Labor and Delivery

Which term describes the white biofilm that covers neonatal skin at birth?

After reviewing the patient’s chart, which order(s) require clarification? Review the patient’s chart, then select all that apply.

The postpartum nurse is supervising new parents placing their newborn into the car seat to drive home during a snowstorm. Which observation is most concerning?

A baby is born precipitously to a mother who did not have prenatal care. The neonate requires only the initial steps of resuscitation but is found to have a bilateral cleft lip and palate. Review the patient’s assessment here: Position at rest: Complete flexion Square window: 0° Arm recoil: 75° Popliteal angle: 80° Scarf sign: Elbow does not cross midline Heel to ear: Foot does not reach the umbilicus Skin: No veins visible, cracking of skin at joints, dry Lanugo: Mostly bald skin Plantar surface: Creases over entire sole Breast: 4 mm bud with raised areola Ear: Formed pinna with instant recoil Genitals: Descended testes bilaterally, rugae over entire scrotum For which referrals does the nurse advocate for the baby prior to discharge? Select all that apply.

The 2-day-old full term child has been rooming in with the mother who reports successful breastfeeding. Which information is most important to report to the provider?

The nurse counsels which women against the use of black cohosh as an herbal supplement?  

The nurse in a tertiary medical center with attached pediatric hospital is caring for the 28-year-old gravida 3 para 2 woman who is 40-weeks pregnant and presents to the labor and delivery unit 1 hour after spontaneous rupture of membranes. Patient had good prenatal care, an amniotic fluid index of 12, and pregnancy is complicated only by the antenatal diagnosis of fetal single ventricle anatomy.  Labor is progressing well and the fetus is tolerating contractions well with moderate variability in fetal heart tones. The nurse is most concerned with having which item in the delivery room? 

The 18-day-old neonate has musty-smelling urine and vomits with almost every feeding. The patient, who was born after an uncomplicated pregnancy and delivery, had a normal newborn screening that was drawn in the hospital after birth. Which action by the nurse is most appropriate?   

The nurse is preparing to care for a baby antenatally diagnosed with type C esophageal atresia with tracheoesophageal fistula. Which interventions are the priority in the first day after birth?  

The 36-hour-old neonate who was born at 37 weeks gestation to a G3P2 mother has yet to pass meconium. The baby was born by cesarean section due to refractory preeclampsia with severe features. The mother reports the baby has been breastfeeding well after a slow first 12 hours. Upon assessment, the baby appears well with good tone and responsiveness. The baby’s anus is patent and the abdomen is soft and rounded; bowel sounds present. The mother denies emesis in the baby. An abdominal x-ray is obtained, which is normal. The nurse informs the mother that which test will be performed next? 

During the shift assessment of the healthy, full-term neonate born 24 hours ago to the 25-year-old G1P1 mother who had an uncomplicated pregnancy and delivery, the nurse notes the urethral meatus is on the ventral part of the penile shaft. The assessment is also notable for wide-spaced, downward-slanting eyes that resemble the baby’s father. The baby is pink, well-perfused, and breathing comfortably with normal heart and lung sounds. The mother reports the child is breastfeeding every 2 hours and has voided and stooled several times. Which additional assessment is most important? 

The 20-year-old mother brings her 6-day-old infant to the clinic because the child has had yellow drainage from both eyes since yesterday that returns despite wiping it away. Upon assessment, bilateral eyes are closed due to a sticky, mucopurulent discharge. The mother reports a normal spontaneous vaginal delivery after an uncomplicated history. The baby went to breast immediately and the pair were discharged from the hospital 48 hours after birth. The nurse performs a swab of the drainage and anticipates which gram stain result? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 31-year-old patient G2P1 woman presents to the clinic for 30 week appointment. She was diagnosed at 24 weeks with gestational diabetes. For 6 weeks, she changed her diet and exercised more regularly while checking her blood sugars. She logged fasting glucose levels of 108-135 mg/dL. She has no proteinuria or glycosuria. The nurse provides which information to the patient?  

The 28-year-old G2P1 patient presents after rupture of membranes 2 hours ago at 39 weeks gestation. She has a history of prior cesarean section for failure to progress but is otherwise healthy; this pregnancy is uncomplicated. Contractions are painful and labor is progressing. Abruptly, the patient complains of extreme abdominal pain; the nurse observes a significant amount of blood coming from her vagina. Which action is most important? 

The 28-year-old G2P1 patient presents after rupture of membranes 2 hours ago at 39 weeks gestation. She has a history of prior cesarean section for failure to progress but is otherwise healthy; this pregnancy is uncomplicated. Contractions are painful and labor is progressing. Abruptly, the patient complains of extreme abdominal pain; the nurse observes a small amount of blood coming from her vagina. Which assessment prompts the nurse to prepare the patient for an emergency cesarean section?