ABSN Hybrid Summer -NURS428 Reassessment 1 EBR Roseman University of Health Sciences School of Nursing.
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Free ABSN Hybrid Summer -NURS428 Reassessment 1 EBR Roseman University of Health Sciences School of Nursing. Questions
The nursery nurse begins caring for the infant in the delivery room as soon as the infant is delivered. When is the appropriate time for the nurse to perform the APGAR assessment?
- When the infant has signs of distress, such as difficulty breathing.
- The health care provider will perform the first Apgar assessment.
- At least twice; 1 minute and 5 minutes after birth.
- Every 15 minutes during the first hour after birth.
Explanation
Explanation
Correct Answer: C) At least twice; 1 minute and 5 minutes after birth
The APGAR assessment is a standardized newborn evaluation performed at 1 minute and 5 minutes after birth for all newborns, regardless of whether distress is apparent. The 1-minute score reflects the newborn's transition from intrauterine to extrauterine life, while the 5-minute score evaluates response to any resuscitative efforts. If the score remains low at 5 minutes, additional assessments are performed at 10-minute intervals.
It is not performed only when distress is present — it is a routine assessment for all newborns (A is incorrect). The APGAR is performed by the nurse, not reserved for the provider (B is incorrect). Every 15 minutes is the frequency for routine vital sign monitoring, not APGAR scoring (D is incorrect).
The labor and delivery nurse is preparing for the delivery of their client's newborn infant. The nurse brings a stack of warm blankets into the room and places them at the bedside. Which statement by the nurse best educates the parents on why warm blankets are needed?
- "We will use the warm blankets to dry the baby which will help to prevent cold stress"
- "We will wrap the baby in warm blankets after delivery so that they will not shiver."
- "We will use the blankets to warm the baby's hands and feet to prevent acrocyanosis."
- "We will use the warm blankets only if the baby has a low temperature."
Explanation
Explanation
Correct Answer: A) "We will use the warm blankets to dry the baby which will help to prevent cold stress"
Newborns are at high risk for cold stress (hypothermia) immediately after birth because they are wet with amniotic fluid and transition from a warm intrauterine environment to a cooler external environment. Drying the newborn promptly with warm blankets is the primary intervention to prevent evaporative heat loss — the most significant mechanism of heat loss at birth — thereby preventing cold stress and its metabolic consequences such as hypoglycemia and acidosis.
Newborns do not shiver effectively as a thermoregulatory mechanism — they rely on non-shivering thermogenesis through brown fat metabolism (B is inaccurate). Acrocyanosis (bluish hands and feet) is a normal finding in newborns and is not caused by temperature loss requiring blankets (C). Warm blankets are used routinely for all newborns at delivery, not only for those with documented low temperature (D).
A client at 38 weeks gestation presents to OB triage complaining of contractions for 2 hours. How can the nurse best assess for true labor? (Select all that apply)
- Assess for fetal lightening
- Ask the client about relief with ambulation
- Assess contraction frequency
- Check for cervical change
Explanation
Explanation
Correct Answers: B) Ask the client about relief with ambulation, C) Assess contraction frequency, and D) Check for cervical change
True labor is distinguished from false labor (Braxton Hicks) by three key assessments. True labor contractions do not subside with walking — asking about relief with ambulation helps differentiate, as false labor often improves with movement. Contraction frequency, duration, and regularity are hallmarks of true labor — true contractions become regular and progressively closer together. Most definitively, cervical change (effacement and dilation) confirms true labor, as Braxton Hicks contractions do not produce cervical change.
Fetal lightening — the descent of the fetal head into the pelvis — occurs weeks before labor in primiparas and is not a reliable real-time indicator of true versus false labor at the time of triage assessment.
The nurse is caring for a client who asks why their newborn needs a Vitamin K injection. What is the nurse's best response?
- "Most mothers have a diet deficient in vitamin K, which results in the infant being deficient."
- "Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection."
- "Newborns cannot synthesize their own vitamin K which increases their risk of bleeding."
- "The supply of vitamin K is inadequate for at least the first year and must be supplemented."
Explanation
Explanation
Correct Answer: C) "Newborns cannot synthesize their own vitamin K which increases their risk of bleeding."
Newborns are born with very low levels of vitamin K because it does not cross the placenta well, and their gut has not yet been colonized by the bacteria that produce vitamin K. Since vitamin K is essential for the synthesis of clotting factors (II, VII, IX, X), deficiency places newborns at risk for Vitamin K Deficiency Bleeding (VKDB), a potentially life-threatening condition. The intramuscular injection at birth prevents this.
Maternal dietary deficiency is not the primary reason — the issue is the newborn's own inability to produce sufficient vitamin K. Vitamin K actually promotes (not prevents) prothrombin synthesis, making option B factually incorrect. The supplementation is not required for the entire first year — a single injection at birth is sufficient for most newborns.
The nurse is caring for a postpartum client who delivered vaginally 4 hours ago. The client has a fundal height of 2 fingerbreadths above the umbilicus and is deviated to the right. What is the priority nursing action?
- Immediately notify the healthcare provider.
- Assist the client to empty their bladder.
- Administer intravenous pain medications.
- Insert a sterile foley catheter.
Explanation
Explanation
Correct Answer: B) Assist the client to empty their bladder.
A fundus that is elevated and deviated to the right indicates a distended bladder, which prevents the uterus from contracting effectively and increases the risk of postpartum hemorrhage. The priority is to assist the client in voiding to allow the uterus to return to midline and contract properly.
Notifying the provider is not necessary as a first action, pain medication does not address the cause, and catheterization is only needed if the client is unable to void.
The nurse is caring for a client who has been prescribed an IV infusion of oxytocin to induce labor. The client is gravida 1 para 0. The fetus is in a vertex/cephalic presentation and the patient’s cervix is dilated 1 cm. Which is the priority action for the nurse before starting the oxytocin induction?
- Administer a 1000cc bolus of IV fluid to prevent hypotension
- Educate the family about risks and benefits of the medication
- Notify the provider of malposition of the fetus and hold the medication
- Place monitors to evaluate fetal heart rate and contraction pattern
Explanation
Explanation
Correct Answer: D) Place monitors to evaluate fetal heart rate and contraction pattern
Before initiating oxytocin, baseline fetal heart rate and uterine activity must be established using continuous electronic fetal monitoring. This ensures that the fetus can tolerate labor and allows early detection of complications such as tachysystole or fetal distress once the medication begins.
Fluid bolus is not routinely required, education is important but not the immediate priority, and the fetus is already in a normal vertex position, so no need to notify the provider.
The nurse is caring for a couple at a fertility clinic. After determining the client has a low sperm count, they have opted for artificial insemination. What should the nurse include in the teaching to prepare them for this procedure?
- You will be fully numbed before the abdominal needle insertion.
- There will be a speculum inserted in the vagina to get the sperm closer to the uterus.
- We will use the embryo that was fertilized in the laboratory.
- This procedure is highly successful and will only need to be performed one time.
Explanation
Explanation
Correct Answer: B) There will be a speculum inserted in the vagina to get the sperm closer to the uterus.
Artificial insemination (intrauterine insemination) involves placing prepared sperm directly into the uterus using a catheter, typically after inserting a speculum. This is a minimally invasive procedure and does not involve abdominal needles or anesthesia.
Option A describes procedures like amniocentesis. Option C refers to in vitro fertilization. Option D is incorrect because multiple attempts are often needed, and success rates vary.
The nurse is caring for a client with A+ blood who has been prescribed a blood transfusion. The nurse places a 20-gauge peripheral intravenous (IV) line, flushes it with normal saline, and verifies the client has signed consent. What is the next step in the transfusion process?
- Pick up blood from the blood bank
- Double check the blood with another registered nurse (RN)
- Prime Y tubing with blood and saline
- Initiate the blood transfusion within one hour of obtaining blood
Explanation
Explanation
Correct Answer: A) Pick up blood from the blood bank
After ensuring IV access and consent, the next step is to obtain the blood from the blood bank. Verification with another nurse and initiation occur after the blood is obtained.
Priming tubing and starting transfusion are done after proper verification procedures.
The nurse is caring for a client at 32 weeks gestation with uterine contractions who is receiving nifedipine. What will the nurse consider the priority assessment finding related to nifedipine therapy that requires further action?
- 2 contractions/hour
- Pulmonary edema
- Decreased pulse
- Blood pressure 84/60 mmHg
Explanation
Explanation
Correct Answer: D) Blood pressure 84/60 mmHg
Nifedipine is a calcium channel blocker that can cause hypotension. A blood pressure of 84/60 mmHg is dangerously low and requires immediate intervention to prevent decreased placental perfusion.
The other findings are either expected or less immediately life-threatening compared to severe hypotension.
The nurse is caring for a client during a prolonged second stage of labor. The nurse observes that the fetal head retracts against the client’s perineum immediately following delivery of the head (turtle sign). Which of the following action(s) will the nurse anticipate in this situation? (Select all that apply)
- Administer fundal pressure
- Apply suprapubic pressure
- Assist client in flexing thighs out and towards ears
- Call for additional assistance
- Prepare for emergency interventions
Explanation
Explanation
Correct Answer: B) Apply suprapubic pressure, C) Assist client in flexing thighs out and towards ears, D) Call for additional assistance, E) Prepare for emergency interventions
The turtle sign indicates shoulder dystocia, an obstetric emergency where the fetal shoulders are impacted. Immediate interventions include the McRoberts maneuver (flexing thighs), applying suprapubic pressure to dislodge the shoulder, calling for help, and preparing for further emergency measures if initial maneuvers fail.
Fundal pressure is contraindicated because it can worsen impaction and increase the risk of fetal injury or uterine rupture.
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