RPN Maternal and Newborn Care 3 — Questions and Answers
Question 1: Which assessment finding in a newborn at 24 hours of age should be reported to the provider immediately?
- Acrocyanosis of the hands and feet
- Respiratory rate of 68 breaths/min (Correct answer)
- Presence of vernix in skin folds
- Milia on the nose and cheeks
Correct answer: Respiratory rate of 68 breaths/min
A respiratory rate above 60 breaths/min (tachypnea) in a newborn may indicate respiratory distress and requires immediate evaluation.
Question 2: A client at 32 weeks gestation presents with painless, bright red vaginal bleeding. Which condition does the nurse suspect?
- Placental abruption
- Placenta previa (Correct answer)
- Preterm labor
- Bloody show
Correct answer: Placenta previa
Painless, bright red vaginal bleeding in the third trimester is the classic presentation of placenta previa.
Question 3: When caring for a client with preeclampsia receiving magnesium sulfate, which finding requires the nurse to withhold the next dose?
- Respiratory rate of 14 breaths/min
- Urinary output of 25 mL/hr (Correct answer)
- Deep tendon reflexes 2+
- Blood pressure of 148/96 mmHg
Correct answer: Urinary output of 25 mL/hr
Urinary output below 30 mL/hr indicates decreased renal clearance, increasing the risk of magnesium toxicity.
Question 4: A nurse is assessing a newborn and notes that the anterior fontanelle is bulging and tense. This finding is associated with:
- Dehydration
- Increased intracranial pressure (Correct answer)
- Normal crying response
- Caput succedaneum
Correct answer: Increased intracranial pressure
A bulging, tense anterior fontanelle is a sign of increased intracranial pressure and requires immediate evaluation.
Question 5: Which instruction should a nurse include when teaching a postpartum client about episiotomy care?
- Apply ice packs continuously for the first 72 hours
- Use sitz baths 3–4 times daily starting after 24 hours (Correct answer)
- Keep the perineum dry and avoid all moisture
- Change perineal pads every 6–8 hours
Correct answer: Use sitz baths 3–4 times daily starting after 24 hours
Sitz baths promote healing, reduce edema, and provide comfort; they are recommended beginning 24 hours after delivery.
Question 6: A nurse is assessing a 2-hour-old newborn's blood glucose and obtains a result of 38 mg/dL. What is the priority nursing action?
- Recheck in 1 hour as this is a normal value
- Initiate an IV dextrose infusion immediately
- Encourage breastfeeding or provide formula (Correct answer)
- Notify the provider and obtain a full metabolic panel
Correct answer: Encourage breastfeeding or provide formula
For a symptomatic or borderline glucose level, the first intervention is oral feeding to raise blood glucose before escalating to IV treatment.
Question 7: Which finding is consistent with late decelerations on a fetal heart rate monitor?
- Decelerations that begin and end with contractions
- Decelerations that begin after the peak of a contraction (Correct answer)
- Abrupt drops in FHR unrelated to contractions
- Decelerations that begin before the onset of contractions
Correct answer: Decelerations that begin after the peak of a contraction
Late decelerations are gradual decreases in FHR that begin after the peak of a contraction and return to baseline after the contraction ends, indicating uteroplacental insufficiency.
RPN Maternal and Newborn Care 3
Which assessment finding in a newborn at 24 hours of age should be reported to the provider immediately?