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Maternal-Child Nursing
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Elsevier Review Questions
Maternal-Child Nursing

June 2, 2014

TEST 1

Chapter 1 : Foundation of Maternity, Womens Health, and Child Health Nursing

2

1.Some problems associated with hospital births in the early 1960s include the following issues: (Choose all that apply.)

A. CorrectPatient teaching was not valued.
B. CorrectBonding was hindered due to strong medications given to the mother.
C. CorrectThe father was not included in the process.
Correct The nurse’s primary function was to follow medical orders, so teaching was not valued. Strong medications were given to the patient that left her heavily sedated. Fathers were usually sent to the waiting room: <div>The use of lay midwives was declining at this time and nurse-midwives were not well established.<

3

2. A woman is giving birth to her third child in a setting that allows her husband and children to be actively involved in the process. The nurse caring for her must also consider the husband and the two children as patients and work to meet their needs. This type of setting is termed(left incorrect answers due to wanting definition for them

• Family-centered care Correct
• Emergency are
• Hospice care
• Individual care
A. Family-centered care is any setting where the pregnant woman and her family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family.
B. In emergency care settings, the nurse deals primarily with the patient who is having difficulty.
C. In hospice care settings, the nurse deals with patients who have terminal illnesses
D. Individual care deals only with the patient and does not include the family.

4

3. A 27-year-old pregnant woman is seeing a nurse-midwife for prenatal care. Her first baby was born by cesarean because the baby was too large to fit through the woman’s pelvis. She has also developed gestational diabetes during this pregnancy. When discussing with the woman her options for places of birth, what is the best choice for her?

• LDRP in a hospital setting Correct
C. Home births and freestanding birthing centers should be used for patients with very low risk for complications. The woman’s past history and present complication with this pregnancy place her in a high-risk category. Therefore, she needs to be in a setting where emergency care is quickly available.

5

4. In the 19th century, the most common cause of infant death was __________________.

Correct Responses: "infectious diarrhea, infectious diarrhea"

6

5. A 4-year-old is hospitalized for treatment of pneumonia. The nurse informs the child’s mother that the pediatric unit is a Family-Centered Child Care unit. What does this mean for her?

• She will be allowed input into her child’s care. Correct
A. Family-Centered Child Care recognizes and respects the pivotal role of the family in the child’s life. It supports families and views parents and professionals as equal partners.

7

6. A 27-year-old woman newly diagnosed with diabetes is admitted to an agency to regulate her medication and receive patient teaching on diabetes. She is assigned a case manager on her first day. To best explain this role to the woman, the nurse states that a case manager will

• Manage and collaborate the woman’s care to ensure optimal outcomes Correct
B. A case manager will focus on both quality and cost outcomes. They will coordinate services needed and manage the care collaboratively to ensure optimal outcomes.

8

7. During a presentation on prenatal care, the student nurse stated, “In 2000 the maternal mortality rate for African-American women was 22.” The number “22” in this statement means there have been

• 22 maternal deaths per 100,000 live births Correct
A. Maternal mortality rate is based on the number of maternal deaths from childbirth or complications of pregnancy, childbirth, or puerperium per 100,000 live births.

9

8. A woman brings her two sons, ages 2 and 4, to the health clinic. She tells the nurse that they have been in the United States for only 1 year and are homeless. Because of this history, the nurse will assess the children for infections and

• Malnutrition Correct
D. Homeless women and children are at high risk for poor nutrition and exposure to various infections.

10

9. The nurse has been assigned to care for a patient during the night shift. The patient’s medication to prevent seizures was due at 6 AM. At that time the nurse was involved with another patient and did not administer the medication. At 10 AM, the patient ambulated to the bathroom, had a seizure, fell, and later developed brain damage as a result of the fall. The nurse can be sued for

• Malpractice Correct
B. Malpractice has four elements that must be proved: a duty (the nurse was assigned to care for the patient), breach of duty (the nurse did not render care by neglecting the medication), damage (the patient suffered brain damage), proximate cause (brain damage was due to the fall during the seizure).

11

10. The role of the pediatric nurse is influenced by trends in health care. What is the greatest trend in health care?

• Shift of focus to health promotion and disease prevention. Correct
D. This is the current focus of health care in which nursing plays a major role

12

11. The most overwhelming adverse influence on health is

• Socioeconomic status Correct
C. A higher percentage of lower-class individuals have some health problem at any one time than other individuals in different classes. There is a high correlation between poverty and poor nutrition.

13

Chapter 2:

The Nurses role in Maternity, Womens Health, and Pediatric Nursing:

14

1.To administer an IM injection safely to a 6-year-old, the nurse must be aware of the child’s developmental stage. This knowledge will assist the nurse in gaining the child’s cooperation prior to the treatment. During this process, the nurse is functioning in the role of

• Care provider Correct
A. The care provider provides direct nursing care. The role includes understanding developmental stages and appropriately altering care to meet the patient’s needs.

15

2. An experienced maternity nurse needs to teach a new mother about bottle feeding. The mother is 25 years old and has a 2-year-old that she also bottlefed. She has been in the United States for 1 year and has a limited understanding of the English language. What factors will negatively influence the learning process and will cause the nurse to alter her teaching techniques?

• Language and culture Correct
C. The new mother is from a different culture and has English as a second language. The nurse will need to alter her teaching methods to accommodate these two factors to ensure learning.

16

3. A 54-year-old woman is experiencing symptoms of a urinary tract infection and needs to seek health care. Which advanced practice nurse would be the best choice for this woman?

• Family nurse practitioner Correct
C. A family nurse practitioner is prepared to care for people of all ages. They can assess, diagnosis, and treat patients.

17

4. A 28-year-old postpartum patient tells the nurse, “I won’t be going home for about 2 weeks.” To clarify the statement, the nurse may state

• “Tell me what you mean when you say you won’t be going home for 2 weeks.” Correct
A. To clarify a statement is to ensure understanding and accuracy of the message. The nurse can clarify a message by asking for further specific information.

18

5. The nurse is admitting a woman to the labor unit. During the admission procedure, the nurse obtains the woman’s blood pressure, pulse, respirations, temperature, and fetal heart rate. The nurse is using the ____________ part of the nursing process.

Correct Responses: "assessment, assessment"

19

6. Which nursing interventions are written correctly?

• Provide 100 mL of fluids of choice every 2 hours while awake. Correct
D. Nursing interventions are to be specific. Vague interventions may be confusing and the level of care may be altered.

20

7. After admitting a new patient to the pediatric unit, the nurse writes a plan of care. This process of determining outcomes and interventions is which stage of the nursing process?

• Planning Correct
B. During the planning stage, the nurse establishes outcomes and writes nursing interventions.

21

8. A nurse who speaks on behalf of a patient is acting in the role of a(n) ___________.

Correct Responses: "advocate, advocate"

22

9. When comparing therapeutic communication with social communication, therapeutic communication is

• Goal-directed and focused Correct
A. Therapeutic communication is patient-oriented and goal-directed. The focus is the patient.

23

10. When a nurse faces a difficult problem, the thinking process should be controlled and directed toward finding solutions or opinions. This form of thinking is termed

• Critical thinking. Correct
A. Critical thinking is controlled and directed. It includes recognizing assumptions, examining biases, analyzing the need for closure, collecting and analyzing data, and evaluating emotions and environmental factors.

24

Chapter 32:

Womens Health Care

25

1. When doing patient teaching, it is important for the nurse to include breast self-examination information for all women older than _________.

Correct Responses: "20, 20"

26

2. The American Cancer Society recommends yearly mammography to screen for breast cancer in women starting at which age?

• 40 Correct
C. Yearly mammography exams should start at 40 years of age. Women at higher risk for breast cancer or with a suspicious growth in the breast may need the exam at a young age.

27

3. When doing a vulvar self-examination, the woman should inspect for

• New moles Correct
B. She should inspect the complete vulva for new moles, warts, growths, ulcers, sores, and changes in skin color or areas of inflammation.

28

4. Which piece of the usual equipment setup for a pelvic examination is not used with a Pap test?

• Lubricant Correct
D. Lubricants interfere with the accuracy of the cytology report.

29

5. As part of the patient teaching concerning fecal occult blood testing, the nurse should tell patents to

• Avoid vitamin C intake for 72 hours before testing Correct
C. Vitamin C should be avoided for 72 hours prior to the testing

30

6. A woman noted a lump in her breast. The physician ordered a mammogram, which showed a suspicious area. The next step that may be taken in order to differentiate if the lump is a cyst or a malignant mass may be:

• Ultrasound. Correct
A. An ultrasound imaging is a noninvasive method of differentiating fluid-filled cysts from solid tissue that is more likely to be malignant.

31

7. The most common sites of breast cancer metastasis are the _____________________

Correct Responses: "brain, lungs, liver, and bones, brain, lungs, liver, and bones"

32

8. Which patient would be classified as having primary amenorrhea?

• A 19-year-old who never has had a period Correct
D. Primary amenorrhea occurs if the girl passes the age by which menstruation has normally started.

33

9. Which statement is true about primary dysmenorrhea?

• It may be caused by excessive endometrial prostaglandin. Correct
C. Some women produce excessive endometrial prostaglandin during the luteal phase of the menstrual cycle. Prostaglandin diffuses into endometrial tissue and causes uterine cramping.

34

10. Which woman is most likely to have osteoporosis?

• A 55-year-old woman with a sedentary lifestyle Correct
C. Risk factors for the development of osteoporosis include smoking, alcohol consumption, sedentary lifestyle, family history of the disease, and a high-fat diet.

35

Chapter 31:

Management of Fertility and Infertility:

36

1. A woman just gave birth to her sixth child. She states to the nurse, “I just can’t have another baby, but I don’t want surgery to prevent it either. What can I do?” What contraceptive method can the nurse suggest to the woman as being the most effective?

• Copper IUD Correct
B. Copper IUD has an effectiveness rate of 99.2%, and there is no error because of noncompliance (forgetting to take a pill or using other types).

37

2. A 36-year-old comes to the clinic requesting contraception. She presents with a history of hypertension (now under control with treatment) and a past history of pelvic inflammatory disease. She smokes one pack of cigarettes a day and admits to having “numerous” sexual partners. Which contraceptive method is appropriate for her?

• Condoms Correct
D. Condoms offer protection against STDs and will not interfere with her treatment for hypertension. Condoms will not increase her risk for PID.

38

3. A woman is seeing the nurse practitioner for her yearly Pap smear. She tells the nurse that she has heard of a nonsurgical sterilization method and that she is interested in more information. The nurse’s teaching should be based on the knowledge that

• The procedure will permanently block the fallopian tubes, but another method of birth control must be used until a hysterosalpingogram proves blockage Correct
C. A small coil is inserted into each fallopian tube. It takes about 3 months for tissue to grow into the inserts to block the opening of the tubes. A hysterosalpingogram is performed to ensure completely blockage.

39

4. A woman calls the nurse at the clinic stating, “I forgot to take my birth control pill this morning before I left for work. What should I do?” The nurse’s answer should be based on the knowledge that

• The woman should take the one missed pill as soon as possible and the next pill at the regular scheduled time. She will not need back-up contraception Correct
B. The delay of one birth control pill should not lower the blood hormone levels enough to stimulate ovulation. If she is able to take the missed pill as soon as possible and continue on with her regular scheduled time for taking the next pill, she will not need a backup method of contraception.

40

5. A woman has been diagnosed with a severe sinus infection. The physician prescribed amoxicillin (Amoxil) 500 mg every 8 hours as an antibiotic. As the woman is preparing to leave the office, the nurse notices that the woman is also taking oral contraceptives. What patient teaching is important at this time?

• Some antibiotics will decrease the effectiveness of oral contraceptives and the woman should use another method of contraceptives. Correct
A. Amoxicillin will decrease the effectiveness of oral contraceptives. It is important for the patient to be aware of this fact so that backup contraceptives will be used.

41

6. Women should start emergency contraceptives within __________ of unprotected intercourse.

Correct Responses: "72 hours, 72 hours"

42

7. During a postpartum teaching session concerning contraception, the woman states she will continue to use her diaphragm she has had for 2 years. The best response by the nurse should be based on the fact that

• Diaphragms should be refitted after the birth of a baby Correct
C. A woman should be checked for size changes yearly and after a pregnancy. If the diaphragm does not fit properly, the effectiveness will decrease.

43

8. The role of the nurse in family planning is to

• Educate couples on the various methods of contraception Correct
B. The nurse’s role is to provide information to the couple so that they can make an informed decision about family planning.

44

9. The situation that best describes secondary infertility is a couple who has

• One child but has not been able to conceive a second time Correct
C. Secondary infertility occurs in couples who have conceived before but are unable to conceive again.

45

10. The procedure in which ova are removed, mixed with sperm, and the fertilized ova returned to the woman’s uterus is called _____________________.

Correct Responses: "In vitro fertilization., In vitro fertilization."

46

11. A semen analysis shows a sperm concentration of 2 million per mL. In explaining this result to a couple, the nurse can base her answer on the knowledge that

• Normal sperm concentration is 20 million/mL or greater Correct
A. Sperm concentration should be 20 million/mL or greater.

47

Chapter 10:

Heredity and Environmental Influences on Development

48

1. When doing genetic counseling with a pregnant woman, the nurse will need to do additional teaching if the patient states

• “Both my husband and I are B blood type, so our baby will have to be B type also.” Correct
B. B blood type is dominant, however, both parents may have an “O” recessive gene that can be passed on to a child.

49

2. A woman is in active labor and planning to deliver a baby girl (diagnosed by ultrasound). The woman’s husband has hemophilia A. The nursery nurse planning to care for the infant needs to be aware that she

• Will be a carrier Correct
C. Hemophilia is a X-linked recessive disorder. The father will pass the disorder to 100% of their daughters, and the daughters will become carriers.

50

3. A 39-year-old is seeing the nurse-midwife for her first prenatal visit. The pregnancy was a surprise—“I thought I was going through the change of life.” This is her first pregnancy, and she has no previous health problems. She does not smoke and drank one alcoholic beverage a week until she discovered she was pregnant. Which part of the woman’s history shows the highest risk for the fetus developing a chromosomal abnormality such as trisomy 21 and therefore alerts the nurse-midwife to discuss doing genetic studies on the fetus?

• The fact that the woman is 39 years old Correct
B. Maternal age greater than 35 is the highest risk factor for chromosomal abnormalities such as trisomy 21. The low alcohol intake and not planning for the pregnancy are not risk factors for this disorder.

51

4. A woman is admitted to the labor unit in active labor. She informs the nurse that she has had no prenatal care. She has been taking Fioricet (acetaminophen, butalbital, caffeine) for pain throughout the pregnancy. The nurse is aware that this drug is classified as “X” and therefore

• Is a teratogen and the fetus may be harmed Correct
B. A class “X” medication means that the drug is well established as being harmful to a fetus and should not be used during pregnancy.

52

5. The nursery nurse is called in to the delivery room of a 22-year-old primigravida. The delivery nurse informs the nursery nurse that the patient had oligohydramnios throughout the pregnancy. In planning care for the newborn, the nursery nurse is aware that the baby may develop _______________.

"respiratory problems, respiratory problems"

53

6. In planning care for a new patient in the prenatal clinic, the nurse is aware that various test are available to screen for fetal abnormalities. One that is used early in pregnancy is

• Chorionic villus sampling Correct
C. Chorionic villus sampling is done in the first trimester and will do a chromosomal analysis of the fetus.

54

7. During teaching to an antepartum patient, it is important for the nurse to give information about ways to avoid some birth defects. One area of concern that can be taught at this time is

• Lifestyle changes Correct
A. Lifestyle changes such as stopping alcohol consumption, stopping smoking, and avoiding chemicals and medications that are teratogenic can prevent some birth defects.

55

8.The karyotype of a person is 47, XY, +21. This person is a __________________.

Correct Responses: "male with Down syndrome, male with Down syndrome"

56

9. When assisting with the collection of a specimen for chromosome analysis, the nurse must

• Ensure that the cells in the specimen stay alive Correct
C. Specimens for chromosome analysis must contain living cells, because chromosomes are visible microscopically only in living dividing cells.

57

10. People who have two copies of the same abnormal autosomal dominant gene will usually be

• More severely affected by the disorder than people with one copy of the gene Correct
A. People who have two copies of an abnormal gene are usually more severely affected by the disorder because they have no normal gene to maintain normal function.

58

Chapter 11:

Reproductive Anatomy and Physiology:

59

1. A woman who is 6 weeks’ pregnant is in for her prenatal appointment and asks the nurse when the sex of the baby can been determined by ultrasound. The nurse bases her answer on the knowledge that

• The external genitalia look similar in both males and females until about 9 weeks of gestation Correct
C. The external genitalia starts to change at about 9 weeks of gestation. Prior to that time, males and females look similar and it is not possible to determine the sex from ultrasound.

60

2. When teaching a group of mothers of preteen girls, the nurse explains that the earliest outward sign of puberty starting is ____________.

"breast changes, breast changes"

61

3. A 16-year-old is being seen for the first time by the nurse practitioner. The young woman states that she has not had the onset of menstruation yet. Her breasts are developing and her pelvis has widened. The term used to describe this list of signs and symptoms is ___________.

"primary amenorrhea, primary amenorrhea"

62

4. The nurse is reviewing the lab reports on a 17-year-old new patient. The gonadotropin-releasing hormone levels are extremely low. The nurse can anticipate that the patient will

• Not have primary or secondary sexual characteristics Correct
B. Gonadotropin-releasing hormone is responsible for initiating the beginning of puberty.

63

5. A 23-year-old postpartum woman is having trouble breastfeeding. Upon assessment, the nurse discovers that the woman does not have a let-down reflex. One reason for this may be that she is lacking the hormone ________________.

"oxytocin, oxytocin"

64

6. When comparing the endometrial cycle with the ovarian cycle on day 22,

• The progesterone level is at its peak, but the LH level is low Correct
A. In the endometrial cycle on day 22, the progesterone level has reached its peak and will start decreasing in 1 to 2 days. In the ovarian cycle at the same time, the LH levels have already dropped and will remain low until about day 10 on the next cycle.

65

7. During a childbirth class a woman asks the nurse, “I’m just 8 weeks pregnant. I know the placenta is not fully developed yet, so what is producing all the hormones I need?” The nurse will development her answer on the knowledge that

• The corpus luteum secretes the extra hormones necessary until the placenta develops Correct
D. LH causes the follicle to persist as a corpus luteum for about 12 days after ovulation. If conception occurs, the fertilized ovum secretes human chorionic gonadotropin that causes the corpus luteum to persist. The corpus luteum produces the extra estrogen and progesterone necessary to support the pregnancy.

66

8. Which is a secondary sexual characteristic?

• Female breast development Correct
A. A secondary sexual characteristic is one not directly related to reproduction, such as development of the characteristic female body form.

67

9. The average man is taller than the average woman at maturity because of

• A longer period of skeletal growth. Correct
A. The man’s greater height at maturity is the combined result of beginning the growth spurt at a later age and continuing it for a longer period of time.

68

10. Fertilization of the ovum takes place in which part of the fallopian tube?

• Ampulla Correct
B. The ampulla is the wider middle part of the tube lateral to the isthmus and is where fertilization occurs.

69

Chapter 12:

Conception and Prenatal Development:

70

1. During the first 2 weeks after conception, the fertilized ovum is called a ____________.

"zygote, zygote"

71

2. To maintain the corpus luteum and the continuing supply of estrogen and progesterone, the zygote secretes which hormone?

• Human chorionic gonadotropin Correct
C. The cells of the zygote secrete human chorionic gonadotropin. The hCG feeds back into the ovum to prolong the corpus luteum.

72

3. Implantation of the zygote should occur in the upper portion of the uterus. This is the best area for the growing fetus and placenta for all of these reasons except

• The upper uterus is supplied with the beginnings of the umbilical cord Correct
C. The umbilical cord develops from the zygote.

73

4. Basic structures of all major body organs are completed during the __________ period of development.

"embryonic, embryonic"

74

5. A woman who is 12 weeks’ pregnant comes to the clinic for counseling concerning an abortion. The nurse is aware that the woman needs further teaching when she says

• “I know that this pregnancy is just a group of round cells at this point.” Correct
A. Early in the zygote stage of development, the fertilized ovum divides into cells. They resemble a ball at that point. By 12 weeks, the fetus has arms, legs, a head, and major organs.

75

6. A woman told the nurse the doctor had written down that she had experienced quickening. When explaining this to the woman, the nurse uses the knowledge that quickening is

• The first sensation of fetal movement Correct
B. The first sensation of fetal movement detected by the woman is called quickening.

76

7. Dizygotic twins develop from

• two fertilized ova and may be the same sex or different sexes. Correct
D. Dizygotic twins are two different zygotes, each conceived from a single ovum and a single sperm. They may be both male, both female, or one male and one female.

77

8. Which part of the mature sperm contains the male chromosomes?

• The head of the sperm Correct
A. The head of the sperm contains the male chromosomes that will join the chromosomes of the ovum.

78

9. One of the assessments performed in the delivery room is checking the umbilical cord for blood vessels. Which finding is considered to be within normal limits?

• Two arteries and one vein Correct
A. The umbilical cord contains two arteries and one vein to transport blood between the fetus and the placenta.

79

10. The nurse understands that prenatal growth and development proceed in a cephalocaudal pattern, meaning that

• The brain will develop first Correct
A. Cephalocaudal development means it occurs in a head-to-toe manner. Therefore, the brain will develop first.

80

Chapter 14:

Nutrition for Childbearing:

81

1. The nurse is admitting a woman to the labor unit. When reviewing the prenatal record, the nurse notices that the woman did not gain the adequate amount of weight that was recommended for her pregnancy. The nurse is aware that the neonate will be at risk for ____________________.

Correct Responses: "low birth weight, low birth weight"

82

2. In teaching about weight gain during pregnancy, the nurse should include

• During the third trimester, the pregnant woman should gain about 1 pound of weight per week. Correct
C. The pattern of weight gain is as important as the total increase. The general recommendation for the third trimester is 1 pound per week.

83

3. To increase her folic acid intake, what snack would be most beneficial for a pregnant woman?

• Orange juice and fortified cereal Correct
A. Both orange juice and fortified cereal are excellent sources of folic acid

84

4. A woman has been diagnosed with iron deficiency anemia. The nurse knows that patient teaching about increasing iron intake has been effective if the woman chooses

• Green salad with broccoli, black beans, and strawberries Correct
C. Green leafy vegetables and legumes are rich in iron. The strawberries are rich in vitamin C, which increases the absorption of iron.

85

5. A Native American woman has lactose intolerance. In doing patient teaching, the nurse should instruct Pam to include what foods in her diet to increase calcium intake?

• Dried pinto beans, dark-green leafy vegetables, nuts Correct
C. Dried pinto beans, dark-green leafy vegetables, and nuts are substitutes for dairy products.

86

6. A 27-year-old is in her third trimester. She gives the nurse the following 24-hour dietary recall:
Breakfast: 1 cup cereal with 1 cup skim milk, ½ cup orange juice
Lunch: 1 ounce ham and 2 slices whole wheat bread and 1 cup yogurt
Supper: 3 ounces broiled chicken breast, ½ cup green beans, whole wheat roll
Snack: 2 ounces cheese with 8 crackers

When comparing this dietary recall with MyPlate, which snacks should the nurse suggest to the woman to meet her dietary deficits?

• 2 cups salad greens with 3 ounces lean turkey, broccoli, and kidney beans Correct
D. The woman is low on protein, vitamin A source, and vegetables. The broccoli and dark green salad greens are a good vitamin A source, plus they satisfy the need for vegetables. The turkey and kidney beans satisfy the protein needs.

87

7. A woman from Southeast Asia has been in the United States for 6 months. She just delivered her first child. The nurse notices that the woman does not drink any of the fluids that are offered (ice water, iced tea, and juices) and mentions this concern at the team meeting. The nurse manager states the problem may be cultural and that the woman may consider the postpartum period to be “cold.” If this is correct, which fluids may be acceptable to the woman?

• Hot tea, lukewarm or hot water Correct
C. Because the postpartum period is “cold,” the woman will not drink cold fluids. She may feel this would cause the loss of more heat and would have ill effects on her health.

88

8. The nurse is teaching a young adolescent pregnant woman about proper diet. The nurse starts by collecting a 24-hour dietary recall. Which statement by the nurse would increase the likelihood of compliance to dietary changes by the woman?

• “This diet looks good but is low in calcium. Which of these high calcium foods do you think you could include in your diet?” Correct
A. This statement allows the woman to have control over the changes necessary. When she is in control, compliance increases.

89

9. A woman has just decided to become a vegetarian and is 7 months’ pregnant. The nurse knows that her patient teaching concerning protein foods has been successful when the woman chooses which foods to help satisfy her protein needs?

• Pinto beans with cornbread Correct
C. The combination of legumes and grains will give a complete protein that contains all of the essential amino acids.

90

10. A woman who is 8 weeks’ pregnant calls the physician’s office complaining of nausea and vomiting in the mornings. Which suggestions by the nurse would be helpful to decrease the nausea and vomiting? (Choose all that apply.)

A. CorrectDrink fluids between meals instead of with meals.
B. CorrectEat dry crackers before getting up in the morning.
C. CorrectEat some cheese before bedtime.

91

Chapter 15:

Prenatal Diagnostic Tests:

92

1. A woman who is 6 weeks’ pregnant is scheduled for an ultrasound. She asks the nurse what can be seen at this stage of the pregnant. The nurse would be correct if she responded:

• The baby’s heartbeat Correct
B. The heartbeat is visible when the embryo is 5 mm in length. Fetal sex and details about the baby cannot be seen until later in the pregnancy.

93

2. The nurse is teaching a woman in her second trimester about an upcoming ultrasonography exam. The nurse knows her teaching has been successful when the woman states

• “I will drink several glasses of water about an hour before I come in for the test.” Correct
A. Drinking several glasses of clear fluid 1 hour before the time of the examination will produce a full bladder. The bladder will displace the intestines and elevate the uterus for better visibility.

94

3. On which aspect of fetal diagnostic testing do parents usually place the most importance?

• Safety of the fetus Correct
A. Although all of these are considerations, parents are usually most concerned about the safety of the fetus.

95

4. The nurse is explaining the results of a maternal serum alpha-fetoprotein screening test to the woman. The nurse knows the woman does not understand the teaching if she says

• “Since the levels were within normal limits, I know the baby does not have any anomalies.” Correct
A. Alpha-fetoprotein levels are a screening test. Some fetal defects are covered by skin and do not produce elevated levels of AFP.

96

5. A woman had a chorionic villus sampling procedure. Prior to discharge the nurse should teach her to report what symptom that may be an indication of a complication?

• Vaginal bleeding or passage of amniotic fluid Correct
D. Vaginal bleeding or passage of amniotic fluid suggests possible miscarriage and should be reported.

97

6. A woman who is 8 months pregnant has been advised to have an amniocentesis. She asked the nurse the reason for the procedure. The usual reason for an amniocentesis during this period of pregnancy is to determine _________________________.

"fetal lung maturity, fetal lung maturity"

98

7. The results of a nonstress test shows three fetal heart rate accelerations with fetal movement that peak at 15 beats per minute above baseline and last 15 seconds. The nurses next action should be to

• This is a reassuring sign and no other testing is necessary at this time Correct
B. A reactive sign is at least two fetal heart rate accelerations with or without fetal movement, occurring within a 20-minute period, peaking at least 15 beats per minute about the baseline, and lasting 15 seconds. This is reassuring, and no further testing is necessary.

99

8. A woman who is 8 months’ pregnant had a biophysical profile test done. The results give a score of 4

10. The nurse can anticipate that the next plan of action may be to ______________./

consider delivery

100

9. When is the most accurate time to determine gestational age through ultrasound?

• First trimester Correct
A. During the first trimester, measurement of the crown-rump length of the embryo is the most reliable indicator of gestational age.

101

10. The purpose of initiating contractions in a contraction stress test is to

• Apply a stressful stimulus to the fetus Correct
B. The contraction stress test involves recording the response of the fetal heart rate to stress induced by uterine contractions.

102

Chapter 13:

Adaptations to Pregnancy:

103

1. A woman tells the nurse she is 16 weeks’ pregnant. During the assessment, the nurse measures the fundus of the uterus to be at the umbilicus. The nurse correctly interprets the comparison of the dates with the measurements to be

• Incongruent Correct
C. The fundus should be at the umbilicus by 20 weeks. At 16 weeks, it is normally midway between the symphysis pubis and the umbilicus. The two sets of data do not match, and more assessment is necessary.

104

2. A woman is 35 weeks’ pregnant during her clinic visit. She complains of numerous vaginal infections during the pregnancy. She tells the nurse, “I’m afraid I have diabetes, because I have some infections.” The best response by the nurse would be

• “A vaginal infection is a symptom of diabetes, but it also is a problem with normal pregnancies due to the changes in your vaginal area.” Correct
B. During pregnancy, the glycogen levels of the vaginal area increase. This favors the growth of yeast-causing infections.

105

3. The nurse notes that the hemoglobin level of a woman at 35 weeks of gestation is 11.5 g per dL. The nurses next action should be to

• Note that this is within the normal range for pregnancy Correct
A. The normal range of hemoglobin for pregnancy is greater than 11 g/dL in the first and third trimesters and greater than 10.5 g/dL in the second trimester.

106

4. A woman is concerned that she has developed numerous nosebleeds during this pregnancy. She feels this is a sign of leukemia and wants to be screened. The nurse’s response to the woman should be based on the fact that

• Nose bleeds are a common occurrence during pregnancy Correct
B. Estrogen causes increased vascularity of the mucous membranes of the upper respiratory tract. The congestion may result in epistaxis.

107

5. While the vital signs of a pregnant woman in her third trimester are being assessment, the woman, who is lying supine, complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

• Have the patient turn to her left side, recheck her blood pressure in 5 minutes. Correct
D. Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

108

6. The nurse understands that additional patient teaching is needed about the signs of pregnancy when the patient states

• “I know I am pregnant because I have missed two periods.” Correct
C. Amenorrhea is a presumptive indication of pregnancy. Presumptive indicators are mainly subjective changes that the woman experiences and reports. These changes are the least reliable indicators of pregnancy, because they can be caused by conditions other than pregnancy.

109

7. During her first prenatal visit to the clinic, a woman gives the following obstetric history: a boy born 9 years ago at full term, twin girls born 5 years ago at 36 weeks, a miscarriage at 9 weeks 2 years ago. The nurse correctly records her obstetric history as

• Gravida 4, para 2, aborta 1 Correct
A. The woman is currently pregnant and has been pregnant 3 more times, that makes her a gravida 4. She has delivered two pregnancies after 20 weeks of gestation, that makes her a para 2. The twin girls count as one pregnancy. She delivered one pregnancy prior to 20 weeks, that makes her an aborta 1.

110

8. A woman is seeing the nurse for her first prenatal visit. She informs the nurse that she had a normal period starting on January 6 and spotted on February 4. The nurse correctly calculates her estimated date of delivery as ______________________.

October 13

111

9. During a prenatal visit at 36 weeks of gestation, the nurse tested a woman’s urine for glucose and protein. The results indicated a trace amount of glucose. The nurse’s next action should be to

• Consider this as a normal result for this stage of pregnancy Correct
D. Small amounts of glucose in the urine may indicate physiologic spilling that occurs during normal pregnancy and further testing is not necessary. Larger amounts of glucose in the urine require further testing.

112

10. A woman who is 10 weeks’ pregnant asks the nurse about the multiple marker screen testing that the nurse-midwife has ordered. The nurse should base her ANSwer on the knowledge that

• A multiple marker screen test will screen for fetal anomalies Correct
B. The multiple marker screen test consist of maternal serum alpha-fetoprotein, human chorionic gonadotropin, and estriol levels. These tests screen for fetal anomalies such as Down syndrome or neural tube defects.

113

11. A woman who is 10 weeks’ pregnant is complaining of nausea and vomiting every morning. Which action can the nurse suggest to the woman to alleviate the nausea?

• Eat dry crackers before arising in the morning. Correct
A. Eating dry crackers or toast before arising in the morning has been found to decrease nausea. The woman needs to get out of bed slowly.

114

12. During prenatal teaching it is important for the nurse to inform the patient about danger signs in pregnancy. Which sign need to be reported immediately to the health care provider?

• Vaginal bleeding Correct
C. Vaginal bleeding during pregnancy needs to be reported immediately. It may be an indication of several complications of pregnancy, such as placenta previa or abruptio placenta.

115

13. A woman who is 26 weeks’ pregnant asks the nurse educator during a childbirth class about herb use during pregnancy. The nurse should base his or her ANSwer on the knowledge that

• Some herbs are safe for pregnancy, some are not. The patient needs to discuss which one she desires to use with her health care provider Correct
C. Some complementary and alternative therapies are very safe and helpful during pregnancy. However, some can be harmful. Prior to ingesting any herb or using any therapy the patient needs to discuss them with her health care provider.

116

14. In trying to confirm that she is pregnant, a woman says to the nurse

• “I have been going to the bathroom more often, do you think I could be pregnant?” Correct
C. The woman is looking for confirmation, so she is observing her body carefully for changes indicating pregnancy.

117

15. Which statement would be expected for a pregnant woman to make in her first trimester?

• “My jeans are too tight, I guess I will need to buy new clothes.” Correct
B. During the first trimester, the woman’s primary focus is on herself, not on the fetus. The fetus remains vague and unreal until the second trimester. The focus during the second trimester turns toward the fetus.

118

16. A woman who is 7 months’ pregnant states, “I’m worried that something will happen to my baby.” The nurse’s best response is

• “Tell me about your concerns.” Correct
C. Encouraging the woman to discuss her feelings is the best approach. The nurse should not disregard or belittle the woman’s feelings.

119

17. A woman makes a prenatal appointment with a nurse-midwife as soon as she discovers she is pregnant. She also questions her mother and aunts about self-care during pregnancy. She is in working through which psychological task of pregnancy?

• Seeking safe passage Correct
A. When the woman is seeking safe passage, she will seek out advice of health care professionals and adhere to cultural practices. This is the woman’s priority task. If she cannot be assured of safety for herself and her baby, she cannot move on to the other tasks.

120

18. A man seeks medical attention for sudden onset of nausea, vomiting, loss of appetite, and fatigue. He informs the physician that his wife is 3 months pregnant with their first child and is experiencing the same symptoms. One possible explanation for his physical symptoms is

• Couvade Correct
A. The term couvade refers to pregnancy-related symptoms and behavior in expectant fathers. The fathers sometimes experience a cluster of physical symptoms similar to those experienced by women during the pregnancy.

121

19. A woman is expecting her second child. She expressed concern to the nurse about how her 4-year-old will adapt to the new baby. The following are some suggestions the nurse should include in her teaching. (Choose all that apply.)

A. CorrectCome in and listen to the baby’s heartbeat.
B. CorrectSpend more time with grandmother to prepare him for being away from mother during the birth.
C. CorrectTake a sibling class offered by the hospital.

122

20. A woman of Muslim culture tells the nurse she needs to find a physician to take care of her during her pregnancy. Being aware of the cultural beliefs of this woman, the nurse will recommend _______________.

an older female physician

123

21. When preparing a woman for a pelvic examination, the nurse notices that she had undergone a genital mutilation. During the examination, the nurse needs to plan for the woman to

• experience pain and to make her as comfortable as possible Correct
D. Because the introitus is so small and there is scar tissue that is inelastic, the woman will experience pain with the examination.

124

22. A Muslim couple has given birth to a baby girl. After the baby is assessed, the nurse goes to talk with the father. The nurse puts her hand on his shoulder and states, “Come over and look at your new baby girl.” The father immediately pulls away from the nurse and refuses to go with her. The nurse understands that this action is due to the father being

• Offended by being touched by the female nurse Correct
B. In some Muslim cultures, touching by a woman other than the wife is offensive to men.

125

23. A woman is expecting her first baby in 7 months. During the nurses assessment Anna continues to ask questions about changes in her body. The nurse can recommend which type of class to assist the woman with her questions?

• Early pregnancy class Correct
B. An early pregnancy class focuses on the first two trimesters.

126

Chapter 24:

The Childbearing Family with Special Needs:

127

1. A 15-year-old is 7 months’ pregnant and comes to the clinic for her first prenatal visit. As the nurse is doing the initial assessment, she is aware that the adolescent is at risk for what complication?

• Preeclampsia and anemia Correct
B. Adolescents with poor prenatal care are at increased risk for preeclampsia and anemia during the pregnancy.

128

2. The most dangerous effect on the fetus of a adolescent woman who smokes cigarettes while pregnant is

• Intrauterine growth restriction Correct
D. The major consequences of smoking tobacco during pregnancy are low birth weight infants, prematurity, and increased perinatal loss.

129

3. What is a major barrier to health care for teen mothers?

• The teen must be prepared to see a different nurse and/or physician at every visit. Correct
C. Whenever possible, the teen should be scheduled to see the same nurses and practitioners for continuity of care.

130

4. An older mother is least likely to be concerned about

• Financial security Correct
D. Older women are more financially secure and can afford better health care.

131

5. The older mother is at greater risk for postpartum hemorrhage because of __________________.

uterine myomas

132

6. The nurse informs the 36-year-old primigravida that she may have a multiple marker screening test preformed because she is at risk for

• Chromosomal anomalies of the fetus Correct
C. The fetus of a mature woman is at increased risk for chromosomal anomalies. A multiple marker screening is used to screen for specific types of chromosomal anomalies.

133

7. A patient informs the nursery nurse that she has taken cocaine throughout her pregnancy. The nurse needs to be alert to signs of which problem in the woman’s newborn?

• Intracranial bleeding Correct
A. Cocaine raises the blood pressure of the woman and the fetus when consumed by the pregnant woman. This increased blood pressure puts both the woman and the fetus at risk for intracranial bleeding.

134

8. A patient informs the nurse that she has taken cocaine throughout her pregnancy. The nurse needs to be alert to what signs of pregnancy complications? (Choose all that apply.)

A. CorrectAbruptio placentae
B. CorrectPreeclampsia
C. CorrectPreterm labor

135

9. An infant was born with multiple physical defects. A few hours after the birth the mother tells the nurse: “I told the doctor over and over I thought something was wrong, but he never did anything about it and now it is too late!” The best response by the nurse would be

• “You are angry because no one listened to you?” Correct
A. Anger is an expected emotion from the mother. The nurse should encourage her to express her feelings.

136

10. In promoting bonding between a mother and an infant with physical defects it is important for the nurse to

• Try to emphasize the normal aspects of the infant’s body Correct
C. By emphasizing the normal aspects of the infant’s body, the nurse is modeling the behavior of acceptance. The woman can start looking for positive aspects of the newborn and begin to work toward acceptance.

137

Chapter 25:

Pregnancy-Related Complications:

138

1. A 42-year-old is at the clinic for her first prenatal visit. The nurse is doing the initial assessment and is aware that the woman is at risk for

• Having a spontaneous abortion prior to 12 weeks Correct
A. Women older than 40 years have a 26% risk of spontaneous abortion.

139

2. When comparing threatened abortion to inevitable abortion, inevitable abortion has

• Cervical dilation Correct
C. Abortion becomes inevitable when the membranes rupture and the cervix dilates.

140

3. A woman is seeing her primary physician for complaints of frequent nosebleeds. She states she thought she was pregnant about 3 months ago, but her periods started and the symptoms disappeared. The health care provider should be alert for what complication of a missed abortion?

• Disseminated intravascular coagulation Correct
C. Disseminated intravascular coagulation is a major complication of a missed abortion. Bleeding may occur from any area, such as gums, nose, and cuts.

141

4. When doing an initial assessment on a newly diagnosed pregnant woman, she tells the nurse, “In my younger days, I did some stupid things and had different types of STDs and once had a pelvic inflammatory disease.” The nurse is aware that the woman is at risk for

• Ectopic pregnancy Correct
C. STDs and PID both may cause scar tissue in the fallopian tubes. This will prevent the fertilized ovum from traveling into the uterus, and therefore it will implant in the tube.

142

5. A woman has been admitted to the birthing unit with a diagnosis of spontaneous abortion. She has increased bleeding and is having her pads weighed to estimate the blood loss. The weight of an unused pad is 1.5 grams, the pads used between 7 AM and 9 AM weigh 4.5, 6.5, 10, 15, and 11.5 grams. What is the estimated blood loss?

• 40 mL Correct
B. When weighing pads or linen, a difference of 1 gram of weight equals approximately 1 mL of fluid volume. There was a 40-gram difference in the pads, and therefore a 40-mL blood loss.

143

6. When taking an initial prenatal history on a woman, she admitted to cocaine use during the early days of the pregnancy. The nurse is aware that this would put her at risk for

• Placenta previa
• Abruptio placentae
• Both a and b Correct
A. Cocaine use is associated with placenta previa.
B. Cocaine use is associated with abruptio placentae.
D. Cocaine use is associated with placenta previa and abruptio placentae.

144

7. A woman is admitted with a diagnosis of hyperemesis gravidarum. The nurse is assessing for deficient fluid and signs of dehydration. (Choose all that apply.)

A. CorrectDecreased urinary output
B. CorrectNonelastic skin turgor
C. CorrectConstipation

145

8. A woman with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is

• Anticonvulsant Correct
B. This anticonvulsant drug acts by blocking neuromuscular transmission and depresses the central nervous system to control seizure activity.

146

9. What is the only known cure for preeclampsia?

• Delivery of the fetus Correct
C. If the fetus is viable and near term, delivery is the only known "cure" for preeclampsia.

147

10. The classic sign of placenta previa is the sudden onset of ___________ uterine bleeding in the latter half of pregnancy.

Painless

148

Chapter 26:

Concurrent Disorders During Pregnancy:

149

1. Which factor is most important in diminishing maternal,fetal,neonatal complications in a pregnant woman with diabetes?

• Degree of glycemic control before and during the pregnancy Correct
D. The occurrence of complications can be greatly diminished by maintaining normal blood glucose levels before and during the pregnancy.

150

2. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

• Hypoglycemia Correct
A. The neonate is at higher risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia.

151

3. Gestational diabetes mellitus (GDM) is a carbohydrate intolerance that develops during pregnancy. The following are factors associated with a higher risk for GDM. Choose all that apply:

A. CorrectOverweight (body mass index [BMI] 25 to 25.9, obese (BMI 30 to 39.9), or morbidly obese (≥40)
B. CorrectHypertension
C. CorrectMember of a high-risk ethnic group

152

4. Signs and symptoms of maternal hypoglycemia include the following except

A. CorrectShakiness (tremors)
B. CorrectSweating
C. CorrectHeadache

153

5. The nurse is teaching a woman how to administer insulin sq. Which precautions should the nurse emphasize during the teaching session?

• Insulin is injected slowly (over 2 to 4 seconds) Correct
A. Insulin is injected slowly (over 2 to 4 seconds) to allow tissue expansion and minimize pressure, which can cause insulin leakage.

154

6. When teaching a pregnant woman with class II heart disease, the nurse should

• Instruct her to avoid strenuous activity Correct
C. Activity may need to be limited so that cardiac demand does not exceed cardiac capacity.

155

7. Women with cardiomyopathy have no underlying heart disease, but symptoms of cardiac decompensation appear during the last weeks of pregnancy or from 2 to 20 weeks postpartum. The following are symptoms of congestive heart failure. (Choose all that apply.)

A. CorrectDyspnea
B. CorrectWeakness
C. CorrectHeart palpitations

156

8. Because of the risk for toxoplasmosis infection, pregnant women who own a cat are advised to not change the ____________________.

litter box

157

9. Maternal anemia is associated with the following except

• Preterm birth
• Low birth weight
• Pica
• Hemoglobin is lower than 13 g/dL in the first and third trimesters or lower than 12g/dL in the second trimester Correct
Correct Feedback:
Anemia is a condition in which a decline in circulating red blood cell mass reduces the capacity to carry oxygen to the vital organs of the mother or fetus. Significant maternal anemia is associated with preterm birth and low birth weight. Pica (consuming nonfood substances such as clay, dirt, ice, or starch) also is a sign of iron deficiency anemia.
Incorrect Feedback:
A woman is usually considered anemic if her hemoglobin is lower than 11 g/dL in the first and third trimesters or lower than 10.5 g/dL in the second trimester.

158

10. Infants exposed to rubella during the first trimester are at risk for which complication?

• Microcephaly Correct
D. If maternal infection occurs during this time, about 90% of fetuses will have CRS. Hearing loss, mental retardation, cataracts, cardiac defects, growth restriction, and microcephaly are common fetal complications.

159

Chapter 17:

Intrapartum Fetal Surveillance:

160

1. Which of these conditions may cause the fetal heart rate to be lower during labor? (Choose all that apply.)

A. CorrectStimulation of the baroreceptors, which in turn stimulates the vagus nerve
B. CorrectProlonged hypoxia, hypercapnia, and acidosis
C. CorrectStimulation of the parasympathetic nervous system

161

2. The nurse is monitoring the fetal heart rate periodically with Doppler auscultation. At the end of a contraction, the fetal heart rate is 100 and gradually increases to 140 within 30 seconds. The nurse would need to assess the rate further, because this is an indication of ______________.

late deceleration

162

3. A woman is admitted to the birthing unit in labor. Upon assessment, it is noted that she is 3 cm dilated, 80% effaced with intact membranes. The nurse understands that her fetal monitoring will be done by ___________.

external electrodes

163

4. The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation?

• This deceleration pattern is associated with uteroplacental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply. Correct
B. This is a description of a late deceleration. Oxygen should be given via snug facemask. The nurse should position the woman on her side to increase placental blood flow.

164

5. Proper placement of the tocotransducer for electronic fetal monitoring is

• Over the uterine fundus Correct
A. The tocotransducer monitors uterine activity and should be placed over the fundus where the most intensive uterine contractions occur.

165

6. After monitoring the fetal heart rate for 10 minutes, the nurse notices the rate is staying at 175 bpm. The nurse is correct in classifying this baseline rate as

• Tachycardia Correct
C. Tachycardia is a heart rate greater than 160 bpm, persisting for at least 10 minutes.

166

7. What can be determined only by electronic fetal monitoring?

• Variability Correct
A. Variability cannot be determined by auscultation, because auscultation provides only an average fetal heart rate as it fluctuates.

167

8. Why should continuous electronic fetal monitoring be used when oxytocin is administered?

• Uteroplacental exchange may be compromised. Correct
B. The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves.

168

9. The physician obtains a sample of fetal scalp blood to evaluate the pH. The results of the pH were 7.35. The nurse knows the next action will be

• Nothing—this is a normal pH Correct
A. Normal scalp pH of a fetus is 7.25 to 7.35.

169

10. The nurse has just started a new shift and is reviewing the chart for her assigned patient. The patient is 6 cm dilated, 100% effaced, -4 station with intact membranes. Ten minutes later, the patient informs the nurse that her membranes have just ruptured. The nurse notices variable decelerations on the monitor. The nurse’s next action should be to

• Assess for a prolapsed cord Correct
A. With a -4 station, the fetus is at high risk for a prolapsed cord when the membranes rupture.

170

Chapter 18:

Pain Management for Childbirth:

171

1. The nurse is preparing to admit a woman in labor. The nurse notices on the prenatal record that the fetus is in an occiput posterior position. This position means the woman may have

• More back pain with the labor Correct
C. When the fetus is in this position, the contractions push the fetal occiput against the woman’s sacrum. This causes intense back discomfort that persists between contractions.

172

2. A woman is 2 cm dilated and requesting pain medication. Because of the early stage of labor, pain medication is not recommended. What can the nurse offer the woman to assist in managing pain?

• A massage Correct
B: A massage is a nonpharmacologic technique that can assist the woman to relax. It can be used during any stage of labor.

173

3. Prior to a woman’s receiving an epidural block during labor, an important nursing measure is to administer at least 500 mL of lactated Ringer's solution. The rationale behind this nursing measure is to

• Fill the vascular system with fluid to prevent hypotension due to vasodilation Correct
C. An epidural block may clock the sympathetic nerves, also, this results in vasodilation and hypotension. Maternal hypotension may produce nonreassuring signs of the electronic fetal monitor strip. Increasing the woman’s IV fluid intake prior to the block will help prevent hypotension.

174

4. An important nursing intervention after a woman in labor has had an epidural block is to

• Monitor the woman’s bladder Correct
A. With the large quantity of IV solutions the woman has received, her bladder fills quickly. The epidural block decreases the sensation of a full bladder so the woman may not be aware of her need to void.

175

5. After a cesarean section, the woman received a dose of an epidural opioid. Two hours later the nurse is assessing the woman and noted she was rubbing her face and neck and complaining of itching. The nurse’s next action should be to

• Administer a prescribed medication to relieve the itching Correct
D. Pruritus of the face and neck is a harmless but annoying side effect of epidural opioids. Administering diphenhydramine or small doses of naloxone or nalbuphine may help relieve some of the pruritus.

176

6. When administering intravenous opioids to a laboring woman, the nurse should give the medication at the ___________ of the contraction.

Beginning

177

7. Excessive anxiety during labor heightens the woman’s sensitivity to pain by increasing

• Muscle tension Correct
A. Anxiety and fear increase muscle tension, diverting oxygenated blood to the woman’s brain and skeletal muscles. Prolonged tension results in general fatigue, increased pain perception, and reduced ability to use coping skills.

178

8. The best time to teach nonpharmacologic pain control methods to an unprepared laboring woman is during the ___________ phase.

Latent

179

9. A woman received 25 mg of meperidine (Demerol) intravenously 1 hour before delivery. What drug should the nurse have readily available at delivery?

• Naloxone (Narcan) Correct
D. Naloxone reverses narcotic-induced respiratory depression, which may occur with the administration of narcotic analgesia.

180

10. The most important nursing intervention for the woman who has received an epidural narcotic is

• Monitoring respiratory rate hourly Correct
A. The possibility of respiratory depression exists for up to 24 hours after administration of an epidural narcotic.

181

Chapter 16:

Giving Birth:

182

1. The nurse is timing her patient’s contractions. The following pattern occurs:
Contraction starts: 7:32
Contraction ends: 7:32 (lasts 30 seconds)
Contraction starts: 7:37
Contraction ends: 7:38 (lasts 30 seconds)
Contraction starts: 7:42
Contraction ends: 7:42 (lasts 30 seconds)

The nurse records the frequency of the contraction as

• Every 4–5 minutes
• Lasting 30 seconds
• Every 5 minutes Correct
• Lasting 30 seconds to 1 minute
C. Frequency of contractions is the period from the beginning of one contraction to the beginning of the next contraction.

183

2. During labor, the nurse is aware that the woman’s vital signs are best assessed between contractions. The rationale for this is that

• The contractions decreases blood flow to the placenta, therefore increasing the woman’s blood volume and altering her vital signs. Correct
C. This increase in the woman’s blood volume during a contraction will increase her blood pressure slightly and slow her pulse rate.

184

3. During labor, a woman has been hyperventilating. She begins to complain of tingling in her hands and dizziness. The next action by the nurse should be to:

• Help the woman slow her breathing and to breathe into a paper bag. Correct
A. Hyperventilation causes a loss of too much carbon dioxide, which produces the symptoms of tingling and numbness in the hands and feet and dizziness. By slowing the breathing down and rebreathing the carbon dioxide, the symptoms should subside.

185

4. During an assessment, the nurse notes that the fetus is in complete flexion, with the head flexed toward the chest and the arms and legs flexed over the thorax. The fetal back is curved in a convex shape. This is termed fetal

• Attitude Correct
B. The fetal attitude describes relationship of fetal body parts to each other. The normal fetal attitude is flexion.

186

5. Pregnant women can usually tolerate the normal blood loss associated with childbirth because they have

• Increased blood volume Correct
B. Pregnant women have an increased blood volume during pregnancy by 1 to 2 L.

187

6. During a pelvic exam the nurse feels the fetal posterior fontanel toward the woman’s left side and anterior. The nurse would report the position as ________.

LOA

188

7. The best distinction between true labor and false labor is the progressive changes in the ________.

Cervix

189

8. Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet?

• Engagement Correct
A. Engagement is when the fetal presenting part as its widest diameter reaches the level of the ischial spines of the mother’s pelvis.

190

9. The physician noted that the woman was 7 cm dilated and 100% effaced. The nurse is aware that the woman is in which phase of labor?

• Transition Correct
C. The transition phase of the first stage is from about 7 or 8 cm to complete

191

10. A woman in active labor and has been admitted to the birthing unit. She calls the nurse and says her “water just broke.” The first nursing action should be

• Assessing the fetal heart rate for 1 minute Correct
B. When the membranes rupture, there is a risk for the umbilical cord to be displaced. Assessment of the fetal heart rate at this time will identify compression of the cord if it occurs.

192

11. Which maternal factor may inhibit fetal descent?

• A full bladder Correct
B. A full bladder may inhibit fetal descent, because it occupies space in the pelvis needed by the fetal presenting part.

193

12. To prevent heat loss after the infant is born the nurse’s first action should be to

• Dry the infant Correct
A. To reduce evaporative heat loss, the infant should be dried after birth.

194

Chapter 19:

Nursing Care During Obstetric Procedures

195

1. The patient has been diagnosed with hydramnios. When an amniotomy is preformed, the nurse is aware that the patient is at risk for which complication?

• Abruptio placenta Correct
B. Abruptio placenta may occur after an amniotomy if the uterus is distended. Hydramnios will distend the uterus.

196

2. Following an amniotomy, the priority nursing intervention is to

• Assess the fetal heart rate Correct
A. The fetus is at risk for cord compression after an amniotomy. Assessing the fetal heart rate will detect persistent bradycardia.

197

3. What factor is a contraindication for induction of labor?

• Previous cesarean section with a classic incision Correct
C. A classic incision for a cesarean section is a contraindication for induction of labor. This woman would be at high risk for uterine rupture.

198

4. In order to monitor for one of the side effects of oxytocin, it is important for the nurse to note the patient’s __________.

intake and output

199

5. The nurse noted that the woman’s Bishop’s score was 9. This indicates that the woman

• Has a high likelihood of successful induction Correct
A. The Bishop scoring system uses five factors to estimate cervical readiness for labor. The higher the score, the greater is the chance of success of induction.

200

6. After seeing the physician, the woman is confused about her upcoming induction. She states to the nurse, “The doctor said I would need a gel inserted prior to going into labor. What does that mean?” The nurse’s response should be based on knowledge that

• A gel is inserted prior to induction to ripen the cervix Correct
C. Prostaglandin E2 gel can be inserted prior to induction. This ripens the cervix so that it dilates easier.

201

7. One side effect of oxytocin stimulation is hypertonic contractions. This can be detrimental to the fetus because

• There is a reduction of placental blood flow Correct
B. Hypertonic contractions can reduce placental blood flow and therefore reduce exchange of fetal oxygen and waste products.

202

8. After the use of forceps during labor, the nurse should assess the woman for signs of

• Vaginal lacerations Correct
C. Maternal risks include laceration or hematoma of the vagina, perineum, or periurethral area.

203

9. Internal version might be used to manipulate the

• Fetus from a breech to a cephalic presentation before labor begins
• Fetus from a transverse lie to a longitudinal lie before cesarean birth
• Second twin from an oblique lie to a transverse lie before labor begins
• Second twin from a transverse lie to a breech presentation during vaginal birth Correct
A. This is done with external version.
B. This is done with external version.
C. This is done with external version.
D. Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally.

204

10. Examples of situations when the birth attendant may do an episiotomy include the following. Choose all that apply

A. CorrectFetal shoulder dystocia
B. CorrectForceps- or vacuum extractor–assisted births
C. CorrectFetus in an occiput posterior position

205

Chapter 27:

The Woman with an Intrapartum Complication:

206

1. A woman is 6 cm dilated. Her labor had been progressing as expected until about 2 hours ago. At that time she stated that the contractions were not as painful, the nurse noted the abdomen was easy to indent. A vaginal exam showed no progression of dilation in 2 hours. Some nursing measurers to help correct hypotonic contractions are to increase fluid intake and

• Assist her to walk Correct
A. Moving around will assist the labor progression and is more comfortable for the woman.

207

2. A patient is complaining of back pain with contractions. The nurse notices the fetal position is LOP. A maternal position that will aid the rotation of the fetal head is ________________.

right side lying

208

3. During a precipitate labor it is important for the nurse to

• Stay with the mother at all times to assist with an emergency birth if needed Correct
D. The nurse must remain with a mother in precipitate labor in order to provide support and to assist with an emergency birth if it occurs.

209

4. A woman has a nursing diagnosis of risk for infection related to prolonged rupture of membranes. Appropriate nursing interventions are to

• Monitor the odor of the amniotic fluid Correct
C. Amniotic fluid should be clear with a mild odor. If it becomes yellow or cloudy with a foul odor, this suggests an infection.

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5. The nurse notes on the patient’s record that the fetal fibronectin results were positive 1 week ago. The nurse is aware that the woman is at risk for

• Preterm labor Correct
B. A positive ffN test during midpregnancy may identify the woman at risk for PTL, possibly due to maternal or fetal infections.

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6. A hospitalized woman in preterm labor is being given magnesium sulfate intravenously. The expected outcome for this treatment will be met if

• Labor contractions are suppressed Correct
A. The primary reason for administering magnesium sulfate to a woman in preterm labor is to suppress uterine contractions.

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7. A hospitalized woman in preterm labor is being treated with terbutaline. The nurse would hold the next dose of this medication if the maternal heart rate was over ___________.

120

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8. Which patient is at risk for a prolapsed cord?

• The patient has hydramnios. Correct
D. A diagnosis of hydramnios indicates an unusually large amount of fluid. This extra fluid exerts more pressure to push the cord out when membranes rupture.

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9. A woman who had two previous cesarean births is in active labor when she suddenly complains of pain between her scapulae. The nurse’s priority action should be to

• Notify the physician promptly Correct
D. Pain between the scapulae may occur when the uterus ruptures because blood accumulated under the diaphragm. This is an emergency that requires medical intervention.

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10. What action should be initiated to limit hypovolemic shock when uterine inversion occurs?

• Administer oxygen at 4 L/min by nasal cannula.
• Administer an oxytocin drug by intravenous push.
• Monitor the fetal heart rate every 5 minutes.
• Restore circulating blood volume by increasing the intravenous infusion rate. Correct
A. Administering oxygen will not prevent hypovolemic shock.
B. Oxytocin drugs should not be given until the uterus is repositioned.
C. A uterine inversion occurs during the third stage of labor.
D. Intravenous fluids are necessary to replace the lost blood volume that occurs in uterine inversion.