Exhibits

A nurse is assisting in the care of a newborn. Which of the following should be included in the electronic medical record (EMR)? Select all that apply.

Weight

Type of birth

Apgar scores

Gestational age

Heart rate

Length

Answer and Explanation

Correct Answer : A,B,C,D,E,F

Choice A rationale: Weight is a crucial anthropometric measurement for evaluating a newborn's physical development, nutritional status, and overall health. It is typically recorded in grams or kilograms immediately after birth and monitored regularly. Normal birth weight is generally between 2,500 grams (5 lbs 8 oz) and 4,000 grams (8 lbs 13 oz). Deviations from this range, such as low birth weight, necessitate closer monitoring and specialized care.

Choice B rationale: The type of birth, whether vaginal, operative vaginal (e.g., forceps or vacuum assisted), or cesarean section, is a vital piece of obstetric history. This information is critical as it highlights potential risks the neonate may have encountered, such as transient tachypnea of the newborn following a C-section or trauma associated with a complicated vaginal delivery, and informs future care decisions.

Choice C rationale: The Apgar scores are a rapid, standardized assessment of five physiologic signs (Appearance, Pulse, Grimace, Activity, Respiration) used to evaluate a newborn's transition to extrauterine life. Scores are recorded at one and five minutes after birth. A score between 7 and 10 is considered normal and reassuring, while lower scores indicate the need for immediate intervention and closer observation.

Choice D rationale: Gestational age, typically determined by the last menstrual period and validated by a physical assessment (e.g., Ballard Scale), is essential for classifying the neonate as preterm, full-term, or post-term. It directly correlates with the maturity of organ systems, including the lungs and brain, and dictates the expected range of normal findings and potential risk for specific complications like hyperbilirubinemia or respiratory distress syndrome.

Choice E rationale: The heart rate is a fundamental vital sign, reflecting cardiovascular stability and is a key component of the Apgar score. Normal range for a newborn is typically 110 to 160 beats per minute. A sustained heart rate outside this range, either bradycardia or tachycardia, can signal distress, hypoxia, infection, or other underlying pathology, requiring immediate clinical investigation and intervention.

Choice F rationale: Length (or Crown-Heel length) is an important anthropometric measure recorded alongside weight and head circumference. It helps assess the newborn's growth potential and identify potential intrauterine growth restriction or genetic syndromes when plotted on standardized growth charts. Normal full-term length is generally between 45 and 55 centimeters (17.7 to 21.7 inches).

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A rationale

Oral contraceptives (OCs), particularly combined estrogen-progestin pills, have been scientifically demonstrated to provide a protective effect against the development of both endometrial and ovarian cancers. This effect is thought to be mediated by the suppression of ovulation and reduction in the monthly exposure of the endometrium to unopposed estrogen, thereby modulating cellular proliferation and differentiation within the reproductive tract.

Choice B rationale

Combined estrogen-progestin contraceptive pills typically cause shorter, lighter periods (often referred to as withdrawal bleeding or scheduled bleeding) due to the suppression of endometrial proliferation. The progestin component induces a thin, atrophic endometrium that results in less tissue to shed each month, a benefit for clients experiencing menorrhagia or dysmenorrhea.

Choice C rationale

Medroxyprogesterone acetate (Depo-Provera) is an injectable contraceptive that is administered intramuscularly or subcutaneously. It is designed to provide effective contraception for a duration of three months, requiring the client to receive an injection once every 12 to 13 weeks, not once per month. This prolonged action is due to the slow release and metabolism of the progestin compound.

Choice D rationale

A diaphragm, a barrier method of contraception, is typically made of latex or silicone and needs to be replaced under two primary conditions: significant weight change (gain or loss of 10 pounds or more) or after a full-term pregnancy, as the size and shape of the cervix and vagina may change. Routine replacement due to material degradation is typically advised only every one to two years, not every four years, and only if material integrity is compromised.

A. Apply oxygen by face mask. B. Weigh the perineal pad. C. Perform fundal massage. D. Monitor urine output.

Correct Answer is C

Explanation

Choice A rationale

. Applying oxygen is a supportive measure for the client experiencing significant blood loss and circulatory compromise, but it is not the highest priority action to stop the hemorrhage. The physiological basis for applying oxygen is to maximize the oxygen content of the circulating blood, addressing tissue hypoxia secondary to hypovolemic shock.

Choice B rationale

. Weighing the perineal pad is a necessary step to accurately quantify blood loss (1 gram of weight equals approximately 1 milliliter of blood) for accurate diagnosis of postpartum hemorrhage (PPH) and to guide treatment. However, it is an assessment and documentation action, not the most critical intervention to immediately address the source of the bleeding.

Choice C rationale

. Performing a fundal massage is the highest priority and most critical intervention when a client reports rapid and heavy postpartum bleeding, which suggests uterine atony (a soft, boggy uterus). Uterine atony is the most common cause of early postpartum hemorrhage, and manual stimulation immediately causes the uterine muscle fibers to contract, which constricts the blood vessels and rapidly reduces blood loss.

Choice D rationale

. Monitoring urine output is an important assessment of renal perfusion and fluid status, which is essential to track the progression of potential hypovolemic shock due to hemorrhage. A urine output of less than 30 mL/hour suggests inadequate renal perfusion. However, this is an assessment and a later indicator of the severity of shock, not the immediate, life-saving intervention needed to halt the bleeding source.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Exhibits A nurse is assisting in the care of a newborn. Which of the following should be included in the electronic medical record (EMR)? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client about various contraceptive methods. Which of the following statements should the nurse include in the teaching?

Correct Answer is A

Explanation

A nurse is assisting in the care of a client who is 3 hours postpartum and reports complete saturation of their perineal pad in the past 30 minutes. Which of the following actions is the highest priority?

Correct Answer is C

Explanation

A nurse is caring for a newborn in the maternity unit. Exhibits A nurse is assisting in the care of a newborn. Click to highlight the findings that require follow-up by the nurse. To deselect a finding, click on the finding again.

Exhibits Based on the Day 3 Nurses' Notes, I&O, and Diagnostic Results, which of the following findings indicate the newborn is progressing as expected? Select all that apply.

A nurse is reinforcing teaching with a client about the use of a transcutaneous electrical nerve stimulation (TENS) device for back pain during labor. Which of the following information should the nurse include?

A nurse is collecting data from a newborn who is 4 hours old. Which of the following findings should the nurse report to the provider?

A nurse is reinforcing teaching about laboratory testing with a client who is at 6 weeks of gestation. Which of the following statements should the nurse include?

The nurse collects client data and determines the newborn is most likely experiencing hypoglycemia as evidenced by which of the following?

A nurse is collecting data from a late preterm newborn. Which of the following findings should the nurse expect?

A nurse is reinforcing discharge teaching with a client who is pregnant and was treated for a urinary tract infection. Which of the following should the nurse include in the discharge instructions? (Select all that apply.)

Exhibits

A nurse is assisting in the care of a newborn. Which of the following should be included in the electronic medical record (EMR)? Select all that apply.