Maternal and Neonatal Nursing Flashcards

A client at 38 weeks gestation reports sudden, painless, bright red vaginal bleeding. The LPN should first:

Answer: Notify the charge nurse immediately and do NOT perform a vaginal exam

Sudden painless bright red bleeding in the third trimester suggests placenta previa. Vaginal exams are contraindicated as they can cause massive hemorrhage. The charge nurse must be notified immediately.

An Apgar score is assessed at 1 minute and 5 minutes after birth. Which Apgar score at 5 minutes indicates a neonate in good condition?

Answer: Score of 7–10

An Apgar score of 7–10 at 5 minutes indicates a neonate in good condition requiring only routine care. Scores below 7 indicate the need for intervention.

A postpartum client 6 hours after vaginal delivery has a uterus that is boggy, displaced to the right, and 2 fingerbreadths above the umbilicus. The LPN's first action should be:

Answer: Have the client void, then reassess fundal height and tone

A displaced uterus suggests a full bladder displacing the uterus upward and to the side, preventing proper contraction. Voiding should occur before fundal massage.

The LPN is monitoring a laboring client and notes late decelerations on the fetal monitor. What is the appropriate intervention?

Answer: Reposition the client to her left side, administer oxygen, and stop Pitocin

Late decelerations indicate uteroplacental insufficiency. The nurse should reposition to left lateral, apply oxygen, stop Pitocin, and notify the charge nurse and provider immediately.

A breastfeeding client 2 days postpartum reports breast engorgement. The LPN should advise the client to:

Answer: Feed frequently (every 1–2 hours), apply warm compresses before feeding, and cold packs after

Frequent feedings reduce milk accumulation, warm compresses before feeding promote let-down, and cold packs after feeding reduce inflammation and discomfort.

A newborn's blood glucose is 38 mg/dL at 2 hours of age. The infant is jittery and feeding poorly. The priority intervention is:

Answer: Administer oral glucose gel per protocol and notify the provider

A blood glucose below 45 mg/dL in a symptomatic neonate requires treatment. Oral dextrose gel per protocol is the first-line treatment along with early feeding, and the provider must be notified.

A client at 36 weeks gestation presents with a blood pressure of 158/104 mmHg, proteinuria (3+ on dipstick), and a severe frontal headache. The LPN should recognize this as:

Answer: Severe preeclampsia requiring immediate escalation

BP ≥160/110 mmHg with proteinuria and severe headache meets criteria for severe preeclampsia, a dangerous obstetric emergency requiring immediate intervention and possible delivery.

A client receiving magnesium sulfate for preeclampsia has absent deep tendon reflexes (DTRs) and a respiratory rate of 12 breaths/minute. The LPN should immediately:

Answer: Stop the magnesium infusion and administer calcium gluconate IV

Absent DTRs and respiratory rate of 12 are signs of magnesium toxicity. The infusion must be stopped immediately and calcium gluconate (the antidote) administered.

A client 12 hours postpartum is assessed and has a temperature of 38.9°C (102°F). The LPN should first:

Answer: Notify the charge nurse — a fever this high this early may indicate infection

A temperature of 38.9°C (102°F) within 24 hours of delivery (beyond the first 24-hour physiologic rise) is abnormal and may indicate endometritis, UTI, or wound infection requiring prompt evaluation.

When performing a newborn assessment, the LPN notes the following: acrocyanosis of hands and feet, heart rate 138 bpm, and respiratory rate 44 breaths/minute. The appropriate action is:

Answer: Document findings as normal for a newborn

Acrocyanosis (blue hands and feet) is normal in the first 24–48 hours of life. Heart rate 120–160 bpm and respiratory rate 30–60 breaths/minute are normal for neonates.

A nurse is assessing a newborn and notes a soft mass on the back of the skull that crosses the suture line. This finding is consistent with:

Answer: Caput succedaneum

Caput succedaneum is soft tissue edema of the scalp that crosses suture lines, present at birth, and resolves within days. Cephalohematoma is subperiosteal bleeding that does NOT cross suture lines.

A postpartum client who is Rh-negative delivered an Rh-positive baby. The LPN knows that Rho(D) immune globulin (RhoGAM) must be administered:

Answer: Within 72 hours of delivery

RhoGAM must be given within 72 hours of delivery to prevent Rh sensitization in the Rh-negative mother, protecting future pregnancies from hemolytic disease of the newborn.

A client is in active labor and suddenly reports a tearing sensation followed by cessation of contractions and severe abdominal pain. The fetal heart rate shows severe variable decelerations. The LPN recognizes this as:

Answer: Uterine rupture — a life-threatening emergency

Uterine rupture presents with sudden severe abdominal pain, cessation of contractions, and fetal distress. This is a life-threatening obstetric emergency requiring emergency cesarean delivery.

A newborn's bilirubin level is 14 mg/dL at 36 hours of age. The LPN knows that phototherapy works by:

Answer: Converting unconjugated bilirubin to water-soluble photoproducts excreted in bile and urine

Phototherapy converts fat-soluble unconjugated bilirubin to water-soluble isomers (lumirubin and photobilirubin) that can be excreted in bile and urine without hepatic conjugation.

A client at 40 weeks gestation is being evaluated for prolonged labor. She has been in active labor for 18 hours without delivery and an oxytocin infusion is running. The fetal heart rate suddenly drops to 60 bpm for 30 seconds. The LPN's FIRST action is to:

Answer: Turn the Pitocin off and call the charge nurse

A prolonged fetal bradycardia (60 bpm for 30 seconds) while receiving oxytocin indicates uterine hyperstimulation or cord compromise. The first action is to stop the Pitocin and call the charge nurse.

A postpartum client reports bilateral leg cramping but no unilateral leg swelling. The LPN's assessment reveals no warmth or redness in either leg. This finding is most likely:

Answer: Normal postpartum muscle cramping related to fatigue and fluid shifts

Bilateral leg cramping without swelling, redness, warmth, or tenderness is typically normal postpartum discomfort from fatigue, fluid redistribution, and muscle strain from labor.

When caring for a client with a suspected ectopic pregnancy presenting with sharp right lower quadrant pain, vaginal spotting, and a positive pregnancy test, the LPN's priority is:

Answer: Monitor vital signs closely and report signs of shock to the charge nurse

Ruptured ectopic pregnancy can cause life-threatening intraabdominal hemorrhage and hypovolemic shock. The LPN must monitor vital signs and report deterioration immediately.

A breastfed newborn has lost 10% of birth weight by day 3 of life. The LPN should:

Answer: Document the weight loss and report to the charge nurse or pediatric provider

Weight loss of up to 7–10% in the first few days is normal, but 10% is at the upper limit and warrants assessment of breastfeeding effectiveness and reporting to the provider.

A client in the second stage of labor begins pushing. The fetal presenting part is at +3 station. The LPN recognizes that:

Answer: Delivery is imminent — the presenting part is 3 cm below the ischial spines

+3 station means the fetal presenting part is 3 cm below the ischial spines, very close to the perineum, indicating imminent delivery.

A client who delivered 2 days ago develops a temperature of 38.5°C (101.3°F), chills, and unilateral breast tenderness with redness and warmth. The LPN suspects:

Answer: Mastitis and should report findings to the charge nurse

Unilateral breast redness, warmth, tenderness, and fever are classic signs of mastitis — a breast infection most common in breastfeeding women requiring antibiotic treatment.