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Maternal Newborn Proctored Exam – Nursing Comprehensive Assessment

ATI Maternal Newborn Proctored Exam 2025

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88 

86 

Categorization 1 point 

A nurse is preparing to discharge a new family home and is reviewing safe sleep practices. Sort safe sleep practices into the “recommended” or “not 

Recommended 

No Answers Chosen 

Not recommended 

No Answers Chosen 

Possible answers 

#dressing the baby in an undershirt, sleeper, a sleep sack, and placing a fleece type blanket over the lower half of their body 

#sharing a bed with your newborn is helpful if the baby is not sleeping 4-6 hours at a time by 8 weeks of age 

Assure that your baby’s crib is entirely empty except for snug fitting crib sheet. 

co-rooming with the newborn for at least 6 month 

#placing the baby on their back to sleep 

#placing a firm pillow in your baby’s crib after three months of age 

87 

Multiple Choice 1 point 

Attempt to push the umbilical cord back into the uterus 

Assist the patient to a knee-chest positon and manually displace the presenting part of the fetus off the cord. 

Place an fetal electrode to monitor the fetus effectively 

Numeric 1 point 

The nurse is caring for a 38 week client who has preeclampsia with severe features. Magnesium sulfate, 4 grams IV is ordred to infuse over 30 minu a concentration of 20 grams/500 mL D5W. Calculate the IV pump rate in mL/hour. 

Answer 

85 

Multiple Choice 1 point 

A nurse is assessing a male newborn immediately after birth. Which of the following findings indicates the newborn has epispadias

The urethral opening is on the underside of the penis and urine cannot be exceted. 

The urethral opening is located on the midshaft underside of the penis and urine is excreted from the opening. 

There is not a urethral opening at the tip of the penis and urine cannot be excreted. 

The urethral opening is on the top of the penis glans and urine is able to be excreted from the urethra. 

84 

Multiple Choice 1 point 

In order to prevent neural tube defects, any patient who could become pregnant should be taking a multivitamin containing which nutrient? 

Folic actu 

C Iron 

C Vitamin

Vitamin A 

83 

Multiple Choice 1 point 

82 

82 

Multiple Choice 1 point 

A nurse is assessing a client who is at 36 weeks of gestation. Which of the following findings requires immediate follow-up? 

Breasts leaking colostrum 

Occassional contractions 

Decreased fetal movement 

Urinary frequency 

81 

Multiple Choice 1 point 

80 

79 

A patient presents to OB triage at 33 weeks gestation with c/o severe headache and right upper quadrant pain. The patient’s VS are Temp 98.1, Pulse There have been three attempts to secure IV access without success. What medication should the nurse expect the provider to order for urgent treat hypertension? 

hydralazine IV push 

Labetalol IV push 

Betamethasone IM x2 doses 24 hours apart 

Nifedipine, immediate release, PO 

Multiple Choice 1 point 

Recommendations for weight gain during pregnancy are based on what data 

The patient’s BMI at the end of the 1st trimester 

The patient’s prepregnancy body mass index 

The patient’s height 

The patient’s usual adult weight 

Multiple Answer 1 point 

A nurse is caring for a newborn who is experiencing jaundice and has been prescribed phototherapy. Which of the following interventions should the of care? 

Provide water suppliments after breast feeding 

Place eye patches on the baby while under phototherapty 

Restrict breastfeeding and feed the baby with formula so that the volume can be monitored 

Stop oral feeding and place an IV for nutrition/hydration 

Ensure good skin exposure by placing newborn under phototherapy light with just a diaper on 

78 

Multiple Choice 1 point 

What is the fetal positon in relation to the birthing pelvis in the image below? 

Left Occipital Posterior (LOP) 

Right Occipital Posterior (ROP) 

Right Occipital Anterior (ROA) 

Left Occipital Anterior (LOA) 

Multiple Choice 1 point 

A client that was diagnosed with gestational hypertension has come to the clinic for their 6 month postpartum visit. At this visit their Blood pressure wa been their average since their delivery date. What diagnosis does this client have? 

Chronic Hypertension 

Preeclampsia 

Gestational Hypertension 

O Inter-pregnancy hypertension 

A nurse is performing a health history interview with a client who is pregnant. Which of the following findings should the nurse identify as placing the clie pregnancy complications? (select all that apply) 

Currently smokes 2-3 cigarettes a day 

Uterine fibroids 

Two prior premature births 

Had an elective abortion a year ago 

Prior pregnancy was 3 years ago 

75 

Multiple Choice 1 point 

74 

73 

A nurse is working in an ambulatory setting that cares for pregnant clients. The nurse recognizes that Rh negative clients are at risk for sensitization blood cells. Administering RhoGAM antenatally and postpartm has reduced the morbidity for future pregnancies. What is the evidence based stand Rh negative clients? 

RhoGAM is only given to clients who are pregnant for the first time. 

RhoGAM is given to all pregnant clients at 28 weeks gestation antenatally. 

RhoGAM is give at 28 weeks antenatally and within 72 hours postpartum for clients who birth an Rh positive child. 

RhoGAM is only given when it is suspected that maternal and fetal blood cells have mixed. 

Multiple Choice 1 point 

Severe fetal anemia 

Cytomegalovirus (CMV) 

Ventricular septal defect (VSD) 

Meconium aspiration syndrome 

Multiple Choice 1 point 

During labor, a nurse frequently assesses the fetal heart rate pattern in response to labor. As the client progresses through the first stage of labor, v physiologic adaptations promote fetal oxygenation? 

Client bradyapnea 

Physiologic hypertension 

Decrease in client blood volume 

Increase in client’s cardiac output 

72 

Multiple Answer 1 point 

A nurse is caring for a newborn at 34 weeks gestation who was born 45 minutes ago. The nurse contacts the pediatrician with concern for respirator prematurity. What findings inform the nurse’s concerns? 

respiratory rate of 80 breaths per minute 

Intercostal retractions 

Axillary temperature of 99.0 degrees ferinheight 

Presence of acrocyanosis 

Nasal flaring 

72 

Multiple Answer 1 point 

A nurse is caring for a newborn at 34 weeks gestation who was born 45 minutes ago. The nurse contacts the pediatrician with con prematurity. What findings inform the nurse’s concerns? 

respiratory rate of 80 breaths per minute 

Intercostal retractions 

Axillary temperature of 99.0 degrees ferinheight 

Presence of acrocyanosis 

Nasal flaring 

70 

Ordering 1 point 

Order the progression of embryogenesis 

Embryo 

⠀ Zygote 

Blastocyst 

Fetus 

69 Matching 1 point 

Match the phase of the menstruation cycle with the physiological occurrence. 

Ovulation 

Follicular phase 

Menstruation 

Luteal Phase 

68 

Multiple Choice 1 point 

estrogen levels incre 

progesterone levels i stable 

shedding of the uteri 

the egg is released fr 

A nurse has been called to the room of a maternal client who has diabetes and just experienced a difficult vaginal birth at 40 weeks of gestation. Newborn vital signs are heart rate 142 beats per minute, respiratory rate 52 breaths per min and pulse oximetry on right hand is 95%. Which of the following actions is a priority to include in the plan of care for th 

Prepare to administer surfactant for respiratory distress 

Obtain a serum glucose to identify hyperglycemia 

Provide oxygen to prevent respiratory distress 

Initiate early and frequent feedings 

67 

Multiple Choice 1 point 

weeks 6-7 

Weeks 18-19 

week 12 

week 16 

66 

Numeric 1 point 

On arrival to the antepartum unit, a client’s blood pressure is 190/125. The nurse receives the following order from th IV push now. The labetalol concentration available is 100 mg/mL. How many mL should the nurse adminster? 

Answer 

Fine crackles were noted upon auscultation of the lung bilaterally. 

A small hole in the soft palate was noticed when the baby was crying. 

64 

Multiple Choice 1 point 

63 

Multiple Answer 1 point 

A nurse is assessing a newborn on the first day of life. Which of the following is an expected finding? 

Hypospadias is noted in the male newborn 

Fusion of labia in female genitalia 

Postive babinski reflex 

Erythema toxicum on a newborn’s skin 

Negative Ortolani sign 

62 

Multiple Answer 1 point 

61 

A nurse is caring for a client who is 38 weeks gestation and admitted for preeclampsia with severe features. The nurse Sulfate 4 grams over 20 minutes followed by 2 grams/hour. Which of the following interventions should the nurse inclu 

Assess deep tendon reflexes, level of conciousness, and lung sounds hourly 

Educate the client that magnesium sulfate may cause flushing and dizzyness 

Ensure seizure precautions are in place 

Titrate the magnesium sulfate up by 0.5 grams for sustained severe hypertension 

Frequent assessement of blood pressure 

Multiple Choice 1 point 

“I should expect to feed my baby 8-12 times per day.” 

“I will feed the baby on an every four hour schedule so I get plenty of rest.”” 

“I will wait to feed my baby until they cry.” 

“I will know that my baby is getting enough milk if they are having at least 12 wet diapers a day.” 

OU 

Multiple Choice 1 point 

A nurse is caring for a client who is at 12 weeks of gestation during an initial prenatal visit. The client asks, “What is a nor following ranges should the nurse provide? 

80-120 

100-180 

110-160 

100-150 

59 

Multiple Answer 1 point 

58 

Microcephally 

Blindness 

Incontinance 

Paralysis/loss of sensation 

Nerve tissue and spinal fluid protrudes through an opening in the back. 

Multiple Choice 1 point 

A nurse is providing education to a client who is intrapartum with a history of anxiety and a previous traumatic birth labor. Which of the following should the nurse suggest helping control anxiety? 

Including many family and friends in the labor and birth 

medication that may help by sedating them 

Thinking more about the baby instead of the labor and birth 

Practicing controlled breathing and focus techniques 

57 

Multiple Choice 1 point 

A client has come in for their 26 week prenatal appointment. In their previous appointment at 22 weeks, they had a b 

their blood pressure is 150/96, with no other abnormal findings. Prior to these appointments, they had never had inc 

readings, what condition would the nurse be concerned about the client having? 

Gestational Hypertension 

Eclampsia 

Pre-eclampsia 

Chronic Hypertension 

55 

A client states that she is currently pregnant. She has had 2 miscarriages, 3 elective abortions, and 1 delivery at 34 wee currently in daycare. What is her GTPAL? 

T1 

L2 

PO 

G5 

P2 

L1 

LO 

A 3 

G7 

P1 

A2 

G2 

A 5 

ΤΟ 

Multiple Choice 1 point 

Moro relex exibited on the left side but not on the right 

The left arm positioned against the body and rotated outward. 

Bilaterally equal arm recoil 

Facial asymmetry when crying 

A nurse is assessing a client for deep vein thrombosis 5 hr postpartum. Which of the following manifestations should the (Select all that apply.) 

Erythema 

increase in size of affected calf 

Warm to touch 

Cool to touch 

Localized calf tenderness 

53 

Matching 1 point 

Match the respiratory anomaly with the etiology. 

Meconium Aspiration Syndrome (MAS) 

Respiratory distress syndrome (RDS) 

Congenital Diaphramatic Hernia (CDH) 

Transiant Tachyapnea of the Newborn (TTN) 

Delayed absorption of 

52 

Multiple Choice 1 point 

Which of the following fetal structures allows blood to pass from the right atrium to the left atrium? 

Ductus venosus 

Umbilical Vein 

Ductus Arteriosus 

Foramen Ovale 

51 

Multiple Choice 1 point 

A client that is 37 weeks has come to the labor and delivery floor and is complaining of painless vaginal bleeding. What nurse suspect? 

Placenta accreta 

Retained placenta 

Placenta abruption 

Placenta Previa 

50 

Multiple Choice 1 point 

When completing a newborn assessment, the nurse notes that which of the following reflexes aids in infant feeding 

Rooting 

Stepping 

Tonic Neck 

Moro 

49 

Multiple Choice 1 point 

A nurse in the NICU is providing care to a newborn who is suspected of having esophogeal atresia (EA) and tracheal-es following actions should the nurse include in the plan of care? 

Provide positve pressure ventilation to support breathing 

Place an nasograstric tube to support nutrition and prevent aspiration 

Position the newborn supine with the head of the bed flat 

Keep the newborn NPO and maintain the head of bed in an elevated position 

48 

Multiple Choice 1 point 

During a routine assessment of a newborn that was delivered vaginally, 4 hours ago, the nurse notices an edematous a defined in area, extending from the left parietal bone across the sagittal suture. The nurse correctly documents this as characteristics? 

Overriding of sutures. 

Caput Succedaneum 

Cephalic hemangioma. 

Cephalohematoma 

47 

Numeric 1 point 

Answer 

46 

Multiple Choice 1 point 

A nurse is caring for a client in an OB clinic who reports the date of her LMP as February 18. Using Naegele’s Rule, the date of delivery as 

November 25 

May 25 

October 11 

May 11 

45 

Multiple Choice 1 point 

A nurse is caring for a postpartum client who gave birth 4 hr ago. Their vital signs are as follows: blood pressure 80/50 temperature 37° C (98.6° F), respiratory rate 20/min, SpO2 97% on room air. Which of the following conditions would vital signs in a postpartum client? 

Postpartum hemorrhage 

Infection 

Anxiety 

Preeclampsia 

choose your answer… 

choose your answer… 

head compression 

early 

placental insufficiency 

prolonged 

cord compression 

late 

44 

Fill in the Blank 1 point 

43 

Multiple Choice 1 point 

42 

Categorization 1 point 

Sort the risk factors for high risk pregnancy into to the risk domain. 

Biophysical factors 

No Answers Chosen 

Sociodemographic factors 

Possible answers 

Substance use disorder 

No Answers Chosen 

Psychosocial factors 

No Answers Chosen 

Environmental factors 

No Answers Chosen 

Placental previa 

Exposures to animals 

Medications used during pregnancy 

Cultural beliefs and practices 

food scarcity 

Gestational diabetes 

Access to health care 

Exposure to le 

Bipolar disorder 

Race and ethnicity 

Human immunodeficiency virus (HIV) 

41 

Ordering 1 point 

A nurse is caring for a client who delivered their baby about 40 minutes ago. The fundus and bleeding have been assessed every 15 minutes since birth. finds the fundus 2/U, boggy and deviated to the client’s right side. There is a large amount of bright red blood on the client’s underpad. Order the steps addressing the PP hemorrhage. 

40 

Assist patient and provider with placement of a tamponade device (Bakri) or compression device (Jada) 

Support patient and provider performing a bimanual exam (internal and external at the same time) 

Bladder assessment/empty bladder 

Administer uterotonic medications, as ordered 

Perform fundal massage, continously assessing status of bleeding 

Debrief the hemorrhage with the care team and identify next steps in plan of care 

Call for help if uterine atony and bleeding persists 

Numeric 1 point 

Answer 

39 

Multiple Choice 1 point 

Notify the provider. 

Palpate the client’s pulse 

Collect a lab specimen for a CBC to r/o an intrauterine infection. 

Assess vaginal bleeding. 

38 

Multiple Choice 1 point 

Epidural 

Opioids 

Spinal block 

General anesthesia 

A nurse is admitting a client for induction of labor at 41 weeks gestation. The nurse identifies von Willebrand disease in the client’s medical history as a r hemorrhage. Which bleeding etilogy is alligned with the risk factor? 

Thrombin 

Tissue 

Tone 

Trauma 

36 

Multiple Choice 1 point 

The baby blues 

Maladaptive role developement 

Postpartum depression 

Postpartum psychosis 

35 

Numeric 1 point 

Answer 

A client whose pregnancy is complicated by chornic hypertension and gestational diabetes requires closer fetal assessment in the third trimester of the p the following finding is a good indicator of placental insufficiency? 

Fundal height of 33 cm at 32 weeks gestation 

Leaking of breastmilk 

Occassional mild contractions 

Oligohydramnios 

33 

Multiple Choice 1 point 

A nurse is caring for a 1-day-old term newborn who has a cephalohematoma. Which of the following actions is appropriate to include in the plan of ca 

Education the parents that the baby may need a cerebral shunt placed 

Measure a occipital-frontal head circumferance every 4 hours 

Assess for jaundice. 

Prepare the newborn for hyperbaric oxygen therapy 

32 

Numeric 1 point 

The patient you are caring for has an order to start an oxytocin infusion for induction of labor. The order is written to start the infusion at 2milliunit 30 units/500mL. What rate do you program the pump to infuse the medication? Round to the nearest whole number. 

Answer 

DI 

1 point 

Which of the following will place a client at risk for sexually transmitted infections? (Select all that apply

0000 

First sexual encounter happening before age 14 

Spending large amounts of time in hot tubs with other people. 

Using oral contraception as only method of protection 

Having multiple sexual partners 

30 

Multiple Choice 1 point 

A nurse is teaching a new nurse about neonatal infection. Which statement should the nurse include? 

All newborns are given a single injection of pennicillin G within the first 12 hours of life to prevent Group B Strep infection. 

The incidence of Group B Strep sepsis is higher that it has been in the last 15 years. 

Newborns with congenital syphylis may present with cutaneous lesions on their palms and feet 

Newborns rarely become extremely ill with infections because they get immunity from thier birthing parent that lasts for approximately 90 day 

29 

Multiple Answer 1 point 

Reposition the client 

Assess the clients bladder 

Prepare the client for emergent delivery 

Reduce the Oxytocin (Pitocin) by half 

Administer supplimental oxygen with non-rebreather mask at 10 L/min 

The patinet reports seere cramping 3 hours post cesarean delivery. The provider orders Torodol 30 mg IV every 6 hours for pain. Toradol is available in a many mL should be administered? 

Answer 

A nures is admitting a client and their baby to the postpartum care unit. The birthing parent’s blood type is B negative and newborn’s blood type is O pos test is positive. Based on this information, what will the nurse include in the newborn’s initial plan of care? (select all that apply

Provide education to the parents regarding associated risks of hyperbilirubinemia and importance of effective feeding. 

Assess the newborn for onset of jaundice prior to 24 hours of life. 

An exchange transfusion to prevent brain injury 

Monitor oral intake and bowel movements 

Implement phototherapy to prevent hyperbilrubinemia 

The nurse performs a vaginal exam and notes the patient is 5 cm dilated, 90% effaced, and station -2. Which of the following should the nurse conclude? 

The fetal head is engaged 

The cervix is thin. 

The patient is in second stage labor 

The fetal membranes are bulging 

A nurse is planning a presentation about the impact of hyperemesis gravidarum on client health. Which of the following statements should the nurse in 

“Measures can be taken to prevent this disease from occurring.” 

“Psychological disorders may occur due to the impact on the client’s quality of life.” 

“Hyperemesis gravidarum usually resolves by the end of the first trimester” 

“Clients who have hyperemesis gravidarum may seek care early in their pregnancy.” 

You are caring for a patient who is being discharged home with a prescription for an oral suspension of acetaminophen 500mg/30mL due to her inabilit prescription is written for her to take 45mL every 6 hours as needed for moderate pain. The patient states that she does not have a way to measure mL the equivalent is in TBSP. How many TBSP do you instruct her to take per dose? 

Answer 

A nurse is performing a physical assessment of a term female newborn born 2 hours earlier by cesarean birth because of frank breech presentation. The which of the following findings may indicate a hip condition? 

The length of the legs are even. 

The side of the affected hip turns inward. 

There is a dimple at the base of the spine. 

Bilateral gluteal skin folds are uneven. 

22 

Matching 1 point 

Review the patient descriptions and identify which stage of labor they are in. 

Client is 2cm, 50% effaced and -3 station and is able to rest through contractions 

Stag 4 

Patient is complete and pushing 

Stage 2 

Client has delivered the newborn is awaiting placental expulsion 

Stage 3 

Stage 1 

Client is 1 hour postpartum and breastfeeding 

Client is 9cm dilated, 90% effaced, and +1 station, feeling increased perineal pressure 

21 

Multiple Choice 1 point 

next appropriate intervention? 

Discontinue the fetal monitoring and procede with the induction 

Delay the induction and notify the provider of a catagory 2 tracing 

Reposition the client laterally and initiate an IV fluid bolus 

Perform a vaginal exam to determine if the patient is in labor 

A1011 SEP 1211000 

20 

Multiple Answer 1 point 

19 

A nurse is caring for a newborn immediately following birth who has a large abdominal wall defect that is protruding from the right of the umbilicus a membrane. Which of the following actions should the nurse take? 

Initiate oral feedings of 15 ml or less 

Monitor temperature closely as the newborn is at risk for hypothermia 

Postion the newborn laterally to improve perfusion to the displaced bowel. 

Place the newborn in a sterile bag that is sinched at the level of the chest. 

Allow for at least 6 cm of umbilical cord length to help with repair. 

Numeric 1 point 

The physician orders misoprostol 0.1 mg by mouth every 4 hours. The medication available is 100 micrograms per tablet. How many tablets would be dose? 

Answer 

18 

Multiple Choice 1 point 

Which of the following conditions are considered abnormal in a newborn? 

Mottled skin 

Milia. 

Cyanosis of the trunk (abdomen and chest) 

Acrocyanosis. 

17 

Multiple Choice 1 point 

A postpartum phone triage nurse has messages from four clients. Which of the following clients should the nurse call back first? 

A client who took acetaminophen for a headache and reports an improvement in pain. 

A client who needs to have a bowel movement but is nervous to do so. 

A client who is concerned about the presence of lochia alba 3 weeks postpartum. 

A client who has recently developed blurry vision. 

16 

Multiple Choice 1 point 

A nurse is caring for a newborn who has a ductal dependent cardiac defect with anticipated surgical intervention. Which of the following is a priorit plan of care? 

Adminster PGE1 by continuous IV infusion 

Obtain blood pressures on the lower extremities 

Facilitating skin to skin care with the parent to support thermoregulation 

Obtain capillary blood gas 

A nurse is caring for a client who has placenta previa. Which of the following are considered risk factors for placenta previa? 

Previous cesarean birth 

The pregnant person is 30 years old 

multifetal pregnancy 

When there is scarring in the fallopian tubes 

When pregnancy is achieved through assisted reproduction technology (ART)/fertility treatment 

14 

Multiple Choice 1 point 

13 

The fetal heartbeat is first detected at approximately 16 weeks gestation 

Multiple Choice 1 point 

A nurse is performing a shift assessment at the bedside on a newborn who is 36 hours old. The parent asks if the white spots across their baby’s no The nurse recognizes the parent is referring to 

Mongolian Spots 

Stork Bites 

Milia 

Erythema Toxicum 

12 

Multiple Answer 1 point 

00 

“Having Lupus increases your risk of pregnancy loss.” 

Smoking increases your risk for pregnancy loss 

“Being 32 years old inceases your risk for pregnancy loss” 

“Malnutriion increases the risk for miscarriage” 

11 

Multiple Choice 1 point 

A nurse is caring for a client who has a placental abruption. Which of the following are risk factors for placental abruption? 

A single fetus pregnancy 

Preeclampsia 

Migraine headaches 

Exposure to the influenza virus in the first trimester 

10 

Multiple Answer 1 point 

A client who is 2 days postpartum following a cesarean birth has been diagnosed with a deep vein thrombosis (DVT). What nursing interventions a the plan of care? (select all that apply

0000 

Monitor blood pressure every 2 hours 

Administer a transfusion of two units of platelets 

Increase monitoring of lochia/vaginal bleeding 

Administer low molecular weight heparin as prescribed 

Multiple Choice 1 point 

Following the delivery of the placenta, important endocrine changes occur. Estrogen and progesterone levels drop triggering. 

A sharp increase of human chorionic gonaditropin (HCG) that stimulates ovulation 

The production of prolactin to stimulate breastmilk production 

An increase in meletonin 

A decrease in oxytocin to stop contractions 

Multiple Choice 1 point 

Multiple Choice 1 point 

Which factor in a postpartum client’s history would lead the nurse to monitor them closely for an infection? 

Elevated WBC count during intrapartum period. 

Multiparity of 5 pregnancies. 

Manually extracted placenta. 

Rupture time of 2 hours prior to delivery. 

Multiple Answer 1 point 

The client must be fasting for 12 hours prior to the glucose challange test 

The client will have three labs drawn on the day of the screening. 

The test will be performed between 24 and 28 weeks of gestation. 

Multiple Choice 1 point 

facilitate thermoregulation after the delivery of the newborn. 

Slow the progression of labor 

Fetal lung maturity 

A nurse is caring for a newborn who has experienced excess oral and nasal secretions followed by cyanosis, choking, and coughing during the initial feedi of the following actions should the nurse plan to take? 

Suction nose and monitor airway with next feeding. 

Withhold feedings until further diagnostics. 

Position the newborn supine with the radiant warmer flat. 

Anticipate preparing the newborn for immediate surgery. 

Multiple Choice 1 point 

A nurse knows that drying a newborn immediately after birth reduces heat loss by what mechanism of heat loss? 

Conduction 

Radiation 

Convection 

Evaporation 

Multiple Choice 1 point 

A nurse is attending the cesarean section delivery of a newborn who has been diagnosed with a congenital diaphratic hernia. Which of the following interventions for this newborn immediately after delivery? 

Position the newborn in a prone position 

Planned, immediate endotracheal intubation 

Place the newborn in a sterile, clear bag to reduce the risk of infection 

Position the newborn in a high-fowlers position to reduce pressure on the lungs 

Multiple Answer 1 point 

98 

You have just received report on a client in labor. The client is being induced at 39.0 weeks electively. G2P1, prior vaginal birth in 2020, term, male, bedside, SVE 5cm. 80%, -1 station. The patient’s membranes are artificially ruptured for a moderate amount of clear fluid at that time. The fetal tra after the AROM. Identify which nurse interventions are appropriate. (select all that apply

TECO JUP 

BCO SUP 

Anticipate the initation of an amnioinfusion (put fluid into the uterus) 

Prepare a delivery table 

Perform a sterile vaginal exam 

Request the provider to come to the bedside as this is a category 3 tracing 

Administer terbutaline to reduce the number of contractions 

Reposition the patient 

Multiple Choice 1 point 

A nurse is caring for a client who is in labor. Which of the following clients has begun the second stage of labor? 

A client who just delivered the placenta. 

A client with the urge to push during a vaginal exam who is dilated 8cm/90% effacted, O station 

A client who has just delivered the baby. 

A client whose cervical exam is determined to be 10 cm, 100% effacted, and a fetal station of

97 

Numeric 1 point 

Answer 

95 

96 

Categorization 1 point 

Sort the manifestations into the categories of pregnancy signs. 

Presumptive 

Positive 

Possible answers 

Chadwicks sign 

#amenorrhea 

Hegar’s sign 

No Answers Chosen 

No Answers Chosen 

Probable 

No Answers Chosen 

Ballottement 

urinary frequency 

postive pregnancy test 

nausea/vomiting 

Fetal cardiac activety observed with ultrasound 

Quickening 

Fetal movement palpated by a clini 

Multiple Choice 1 point 

A nurse is teaching a group of clients about hemolytic disorders in newborns. Which of the following statements should the nurse include? 

If you have Rh-positive blood and your newborn has Rh-negative blood, there is a higher risk of incompatibility and hyperbilirubinemia.” 

“If you have type O blood and your newborn has type O blood, there is a higher risk of incompatibility and hyperbilirubinemia.” 

“If you have type O blood and your newborn has type B blood, there is a higher risk of incompatibility and hyperbilirubinemia.” 

“If you have Rh-negative blood and your newborn has Rh-negative blood, there is a higher risk of incompatibility and hyperbilirubinemia.” 

94 

Multiple Answer 1 point 

Which of the following are true of transiant tachapnea of the newborn (TTN)? (select all that apply

TTN is expected to resolve within 48-72 hours 

TTN is caused by lack of lung maturity and minimal presence of surfactant in the lungs 

Most newborns who develop TTN will require endotacheal intubation and ventilatory support. 

Newborns who are born via a planned cesarean section without labor are at increased risk for developing TTN 

93 

Multiple Choice 1 point 

A nurse is assessing a 48-hr-old newborn of a client who had a prenatal history of substance use disorder. Which of the following manifestations shou 

Newborn exhibits hypothermia and mild jitters. 

Newborn exhibits excessive crying and tremors

Newborn is awake crying, but calms with swaddling. 

Newborn wakes every 2 to 3 hr for breastfeeding and is content between feedings. 

92 

Multiple Choice 1 point 

A nurse is assessing a 1-day-old newborn. Which of the following findings should the nurse identify as requiring follow-up? 

A large, deep sacral dimple above the gluteal cleft 

Edema on the scalp that crosses the suture line 

A hymenal tag and white discharge on genitalia 

An intermittent heart murmur 

91 

Multiple Choice 1 point 

A nurse is caring for an adolescent client who is pregnant. Which of the following is a risk factor for adolescent pregnancy? 

The inclusion of sex education in school curriculum 

A sister who had a fetal demise 

Education about contraception 

Lack of parental support 

90 

Multiple Choice 1 point 

A nurse is teaching a client at 12 weeks of gestation about the risk factors for hyperthyroidism. Which of the following statements is not accurate in the education? 

“A history of autoimmune disease increases the risk for developing hyperthyroidism.” 

“Smoking places you are increased risk for hyperthyroidism” 

“Radiation treatments on the upper body increase the risk of hyperthyroidism.” 

“Genetics is a risk factor for developing hyperthyroidism.” 

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