RPN Maternal and Newborn Care 4 — Questions and Answers
Question 1: A nurse is preparing to administer vitamin K to a newborn. Which statement best explains the rationale for this injection?
- Newborns have immature immune systems requiring vitamin K supplementation
- Newborns lack intestinal bacteria needed to synthesize vitamin K, increasing bleeding risk (Correct answer)
- Vitamin K prevents hyperbilirubinemia in the first week of life
- Vitamin K is required for the development of the blood-brain barrier
Correct answer: Newborns lack intestinal bacteria needed to synthesize vitamin K, increasing bleeding risk
Newborns are born without intestinal flora that synthesize vitamin K, making them susceptible to hemorrhagic disease of the newborn.
Question 2: A postpartum client on day 2 reports calf pain, warmth, and redness in her left leg. Which nursing action takes priority?
- Apply warm compresses and elevate the leg
- Encourage ambulation to improve circulation
- Notify the provider and avoid massaging the leg (Correct answer)
- Administer prescribed ibuprofen for discomfort
Correct answer: Notify the provider and avoid massaging the leg
These signs suggest deep vein thrombosis; the nurse must notify the provider and avoid massaging the leg to prevent embolization.
Question 3: Which assessment best confirms that a newborn has passed the initial gastrointestinal transition successfully?
- Presence of rooting and sucking reflexes
- Passage of meconium within 24–48 hours (Correct answer)
- Urine output of 6 wet diapers by day 1
- Blood glucose level above 50 mg/dL
Correct answer: Passage of meconium within 24–48 hours
Passage of meconium within the first 24–48 hours confirms patency of the gastrointestinal tract.
Question 4: A nurse is caring for a client in transition phase of labor who is 8 cm dilated. She begins hyperventilating. What is the most effective initial intervention?
- Administer supplemental oxygen via face mask
- Coach the client to breathe into a paper bag
- Have the client breathe slowly and deeply with coaching (Correct answer)
- Notify the physician of impending delivery
Correct answer: Have the client breathe slowly and deeply with coaching
Coaching slow, paced breathing corrects the respiratory alkalosis caused by hyperventilation and is the safest immediate intervention.
Question 5: A nurse notes that a newborn's umbilical cord has one artery and one vein instead of the normal two arteries and one vein. What is the most important follow-up action?
- Document the finding; no further action is needed
- Notify the provider, as this may indicate renal or cardiac anomalies (Correct answer)
- Repeat the assessment to confirm the finding
- Apply an extra clamp to prevent bleeding
Correct answer: Notify the provider, as this may indicate renal or cardiac anomalies
A single umbilical artery (two-vessel cord) is associated with renal, cardiac, and chromosomal anomalies and must be reported to the provider.
Question 6: A nurse is assessing lochia on a postpartum client at day 5. Which description is expected?
- Lochia rubra: bright red, moderate flow
- Lochia serosa: pinkish-brown, decreasing flow (Correct answer)
- Lochia alba: yellow-white, scant flow
- No lochia present; discharge has resolved
Correct answer: Lochia serosa: pinkish-brown, decreasing flow
Lochia serosa, which is pinkish-brown and decreasing in amount, is the expected finding between approximately days 3 and 10 postpartum.
Question 7: Which intervention is most appropriate when a client in the second stage of labor has a prolonged deceleration on the fetal monitor?
- Prepare for immediate cesarean delivery
- Reposition the client, administer oxygen, and increase IV fluids (Correct answer)
- Decrease the oxytocin infusion by half
- Apply a fetal scalp electrode for better monitoring
Correct answer: Reposition the client, administer oxygen, and increase IV fluids
Repositioning, oxygen administration, and IV fluid bolus are the first-line intrauterine resuscitation measures for a prolonged deceleration.
RPN Maternal and Newborn Care 4
A nurse is preparing to administer vitamin K to a newborn.
Which statement best explains the rationale for this injection?