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hsi test/103 Questions and Answers (Maternity)
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hsi test/103 Questions and Answers(Maternity)
A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28-weeks
gestation in preterm labor. She is given 3 doses of terbutaline sulfate
(Brethine) 0.25 mg subcutaneously to stop her labor contractions. The nurse
plans to monitor for which primary side effect of terbutaline sulfate? - -
Tachycardia and a feeling of nervousness.
-side effects of magnesium sulfate - -Depressed reflexes and increased
respirations. A flushed, warm feeling and a dry mouth.
-Terbutaline sulfate (Brethine), a beta-sympathomimetic drug, - -stimulates
beta- adrenergic receptors in the uterine muscle to stop contractions
-primary side effect. Terbutaline sulfate (Brethine), a - -Tachycardia and a
feeling of nervousness.
-secondary side effect of Terbutaline sulfate (Brethine), a - -Drowsiness and
bradycardia.
-The nurse observes a new mother avoiding eye contact with her newborn.
Which action should the nurse take? - -Observe the mother for other
attachment behaviors.
-To assess for other attachment behaviors, continued observation of the
new mother's interactions with her infant - -Observe the mother for other
attachment behaviors. helps the nurse determine problems in attachment.
Ask the mother why she won't look at the infant may cause undue confusion,
stress, or impact the mother's self-confidence.
-A 4-week-old premature infant has been receiving epoetin alfa (Epogen) for
the last three weeks. Which assessment finding indicates to the nurse that
the drug is effective? - -Changes in apical heart rate from the 180s to the
140s.
-Epogen - -given to prevent or treat anemia, stimulates erythropoietin
production, resulting in an increase in RBCs. Since the body has not had to
compensate for anemia with an increased heart rate, changes in heart rate
from high to normal
-Epogen and RR - -Respiratory rate should decrease rather than increase
-Epogen and urinary output - -is not related to Epogen
, -Epogen and bilirubin - -is usually related to resolution of
hyperbilirubinemia, treated with phototherapy or increased oral intake in the
infant.
-A client with no prenatal care arrives at the labor unit screaming, "The baby
is coming!" The nurse performs a vaginal examination that reveals the cervix
is 3 centimeters dilated and 75% effaced. What additional information is
most important for the nurse to obtain? - -Date of last normal menstrual
period.
Evaluating the gestation of the pregnancy (C) takes priority. If the fetus is
preterm and the fetal heart pattern is reassuring, the healthcare provider
may attempt to prolong the pregnancy and administer corticosteroids to
mature the lungs of the fetus.
-A 30-year-old multiparous woman who has a 3-year-old boy and an
newborn girl
␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣
␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣␣ manage both children when I get home." How
should the nurse respond? - -Regression in behaviors in the older child is a
typical reaction so he needs attention at this time.
-Twenty-four hours after admission to the newborn nursery, a full-term male
infant develops localized edema on the right side of his head. The nurse
knows that, in the newborn, an accumulation of blood between the
periosteum and skull which does not cross the suture line is a newborn
variation known as - -a cephalhematoma, caused by forceps trauma and
may last up to 8 weeks.
Cephalhematoma (A), a slight abnormal variation of the newborn, usually
arises within the first 24 hours after delivery. Trauma from delivery causes
capillary bleeding between the periosteum and the skull
-A mother who is breastfeeding her baby receives instructions from the
nurse. Which instruction is most effective to prevent nipple soreness? - -
Correctly place the infant on the breast.
-The nurse is performing a gestational age assessment on a full-term
newborn during the first hour of transition using the Ballard (Dubowitz) scale.
Based on this assessment, the nurse determines that the neonate has a
maturity rating of 40-weeks. What findings should the nurse identify to
determine if the neonate is small for gestational age (SGA)? (Select all that
apply.) - -A. Admission weight of 4 pounds, 15 ounces (2244 grams). B. Head
to heel length of 17 inches (42.5 cm). C. Frontal occipital circumference of
12.5 inches (31.25 cm).
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