215 notecards = 54 pages (4 cards per page)
Elsevier Review Questions
Chapter 1 : Foundation of Maternity, Womens Health, and Child Health Nursing
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.
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
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
4. In the 19th century, the most common cause of infant death was __________________.
Correct Responses: "infectious diarrhea, infectious diarrhea"
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
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
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
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
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
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
11. The most overwhelming adverse influence on health is
• Socioeconomic status Correct
The Nurses role in Maternity, Womens Health, and Pediatric Nursing:
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
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
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
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
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"
6. Which nursing interventions are written correctly?
• Provide 100 mL of fluids of choice every 2 hours while awake. Correct
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
8. A nurse who speaks on behalf of a patient is acting in the role of a(n) ___________.
Correct Responses: "advocate, advocate"
9. When comparing therapeutic communication with social communication, therapeutic communication is
• Goal-directed and focused Correct
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
Womens Health Care
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"
2. The American Cancer Society recommends yearly mammography to screen for breast cancer in women starting at which age?
• 40 Correct
3. When doing a vulvar self-examination, the woman should inspect for
• New moles Correct
4. Which piece of the usual equipment setup for a pelvic examination is not used with a Pap test?
• Lubricant Correct
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
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
7. The most common sites of breast cancer metastasis are the _____________________
Correct Responses: "brain, lungs, liver, and bones, brain, lungs, liver, and bones"
8. Which patient would be classified as having primary amenorrhea?
• A 19-year-old who never has had a period Correct
9. Which statement is true about primary dysmenorrhea?
• It may be caused by excessive endometrial prostaglandin. Correct
10. Which woman is most likely to have osteoporosis?
• A 55-year-old woman with a sedentary lifestyle Correct
Management of Fertility and Infertility:
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
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
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
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
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
6. Women should start emergency contraceptives within __________ of unprotected intercourse.
Correct Responses: "72 hours, 72 hours"
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
8. The role of the nurse in family planning is to
• Educate couples on the various methods of contraception Correct
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
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."
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
Heredity and Environmental Influences on Development
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
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
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
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
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"
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
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
8.The karyotype of a person is 47, XY, +21. This person is a __________________.
Correct Responses: "male with Down syndrome, male with Down syndrome"
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
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
Reproductive Anatomy and Physiology:
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
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"
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"
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
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 ________________.
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
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
8. Which is a secondary sexual characteristic?
• Female breast development Correct
9. The average man is taller than the average woman at maturity because of
• A longer period of skeletal growth. Correct
10. Fertilization of the ovum takes place in which part of the fallopian tube?
• Ampulla Correct
Conception and Prenatal Development:
1. During the first 2 weeks after conception, the fertilized ovum is called a ____________.
2. To maintain the corpus luteum and the continuing supply of estrogen and progesterone, the zygote secretes which hormone?
• Human chorionic gonadotropin Correct
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
4. Basic structures of all major body organs are completed during the __________ period of development.
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
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
7. Dizygotic twins develop from
• two fertilized ova and may be the same sex or different sexes. Correct
8. Which part of the mature sperm contains the male chromosomes?
• The head of the sperm Correct
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
10. The nurse understands that prenatal growth and development proceed in a cephalocaudal pattern, meaning that
• The brain will develop first Correct
Nutrition for Childbearing:
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"
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
3. To increase her folic acid intake, what snack would be most beneficial for a pregnant woman?
• Orange juice and fortified cereal Correct
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
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
6. A 27-year-old is in her third trimester. She gives the nurse the following 24-hour dietary recall:
• 2 cups salad greens with 3 ounces lean turkey, broccoli, and kidney beans Correct
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
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
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
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.
Prenatal Diagnostic Tests:
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
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
3. On which aspect of fetal diagnostic testing do parents usually place the most importance?
• Safety of the fetus Correct
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
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
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"
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
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 ______________./
9. When is the most accurate time to determine gestational age through ultrasound?
• First trimester Correct
10. The purpose of initiating contractions in a contraction stress test is to
• Apply a stressful stimulus to the fetus Correct
Adaptations to Pregnancy:
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
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
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
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
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
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
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
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 ______________________.
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
The Childbearing Family with Special Needs:
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
2. The most dangerous effect on the fetus of a adolescent woman who smokes cigarettes while pregnant is
• Intrauterine growth restriction Correct
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
4. An older mother is least likely to be concerned about
• Financial security Correct
5. The older mother is at greater risk for postpartum hemorrhage because of __________________.
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
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
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
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
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
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
2. When comparing threatened abortion to inevitable abortion, inevitable abortion has
• Cervical dilation Correct
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
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
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
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
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
8. A woman with preeclampsia is being treated with bed rest and intravenous magnesium sulfate. The drug classification of this medication is
• Anticonvulsant Correct
9. What is the only known cure for preeclampsia?
• Delivery of the fetus Correct
10. The classic sign of placenta previa is the sudden onset of ___________ uterine bleeding in the latter half of pregnancy.
Concurrent Disorders During Pregnancy:
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
2. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
• Hypoglycemia Correct
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)
4. Signs and symptoms of maternal hypoglycemia include the following except
A. CorrectShakiness (tremors)
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
6. When teaching a pregnant woman with class II heart disease, the nurse should
• Instruct her to avoid strenuous activity Correct
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.)
8. Because of the risk for toxoplasmosis infection, pregnant women who own a cat are advised to not change the ____________________.
9. Maternal anemia is associated with the following except
• Preterm birth
10. Infants exposed to rubella during the first trimester are at risk for which complication?
• Microcephaly Correct
Intrapartum Fetal Surveillance:
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
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 ______________.
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 ___________.
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
5. Proper placement of the tocotransducer for electronic fetal monitoring is
• Over the uterine fundus Correct
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
7. What can be determined only by electronic fetal monitoring?
• Variability Correct
8. Why should continuous electronic fetal monitoring be used when oxytocin is administered?
• Uteroplacental exchange may be compromised. Correct
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
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
Pain Management for Childbirth:
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
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
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
4. An important nursing intervention after a woman in labor has had an epidural block is to
• Monitor the woman’s bladder Correct
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
6. When administering intravenous opioids to a laboring woman, the nurse should give the medication at the ___________ of the contraction.
7. Excessive anxiety during labor heightens the woman’s sensitivity to pain by increasing
• Muscle tension Correct
8. The best time to teach nonpharmacologic pain control methods to an unprepared laboring woman is during the ___________ phase.
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
10. The most important nursing intervention for the woman who has received an epidural narcotic is
• Monitoring respiratory rate hourly Correct
1. The nurse is timing her patient’s contractions. The following pattern occurs:
• Every 4–5 minutes
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
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
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
5. Pregnant women can usually tolerate the normal blood loss associated with childbirth because they have
• Increased blood volume Correct
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 ________.
7. The best distinction between true labor and false labor is the progressive changes in the ________.
8. Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet?
• Engagement Correct
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
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
11. Which maternal factor may inhibit fetal descent?
• A full bladder Correct
12. To prevent heat loss after the infant is born the nurse’s first action should be to
• Dry the infant Correct
Nursing Care During Obstetric Procedures
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
2. Following an amniotomy, the priority nursing intervention is to
• Assess the fetal heart rate Correct
3. What factor is a contraindication for induction of labor?
• Previous cesarean section with a classic incision Correct
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
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
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
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
8. After the use of forceps during labor, the nurse should assess the woman for signs of
• Vaginal lacerations Correct
9. Internal version might be used to manipulate the
• Fetus from a breech to a cephalic presentation before labor begins
10. Examples of situations when the birth attendant may do an episiotomy include the following. Choose all that apply
A. CorrectFetal shoulder dystocia
The Woman with an Intrapartum Complication:
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
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
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
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
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
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
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 ___________.
8. Which patient is at risk for a prolapsed cord?
• The patient has hydramnios. Correct
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
10. What action should be initiated to limit hypovolemic shock when uterine inversion occurs?
• Administer oxygen at 4 L/min by nasal cannula.