RPN Maternal and Newborn Care 5 — Questions and Answers
Question 1: A client at 41 weeks gestation is scheduled for a nonstress test (NST). Which result indicates a reactive (normal) NST?
- Two or more FHR accelerations of 15 bpm lasting 15 seconds within 20 minutes (Correct answer)
- Absence of FHR decelerations during the test period
- Fetal movement perceived by the mother at least once in 20 minutes
- Baseline FHR between 100–160 bpm with minimal variability
Correct answer: Two or more FHR accelerations of 15 bpm lasting 15 seconds within 20 minutes
A reactive NST requires at least two FHR accelerations of ≥15 bpm above baseline lasting ≥15 seconds within a 20-minute window.
Question 2: A nurse is teaching a postpartum client about warning signs of postpartum depression (PPD). Which symptom requires immediate reporting?
- Crying spells and mood swings on day 3
- Feeling tired and overwhelmed in the first week
- Thoughts of harming herself or the baby (Correct answer)
- Difficulty sleeping even when the baby sleeps
Correct answer: Thoughts of harming herself or the baby
Thoughts of harming herself or the infant are a psychiatric emergency distinguishing PPD with psychosis from the baby blues.
Question 3: A nurse is caring for a client in preterm labor at 30 weeks who is receiving a betamethasone injection. What is the primary purpose of this medication?
- Stop uterine contractions and prolong pregnancy
- Accelerate fetal lung maturity by stimulating surfactant production (Correct answer)
- Prevent maternal infection associated with premature rupture of membranes
- Reduce fetal heart rate to decrease oxygen demand
Correct answer: Accelerate fetal lung maturity by stimulating surfactant production
Antenatal corticosteroids such as betamethasone stimulate surfactant production in the fetal lungs, reducing the risk of respiratory distress syndrome.
Question 4: Which position should the nurse place a postpartum client in immediately after an epidural birth to prevent supine hypotension?
- Supine with legs flat
- Left lateral or semi-recumbent with a lateral tilt (Correct answer)
- High Fowler's position
- Prone with a pillow under the abdomen
Correct answer: Left lateral or semi-recumbent with a lateral tilt
Left lateral positioning or uterine displacement prevents aortocaval compression by the gravid uterus, maintaining cardiac output.
Question 5: A nurse assesses a newborn and notes a soft, fluctuant swelling on the scalp that crosses the suture lines. This finding is consistent with:
- Cephalohematoma
- Caput succedaneum (Correct answer)
- Subdural hematoma
- Craniosynostosis
Correct answer: Caput succedaneum
Caput succedaneum is edema of the scalp soft tissue that crosses suture lines, unlike cephalohematoma which is confined within one suture.
Question 6: A nurse is preparing to administer erythromycin ophthalmic ointment to a newborn. Which statement best describes its purpose?
- To treat congenital cataracts identified at birth
- To prevent ophthalmia neonatorum caused by gonorrhea and chlamydia (Correct answer)
- To reduce intraocular pressure in premature newborns
- To lubricate the eyes damaged by amniotic fluid exposure
Correct answer: To prevent ophthalmia neonatorum caused by gonorrhea and chlamydia
Prophylactic erythromycin ointment is required by law in many states to prevent bacterial conjunctivitis (ophthalmia neonatorum) from Neisseria gonorrhoeae and Chlamydia trachomatis.
Question 7: A nurse is reviewing a client's prenatal record and notes a gravida 3, para 1 (G3P1) designation. How should the nurse interpret this?
- The client has been pregnant 3 times and has 1 living child
- The client is currently in her third pregnancy and had 1 prior delivery after 20 weeks (Correct answer)
- The client has had 3 deliveries and 1 miscarriage
- The client has 1 full-term infant and is currently pregnant for the third time
Correct answer: The client is currently in her third pregnancy and had 1 prior delivery after 20 weeks
Gravida refers to the total number of pregnancies (including current), and para refers to deliveries at or after 20 weeks gestation.
RPN Maternal and Newborn Care 5
A client at 41 weeks gestation is scheduled for a nonstress test (NST).
Which result indicates a reactive (normal) NST?