear vaginal fluid

The nurse is preforming an assessment of a client who is scheduled for a cesarean delivery. Which
assessment finding would indicate the need to contact the health care provider?
1. Hemoglobin of 11g/dL
2. Fetal heart rate of 180 beats/minute
3. Maternal pulse rate of 85 beats/minute
4. White blood cell count of 12,000 cells/mm3

The nurse is reviewing the record of a client in the labor room and notes that the health care provider
had documented the fetal presenting part is at the -1 station. This documented finding indicates that the
fetal presenting part is located at which area?
1. 1 inch below the coccyx
2. 1 inch below the iliac crest
3. 1 cm above the ischial spine
4. 1 fingerbreadth below the symphysis pubis

A client arrives at birthing center in active labor. Her membranes are still intact, and the health care
provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely
outcome of the amniotomy?
1. less pressure on her cervix
2. decreased number of contractions
3. increased efficiency of contractions
4. the need for increased maternal blood pressure monitoring

A postpartum nurse is taking the vital signs of a client who delivered a healthy infant 4 hours ago. The
nurse notes that the client's temperature is 100.2 degrees Farenheit. Which of the following actions
would be appropriate?
1. Notify the physician.
2. Document the findings.
3. Retake the temperature in 15 minutes.
4. Increase hydration by encouraging oral fluids.

A nurse is assessing a client who is 6 hours post-partum after delivering a full-term healthy infant. The
client complains to the nurse of feelings of faintness and dizziness. Which nursing action would be most
appropriate?
1. Elevate the client's legs.
2. Determine the hemoglobin and hematocrit levels.
3. Instruct the client to request help when getting out of bed.
4. Inform the nursery room nurse to avoid bringing the newborn infant to the client until the feelings of
faintness and dizziness have subsided.

A postpartum nurse is providing instructions to a client after delivery of a healthy infant. The nurse
instructs the client that she should expect normal bowel elimination to return:
1. 3 days postpartum
2. 7 days postpartum
3. On the day of delivery
4. Within 2 weeks postpartum

A nurse is planning care for a postpartum client who had a vaginal delivery 2 hours ago. The client had a
midline episiotomy and has several hemorrhoids. What is the priority nursing diagnosis for this client?
1. Acute pain
2. Disturbed body image
3. Impaired urinary elimination
4. Risk for imbalanced fluid volume

A nurse is monitoring the amount of lochia drainage in a client who is 2 hours postpartum and notes that
the client has saturated a perineal pad in 1 hour. The nurse reports the amount of lochial flow as:
1. Scant
2. Light
3. Heavy
4. Excessive

A nurse is teaching a postpartum client about breast-feeding. Which of the following instructions should
the nurse include?
1. The diet should include additional fluids.
2. Prenatal vitamins should be discontinued.
3. Soap should be used to cleanse the breasts.
4. Birth control measures are unnecessary while breast-feeding.

A nurse is prepared to perform a fundal assessment on a postpartum client. The initial nursing action in
performing this assessment is which of the following?
1. Ask the client to turn on her side.
2. Ask the client to urinate and empty her bladder.
3. Massage the fundus gently before determining the level of the fundus.
4. Ask the client to lie flat on her back with the knees and legs flat and straight.
A nurse is caring for four 1-day postpartum clients. Which client has an abnormal finding that would
require further intervention?
1. The client with mild afterpains.
2. The client with a pulse rate of 60 beats per minutes
3. The client with colostrum discharge from both breasts.
4. The client with lochia that is read and has a foul-smelling odor.

A nurse is providing postpartum instructions to a client who will be breast-feeding her newborn. The
nurse determines that the client has understood the instructions if she makes which of the following
statements. SATA
1. "I should wear a bra that provides support."
2. "Drinking alcohol can affect my milk supply."
3. "The use of caffeine can decrease my milk supply."
4. "I will start my estrogen birth control pills again as soon as I get home."
5. "I know if my breasts get engorged I will limit my breast-feeding and supplement the baby/"
6. "I plan on having bottled water available in the refrigerator so I can get additional fluids easily."

When performing a postpartum assessment on a client, a nurse notes the presence of clots in the lochia.
The nurse examines the clots and notes that they are larger than 1 centimeter. Which nursing action is
appropriate?
1. Notify the physician.
2. Document the findings.
3. Reassess the client in 2 hours.
4. Encourage increased oral intake of fluids.

A nurse in a delivery room is assisting with the delivery of a newborn. After delivery, the nurse prepares
to prevent heat loss in the newborn resulting from evaporation by:
1. Warming the crib pad.
2. Closing the doors to the room.
3. Drying the infant with a warm blanket.
4. Turning on the overhead radiant warmer.

The mother of a newborn calls a clinic and reports to a nurse that when cleaning the umbilical cord, the
mother noticed that the cord was moist and that discharge was present. The appropriate nursing
instruction to the mother is which of the following?
1. Bring the infant to the clinic.
2. This is a normal occurrence.
3. Increase the number of times that the cord is cleaned per day.
4. Monitor the cord for another 24 - 48 hours and call the clinic if the discharge continues.

A nurse in a newborn nursery receives a telephone call the prepare for the admission of a 43-week
gestation newborn with Apgar scores of 1 & 4. In planning for admission of this newborn, the nurse's
highest priority should be to:
1. Turn on the apnea and cardiorespiratory monitors.
2. Connect the resuscitation bag to the oxygen outlet.
3. Set up the I.V. line with 5% dextrose in water.
4. Set the radiant warmer control temperature at 97.6 degrees F.

A nurse is assessing a newborn infant after circumcision and notes that the circumcised area is red with a
small amount of bloody drainage. Which of the following nursing actions is appropriate?
1. Contact the physician.
2. Apply gentle pressure.
3. Reinforce the dressing.
4. Document the findings.

A nurse in a newborn nursery is monitoring a preterm newborn for respiratory distress syndrome. Which
assessment signs noted in the newborn would alert the nurse to the possibility of this syndrome?
1. Tachypnea and retractions.
2. Acrocyanosis and grunting.
3. Hypotension and bradycardia.
4. Presence of a barrel chest with acrocyanosis.

A postpartum nurse is providing instruction to the mother of a newborn with hyperbilirubinemia who is
being breast-fed. The nurse provides which appropriate instruction to the mother?
1. Feed the newborn less frequently.
2. Continue to breast-feed every 2 to 4 hours.
Switch to bottle-feeding the infant for 2 weeks.
4. Stop breast-feeding and switch to bottle-feeding permanently.

A nurse is assessing a newborn who was born to a mother who is addicted to drugs. Which assessment
finding would the nurse expect to note during the assessment of this newborn?
1. Lethargy
2. Sleepiness
3. Incessant crying
4. Cuddles when being held

A nurse notes hypotonia, irritability, and a poor sucking reflex in a full-term newborn on admission to the
nursery. The nurse suspects fetal alcohol syndrome and is aware that which additional sign would be
consistent with fetal alcohol syndrome?
1. Length of 19 inches
2. Abnormal palmar creases
3. Birth weight of 6 pounds, 14 ounces
4. Head circumference appropriate for gestational age.

A nurse is preparing a plan of care for a newborn with fetal alcohol syndrome. The nurse should include
which priority intervention in the plan of care?
1. Allow the newborn to establish own sleep-rest pattern.
2. Maintain the newborn in a brightly lighted area of the nursery.
3. Encourage frequent handling of the newborn by staff and parents.
4. Monitor the newborn's response to feedings and weight gain pattern.
A nurse administers erythromycin ointment 0.5% to the eyes of a newborn and the mother asks the
nurse why this is performed. The nurse explains to the mother that this is routinely done to:
1. Protect the newborn's eyes from possible infections acquired while hospitalized.
2. Prevent cataracts in the newborn born to a woman who is susceptible to rubella.
3. Minimize the spread of micoorganisms to the newborn from invasive procedures during labor.
4. Prevent ophthalmia neonatorum from occuring after delivery in a newborn born to a woman with
untreated gonococcal infection.

A nurse prepares to administer a Vitamin K injection to a newborn, and the mtoher asks the nurse why
her infant needs the injection. The best response by the nurse would be:
1. Your newborn needs Vitamin K to develop immunity.
2. The Vitamin K will protect your newborn from being jaundiced.
3. Newborns have sterile bowels, and Vitamin K promotes the growth of bacteria in the bowel.
4. Newborns are deficient in Vitamin K, and this injection prevents your newborn from bleeding.

A nurse develops a plan of care for a woman with HIV and her newborn. The nurse includes which
intervention in the plan of care?
1. Monitoring the newborn's vital signs routinely.
2. Maintaining standard precautions at all times while caring for the newborn.
3. Initiating referral to evaluate for blindness, deafness, learning problems, or behavioral problems.
4. Instruction the breast-feeding mother regarding the treatment of the nipples with nystatin ointment.

A nurse is planning care for a newborn of a diabetic mother. A priority nursing diagnosis for this infant is:
1. Hyperthermia related to excess fat and glycogen
2. Risk for injury related to low blood glucose levels
3. Risk for delayed development related to excessive size
4. Risk for aspiration related to impaired suck and swallow reflexes

The nurse determines that a new mother understands the teaching about prevention of newborn
abduction if she states:
1. I will place my baby's crib close to the door.
2. Some health care personnel won't have name badges.
3. It's okay to allow the nurse assistant to carry my newborn to the nursery.
4. I will ask the nurse to attend to my infant if I am napping and my husband is not here.

The nurse is preparing to care for a newborn receiving phototherapy. Which interventions are
appropriate? SATA
1. Avoid stimulation.
2. Decrease fluid intake.
3. Expose all of the newborn's skin.
4. Monitor skin temperature closely.
5. Reposition the newborn every 2 hours.
6. Cover thew newborn's eyes with eye shields or patches.

A nurse is caring for a client who is receiving Oxytocin/Pitocin to induce labor. The nurse discontinues the
infusion if which of the following is noted on assessment of the client?
1. Fatigue
2. Drowsiness
3. Uterine Hyperstimulation
4. Early decelerations of the fetal heart rate

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse
determines that the client is experiencing toxicity from the medication if which of the following is noted
on assessment?
1. Proteinuria of 3+
2. Respirations of 10 breaths per minute
3. Presence of deep tendon reflexes
4. Serum magnesium level of 6 milliequivilents per liter

Methergine is prescribed for a client with postpartum hemorrhage. Before administering the medication,
a nurse contacts the health care provider who prescribed the medication if which condition is
documented in the client's medical history?
1. Hypotension
2. Hypothyroidism
3. Diabetes mellitus
4. Peripheral vascular disease

A nursing instructor asks a nursing student to describe the procedure for administering erythromycin
ointment to the eyes of a newborn. The instructor determines that the student needs to research this
procedure further if the student states that:
1. I will flush the eyes after instilling ointment.
2. I will clean the newborn's eyes before instilling the ointment.
3. I need to administer the eye ointment within 1 hour after delivery.
4. I will instill the eye ointment into each of the newborn's conjunctival sacs.

A client in preterm labor at 31 weeks who is dilated to 4 centimeters has been started on magnesium
sulfate and contraction have stopped. If the client's labor can be inhibited for the next 48 hours, what
medication does the nurse anticipate will be prescribed?
1. Bethamethasone
2. Nubain
3. RhoGam
4. Cervidil vaginal insert

Methergine is prescribed for a woman to treat postpartum hemorrhage. Before administration of

methergine, the priority nursing assessment is to check the:
1. Uterine tone
2. Blood pressure
3. Amount of lochia
4. Deep tendon reflexes

A nurse is preparing to administer Survanta to to a premature infant who has respiratory distress
syndrome. The nurse plans to administer the medication by which of the following routes?
1. Intradermal
2. Intratracheal
3. Subcutaneous
4. Intramuscular

An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures
that which medication is readily available if respiratory depression occurs?
1. Bethamethasone
2. Morphine sulfate
3. Narcan
4. Demerol

RhoGam is prescribed for a client after delivery and the nurse provides information to the client about
the purpose of the medication. The nurse determines that the woman understands the purpose of the
medication if the woman states that is will protect her next baby from which of the following?
1. Having Rh-positive blood
2. Developing a rubella infection
3. Developing physiological jaundice
4. Being affected by Rh incompatibility

- A nurse is monitoring a client in preterm labor who is receiving I.V. magnesium sulfate. The nurse
monitors for which adverse reactions of this medication? SATA
1. Flushing
2. Hypertension
3. Increased urine output
4. Depressed respirations
5. Extreme muscle weakness
6. Hyperactive deep tendon reflexes

lightening

descent of the uterus into the pelvic cavity that occurs late in pregnancy

Braxton Hicks Contractions

intermittent painless uterine contractions that occur with increasing frequency as the pregnancy
progresses

effacement

Thinning and shortening or obliteration of the cervix that occurs during late pregnancy or labor or both.

process of labor
passageway, passengers, powers, position of mother, psyche

linea terminalis

pelvic inlet

attitude

relationship of fetal body parts to one another

flexion

at term, the ideal attitude for the fetal body is this

fetal position

the relationship of the occiput, sacrum, chin, or scapula of the fetus to the front, back, or sides of the
mother's pelvis

oligohydramnios

too little amniotic fluid often indicative of fetal urinary tract defect

fetal lie

relationship of the cephalocaudal (head-to-buttocks) axis of the fetus to the cephalocaudal axis of the
mother

fetal presentation

that part of the fetus that first enters the pelvis and lies over the inlet (head, face, breech, or shoulders)
describes the part that will bein contact with the cervix

hypoxia

insufficient availability of oxygen to meet metabolic needs is indicated by nonreassuring FHR patterns
meconium or meonium staining

first stools of the infant: vscid, sticky, dark greenish brown, almost black, sterile, odorless) being released
from the fetal rectum in response to hypoxia

engagement

occurs when the biparietal diameter of the fetal head crosses the inlet of the pelvis

descent

downward progress of the presenting part

internal rotation

enables the fetal head to progress through the maternal pelvis

extension

occurs when the occiput passes under the symphysis pubis

restitution

as soon as the head is delivered, it moves to realign with the body and shoulders

external rotaiton

occurs as the shoulders and body move through the birth canal, using the same maneuvers as the head

expulsion

the body of the infant leaves the pelvis

first stage of L&D

dilation; early latent phase 0-3 cm dilation; mid-active phase, 4-7 cm; transitional phase, 7-10 cm

second stage of L&D

delivery, average length is 30 minutes to 2 hours

third stage of L&D

delivery of the placenta

oxytocin

hormone produced by the pituitary gland, drug that stimulates uterine contractions, thus acelerating
childbirth and preventing postdelivery hemorrhage, causes uterus to contract

fourth stage of L&D

stabilization, 2-4 hours monitored

apgar score

done at 1 and 5 minutes of age, criteria includes heart rate, respiratory effort, muscle tone, reflex
irritability, and skin color. Low score indicates serious problems that may require resuscitation. High
score indicates good condition 8-10 is considered optimal

surfactant

this decreases surface tension within the alveoli and permits inflation. At time of delivery, a combination
of chemical, thermal, tactile, and mehanical changes initiates the first breath

amniotomy

artificial rupture of the fetal membrane (AROM)

uterine inertia

absence or weakness of uterine contractions

fetopelvic disproportion

the head of the fetus is larger than the pelvic outlet

puerperium
the period of about six weeks after childbirth during which the mother's reproductive organs return to
their original non-pregnant condition

involution

reduction in size of an organ or part (as in the return of the uterus to normal size after childbirth)

autolysis

the self-dissolution or self-digestion that occurs in tissues or ells by enzymes in the cells themselves

lochia

vaginal discharge during puerperium consisting of blood, tissue and mucus

lochia rubra

amount of blood content is greatest, resulting in bright red drainage generally seen the first day or two
after delivery

lochia serosa

as healing of the placental site occurs, the discharge becomes pink to brown which generally occurs until
the seventh day

lochia alba

after seventh day the drainage is slightly yellow to white

signs of hypovolemic shock

persistent sig bleeding; woman states she feels weak, lightheaded, woman begins to act anxious or
exhibits air hunger; woman's skin turns ashen or grayish; skin feels cool and clammy; pulse rate
increases; blood pressure declines

lactation

function of secreting milk or period during which milk is secreted

prolactin

a hormone secreted by the anterior pituitary gland, is responsible for stimulating milk production in the
mammary alveolar cells

diuresis

the increased formation and secretion of urine

bubble he

breasts, uterus, bladder, bowel, lochia, episiotomy, Homan's sign, emotional status

acrocyanosis

hands and feet may appear slightly blue

harlequin sign

half of the newborn's body appears deep red and the other side of the body appears pale as a result of
vasomotor disturbance, with some vessels constricting while others dilate

icterus neonatorum

first detected over bony prominences on the face and on the mucous membranes. This is abnormal
during the first 24 hours of life. After 24 hours not necessarily abnormal

physiologic jaundice

occuring 48 hours or later after birth, gradually disappearing by the seventh to tenth day and caused by
the normal reduction in the numer of red blood cells may appear because the excessive levels of
hemoglobins are no longer reuired for oxygen transport

vernix caseosa

at birth the skin is covered with a yellowish white cream cheeselike substance

lanugo

downy, fine hair char of the fetus between 20 weeks of gestation and birth; most noticeable over the
shoulders, forehead and cheeks but it is found on nearly all parts of the body except the palms of the
hands, soles of the feet and scalp

fontanelles

broad area or soft spot consisting of a strong band of connective tissue contiguous with touching cranial
bones and located at the junction of the bones

anterior fontanelle

normally large and diamond shaped and closes at approximately 18 months of age

posterior fontanelle

smaller and triangular in shape and normally closes at 2 months of age

molding

overlapping of bones of the skull happens during delivery

caput succedaneum

commonly seen with molding, it is the result of edema in the soft tissue of the scalp, the tissue feels
spongy and may be felt over suture lines. This disappears without treatment

cephalhematoma

caused by bleeding within the periosteum of a cranial bone. It is confined to a particular bone and does
not cross suture lines usually the result of difficult labor and generally appear 1-2 days after birth.
Normally absorb w/o treatment
Epstein's pearls

small, white nodules may be observed on the hard palate and results because of epithelial cells and will
disappear spontaneously within a few weeks.

ophthalmia neonatorum

infection in the neonate's eyes, usually resulting from gonorrheal or other infection contracted when the
fetus passes through the birth canal

strabismus

crossed eyes

nystagmus

abnormal motion of the eyes

umbilical cord

whitish blue-gray with three vessels (one vein and two arteries) and contains a gelatinous tissue called
Wharton's jelly

pseudomenstruation

may occur in response to maternal hormones

cryptorchidism

testicles that have not descended, usually found in preterm infants

moro reflex

infant startle response to sudden, intense noise or movement. When startled the newborn arches its
back, throws back its head, and flings out its arms and legs.

tonic neck reflex

when infant's head is quickly tured to one side, arm, and leg will extend on that side, and opposite arm
and leg will flex; posture resembles a fencing position

crawling reflex

when placed on abdomen, infant will make crawling movements with the arms and legs

dance or stepping reflex

infant is held so that sole of foot touches a hard surface, there wil be a reciprocal flexion and extension
of the leg, simulating walking

babinski reflex

when the sole of the foot is stroked along side of sole beginning at hel and then moving across ball of
foot to big toe, toes will fan out with dorsiflexion of big toe
Down syndrome

mongolism or trisomy 21 caused by the presence of an extra chromosome 21 in the G group

colostrum

breast milk's first substance produces thin, watery and slightly yellow rich in protein and calories in
addition to antibodies and lymphocytes

traditional milk

produced for about 1 week may appear thinner and more watery; and high in fats, lactose and water-
soluble vitamins and contains more calories than colostrum

mature milk

est by 2 weeks after delivery and may appear very thin and watery and provides 20 kcal per ounce and
contains lactose, proteins, minerals, and vitamins

morbidity

state of being diseased

mortality

quality or state of being subject to death

hyperemesis gravida

vomiting during pregnancy excessively to cause major electrolyte imbalances, metabolic and nutritional

hydatidiform mole

gestational trohpoblastic disease; usually fetus, placenta, amniotic membranes or fluid are present but
abnormal

ectopic pregnancy

pregnancy resulting from gestation elsewhere than in the uterus

spontaneous abortion

miscarriage

placenta previa

implantation of placenta in lower uterine segment; degrees: complete, partial or marginal; will have
cesarean birth

abruptio placentae

premature separation of placenta; either from trauma, maternal hypertension, high parity multifetal
gestation; social drug use

disseminated intravascular coagulation

coagulation defect that prevents blood from clotting; may occur with abruptio placentae, incomplete
abortion, hypertensive disease, infectious process, elevated fibrin levels lead to multiple small clots
which could obstruct vessels, cause ischemia, and damage vital organs; it's sudden; chest pain or
dyspnea; shock from hemorrhage; observe for signs of bleeding, vs, fhr, and I&O; needs IV
administration of fibrinogen, blood and other substances; deliver fetus

postpartum hemorrhage

two stage: early postpartum is blood loss greater than 500 mL after vaginal childbirth or 100 mL after
cesarean birth but this is not unusual during childbirth occurs within 24 hours; late postpartum
hemorrhage ocurs after the first 24 hours

pregnancy induced hypertension (gestational hypertension)

bp exceeds 140/90 after 20th week; increased bp, decreased placental perfusion, decreased renal
perfusion, altered glomerular filtration rate, and fluid and electrolyte imbalance