exam 1 maternal newborn

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A woman in her 36th week of pregnancy develops eclampsia and dies at the hospital. The nurse who had been attending her understands that this is an example of which type of maternal death? Choose the most specific term available. 1. Direct obstetric death 2. Indirect obstetric death 3. Late maternal death 4. Postpartum maternal death

1. Direct obstetric death Direct obstetric death is a death resulting from complications during pregnancy (including eclampsia), labor/birth, and/or postpartum, and from interventions, omission of interventions, or incorrect treatment.

6. The nurse on a maternity unit is an Orthodox Jew whose rabbi teaches that pregnancy terminations are permitted only to save the life of the mother. Which situation becomes possible if the nurse puts aside personal values and assists with elective terminations? 1. Moral distress 2. Legal actions 3. Loss of spirituality 4. Professional dilemma

1. Moral distress This is correct. When a nurse puts aside values and carries out an action believed to be wrong, it creates a situation of moral distress.

2. A patient at 33 weeks gestation with a first pregnancy arrives at the labor and delivery unit with contractions. After monitoring the patient, the nurse determines the woman is in active labor and calls the health care provider (HCP), who prescribes a sleeping medication and sends the patient home. Which action does the nurse take? 1. Questions the HCP's prescribed treatment 2. Administers the medication and keeps the patient 3. Calls another HCP for a different prescription 4. Follows the HCP's instructions as prescribed

1. Questions the HCP's prescribed treatment This is correct. According to the ANA Code of Ethics, the nurse promotes, advocates for, and strives to protect the health, safety, and rights of all patients. The nurse needs to question the HCP's prescribed treatment

____ 14. The nurse works in a postpartum maternal-newborn unit and notices a newborn who is exhibiting signs of distress. Through investigation, the nurse learns the newborn's mother has a history of abusing street drugs. Which facility system does the nurse report as being deficient? 1. Risk management 2. Newborn monitoring 3. Patient information 4. Admission process

1. Risk management. This is correct. Of the options given, the deficiency is one related to risk management. A successful risk management program avoids preventable adverse outcomes and decreases the risk of liability through the use of appropriate, timely care, which accurately reflects maternal

A nurse is giving a seminar in a community center about the Healthy People 2020 maternal and infant health goals. Which of the following should the nurse mention? 1. Increased intake of copper among women of childbearing potential 2. Reduction in fetal and infant deaths 3. Increased proportion of infants who are bottle fed 4. Reduction in preterm births 5. Increased abstinence from alcohol among pregnant women

2. Reduction in fetal and infant deaths 4. Reduction in preterm births 5. Increased abstinence from alcohol among pregnant women Healthy People 2020 maternal and infant health goals include a reduction in fetal and infant deaths, an increase in the proportion of infants who are breastfed, the reduction of preterm births, an increase in abstinence from alcohol among pregnant women, and an increased intake of folate (not copper) among women of childbearing potential.

3. The nurse is providing care for a patient in labor. The unborn fetus was diagnosed with severe microcephaly at 20 weeks' gestation. The patient tells the nurse, "We want everything done to save our baby who has as much right to a good life as anyone else." Which ethical approach does this represent? 1. Autonomy 2. Libertarianism 3. Egalitarianism 4. Utilitarianism

3. Egalitarianism This is correct. Egalitarianism is the ethical principle being expressed by the patient. The principle focuses on the belief that all people are equal and resources should be distributed according to need. The focus is to protect the marginal or vulnerable members of society.

____ 15. An experienced OB nurse has accepted a position in labor and delivery of an inner-city hospital providing care for multicultural clients. Which action by the nurse is most helpful in preparation for this position? 1. Reviewing quantitative research focused on current birth procedures 2. Comparing facility policies with recent research recommendations 3. Intensely studying qualitative research focused on practice enhancement 4. Obtaining access to the department's recent research of evidence-based practice

3. Intensely studying qualitative research focused on practice enhancement. This is correct. The most helpful action by the nurse is to be aware of how the new workplace will affect the nurse's practice. It is important that the nurse review quantitative research addressing multicultural attitudes, understanding, and practices during childbirth. This is the most helpful action for preparation related to this job.

A nurse has just assisted with the delivery of a newborn who weighs approximately 2,000 grams. The nurse should understand that the newborn is classified as which of the following? 1. High birth weight 2. Normal birth weight 3. Low birth weight 4. Very low birth weight

3. Low birth weight Neonatal birth weight rates are reported to the Centers for Disease Control and Prevention in three major categories of low, normal, and high. Low birth weight is divided into two categories: low birth weight is defined as birth weight that is less than 2,500 grams but greater than 1,500 grams. Very low birth weight is defined as a birth weight that is less than 1,500 grams. Normal 2500-3999 grams. High 4000 grams.

The highest percentage of women who smoke during pregnancy are ____________. A. American Indian and/or Alaskan Native B. Asian and/or Pacific Islander C. Hispanic D. Non-Hispanic blackE. Non-Hispanic white

A. American Indian and/or Alaskan Native

A new mother is concerned about the survival of her newborn because she lost a prior birth. The nurse instructs the mother to place the infant on the infant's back in the crib. This measure helps reduce the risk of which of the following major causes of infant death? 1. Respiratory distress 2. Accident 3. Pneumonia and influenza 4. Sudden infant death syndrome

4. Sudden infant death syndrome The recent decrease in sudden infant death syndrome can be attributed to instructing parents to place their infants on their backs to sleep versus on their stomachs.

The more prepared a pregnant woman feels for the birth of her baby will lower her anxiety and fear. The behavior is referred to as ____________________.

ANS: nesting behavior

This test is a screening tool for Rh incompatibility

Coombs Test

The greatest increase in birthrate is in women ________. A. 15-19 years of age B. 25-29 years of age C. 30-34 years of age D. 40-45+ years of age

D. 40-45+ years of age

61. Severe itching due to stasis of bile in the liver

ANS: Pruritis gravidarum Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

59. Increased saliva production

ANS: Ptyalism Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

60. Reflux of the stomach contents into the esophagus

ANS: Pyrosis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

84. Stretch marks

ANS: Striae gravidarum Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

What is the most common expected emotional reaction of a woman to the news that she is pregnant? a. Jealousy b. Acceptance c. Ambivalence d. Depression

ANS: c Ambivalence is a normal expected reaction to the news of pregnancy, whether or not the pregnancy is planned or wanted.

Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of: a. Mental illness b. Delusions c. Attachment d. Crisis

ANS: c Correct, because talking to the fetus is a sign of positive maternal adaptation. All other answers indicate pathology.

A 39 year old, 16 week gravid woman has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences any of the following side effects (select all that apply) a. fever or chills b. lack of fetal movement c. abdominal pain d. rash or pruritis e. vaginal bleeding

a b c e

A 12 week gravid client presents in the emergency department with abdominal cramps and scant dark red bleeding. Which of the following signs/symptoms should the nurse assess this client for? (select all that apply) a. tachycardia b. referred shoulder pain c. headache d. fetal heart dysrhythmias e. hypertension

a c d e

A client, 32 weeks gestation with placenta previa, is on total bed rest. The physician expects her to be hospitalized on best rest until her cesarean section, which is scheduled for 38 weeks gestation. To prevent complications, the nurse should do which of the following? (select all that apply) a. perform passive range of motion exercises b. restrict the fluid intake of the client c. decorate the room with pictures of family d. encourage the client to eat a high-fiber diet e. teach the client deep-breathing exercises

a c d e

Which finding should the nurse expect when assessing a client with placenta previa? a. severe occipital headache b. history of thyroid cancer c. previous premature delivery d. painless vaginal bleeding

The nurse suspects that a client is third spacing fluid. Which of the following signs will provide the nurse with the best evidence of this fact? a. client's blood pressure b. client's appearance c. client's weight d. client's pulse rate

Which of the following findings should the nurse expect when assessing a client, 8 weeks gestation, with gestational trophoblastic disease (hydatidiform mole)? a. protracted pain b. variable fetal heart decelerations c. dark brown vaginal bleeding d. suicidal ideations

Which of the following would indicate that a nipple stimulation test is creating the desired effects? a. the woman's inverted nipple become erect b. the woman's nipple and breast tissue hypertrophy c. the woman's uterus contracts 3 times in 10 minutes d. the woman's cervix dilates 2 centimeters in 3 hours

A woman has just been admitted to the ED subsequent to a head on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? (select all that apply) a. placenta previa b. transverse fetal lie c. placental abruption d. severe preeclampsia e. preterm labor

c e

Which of the following nursing diagnoses would be most appropriate for a 15 year old woman who is in her first trimester of pregnancy? a. sleep pattern disturbance related to discomforts of pregnancy b. knowledge deficit related to care of infants c. anxiety related to fear of labor and delivery d. ineffective individual coping related to developmental level

4. The nurse is employed in a NICU. With each new admission, the neonate is classified in a specific category regarding care. The nurse is in the process of admitting a neonate at 22 weeks gestation with multiple life-threatening conditions involving both cardiac and respiratory systems. In which category of care does the nurse expect the neonate to be placed? 1. The category where aggressive care is probably futile. 2. The category where aggressive care is mostly uncertain. 3. The category where aggressive care is likely to be beneficial. 4. The category of "wait and see" to determine possible survival.

1. The category where aggressive care is probably futile. This is correct. The neonate is notably premature with complex issues involving two major, life-sustaining body systems. Aggressive care is probably futile, and the prognosis for a meaningful life is extremely poor or hopeless.

16. A woman has recently given birth to an infant born at 35 weeks and 5 days gestation. What long-term effects should the nurse be concerned about with the infant being born at this gestation? Select all that apply. 1. Cerebral palsy 2. Respiratory disorders 3. Developmental delays 4. Visual impairments 5. Hearing impairments

16. ANS: 1, 2, 3, 4, 5

8. The nurse is assisting a patient in the use of an ethical decision-making model related to quality of life. Which question is inappropriate when using this model? 1. What are the prospects for a normal life? 2. Are arrangements made for prolonging life? 3. Which type of deficits for the patient are likely? 4. Does a present or future condition make life undesirable?

2. Are arrangements made for prolonging life? This is correct. When using the ethical decision-making model for quality of life, the question needs to address if there are plans for comfort or palliative care. It is inappropriate to question about the prolongation of life.

1. The nurse is providing care for a patient in active labor. The patient continuously asks the nurse for medication to "stop the pain." Which ethical principle does the nurse use when replying, "We need to protect the baby from being overmedicated. Let me help you with some breathing and relaxation techniques"? 1. Veracity 2. Beneficence 3. Nonmaleficence 4. Fidelity

2. Beneficence This is correct. Beneficence is the ethical principle related to doing good. The nurse is describing why additional medication is not given but is also offering to assist with other methods of pain management.

As a nurse is reading an article in a nursing journal regarding world health trends, the nurse learns that in 2011 there were 13.83 live births per 1,000 people in the United States. This statistic is an example of which pregnancy-related measure? 1. Fertility rate 2. Birthrate 3. Infant mortality rate 4. Neonatal birth weight rate

2. Birthrate Birthrate is the number of live births per 1,000 people.

A nurse is working with a woman who has just learned that she is pregnant and who smokes a pack of cigarettes per day. The nurse is explaining to the patient the potential effects of tobacco use during pregnancy. Which of the following should the nurse mention as increased risks due to smoking? 1. Newborn obesity 2. Intrauterine growth restriction 3. Miscarriage 4. Placenta abruptio 5. Premature birth

2. Intrauterine growth restriction 3. Miscarriage 4. Placenta abruptio 5. Premature birth Tobacco use during pregnancy is associated with an increased risk of low birth weight (not newborn obesity), intrauterine growth restriction, miscarriage, placenta abruptio, premature birth, sudden infant distress syndrome, and respiratory problems in the newborn.

A nurse has just assisted in the birth of a newborn who was born between 32 and 33 weeks of gestation. Which of the following terms should the nurse use to describe this particular newborn? 1. Very premature 2. Moderately premature 3. Late premature 4. Full term

2. Moderately premature Moderately premature neonates are born between 32 and 33 weeks of gestation.

Which of the following statements is appropriate for the nurse to say to a patient with a complete placenta previa? a. "during the first phase of labor you will do slow chest breathing" b. "you should ambulate in the halls at least two times a day" c. "the doctor will deliver you once you reach 25 weeks gestation" d. "it is important that you inform me if you become constipated"

12. The nurse works in the labor and delivery department. Which action by the nurse indicates a breach in the nursing care principles outlined by AWHONN? 1. Assists with an emergency delivery of a woman in a homeless shelter 2. Informs employer of religious beliefs against pregnancy termination 3. Suggests a nurse care for a patient who speaks the same native language 4. Declines a patient assignment because of a history of illegal drug use

4. Declines a patient assignment because of a history of illegal drug use. This is correct. An AWHONN principle states that the nurse should not abandon a patient or refuse to provide care based on prejudice or bias. The nurse's action is a breach of this principle.

____ 7. The nurse works in the maternal-newborn unit dedicated to management of high-risk pregnancy and delivery. A patient has delivered two children who died from a genetic disorder. The current pregnancy tests positive for the same disorder. Which ethical decision-making model will the nurse use with this patient? 1. The model that focuses on medical treatment 2. The model that focuses on patient preference 3. The model that focuses on religion and culture 4. The model that focuses on the quality of life

4. The model that focuses on the quality of life. This is correct. The most appropriate decision-making model in this scenario is the one that considers the quality of life. The important considerations involve the well-being of both the patient and the unborn fetus.

The two most important predictors of an infant's health and survival after birth are: A. Gestational age and birth weight B. Gestational age and early prenatal care C. Gestational age and complication during labor and birth D. Gestational age and Apgar score

A. Gestational age and birth weight

5. The nurse is caring for a 15-year-old female who is pregnant with her first child. In her previous prenatal visit, the patient tested negative for chlamydia, syphilis, gonorrhea, and HIV. Based on the information provided, which condition is the patient's baby at higher risk for? 1. Intestinal problems 2. Neonatal conjunctivitis 3. Blindness 4. Pneumonia

ANS: 1 1 This is correct. Infants born to teen mothers are at increased risk for various conditions related to prematurity, including infant death, intestinal problems, and/or respiratory distress syndrome. 2 This is incorrect. Infants born to teen mothers who have gonorrhea are at increased risk of neonatal conjunctivitis and blindness. 3 This is incorrect. Infants born to teen mothers with syphilis and gonorrhea are at increased risk of blindness. 4 This is incorrect. Infants born to teen mothers with chlamydia may be at increased risk of developing chlamydial pneumonia.

10. The nurse is educating the pregnant patient with a body mass index (BMI) of 33. The nurse knows that teaching has been effective when the patient states which of the following? 1. "My child may be at increased risk for birth injury." 2. "My child may have a decreased risk of developing childhood diabetes." 3. "I will probably give birth vaginally." 4. "I have a lower risk of developing gestational hypertension."

ANS: 1 1 This is correct. Shoulder dystocia and other birth injuries are associated with infant macrosomia (large size) due to maternal obesity. 2 This is incorrect. Children born to mothers who are obese are at increased risk of developing childhood obesity and diabetes. 3 This is incorrect. Pregnant patients who are obese are at increased risk of cesarean birth. 4 This is incorrect. Pregnant patients who are obese have an increased risk of developing gestational diabetes and gestational hypertension.

11. A pregnant woman weighs 90.9 kg. The nurse is educating the patient on complications that the patient may be at risk for during pregnancy. Which response by the patient indicates that she understands? 1. "Due to my weight, there is a possibility that I may develop gestational diabetes." 2. "I am not overweight, but I am still at risk for gestational diabetes." 3. "My mother had preeclampsia during one of her pregnancies." 4. "I will need to do a glucose tolerance test in my second trimester."

ANS: 1 1 This is correct. The patient is at risk for gestational diabetes due to being obese during pregnancy. 2 This is incorrect. The patient is overweight. 3 This is incorrect. This response is not related to the question. 4 This is incorrect. The patient will need to get the glucose tolerance test in the second trimester, but this response does not relate to the question.

12. The labor and delivery nursing staff is conducting research to determine the benefits of childbirth education (CBE). Which finding does evidence-based practice support? 1. Women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery. 2. Women who are considered to be at high risk had fewer complications if CBE or a birth plan was used. 3. Women of color, younger in age, and who are multipara respond best to CBE and/or a birth plan. 4. Women with a previous cesarean delivery are more likely to have a vaginal delivery after CBE

ANS: 1 This is correct. According to Afshar et al., 2017, and Gagnon, 2011, women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery.

4. The nurse is providing care in a school clinic established for the care of adolescent mothers. When assessing a patient who is 11 years of age and pregnant, which deduction regarding the patient's psychosocial development will the nurse recognize? 1. The adolescent is self-centered and oriented toward the present. 2. At this age, pregnancy is likely a result of attachment to a first love. 3. Moving into the mothering role will be nearly impossible at this age. 4. The role of the grandmother will be as the baby's primary caretaker.

ANS: 1 This is correct. Pregnancy in early adolescence is difficult because the adolescent is self-centered and oriented toward the present, which makes maternal adaptation to pregnancy difficult and interferes with mothering

7. A couple announces to their parents that the couple is pregnant. One expectant grandmother says, "Grandchildren will call me by my first name. I am not ready to be a grandmother." Which feelings are being expressed by the grandmother? 1. The pregnancy presents undeniable evidence the grandmother is growing older. 2. The grandmother has specific wishes about how she is to be addressed as a person. 3. The grandmother is most likely teasing and actually feels overwhelming delight. 4. The grandmother has never thought of herself in this role and will adapt with time.

ANS: 1 This is correct. The feelings expressed in the grandmother's comment is in response to undeniable evidence that the grandmother is growing older.

6. A patient in the second trimester of pregnancy seems distressed. With encouragement, the patient states, "I have been totally avoiding physical contact with my husband to avoid prompting any sexual activity." Which statement by the nurse is the best response? 1. "Nonsexual expressions of affection are important for both of you." 2. "Be honest and tell your husband the reason you are avoiding him." 3. "You need to agree to sex in order to prevent infidelity from occurring." 4. "Sex during pregnancy is a healthy and normal display of affection."

ANS: 1 This is correct. The nurse needs to inform the patient that nonsexual expressions are important during pregnancy to both partners.

A patient who is pregnant does not remember the last date of her menstrual period. In which manner does the nurse expect the estimated date of delivery (EDD) to be determined for this patient? 1. Having an ultrasound examination 2. Using the gestational wheel 3. Asking when previous babies were born 4. Obtaining a history of gestational length

ANS: 1 1 This is correct. A fetal ultrasound will provide information about the fetal development, allowing for an accurate estimated date of delivery (EDD). The nurse expects this manner of determination. 2 This is incorrect. The gestational wheel can only be used if the date of the LMP is known. 3 This is incorrect. The birthdays of the child's siblings are irrelevant. 4 This is incorrect. Whether a mother carries to term is secondary to determining the normal EDD.

The labor and delivery nursing staff is conducting research to determine the benefits of childbirth education (CBE). Which finding does evidence-based practice support? 1. Women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery. 2. Women who are considered to be at high risk had fewer complications if CBE or a birth plan was used. 3. Women of color, younger in age, and who are multipara respond best to CBE and/or a birth plan. 4. Women with a previous cesarean delivery are more likely to have a vaginal delivery after CBE.

ANS: 1 1 This is correct. According to Afshar et al., 2017, and Gagnon, 2011, women who participated in CBE and/or had a birth plan had higher odds of a vaginal delivery. 2 This is incorrect. The research did not address women who were at risk during pregnancy or labor and delivery. 3 This is incorrect. Afshar et al., 2017, and Gagnon, 2011, state that women who attended CBE or had a birth plan were older, more likely to be nulliparous, had a lower body mass index, and were less likely to be African American. 4 This is incorrect. Research by Afshar et al., 2017, and Gagnon, 2011, indicates that individualized prenatal education directed toward avoidance of a repeat caesarean birth does not increase the rate of vaginal birth after caesarean section

The nurse is collecting health information from a patient who is early in the first trimester of pregnancy. Which topic is most important for the nurse to discuss with the patient after learning that the patient works for a commercial cleaning company? 1.Risk related to exposure to environmental toxins 2.Weight limit for lifting during the patient's pregnancy 3. Importance of resting with feet up during the day 4. Reasons for the patient to look for a safer job

ANS: 1 1 This is correct. Exposure to environmental toxins increases the risk for miscarriage, preterm birth, and other complications. The patient's job may involve exposure to solvents and/or cleaning chemicals. 2 This is incorrect. The nurse needs to ascertain if the patient's job involves lifting and make appropriate recommendations; however, this is not currently the most important topic. 3 This is incorrect. Pregnancy sometimes causes edema in the feet and legs, which can be reduced by elevating the feet and legs periodically during the day. However, this is not currently the most important topic. 4 This is incorrect. The nurse needs to explain any identifiable risk the patient's job may create during pregnancy. The nurse will be open to discussion and suggestions for the patient's concerns. It is not appropriate for the nurse to suggest the patient find a safer job, which may not be possible since financial constraints will also cause risks.

The nurse is providing care in a school clinic established for the care of adolescent mothers. When assessing a patient who is 11 years of age and pregnant, which deduction regarding the patient's psychosocial development will the nurse recognize? 1. The adolescent is self-centered and oriented toward the present. 2. At this age, pregnancy is likely a result of attachment to a first love. 3. Moving into the mothering role will be nearly impossible at this age. 4. The role of the grandmother will be as the baby's primary caretaker.

ANS: 1 1 This is correct. Pregnancy in early adolescence is difficult because the adolescent is self-centered and oriented toward the present, which makes maternal adaptation to pregnancy difficult and interferes with mothering. 2 This is incorrect. In early adolescence, pregnancy is most likely related to coercion or abuse. 3 This is incorrect. Moving into the mothering role will be difficult for the adolescent; however, it will not be impossible if teaching, role models, and support are available. 4 This is incorrect. Grandmothers will play a significant role in caring for the infant as well as providing guidance to their daughter regarding mothering skills. However, it should not become the grandmother's role to become the primary care provider for the baby.

16. A patient is experiencing pregnancy complications. Which factors will affect the client's ability to manage this situation? Select all that apply. 1. Current health status 2. Perceived threat to self or fetus 3. Previously used coping skills 4. Existence of a support network 5. Implemented nursing interventions

ANS: 1, 2, 3, 4, 5 1 This is correct. The patient's physical condition will impact the patient's ability to manage this situation. 2 This is correct. The patient's perceived threat to herself or the fetus will affect the patient's ability to manage this situation. 3 This is correct. The patient's previously used coping skills will affect the patient's ability to manage this situation. 4 This is correct. The existence of a support network will assist the patient in her ability to manage this situation. 5 This is correct. The recognition of patient needs and the implementation of appropriate nursing interventions will increase that patient's ability to manage this situation.

A couple announces to their parents that the couple is pregnant. One expectant grandmother says, "Grandchildren will call me by my first name. I am not ready to be a grandmother." Which feelings are being expressed by the grandmother? 1. The pregnancy presents undeniable evidence the grandmother is growing older. 2. The grandmother has specific wishes about how she is to be addressed as a person. 3. The grandmother is most likely teasing and actually feels overwhelming delight. 4. The grandmother has never thought of herself in this role and will adapt with time.

ANS: 1 1 This is correct. The feelings expressed in the grandmother's comment is in response to undeniable evidence that the grandmother is growing older. 2 This is incorrect. The grandmother does have specific wishes about how she wishes to be addressed as a person; however, those wishes are most likely attached to a denial of aging. 3 This is incorrect. The announcement of a new baby is an occasion for celebration. The grandmother's comment is inappropriate and will be a probable source of hurt feelings. 4 This is incorrect. Many grandparents cannot envision themselves as grandparents and will adapt over time to the role. However, the comment is most likely related to aging.

A patient in the first trimester of pregnancy states, "I don't understand how a term baby can be accommodated by my uterus." Which information by the nurse specifically addresses the patient's comment? 1. The uterus size increases in size 20 times over a nonpregnant uterus. 2. The weight of the uterus increases from 7 g to 1,100 g during pregnancy. 3. About 80% of the increased capacity of the uterus is related to uteroplacental content. 4.n About 75% of the increase in uterus size during pregnancy is related to stretching.

ANS: 1 1 This is correct. The information that specifically addresses the patient's comment about how her uterus will accommodate a term baby is clarified with the fact that the uterus increases in size 20 times over the non-pregnant size. 2 This is incorrect. The weight of the uterus does increase from 7 g to 1,100 g; however, this fact does not specifically address the patient's comment. 3 This is incorrect. Eighty percent of the increased uterine capacity is related to uteroplacental content; however, this information does not specifically address the patient's comment. A better factor is the increase in uterine capacity from 10 mL to 5,000 mL. 4 This is incorrect. Both stretching and growth are involved in the increase in the size of the uterus to accommodate the developing fetus. However, an increase from 7 g to 1,000 g supports a greater amount of growth instead of stretching.

A patient in the second trimester of pregnancy seems distressed. With encouragement, the patient states, "I have been totally avoiding physical contact with my husband to avoid prompting any sexual activity." Which statement by the nurse is the best response? 1. "Nonsexual expressions of affection are important for both of you." 2. "Be honest and tell your husband the reason you are avoiding him." 3. "You need to agree to sex in order to prevent infidelity from occurring." 4. "Sex during pregnancy is a healthy and normal display of affection."

ANS: 1 1 This is correct. The nurse needs to inform the patient that nonsexual expressions are important during pregnancy to both partners. 2 This is incorrect. If the nurse tells the patient to be honest and share her reasons for avoiding her husband, the patient will not change her behaviors. Continuation of avoidance can create tension in the relationship. 3 This is incorrect. The nurse should not tell the patient that having sex is a method to prevent infidelity. The patient has a right to avoid sex without guilt; however, displaying affection is still important. 4 This is incorrect. Sex can be a healthy, normal display of affection during pregnancy; however, both partners must be willing participants. The patient may have physical changes that make sex undesirable.

A pregnant patient is at the prenatal clinic for a routine visit at 30 weeks gestation. The nurse monitors the patient for indications of physiological demands by the fetus on the patient. Which finding causes the nurse concern? 1. Hgb of 9.5 g/dL and Hct. of 30% 2. PT of 16.5 seconds 3. WBCs of 16,000 mm3 4. Heart rate up 20 bpm

ANS: 1 1 This is correct. The patient's hemoglobin and hematocrit are below normal for the patient. This finding causes the nurse concern because the increased demand of iron for fetal development results in maternal iron deficiency anemia. 2 This is incorrect. The patient's PT is indicative of hypercoagulability, which is an expected physiological response to pregnancy in anticipation of blood loss during delivery. Normal PT is in the range of 11 to 13.5 seconds. This finding does not cause the nurse concern. 3 This is incorrect. WBC count of 16,000 mm3 is not abnormal in a patient who is at 30 weeks gestation, especially if there are no other indications of infection. The scenario does not indicate manifestations of infection. 4 This is incorrect. A 15 to 20 bpm increase in heart rate is expected due to a 40% increase in cardiac output. This finding does not cause the nurse concern.

A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? Select all that apply. 1. Waddling gait 2. Low back pain 3. Increased risk of falls 4. Fractures 5. Severe muscle aches

ANS: 1, 2, 3 1 This is correct. A waddling gait is a normal change during pregnancy and related to increased progesterone and relaxin levels causing softening of joints and increased joint mobility. Widening and increased mobility of the sacroiliac and symphysis pubis result. 2 This is correct. Low back pain is expected during pregnancy and related to increased progesterone and relaxin levels leading to softening of joints and increased joint mobility, resulting in widening and increased mobility of the sacroiliac and symphysis pubis. 3 This is correct. Although it is hazardous, increased risk of falls is expected during pregnancy due to a shift in the center of gravity related to the enlarged uterus. The patient needs to take precautions to avoid falls or activities requiring balance. 4 This is incorrect. Fractures are not expected or normal during pregnancy. 5 This is incorrect. Muscle aches are not normal during pregnancy and may signal an electrolyte imbalance.

19. Which factors will facilitate the integration of evidence-based practice (EBP) in the maternity-newborn clinical setting? Select all that apply. 1. Frame clinical questions in PICOT format. 2. Collect the best and most relevant evidence. 3. Cultivate a spirit of inquiry in the workplace. 4. Encourage the use of trial and error methods. 5. Base practical decisions on nursing consensus.

ANS: 1, 2, 3 This is correct. The PICOT question format will encourage unit nurses to think in scientific terms as they approach their daily work. The PICOT approach includes the important factors that need to be considered when implementing EBP information into the clinical setting. This is correct. Collecting the best, most relevant evidence will facilitate implementing EBP research into the clinical setting. This is correct. A spirit of inquiry is essential for fostering a desire to do things the right, evidence-based way.

A patient is experiencing pregnancy complications. Which factors will affect the client's ability to manage this situation? Select all that apply. 1. Current health status 2. Perceived threat to self or fetus 3. Previously used coping skills 4. Existence of a support network 5. Implemented nursing interventions

18. The nurse is taking the history of a gravida 2 para 1 patient. Which findings in the patient's history warrant further action? Select all that apply. 1. Anemia 2. Severe hemorrhage 3. Infections 4. Malnutrition 5. Eclampsia

ANS: 1, 2, 3, 5 1 This is correct. Anemia is a primary cause of maternal death. 2 This is correct. Severe hemorrhage is a primary cause of maternal death. 3 This is correct. Infection is a primary cause of maternal death. 4 This is incorrect. Malnutrition is not a primary cause of maternal death. 5 This is correct. Eclampsia is a primary cause of maternal death.

19. A nurse is caring for a single teen mother who has just given birth to her first child. The patient notes that the child's father "wants no relationship with his son." The patient goes on to express concerns about the short- and long-term impact of her teen pregnancy on herself and on her child. Which statements made by the nurse are accurate? Select all that apply. 1. "You are more likely than others to have additional children before you turn 20." 2. "You may have difficulty completing high school or college." 3. "Your child is less likely to experience behavioral problems." 4. "Your child is at increased risk of abusing alcohol when he is a teenager." 5. "You may not earn enough money to independently support yourself and your child."

ANS: 1, 2, 4 1 This is correct. Teen mothers are more likely to have additional children than their peers. Roughly 17% of all teen mothers will have at least one more birth before the age of 20. 2 This is correct. Only half of teen mothers earn their high school diploma by age 22. Less than 2% of teen mothers finish college by age 30. 3 This is incorrect. Children of teen mothers are more likely to experience behavioral problems. 4 This is correct. Teenage males without an involved father have a higher risk of abusing alcohol or drugs. 5 This is correct. Around one-fourth of teen mothers begin receiving welfare within 3 years of the birth of their first child. 66% of teen mothers are poor.

17. The nurse works in a prenatal clinic located in a multicultural city. It is important for the nurse to recognize which cultural beliefs as prescriptive? Select all that apply. 1. The mother will aid the baby's circulation by remaining active during pregnancy. 2. The satisfaction of pregnancy cravings will prevent birthmarks on the baby. 3. The mother invites harm to the fetus during the night by sleeping on her back. 4. A safety pin attached to an undergarment will prevent fetal facial deformities. 5. Drinking too much tea will stimulate the fetus and cause a premature birth.

ANS: 1, 2, 4 1 This is correct. The belief of improving the baby's circulation by the mother remaining active during pregnancy is a prescriptive belief. 2 This is correct. It is a prescriptive belief that satisfying a mother's cravings will prevent birthmarks on the baby. 3 This is incorrect. It is a prescriptive belief that the mother will protect the fetus from harm by sleeping on her back, and not invite harm during the night if in this position. 4 This is correct. It is a prescriptive belief that if a mother attaches a safety pin to an undergarment, the baby will be protected from having a cleft lip or palate. 5

The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which assessments will the nurse plan? Select all that apply. 1. Urine testing with a dipstick. 2. Presence of dependent edema. 3. Determine EDD by Naegele's rule. 4. Antibody screening for Rh?2- patient. 5. Check for chromosomal abnormalities.

ANS: 1, 2, 4 1 This is correct. During the second trimester, it is common for the nurse to perform urine testing with a dipstick to check for glucose, albumin, and ketones. Mild proteinuria and glycosuria are expected. 2 This is correct. During the second trimester, the nurse should be checking the patient for slight, dependent edema in the lower extremities due to decreased venous return. Upper body edema is abnormal and requires additional evaluation. 3 This is incorrect. The EDD is estimated using Naegele's rule during the first trimester; EDD is determined in the second trimester if the patient is not aware of her last menstrual cycle. 4 This is correct. In the second trimester, the nurse will perform screening needed to determine if the Rh- patient has produced antibodies. If so, the patient will receive the first dose of Rhogam. The patient's Rh factor is determined in the first trimester. 5 This is incorrect. Chromosomal abnormalities are not routinely screened; however, during the early stage of the second trimester, all patients should be offered the screening and diagnostic testing regardless of age or other risk factors.

The nurse explains to a patient who has missed a second menstrual cycle that a combination of presumptive and probable signs is used to make a practical diagnosis of pregnancy. Which signs are expected by the nurse when making a practical diagnosis? Select all that apply. 1. Elevated hCG levels in blood and urine 2. Brownish pigmentation on the face 3. Fetal movement detected by the examiner 4. Bluish-purple coloration of vagina and cervix 5. Occasional mild contractions

ANS: 1, 2, 4 1 This is correct. Elevated hCG levels in the patient's blood and urine are probable signs of pregnancy and will be considered when making a practical diagnosis of pregnancy. 2 This is correct. Brownish pigmentation on the patient's forehead, temples, cheeks, and/or upper lip is melisma (chloasma), which is a probable sign of pregnancy and will be considered when making a practical diagnosis of pregnancy. 3 This is incorrect. Fetal movement that can be observed and detected by the examiner is considered a positive sign of pregnancy, which does not occur until after or about 20 weeks gestation. The finding would be unexpected at this time. 4 This is correct. Bluish-purple coloration (Chadwick's sign) of the vaginal mucosa, cervix, and vulva occurs at 6 to 8 weeks gestation and is considered a probable sign of pregnancy and will be considered when making a practical diagnosis of pregnancy. 5 This is incorrect. Contractions are not expected, even Braxton-Hicks contractions, until long after the pregnancy is identified.

The nurse works in a prenatal clinic located in a multicultural city. It is important for the nurse to recognize which cultural beliefs as prescriptive? Select all that apply. 1. The mother will aid the baby's circulation by remaining active during pregnancy. 2. The satisfaction of pregnancy cravings will prevent birthmarks on the baby. 3. The mother invites harm to the fetus during the night by sleeping on her back. 4. A safety pin attached to an undergarment will prevent fetal facial deformities. 5. Drinking too much tea will stimulate the fetus and cause a premature birth.

16. Parents of a neonate are grieving over their child's life-threatening disabilities. The neonate's course of treatment has changed three times in the last 24 hours due to irrational parenteral decisions. Which interventions will the NICU nurse implement in order to fulfill nursing responsibility to both the parents and the neonate? Select all that apply. 1. Inform the parents as to realistic expectations. 2. Use neonate's status with parenteral counseling. 3. Elicit parenteral input regarding medical care. 4. Advocate for medical support of the neonate. 5. Inform parents they are the final decision makers.

ANS: 1, 2, 4 This is correct. The neonatal nurse has a responsibility to be truthful to the parents regarding realistic expectations for their neonate. The nurse also has a responsibility to cause no additional harm to the neonate. The ethical principle is for veracity. This is correct. Again, the ethical principle of veracity (truthfulness) is important when counseling the parents of the neonate. The nurse is mindful of fulfilling nursing responsibility for both the parents and the neonate. This is correct. The nurse has a responsibility to both the parents and the neonate to advocate for appropriate medical care of the neonate. Ethically, the nurse needs to do no harm.

15. The nurse is encouraging cultural sensitivity among the nonmedical personnel in a prenatal clinic. Which type of family does the nurse identify as including children? Select all that apply. 1. Nuclear family 2. Extended family 3. Cohabitating family 4. Dyad family 5. Blended family

ANS: 1, 2, 5 1 This is correct. A nuclear family includes a father, mother, and child. 2 This is correct. An extended family includes three generations, including married brothers and sisters and their children. Extended families do not necessarily live together. 3 This is incorrect. A cohabitating family is an unmarried couple living together, which may or may not include children. 4 This is incorrect. A dyad family is a couple living alone without children. 5 This is correct. A blended family is a combination of two families with children from one or both families and sometimes children of the newly married couple.

The nurse is encouraging cultural sensitivity among the nonmedical personnel in a prenatal clinic. Which type of family does the nurse identify as including children? Select all that apply. 1. Nuclear family 2. Extended family 3. Cohabitating family 4. Dyad family 5. Blended family

14. A pregnant patient tells the nurse that her spouse has been diagnosed with Couvade syndrome. Which manifestations does the nurse suspect the spouse is experiencing? Select all that apply. 1. Nausea from unidentifiable causes 2. Physical rejection of sexual advances 3. Significant recent weight gain 4. Unexplainable abdominal pains 5. Self-imposed social isolation

ANS: 1, 3, 4 1 This is correct. Couvade syndrome is diagnosed when the male experiences some of the same manifestations of pregnancy as a pregnant partner. Nausea is a symptom of Couvade syndrome. 2 This is incorrect. The rejection of sexual advances by the male of a pregnant couple is not a manifestation of Couvade syndrome. Some causes may be fear hurting the woman and/or the fetus, or lack of interest related to the physical changes of pregnancy. 3 This is correct. Couvade syndrome is diagnosed when the male experiences some of the same manifestations of pregnancy as a pregnant partner. Weight gain is a symptom of Couvade syndrome. 4 This is correct. Couvade syndrome is diagnosed when the male experiences some of the same manifestations of pregnancy as a pregnant partner. Abdominal pains are a symptom of Couvade syndrome

17. An infant was recently born weighing 1,498 grams. The nurse understands that the birth weight of this infant is an important indicator of what? Select all that apply. 1. Morbidity rate 2. Prenatal care 3. Mortality rate 4. Infant health outcome 5. Postpartum care

ANS: 1, 3, 4 1 This is correct. Morbidity rate is an outcome of low birth weight. 2 This is incorrect. Prenatal care is not an outcome of low birth weight. 3 This is correct. Mortality rate is an outcome of low birth weight. 4 This is correct. Infant health is an outcome of low birth weight. 5 This is incorrect. Postpartum care is not an outcome of low birth weight.

8. A mother has a child who is 4 years of age, and she is expecting another child. The mother expresses concern to the nurse about how the older sibling will receive the newborn. Which intervention shared by the mother does the nurse discourage? 1. "I plan to let him hear the baby's heartbeat at the next prenatal visit." 2. "I think that I will just bring the new baby home as a surprise." 3. "I have enrolled him in a sibling preparation class at the hospital." 4. "I let him pick out a gift for the baby, and have one for him from the baby."

ANS: 2 This is correct. The nurse will discourage the mother from bringing a newborn home as a surprise. The older sibling needs time to adjust to the prospect of having a new baby. This action is likely to create a greater lack of acceptance in the older sibling.

A pregnant patient tells the nurse that her spouse has been diagnosed with Couvade syndrome. Which manifestations does the nurse suspect the spouse is experiencing? Select all that apply. 1. Nausea from unidentifiable causes 2. Physical rejection of sexual advances 3. Significant recent weight gain 4. Unexplainable abdominal pains 5. Self-imposed social isolation

The nurse is preparing a prenatal plan of care for a patient who is in the first trimester of pregnancy. Which long-range goals does the nurse include in the plan of care? Select all that apply. 1. Perform an ongoing assessment of risk status 2. Determine parental outlook on immunizations 3. Build rapport with the childbearing family 4. Make referral to specific resources as needed 5. Implement a risk-appropriate intervention

ANS: 1, 3, 4, 5 1 This is correct. An appropriate long-term goal in a prenatal care plan is to perform an ongoing assessment of risk status of the patient, fetus, and expectant family. 2 This is incorrect. The parenteral outlook regarding immunizations is not an appropriate long-term goal on a prenatal care plan. Attitudes about immunizations can be discussed by health care providers involved with pediatric care. 3 This is correct. An appropriate long-term goal in a prenatal care plan is for the nurse to build a rapport with the child-bearing family. Communication is an important part of prenatal care. 4 This is correct. An appropriate long-term goal in a prenatal care plan is to ascertain and make referrals to specific resources for the fetus, neonate, and family. 5 This is correct. An appropriate long-term goal in a prenatal care plan is for the nurse to implement any risk-appropriate intervention. During the prenatal period, risks can occur and interventions must be implemented in a timely manner.

The nurse notes that a patient in the third trimester of pregnancy feels unable to "mother" her unborn child. Which information about the patient helps the nurse identify the sources of the patient's ambivalence? Select all that apply. 1. The patient is estranged from her mother. 2. The patient asks about classes for baby care. 3. The patient expresses a loss of independence. 4. The patient's partner is excited about a baby. 5. The patient expresses disgust about body changes.

ANS: 1, 3, 5

13. The nurse notes that a patient in the third trimester of pregnancy feels unable to "mother" her unborn child. Which information about the patient helps the nurse identify the sources of the patient's ambivalence? Select all that apply. 1. The patient is estranged from her mother. 2. The patient asks about classes for baby care. 3. The patient expresses a loss of independence. 4. The patient's partner is excited about a baby. 5. The patient expresses disgust about body changes

ANS: 1, 3, 5 1 This is correct. Women who have a positive relationship with their own mothers more easily identify with the role of motherhood. A source of ambivalence for this patient is likely related to her estranged relationship from her own mother. 2 This is incorrect. Asking about classes for baby care is not a sign of ambivalence. 3 This is correct. When the patient expresses unresolved conflict about her loss of independence, which may relate to the demands of motherhood, the nurse identifies a source of ambivalence. 4 This is incorrect. One of the tasks of motherhood is ensuring social acceptance of the baby by significant others; it is unlikely the excitement about the baby by the patient's partner is a source of ambivalence. 5 This is correct. Acceptance of a pregnancy includes acceptance of the related body changes. The patient's expressed disgust about body changes is a likely source of ambivalence.

18. The nurse works in a prenatal clinic that serves a multicultural population. The nurse is culturally aware, and so, which behaviors by a patient are expected due to common restrictive beliefs? Select all that apply. 1. A pregnant woman denies sexual intercourse during her third trimester. 2. A pregnant woman allows a clinic staff member to take a photo of her. 3. A pregnant woman reaches to an overhead shelf to collect her belongings. 4. A pregnant woman avoids sitting in front of a fan or air conditioner. 5. A pregnant woman refuses to watch a televised eclipse of the moon.

ANS: 1, 5 1 This is correct. The nurse expects a pregnant woman to deny sexual intercourse in the last trimester of pregnancy; it is a restrictive belief aimed at preventing respiratory distress in a newborn. 5 This is correct. A restrictive belief states that a pregnant woman should not see an eclipse of the moon; to do so will cause the baby to have a cleft lip or palate

The nurse is providing dietary teaching to a patient in the first trimester of pregnancy who is overweight. Which daily dietary suggestions does the nurse make? Select all that apply. 1. One cup of 100% juice and cup of dried fruit. 2. Three cups of raw leafy and 1 cup cooked vegetables 3. One and a half cups of cooked pasta, rice, or cereal 4. Six ounces of lean meat, 2 eggs, and cup of beans 5. One cup of milk, 1 cup of yogurt, and oz of cheese

ANS: 1, 5 1 This is correct. In the first trimester of pregnancy, the patient requires 2 cups of fruit; 1 cup of 100% juice and cup of dried fruit daily is a correct suggestion by the nurse. 2 This is incorrect. In the first trimester of pregnancy, the patient requires cups of vegetables daily; 3 cups of raw leafy vegetables and 1 cup of cooked vegetables is too much. 3 This is incorrect. One and a half cups of cooked rice, pasta, or cereal daily is too much; the patient in the first trimester of pregnancy needs 6 ounces of grains per day. 4 This is incorrect. A patient in the first trimester of pregnancy needs ounces of protein daily; the suggested amounts are too much. One ounce of protein consists of 1 ounce of lean meat, poultry, or seafood; cup of cooked beans, ounce of nuts or 2 tablespoons of peanut butter; or 1 egg. The suggested foods provide 10 ounces of protein. 5 This is correct. One cup of milk, 1 cup of yogurt, and ounces of cheese is equal to the recommended daily dairy intake. This suggestion by the nurse is correct.

The nurse works in a prenatal clinic that serves a multicultural population. The nurse is culturally aware, and so, which behaviors by a patient are expected due to common restrictive beliefs? Select all that apply. 1. A pregnant woman denies sexual intercourse during her third trimester. 2. A pregnant woman allows a clinic staff member to take a photo of her. 3. A pregnant woman reaches to an overhead shelf to collect her belongings. 4. A pregnant woman avoids sitting in front of a fan or air conditioner. 5. A pregnant woman refuses to watch a televised eclipse of the moon.

ANS: 1, 5 1 This is correct. The nurse expects a pregnant woman to deny sexual intercourse in the last trimester of pregnancy; it is a restrictive belief aimed at preventing respiratory distress in a newborn. 2 This is incorrect. The nurse does not expect to see a pregnant woman allowing a staff member to take her photo; there is a restrictive belief the action may cause a stillbirth. 3 This is incorrect. The nurse does not expect to see a pregnant woman reach over her head for any reason; there is a restrictive belief the action will cause the cord to wrap around the baby's neck. 4 This is incorrect. The nurse does not expect to see a pregnant woman expose herself to cold in any form due to it causing arthritis or other chronic illness. This is an example of a restrictive belief. 5 This is correct. A restrictive belief states that a pregnant woman should not see an eclipse of the moon; to do so will cause the baby to have a cleft lip or palate.

9. The nurse is counseling a female patient about alcohol use during pregnancy. Which statement by the patient demonstrates successful patient teaching? 1. "I will limit my drinking to just one alcoholic beverage per day." 2. "It's best for my baby if I avoid drinking during pregnancy." 3. "An occasional drink on special occasions is okay." 4. "Drinking alcohol is only acceptable in the first trimester."

ANS: 2 1 This is incorrect. Alcohol should not be consumed while pregnant. 2 This is correct. Drinking alcohol while pregnant can cause low birth weight, fetal alcohol syndrome, mental retardation, and intrauterine growth restriction. 3 This is incorrect. Alcohol should not be consumed while pregnant. 4 This is incorrect. Alcohol should not be consumed while pregnant.

6. The nurse is caring for a 23-year-old patient who arrives at the clinic for a pregnancy test. The test confirms the patient is pregnant. The patient states, "I do not need to stop smoking my electronic cigarette because it will not harm my baby." Which is the best response by the nurse? 1. "You are correct. Electronic cigarettes are not harmful during pregnancy." 2. "Tobacco products, including electronic cigarettes, should not be used during pregnancy due to risking nicotine toxicity." 3. "According to the FDA, although electronic cigarettes are safe for you, they can cause harm to the fetus during pregnancy." 4. "Electronic cigarettes are considered harmful only in the first trimester."

ANS: 2 1 This is incorrect. Electronic cigarettes can be harmful during pregnancy. 2 This is correct. Pregnant women should not use tobacco products or electronic cigarettes during pregnancy. 3 This is incorrect. Electronic cigarettes are not controlled by the FDA and may be harmful to both mother and fetus. 4 This is incorrect. Electronic cigarettes are considered harmful during pregnancy.

4. The nurse is caring for a 14-year-old patient who is 32 weeks pregnant. After complaining of genital sores and discomfort, the patient tests positive for syphilis. The fetus is at increased risk of which condition? 1. Diabetes 2. Blindness 3. Pneumonia 4. Hypertension

ANS: 2 1 This is incorrect. Maternal obesity increases a child's risk of developing childhood obesity and diabetes. 2 This is correct. Neonatal blindness, maternal death, and neonatal death are all associated with a patient who contracts syphilis during pregnancy. 3 This is incorrect. Chlamydial pneumonia is associated with maternal chlamydia. 4 This is incorrect. Teen mothers may have a higher risk of contracting sexually transmitted illnesses and hypertension during pregnancy; however, maternal syphilis is not associated with fetal hypertension.

15. A nursing student is asked to set goals that will decrease the fetal death outcomes during delivery. What guidelines will the nursing student use to assist in setting her goals? 1. WHO Maternal care guidelines 2. Healthy People 2020 3. AWHONN white papers 4. State Practice Act

ANS: 2 1 This is incorrect. The WHO guidelines are too broad for this purpose and the nurse will need to use national goals. 2 This is correct. The national goals for improving maternal and infant health are found in Healthy People 2020. 3 This is incorrect. AWHONN white papers will present positions but not necessarily detail health promotion goals. 4 This is incorrect. State practice acts specify legal requirements rather than health promotion goals.

3. The nurse works in a prenatal clinic and interacts with multiple patients from various socioeconomic backgrounds. Which patient does the nurse assess most carefully for a mental health issue? 1. A woman who chooses single parenthood 2. A military veteran who was deployed twice 3. The pregnant partner of a lesbian relationship 4. The mother who is multigestational with triplets

ANS: 2 This is correct. A military veteran who was deployed twice is at greater risk for depression. The nurse ascertains if the patient was treated for PTSD and any signs of mental health issues.

11. The nurse is counseling a couple in the third trimester of pregnancy and recommends the couple attend childbirth education classes. For which reason is the nurse least likely to recommend the classes? 1. The classes will affirm the normalcy of birth. 2. The techniques will enable a medication-free delivery. 3. The classes acknowledge a woman's ability to inherently give birth. 4. The classes explore ways to find strength and comfort during labor

ANS: 2 This is correct. Childbirth classes do not focus on teaching techniques that enable a medication-free delivery. However, the classes may enable the mother to require less medication because of greater understanding of the birthing process.

10. A couple is planning for the birth of their first child and is discussing the difference between a physician and a midwife. Which information presented by the couple does the nurse validate as being true? 1. Midwives are commonly self-taught without formal training. 2. Physicians provide care for both low- and high-risk patients. 3. Midwives primarily deliver babies in the home setting. 4. Physicians rely on the use of technological procedures for birth.

ANS: 2 This is correct. It is true that physicians are able to manage both low- and high-risk patients during childbirth

A mother has a child who is 4 years of age, and she is expecting another child. The mother expresses concern to the nurse about how the older sibling will receive the newborn. Which intervention shared by the mother does the nurse discourage? 1. "I plan to let him hear the baby's heartbeat at the next prenatal visit." 2. "I think that I will just bring the new baby home as a surprise." 3. "I have enrolled him in a sibling preparation class at the hospital." 4. "I let him pick out a gift for the baby, and have one for him from the baby."

ANS: 2 1 This is incorrect. A good tip for sibling preparation for a newborn is to allow the sibling to hear the baby's heartbeat during a prenatal visit. 2 This is correct. The nurse will discourage the mother from bringing a newborn home as a surprise. The older sibling needs time to adjust to the prospect of having a new baby. This action is likely to create a greater lack of acceptance in the older sibling. 3 This is incorrect. Taking the sibling on a tour of the hospital or the birthing center will help the child develop a sense of reality and understanding. A sibling preparation class is designed to help the older sibling prepare for the presence of a newborn. 4 This is incorrect. Having the older sibling pick out a present for the newborn, and having a gift for the sibling from the newborn will help alleviate feelings of animosity and foster a caring relationship.

A patient arrives at a maternal health client and tells the nurse she has missed a period and thinks she is pregnant. Which information shared with the nurse is a presumptive sign of pregnancy? 1. Positive results on a home pregnancy test 2. Breast enlargement, tenderness, and tingling 3. First awareness of fetal movements 4. Increased appetite

ANS: 2 1 This is incorrect. A positive result on a home pregnancy test is a probable sign of pregnancy, not a presumptive sign, which is primarily subjective information provided by the patient. 2 This is correct. If the patient experiences breast enlargement, tenderness, and tingling after missing a period, the patient has a presumptive sign of pregnancy. This is considered a subjective finding that occurs 2 to 3 weeks after conception. 3 This is incorrect. After missing one period, it is not likely the patient will experience the first awareness of fetal movement, which is a presumptive sign but does not occur until 18 to 20 weeks after conception. 4 This is incorrect. An increase in appetite is not a presumptive sign of pregnancy. A more likely sign is nausea and vomiting, which can occur from 2 through 12 weeks.

The nurse is counseling a couple in the third trimester of pregnancy and recommends the couple attend childbirth education classes. For which reason is the nurse least likely to recommend the classes? 1. The classes will affirm the normalcy of birth. 2. The techniques will enable a medication-free delivery. 3. The classes acknowledge a woman's ability to inherently give birth. 4. The classes explore ways to find strength and comfort during labor.

ANS: 2 1 This is incorrect. Childbirth classes are designed to affirm the normalcy of childbirth and remove the ideas that it is an illness or the mother is sick. 2 This is correct. Childbirth classes do not focus on teaching techniques that enable a medication-free delivery. However, the classes may enable the mother to require less medication because of greater understanding of the birthing process. 3 This is incorrect. Childbirth classes focus on the ability of women to inherently give birth; it is a normal and natural function, which can often happen with minimal assistance or interference. 4 This is incorrect. Childbirth classes will help the mother and her coach to explore ways in which to promote strength and comfort during labor and delivery.

The nurse is providing care for a patient at 30 weeks gestation. Which topic related to patient concern or discomfort is most important for the nurse to address? 1. Increased breast enlargement 2. Dizziness when lying supine 3.Dependent edema and varicosities 4. Hyperpigmentation on the face

ANS: 2 1 This is incorrect. If the patient is experiencing increased breast enlargement, the nurse should reiterate the importance of a well-fitting bra. This not the most important issue for the nurse to address. 2 This is correct. The most important issue for the nurse to address is the patient's experience of dizziness when lying supine. The nurse will provide education about supine and orthostatic hypotension and advise the patient to refrain from supine positioning. The patient needs to be instructed to use side-lying positions. 3 This is incorrect. The nurse will need to instruct the patient about the management of dependent edema and varicosities, which is to sit or lie with the feet and legs elevated several times daily. This is not the most important issue for the nurse to address. 4 This is incorrect. Because it is so noticeable, many patients will express concern over hyperpigmentation on the face. The nurse needs to review the cause and remind the patient that the coloration is likely to be temporary. This is not the most important issue for the nurse to address.

A couple is planning for the birth of their first child and is discussing the difference between a physician and a midwife. Which information presented by the couple does the nurse validate as being true? 1. Midwives are commonly self-taught without formal training. 2. Physicians provide care for both low- and high-risk patients. 3. Midwives primarily deliver babies in the home setting. 4. Physicians rely on the use of technological procedures for birth.

ANS: 2 1 This is incorrect. Midwives can be self-taught without formal training, but this group manages about 1% of the deliveries in the United States and Canada. Midwives can also be RNs with advanced training who are licensed in midwifery. 2 This is correct. It is true that physicians are able to manage both low- and high-risk patients during childbirth. 3 This is incorrect. Only lay midwives deliver primarily in the home setting. Other midwives can deliver in hospitals and alternative birth centers, as well as in family homes. 4 This is incorrect. Physicians have access to technological procedures for birth, but they do not rely on or use the procedures for uncomplicated births.

12. The nurse is taking a history of a mother who admits to cocaine drug use. Which action should the nurse take first? 1. Refer the patient to a drug abuse program. 2. Screen the infant for side effects associated with cocaine use. 3. Educate the patient of the risks associated with cocaine use during pregnancy. 4. Advise the patient that her baby will be okay even with the history of cocaine use.

ANS: 3 1 This is incorrect. This is appropriate, but not the first action the nurse should take. 2 This is incorrect. The infant is not screened for side effects of maternal drug use until delivery. 3 This is correct. The patient should be educated on possible risks associated with drug use. 4 This is incorrect. It is not appropriate to tell a patient "your baby will be okay" in any circumstance.

The nurse is counseling a patient who shares the intention to become pregnant. Which finding during the collection of health information will the nurse feel the least concern to address? 1. The patient smokes a pack of cigarettes a week. 2. The patient lives in a recently renovated house. 3. The patient travels outside the country for work. 4. The patient has a family history of diabetes mellitus.

ANS: 2 1 This is incorrect. The nurse needs to express the need for the patient to stop smoking; there is no amount of smoking that is harmless during pregnancy. 2 This is correct. The fact that the patient lives in a recently renovated house is the least concern to the nurse. If renovation was in process or the house was old and not renovated, the nurse would be concerned about exposure to environmental hazards. 3 This is incorrect. The nurse needs to further assess where the patient travels for work. Greatest concerns are about sanitation, environmental issues, exposure to potential diseases, and availability of health care if needed. 4 This is incorrect. The nurse needs to further assess the patient's family history of diabetes mellitus. The nurse needs to determine the type of diabetes and any predisposing factors such as obesity. The nurse will provide information for prevention and address a need for additional monitoring.

A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and 32 weeks gestation, respectively, a singleton birth born at 39 weeks gestation, and two pregnancies lost in the first trimester. In which way will the nurse define the patient's obstetrical history? 1. G4, T3, P2, A2, L3 2. G6, T1, P4, A2, L5 3. G5, T1, P2, A2, L5 4. G6, T4, P0, A4, L3

ANS: 2 1 This is incorrect. The only correct information in this option is the one indicating two spontaneous abortions. 2 This is correct. The nurse will correctly determine that the patient has been pregnant six times; delivered one term neonate; had two set of twins born prematurely for a total of four births; had two spontaneous abortions before 20 weeks gestation; and currently has five living children. 3 This is incorrect. In this option, the number of pregnancies and number of premature neonates are wrong. 4 This is incorrect. In this option, all determinations are incorrect except for the number of pregnancies, which is correct at six.

The nurse works in a prenatal clinic and interacts with multiple patients from various socioeconomic backgrounds. Which patient does the nurse assess most carefully for a mental health issue? 1. A woman who chooses single parenthood 2. A military veteran who was deployed twice 3. The pregnant partner of a lesbian relationship 4. The mother who is multigestational with triplets

ANS: 2 1 This is incorrect. The woman who chooses single parenthood will require routine assessment; however, the nurse does not need to assess this patient carefully for mental health issues. 2 This is correct. A military veteran who was deployed twice is at greater risk for depression. The nurse ascertains if the patient was treated for PTSD and any signs of mental health issues. 3 This is incorrect. The pregnant partner of a lesbian relationship does not necessarily need to be assessed for signs of mental health issues. However, the nurse is aware this couple may require additional social and emotional support. 4 This is incorrect. The mother who is multigestational with triplets will require careful physiological monitoring. In addition, the mother may need emotional support related to a higher risk for fetal well-being.

A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit? 1.Signs of infection 2. Breast changes 3. A change in EDD 4. Support bras

ANS: 2 1 This is incorrect. There is no need to cover signs of infection because of the patient's concern. 2 This is correct. The leakage of yellow fluid from the patient's breasts is a normal change during pregnancy. The patient is experiencing a leakage of colostrum, which is rich in antibodies for the neonate. This manifestation can begin as early as 16 weeks. 3 This is incorrect. The presentation of colostrum does not affect the EDD. 4 This is incorrect. The topic of support bras should take place early in the first trimester due to expected breast enlargement. Covering this topic does not address the patient's concern.

The nurse is providing care for a patient in the third trimester of pregnancy. Which topic of patient education is most likely to be needed during this time? 1. Update on fetus growth and behavioral patterns 2. Management for commonly experienced discomforts 3. General health maintenance and promotion topics 4. Counseling and guidance about diet and exercise

ANS: 2 1 This is incorrect. Update of fetal growth and development is appropriate during all trimesters of pregnancy and not specific to the third trimester. 2 This is correct. The patient education most likely needed in the third trimester is related to the management of commonly experienced discomforts. 3 This is incorrect. General health promotion and health maintenance education is appropriate during all trimesters of pregnancy and not specific to the third trimester. 4 This is incorrect. Counseling about diet and exercise is appropriate during all trimesters of pregnancy and not specific to the third trimester.

19. A couple informs the nurse they have decided to make arrangements for a home birth. Which criteria will the nurse share with the couple regarding a safe home birth? Select all that apply. 1. The couple must be trained on how to be in control of the birth. 2. The pregnant woman must be in good health with a normal pregnancy. 3. The birthing home must be within a 1-hour drive of a hospital. 4. Adequate medical supplies and resuscitation equipment is available. 5. The birthing room needs to be sterile prior to labor and delivery.

ANS: 2, 4 2 This is correct. The nurse is correct in informing the couple that the woman must be in good health with a normal pregnancy. High-risk pregnancies are not suitable for home births 4 This is correct. The nurse needs to inform the couple that in addition to being attended by a well-trained health care provider, adequate medical supplies and resuscitation equipment need to be in the home

8. The nurse is caring for a patient at 7 weeks gestation. The nurse suspects that a pregnant patient may have been using marijuana. With consent, the nurse confirms via urine drug screen. Which statement by the nurse is most appropriate? 1. "Did you smoke marijuana when pregnant with your other child?" 2. "To avoid negative effects on your baby, you'll need to stop using marijuana during your last trimester." 3. "Using marijuana while pregnant can have a negative effect on the neurological development of your baby." 4. "Marijuana use while pregnant greatly increases your risk of miscarriage."

ANS: 3 1 This is incorrect. Whether or not the woman used marijuana during her previous pregnancy is not relevant to her current care. 2 This is incorrect. Marijuana should not be used at any point during pregnancy. 3 This is correct. Marijuana use during pregnancy may have a negative effect on the neurological development of the fetus. 4 This is incorrect. There currently is no research linking marijuana use to increased risk of miscarriage.

A couple informs the nurse they have decided to make arrangements for a home birth. Which criteria will the nurse share with the couple regarding a safe home birth? Select all that apply. 1. The couple must be trained on how to be in control of the birth. 2. The pregnant woman must be in good health with a normal pregnancy. 3. The birthing home must be within a 1-hour drive of a hospital. 4. Adequate medical supplies and resuscitation equipment is available. 5. The birthing room needs to be sterile prior to labor and delivery.

ANS: 2, 4 1 This is incorrect. The couple planning a home birth do not need training about how to control the birth, but they do need a solid understanding of the process. 2 This is correct. The nurse is correct in informing the couple that the woman must be in good health with a normal pregnancy. High-risk pregnancies are not suitable for home births. 3 This is incorrect. The nurse needs to share that in case of an emergency or complications, a good method of transportation should be accessible. The couple should evaluate possible consequences of living 1 hour away from emergency assistance. 4 This is correct. The nurse needs to inform the couple that in addition to being attended by a well-trained health care provider, adequate medical supplies and resuscitation equipment need to be in the home. 5 This is incorrect. There is no need for the birthing room in the home to be sterile prior to labor and delivery. The risk for infection in a home birth may be lower than in a hospital.

18. The nursing department of a large facility is interested in improving clinical care with the introduction of EBP. Which barriers to EBP does the nursing department expect within the facility? Select all that apply. 1. Changes in nursing academia to include how to integrate research into practice 2. Outdated facility politics and policies that do not embrace research-based change 3. A general lack of information addressing nursing-focused research and change 4. Limited resources available to clinical care providers from nursing administration 5. Resistance by other health care professionals to providing nursing with autonomy

ANS: 2, 4 This is correct. Many health care facilities have outdated political and policies, which can be a barrier to EBP. Nurses need the support, approval, and process by which to make EBP changes. This barrier can be managed within the facility. This is correct. A very real barrier to EBP at the clinical setting is the possibility of nursing administration failing to provide the resources needed to make changes in clinical care delivery. EBP may include provisions for resources, personnel, and training.

20. The nurse is caring for a woman who is pregnant. The patient reports that she has also smoked less than five cigarettes per day and that she has continued to smoke during her pregnancy. Routine prenatal examination and diagnostics have indicated she tested negative for sexually transmitted infections and has a BMI of 25. Based on statistics, which is likely true about the patient and the developing fetus? Select all that apply. 1. She will breastfeed her infant. 2. She is probably aged 20-24. 3. She likely has earned a college degree. 4. Her child may have impaired brain development. 5. Her child is more likely to be born prematurely.

ANS: 2, 4, 5 1 This is incorrect. Mother who smoke during pregnancy are less likely to breastfeed their infants. 2 This is correct. Only 4.5% of mothers over 35 smoke during pregnancy, which is the lowest smoking prevalence rate of age ranges listed. Mothers aged 20-24 have the highest prevalence of smoking during pregnancy (13%). 3 This is incorrect. Statistics indicate that mothers with less than a high school diploma have the highest prevalence of smoking during pregnancy (14.1%). Patients with a bachelor's degree or higher have the lowest prevalence of smoking during pregnancy (0.9%). 4 This is correct. Fetal brain development may be impaired when the mother continues to smoke throughout pregnancy. 5 This is correct. Tobacco exposure during development is toxic to developing fetuses. It may contribute to a variety adverse effects, including abruptio placenta and premature birth.

____ 17. The labor and delivery nurse is providing care to a patient in active labor. The nurse notes EFM changes that suggest fetal distress and monitors the fetus for an additional 20 minutes before calling the health care provider. The health care provide determines that an emergency cesarean delivery is required. During transport, EFM is interrupted and not resumed due to expectations of an emergent procedure. A stillborn fetus is delivered. For which actions can the nurse be held legally responsible? Select all that apply. 1. Inappropriate use of oxytocin, causing fetal distress. 2. Lack of appropriate response to fetal compromise. 3. Inability to initiate resuscitation to a compromised fetus. 4. Delayed communication resulting in a delay of cesarean. 5. Performance of a technical error related to monitoring.

ANS: 2, 4, 5 This is correct. The nurse can be held legally responsible for the lack of an appropriate response to fetal compromise. The nurse needs to immediately report indications of fetal compromise to colleagues, charge nurses, and

13. A pregnant patient with a BMI of 35 is concerned about health effects she and her baby may face during pregnancy. During routine testing, the patient tested negative for sexually transmitted illnesses (STIs) and indicated that she is in a committed, long-term relationship with the child's father. Which of the following is accurate? 1. The patient's infant is at increased risk of neonatal blindness. 2. The patient's infant has a decreased risk of birth injury. 3. The patient will have increased risk of wound infection. 4. The patient will have a decreased risk of preeclampsia.

ANS: 3 1 This is incorrect. Infants born to mothers with certain sexually transmitted illnesses (STIs) are at increased risk of neonatal blindness. 2 This is incorrect. Infants born to obese pregnant women have increased risk of birth injury related to macrosomia. 3 This is correct. Obese pregnant patients are at increased risk for wound infections. 4 This is incorrect. Obese pregnant patients have an increased risk of developing certain conditions, including gestational diabetes, gestational hypertension, and preeclampsia.

7. The nurse is caring for a 16-year-old patient who is 32 weeks pregnant with her first child, who is male. The patient's mother has accompanied her to today's visit. During the nursing assessment, the patient mentions that she is no longer in a relationship with the baby's father but her mother plans to help her. However, the patient's mother asks whether this will have any impact on the child. Which should the nurse indicate the child is at increased risk of during his adolescence? 1. Hypertension 2. Diabetes 3. Alcohol abuse 4. Intraventricular bleeding

ANS: 3 1 This is incorrect. Teen mothers, rather than their children, are at increased risked of hypertension during pregnancy. 2 This is incorrect. Children born to mothers who are obese have an increased risk of developing childhood obesity and childhood diabetes. 3 This is correct. Statistics have shown that adolescent boys without an involved father may be at higher risk of incarceration, dropping out of school, and abusing drugs or alcohol. 4 This is incorrect. Children born to teen mothers are at increased risk for health problems associated with low birth weight, including intraventricular bleeding

5. The nurse is providing care for a patient who is 42 years of age and in the first trimester of her pregnancy. For which possible complication will the nurse closely monitor the patient and fetus? 1. Elevated blood pressure and proteinuria 2. Indications of maladaptation to pregnancy 3. Alterations in fetal chromosomal studies 4. Subtle indicators of menopause occurring

ANS: 3 This is correct. Due to the patient's age, the nurse will closely monitor for chromosomal alterations in the fetus. Older mothers are a greater risk for fetal chromosome defects.

1. The nurse at a prenatal clinic is aware of the important tasks that each expectant mother will need to address. When an expectant mother states, "I will give up everything I have to make sure this baby is safe and well-cared for," which task is the mother addressing? 1. Expressing an attachment to the child 2. Ensuring safe birth for mother and child 3. Stating a willingness to give of oneself 4. Ensuring social acceptance of the child

ANS: 3 This is correct. The mother's statement specifically addresses the mother's willingness and efforts to make personal sacrifices for the child. The task is that of giving oneself to the demands of motherhood.

The nurse at a prenatal clinic is aware of the important tasks that each expectant mother will need to address. When an expectant mother states, "I will give up everything I have to make sure this baby is safe and well-cared for," which task is the mother addressing? 1. Expressing an attachment to the child 2. Ensuring safe birth for mother and child 3. Stating a willingness to give of oneself 4. Ensuring social acceptance of the child

ANS: 3 1 This is incorrect. Attaching or "binding-in" to the child is the development of maternal-fetal attachment. The mother's statement does not address attachment. 2 This is incorrect. Ensuring a safe passage for herself and her child involves the mother's knowledge and care-seeking behaviors to ensure that both she and the newborn emerge from pregnancy healthy. The mother's statement does not specifically address this task. 3 This is correct. The mother's statement specifically addresses the mother's willingness and efforts to make personal sacrifices for the child. The task is that of giving oneself to the demands of motherhood. 4 This is incorrect. Social acceptance of the child by significant others is important to the pregnant woman. However, the mother's statement does not address the woman's engagement of her family and social network in the pregnancy.

The nurse is providing care for a patient who is 42 years of age and in the first trimester of her pregnancy. For which possible complication will the nurse closely monitor the patient and fetus? 1. Elevated blood pressure and proteinuria 2. Indications of maladaptation to pregnancy 3. Alterations in fetal chromosomal studies 4. Subtle indicators of menopause occurring

ANS: 3 1 This is incorrect. The nurse will need to monitor the patient for signs of preeclampsia, but not in the first trimester of the pregnancy. 2 This is incorrect. Indicators for maladaptation to pregnancy should be monitored for throughout the pregnancy. 3 This is correct. Due to the patient's age, the nurse will closely monitor for chromosomal alterations in the fetus. Older mothers are a greater risk for fetal chromosome defects. 4 This is incorrect. There is no true reason why the nurse will monitor the patient for any indications of menopause; the nurse is focused on the existing pregnancy and the well-being of the mother and fetus.

3. The nurse is providing education to a patient who has given birth to her first child and is being discharged home. The patient expressed concern regarding infant mortality and sudden infant death syndrome (SIDS). The patient had an uncomplicated pregnancy, labor, and vaginal delivery. She has a body mass index of 25 and has no other health conditions. The infant is healthy and was delivered full-term. What will be most helpful thing to explain to the patient? 1. Uses of extracorporeal membrane oxygenation therapy (ECMO) 2. Uses of exogenous pulmonary surfactant 3. The Baby-Friendly Hospital Initiative 4. The Safe to Sleep campaign

ANS: 4 1 This is incorrect. EMCO has been cited as one of the factors that has reduced infant mortality among preterm infants. 2 This is incorrect. Although advances in medical treatments have decreased infant mortality, exogenous pulmonary surfactant is primarily used to reduce mortality of preterm infants. 3 This is incorrect. The Baby-Friendly Hospital Initiative was developed to support breastfeeding and is not directly linked to reduced infant mortality or SIDS. 4 This is correct. The Back to Sleep campaign and the Safe to Sleep campaigns were designed to promote healthy infant sleeping habits. The decrease in SIDS from 1995 to 2015 was attributed to the Safe to Sleep campaign.

2. A patient with a history of hypertension is giving birth. During delivery, the staff was not able to stabilize the patient's blood pressure. As a result, the patient died shortly after delivery. This is an example of what type of death? 1. Early maternal death 2. Late maternal death 3. Direct obstetric death 4. Indirect obstetric death

ANS: 4 1 This is incorrect. Early maternal death is not an example of maternal death. Examples of maternal death include late maternal death, indirect obstetric death, direct obstetric death, and pregnancy-related death. 2 This is incorrect. Late maternal death occurs 42 days after termination of pregnancy from a direct or indirect obstetric cause. 3 This is incorrect. Direct obstetric death results from complications during pregnancy, labor, birth, and/or postpartum period. 4 This is correct. Indirect obstetric death is caused by a preexisting disease, or a disease that develops during pregnancy.

14. The nurse has made it a goal to increase the rate at which women begin prenatal care in the first trimester. The nurse relates this decision to national goals for better maternal and infant outcomes. What guidelines will the nurse use to guide her maternal health goals? 1. WHO Maternal care guidelines 2. State Practice Acts 3. AWHONN white papers 4. Healthy People 2020

ANS: 4 1 This is incorrect. The WHO guidelines are too broad for this purpose, and the nurse will need to use national goals. 2 This is incorrect. State practice acts specify legal requirements rather than health promotion goals. 3 This is incorrect. AWHONN white papers will present positions but not necessarily detail health promotion goals. 4 This is correct. The national goals for improving maternal and infant health are found in Healthy People 2020.

83. Curvature of the spine

ANS: Lordosis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

58. Anterior convexity of the lumbar spine

ANS: Lumbar lordosis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

2. The nurse is providing prenatal care for a patient who is pregnant with a second child. Which understanding about complexity of a second pregnancy does the nurse use to assist the patient with the acceptance of this pregnancy? 1. Point out that the financial obligation is always less with a second child. 2. Make suggestions of how the first child will be a "helper" with the new baby. 3. Recommend career decisions needed because of additional parenting tasks. 4. Offer strategies for working out a new relationship with the first child

ANS: 4 This is correct. Pregnancy tasks are more complex for the multipara due to the relationship between the mother and the first child. The nurse can offer strategies for remodeling this relationship and help the mother with feelings associated with the needed change.

9. A pregnant patient and her spouse live in the same home as the spouse's family who is not supportive of the pregnancy. The patient feels the family is ruining the happiness about the pregnancy. Which is the most important determination for the nurse to make? 1. What the potential for improving the current support network is 2. Who will provide the patient the greatest amount of support 3. Whether the couple's finances support moving into a separate location 4. If threatened or actual abuse from household members occur toward the patient

ANS: 4 This is correct. The most important determination for the nurse to make in this scenario is whether the patient is experiencing a threat or actual abuse from the family members.

The nurse is caring for a patient who is in labor with her first child. The patient's mother is present for support and notes that things have changed in the delivery room since she last gave birth in the early 1980s. Which current trend or intervention may the patient's mother find most different? 1. Fetal monitoring throughout labor 2. Postpartum stay of 10 days 3. Expectant partner and family in operating room for cesarean birth 4. Hospital support for breastfeeding

ANS: 4 This is correct. Hospital support for breastfeeding, including a lactation consultant and employment of the Baby-Friendly Hospital Initiative, were both enacted during the early 1990s.

A patient who is pregnant shares details of being in a physically and psychologically abusive relationship with her baby's father. Which statement by the nurse is indicative of AWHONN's standing regarding intimate partner violence (IPV)? 1. "If you are all alone, you need to make arrangements for someone to stay with you." 2. "Your partner needs to come to the office so that we can confront his behavior." 3. "I will call a women's shelter to make arrangement for you to move in immediately." 4. "Let's explore ways to protect you and stop the abuse you have been enduring."

ANS: 4 1 This is incorrect. AWHONN's view about being alone does not focus on arranging for someone to stay with the patient; the focus is on relaying that the patient is not alone in her situation. Many women experience abuse and receive protection from agencies and individuals. 2 This is incorrect. Stating that the patient's partner needs to come to the office in order to have his behavior confronted is a potential breach in confidentiality. This action is not supported by AWHONN. 3 This is incorrect. The patient needs to be aware of agencies that are available to protect her safety. However, beyond providing the contact information, the nurse is not the decision maker for moving to a shelter. 4 This is correct. AWHONN promotes safety, support, education, and confidentiality as part of the interventions to protect the woman who is experiencing partner abuse; this statement covers the patient's needs.

A patient expresses a desire to become pregnant for a second child. The nurse notes that the patient's first child was born with a serious neural tube defect (NTD) and died of complications at 18 months of age. Which recommendation does the nurse make to this client? 1. Folic acid 0.6 mg/day orally 1 month before conception and throughout pregnancy. 2. Folic acid 0.4 mg/day orally started when pregnant and continued throughout pregnancy 3. Folic acid 4 mg/day orally started when pregnant and continued throughout pregnancy 4. Folic acid 4 mg/day orally for 1 month prior to conception through first trimester of pregnancy

ANS: 4 1 This is incorrect. Folic acid at a dose of 0.6 mg/day is recommended for women who have not delivered a neonate with a neural tube defect (NTD). 2 This is incorrect. After a patient delivers a neonate with an NTD, a dosage of 0.4 mg/day is prescribed for the second and third trimesters. 3 This is incorrect. For a patient who has delivered a neonate with NTD, folic acid is prescribed at 4 mg/day only for 1 month prior to conception and through the first trimester. It is not necessary to continue this dosage through the entire pregnancy. 4 This is correct. The correct dose of folic acid for the patient who previously delivered a neonate with NTD is 4 mg/day for 1 month prior to conception, which is continued through the first trimester. The dose is then reduced to 0.4 mg/day for the remainder of the pregnancy.

A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her last menstrual period (LMP) date as April 14. Using Naegele's rule, the nurse will set the estimated date of delivery (EDD) as what date? 1. July 21 2. January 7 3. July 14 4. January 21

ANS: 4 1 This is incorrect. Naegele's rule requires counting back 3 months from the LMP and adding 7 days. This answer indicates that 3 months forward were considered. 2 This is incorrect. Naegele's rule requires counting back 3 months from the LMP and adding 7 days. In this calculation, 7 days were not added to the LMP. 3 This is incorrect. Naegele's rule requires counting back 3 months from the LMP and adding 7 days. Both the month and the date were miscalculated in this option. 4 This is correct. Naegele's rule requires counting back 3 months from the LMP and adding 7 days. This is the correct calculation and EDD.

The nurse is providing prenatal care for a patient who is pregnant with a second child. Which understanding about complexity of a second pregnancy does the nurse use to assist the patient with the acceptance of this pregnancy? 1. Point out that the financial obligation is always less with a second child. 2. Make suggestions of how the first child will be a "helper" with the new baby. 3. Recommend career decisions needed because of additional parenting tasks. 4. Offer strategies for working out a new relationship with the first child.

ANS: 4 1 This is incorrect. Pregnancy tasks may be more complex for the multipara. The nurse is not necessarily knowledgeable about the financial obligations related to a second child. Income can be affected by a second child, and the needs of the second child may be greater for a variety of reasons. 2 This is incorrect. Nursing knowledge about how to make the first child a "helper" with the new baby may not be appropriate. The first child's age and demeanor need to be considered. 3 This is incorrect. It is not the responsibility of the nurse to recommend career changes to a patient expecting a second child. 4 This is correct. Pregnancy tasks are more complex for the multipara due to the relationship between the mother and the first child. The nurse can offer strategies for remodeling this relationship and help the mother with feelings associated with the needed change.

A pregnant patient and her spouse live in the same home as the spouse's family who is not supportive of the pregnancy. The patient feels the family is ruining the happiness about the pregnancy. Which is the most important determination for the nurse to make? 1. What the potential for improving the current support network is 2. Who will provide the patient the greatest amount of support 3. Whether the couple's finances support moving into a separate location 4. If threatened or actual abuse from household members occur toward the patient

ANS: 4 1 This is incorrect. The nurse does eventually need to examine the potential for improving the current social network. However, another option is most important. 2 This is incorrect. It is helpful for the nurse to know the persons who provide the patient with the most support. However, another option is more important. 3 This is incorrect. The nurse needs to know if the couple's financial situation will support them moving to a separate location. However, there is another option that is most important. 4 This is correct. The most important determination for the nurse to make in this scenario is whether the patient is experiencing a threat or actual abuse from the family members.

A patient in the third trimester of pregnancy reports having heartburn nearly every day. Which recommendations does the nurse make to alleviate the problem? Select all that apply. 1. Consume three moderate-sized meals daily. 2. Sip clear, carbonated beverages when eating. 3. Assume a low Fowler position after meals. 4. Avoid eating 3 hours prior to bedtime. 5. Avoid consuming spicy, fatty, or fried food.

ANS: 4, 5 1 This is incorrect. Heartburn during the third trimester of pregnancy is managed by eating small, frequent meals. Eating three moderate-sized meals daily is a normal eating pattern and will not be effective in managing the discomfort of heartburn. 2 This is incorrect. When a patient experiences heartburn in the third trimester of pregnancy, fluid intake should be avoided during meals. 3 This is incorrect. If a patient experiences heartburn in the third trimester of pregnancy, the patient needs to remain upright for 30 to 45 minutes after eating; a low Fowler position will only increase the incidence of discomfort. 4 This is correct. When a patient experiences heartburn in the third trimester of pregnancy, the patient should avoid eating at least 3 hours prior to bedtime. 5 This is correct. Spicy, fatty, and/or fried foods can contribute to heartburn, especially in the patient who is in the third trimester of pregnancy. These foods need to be eliminated from the diet.

81. Verbalizing someone else's wishes if he or she is unable to do so

ANS: Advocacy Refer To: Chapter 2 KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

82. Absence of menses

ANS: Amenorrhea Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

80. Passive movement of the unengaged fetus

ANS: Ballottement Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

16. The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia

ANS: C Feedback a. Respiratory distress is not the most significant risk to the fetus unless the fetus is also premature. b. Severe neonatal anemia is not associated with pregnancies complicated by cigarette smoking. c. Low neonatal birth weight is the most common complication seen in pregnancies complicated by cigarette smoking. d. Neonatal hyperbilirubinemia is not associated with pregnancies complicated by cigarette smoking. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Application | Content Area: Antepartum Care; Growth and Development | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

71. The clinic nurse promotes a diet rich in vitamin __________ during the third trimester to prevent the possibility of __________ rupture of the membranes.

ANS: C; premature Low levels of vitamin C may predispose women to premature rupture of membranes. As the cellular availability of vitamin C decreases, the rate of degradation of cervical collagen increases. With decreased collagen, the cervix more easily ripens, prompting effacement and dilatation. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

62. Nosebleeds

ANS: Epistaxis Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

57. Lesions at the gum line that bleed easily

ANS: Epulis gravidarum Refer To: Glossary KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

67. The perinatal nurse explains to the new nurse that ptyalism is a condition more acute than the normal nausea and vomiting of pregnancy and is often associated with dehydration, hypokalemia, and weight loss.

ANS: False Hyperemesis gravidarum is a pregnancy-related condition characterized by persistent, continuous, severe nausea and vomiting, often accompanied by dry retching. Hyperemesis gravidarum results in weight loss and fluid and electrolyte imbalance. Ptyalism is an excessive production of saliva. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

True or false: 39. It is critical for the perinatal nurse to learn, as part of the facility's policies and procedures, to immediately perform a vaginal examination on a woman who presents with vaginal bleeding after 24 weeks' gestation.

ANS: False Placenta previa should be suspected in all patients who present with bleeding after 24 completed weeks of gestation. Because of the risk of placental perforation, vaginal examinations are not performed.

True or false: 37. Immediately postpartum, the insulin needs in diabetic women increase dramatically.

ANS: FalseThere is a significant decrease in the need for insulin immediately after delivery related to the loss of antagonistic placental hormones and suppression of the anterior pituitary growth hormone.

True or false: 41. A patient with hypertension who is receiving intravenous magnesium sulfate therapy has requested an epidural anesthetic. The perinatal nurse should first review the patient's complete blood count results for evidence of a decreased platelet count.

ANS: True Baseline information, including complete blood count (CBC), clotting studies, serum electrolytes, and renal function tests, is used to alert the care providers to changes in the patient's condition as additional laboratory tests are obtained.

65. The clinic nurse knows that every time a woman of childbearing age comes in to the office for a health maintenance visit, she should be counseled about the benefits of daily folic acid supplementation.

ANS: True Because of the strong connection between folic acid deficiency and the subsequent development of neural tube defects, all women of childbearing age should take a folic acid supplement of at least 400 mcg/day. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

True or false: 42. The perinatal nurse knows that the laboring diabetic patient's blood glucose level should always be less than 120 mg/dL.

ANS: True Blood glucose levels are assessed every hour, and fluid/insulin adjustments are made as needed to maintain maternal blood glucose levels between 80 and 120 mg/dL.

64. Cecilia, a pregnant woman at 30 weeks' gestation, has her vital signs assessed during a routine prenatal visit. Cecilia's blood pressure has remained at 110/70 for the last few visits, and her pulse rate has increased from 70 to 80 beats per minute. These findings would be considered normal at this time in pregnancy.

ANS: True During the first trimester, blood pressure normally remains the same as prepregnancy levels but then gradually decreases up to around 20 weeks' of gestation. After 20 weeks, the vascular volume expands and the blood pressure increases to reach prepregnant levels by term. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

63. The clinic nurse speaks with the student nurse prior to the physical examination of a pregnant woman who is 32 weeks' gestation. The clinic nurse explains that the heart sounds heard in pregnancy are usually S1 and S3 with a possible murmur related to increased cardiac output.

ANS: True Exaggerated first and third heart sounds and systolic murmurs are common findings during pregnancy. The murmurs are usually asymptomatic and require no treatment. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

True or false: 38. The perinatal nurse observes the placental inspection by the health-care provider after birth. This examination may help to determine whether an abruption has occurred prior to or during labor.

ANS: True Fifty percent of abruptions occur before labor and after the 30th week, 15% occur during labor, and 30% are identified only upon inspection of the placenta after delivery.

66. The perinatal nurse recommends strengthening exercises during pregnancy, as this can improve posture and increase energy levels.

ANS: True Muscle strengthening benefits the woman as she copes with the physical changes of pregnancy, which include weight gain and postural changes. Muscle strengthening exercises also help to decrease the risk of ligament and joint injury. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

True or false: 40. The perinatal nurse knows that the survival rate for infants born at or greater than 28 to 29 gestational weeks is greater than 90%.

ANS: True With appropriate medical care, neonatal survival dramatically improves as the gestational age increases, with over 50% of neonates surviving at 25 weeks' gestation, and over 90% surviving at 28 to 29 weeks of gestation.

The nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of: a. Cultural prescription b. Cultural taboo c. Cultural restriction d. Cultural demonstration

ANS: a Correct. Cultural prescription is an expected behavior of the pregnant woman during the childbearing period.

A pregnant client at 20 weeks' gestation comes to the clinic for her prenatal visit. Which of the following client statements would indicate a need for further assessment? a. "I hate it when the baby moves." b. "I've started calling my mom every day." c. "My partner and I can't stop talking about the baby." d. "I still don't know much time I'm going to take off work after the baby comes."

ANS: a Experiencing quickening as unpleasant may be a sign of maladaptation to pregnancy and needs further assessment by the nurse.

29. A nurse who is discussing serving sizes of foods with a new prenatal patient would state that which of the following is equal to 1 (one) serving from the dairy food group? a.. 1 cup low-fat milk b. ½ cup vanilla yogurt c. ½ cup cottage cheese d.. 1 ounce cream cheese

ANS: a Feedback a. 1 cup of any milk (e.g., whole milk, skim milk, buttermilk, chocolate milk) is equal to 1 serving size from the dairy group. b. 1 cup of yogurt is equal to 1 serving size from the dairy group. c. 1 ½ cup of cottage cheese is equal to 1 serving size from the dairy group. d. Cream cheese is not included in the dairy group. It is a fat product. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Comprehension | Content Area: Antepartum Care; Basic Care and Comfort: Nutrition | Client Need: Health Promotion and Maintenance; Physiological Integrity: Basic Care and Comfort | Difficulty Level: Easy

4. Which of the following assessments would indicate instability in the client hospitalized for placenta previa? a. BP <90/60 mm/Hg, Pulse <60 BPM or >120 BPM b. FHR moderate variability without accelerations c. Dark brown vaginal discharge when voiding d. Oral temperature of 99.9°F

ANS: a Feedback a. A decrease in BP accompanied by bradycardia or tachycardia is an indication of hypovolemic shock. b. FHR with moderate variability can be absent of accelerations during fetal sleep cycles or after maternal sedation. c. Bright red vaginal bleeding is an indication of current bleeding. d. Oral temperature may fluctuate based on the client's hydration status. It should be reassessed. Cause for concern is a temperature of 100.4°F or more.

32. The perinatal nurse is providing care to Marilyn, a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks' gestation. The nurse is preparing to administer the second dose of beta-methasone prescribed by the physician. Marilyn asks: "What is this injection for again?" The nurse's best response is: a. "This is to help your baby's lungs to mature." b. "This is to prepare your body to begin the labor process." c. "This is to help stabilize your blood pressure." d. "This is to help your baby grow and develop in preparation for birth."

ANS: a Feedback a. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours. b. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours. c. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours. d. Antenatal glucocorticoids such as beta-methasone may be given (12 mg IM 24 hours apart) to promote fetal lung maturity if the gestational age is less than 34 weeks and childbirth can be delayed for 48 hours.

21. A patient at 37 weeks' gestation is being seen in the prenatal clinic. Where would the nurse expect the fundal height to be palpated? a. At the xiphoid process b. At a point between the umbilicus and the xiphoid c. At the umbilicus d. At a level directly above the symphysis pubis

ANS: a Feedback a. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. b. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. c. At 20 weeks' gestation, the fundus should be felt at the umbilicus. d. At 12 weeks' gestation, the fundus should be felt directly above the symphysis pubis. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Comprehension | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

17. For the patient with which of the following medical problems should the nurse question a physician's order for beta agonist tocolytics? a. Type 1 diabetes mellitus b. Cerebral palsy c. Myelomeningocele d. Positive group B streptococci culture

ANS: a Feedback a. Beta agonists often elevate serum glucose levels. The nurse should question the order. b. Beta agonists are not contraindicated for patients with cerebral palsy. c. Beta agonists are not contraindicated for patients with myelomeningocele. d. Beta agonists are not contraindicated for patients with group B streptococci.

6. A woman presents to the prenatal clinic at 30 weeks' gestation reporting dysuria, frequency, and urgency with urination. Appropriate nursing actions include: a. Obtain clean-catch urine to assess for a possible urinary tract infection. b. Reassure the woman that the signs are normal urinary changes in the third trimester. c. Teach the woman to decrease fluid intake to manage these symptoms. d. Perform a Leopold's maneuver to assess fetal position and station.

ANS: a Feedback a. Correct. Dysuria, frequency, and urgency with urination are signs and symptoms of a urinary tract infection, necessitating further assessment and testing. b. These are abnormal urinary symptoms in the third trimester. c. Pregnant women need to increase their fluid intake during pregnancy, and dysuria and urgency are abnormal. d. Assessment of fetal position and station is not an appropriate response to reported signs and symptoms of a urinary tract infection. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

6. Which of the following nursing diagnoses is of highest priority for a client with an ectopic pregnancy who has developed disseminated intravascular coagulation (DIC)? a. Risk for deficient fluid volume b. Risk for family process interrupted c. Risk for disturbed identity d. High risk for injury

ANS: a Feedback a. Correct. The client is at high risk for hypovolemia which is life threatening and takes precedence over any psychosocial or less pressing diagnoses. b. This is a psychosocial diagnosis and is not life threatening. c. This is a psychosocial diagnosis and is not life threatening. d. The client is at risk for injury; however, the diagnosis of deficient fluid volume is more descriptive and has clearly defined goals and interventions.

3. Identify the hallmark of placenta previa that differentiates it from abruptio placenta. a. Sudden onset of painless vaginal bleeding b. Board-like abdomen with severe pain c. Sudden onset of bright red vaginal bleeding d. Severe vaginal pain with bright red bleeding

ANS: a Feedback a. Correct. When the placenta attaches to the lower uterine segment near or over the cervical os, bleeding may occur without the onset of contractions or pain. b. The hallmark for abruptio placenta is pain and a board-like abdomen. c. Bright red bleeding could be related to abruptio placenta, placenta previa, or other complications of pregnancy. d. Pain is not a hallmark of placenta previa.

32. The clinic nurse includes screening for domestic violence in the first prenatal visit for all patients. An appropriate question would be: a. This is something that we ask everyone. Do you feel safe in your current living environment and relationships? b. This is something we ask everyone. Do you have any abuse in your life right now? c. Is your partner threatening or harming you in any way right now? d. I need to ask you, do you feel safe from abuse right now?

ANS: a Feedback a. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. b. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home rather than asking if they have any abuse, as women may define abuse differently than care providers. c. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. d. Intimate partner violence is a difficult subject to discuss, and the nurse may fear insulting or psychologically hurting the patient more. A nonthreatening approach is to ask patients directly whether they feel safe going home rather than asking if they have any abuse, as women may define abuse differently than care providers. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

35. The clinic nurse discusses normal bladder function in pregnancy with a 22-year-old pregnant woman who is now in her 29th gestational week. The nurse explains that at this time in pregnancy, it is normal to experience (select all that apply): a. Urinary frequency b. Urinary urgency c. Nocturia d. Incontinence

ANS: a, b, c During pregnancy, the bladder, a pelvic organ, is compressed by the weight of the growing uterus. The added pressure, along with progesterone-induced relaxation of the urethra and sphincter musculature, leads to urinary urgency, frequency, and nocturia. Incontinence of urine is not a normal change during pregnancy. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

12. The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver

ANS: a Feedback a. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver determines which fetal body part (e.g., head or buttocks) occupies the uterine fundus. The examiner faces the patient's head and places the hands on the abdomen, using the palmar surface of the hands to gently palpate the fundal region of the uterus. The buttocks feel soft, broad, and poorly defined and move with the trunk. The fetal head feels firm and round and moves independently of the trunk. b. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. c. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. d. Leopold maneuvers are a four-part clinical assessment method used to determine the lie, presentation, and position of the fetus. The first maneuver is described in this scenario. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

14. Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestationa

ANS: a Feedback a. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. To facilitate this process, it is the nurse's responsibility to gather more information on the woman's dietary practices through a food diary. b. Nutrition and weight management play an essential role in the development of a healthy pregnancy. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. c. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices, not just inform the patient of expected normal weight gain. d. Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, i

18. A nurse is reviewing diet with a pregnant woman in her second trimester. Which of the following foods should the nurse advise the patient to avoid consuming during her pregnancy? a. Brie cheese b. Bartlett pears c. Sweet potatoes d. Grilled lamb

ANS: a Feedback a. Soft cheese may harbor Listeria. The patient should avoid consuming uncooked soft cheese. b. A pear is an excellent food for a pregnant woman to consume. c. Sweet potatoes are an excellent food for a pregnant woman to consume. d. Grilled lamb is an excellent food for a pregnant woman to consume, although it should be well cooked. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential: Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Moderate

27. A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because "I hate oranges." The nurse states that 1 cup of which of the following raw foods will meet the patient's daily vitamin C needs? a. Strawberries b. Asparagus c. Iceberg lettuce d. Cucumber

ANS: a Feedback a. Strawberries are an excellent source of vitamin C. b. Although asparagus has some vitamin C, it is not an excellent source. c. Iceberg lettuce is a poor source of vitamin C. d. Cucumber is a poor source of vitamin C. KEY: Integrated Process: Nursing Process: Implementation; Teaching and Learning | Cognitive Level: Knowledge | Content Area: Health and Wellness | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

28. A primiparous woman has been admitted at 35 weeks' gestation and diagnosed with HELLP syndrome. Which of the following laboratory changes is consistent with this diagnosis? a. Hematocrit dropped to 28%. b. Platelets increased to 300,000 cells/mm3. c. Red blood cells increased to 5.1 million cells/mm3. d. Sodium dropped to 132 mEq/dL.

ANS: a Feedback a. The nurse would expect to see a drop in the hematocrit: The H in HELLP stands for hemolysis. b. The nurse would expect to see low platelets. c. The nurse would expect to see hemolysis. d. The sodium is usually unaffected in HELLP syndrome.

15. Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? a. Increasing abdominal girth measurements b. Profuse vaginal bleeding c. Bradycardia with an aortic thrill d. Hypothermia with chills

ANS: a Feedback a. The nurse would expect to see increasing abdominal girth measurements. b. Profuse vaginal bleeding is rarely seen in placental abruption and is never seen when the abruption is concealed. c. With excessive blood loss, the nurse would expect to see tachycardia. d. The nurse would expect to see a stable temperature.

20. A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? a. The woman is experiencing a normal pregnancy. b. The woman may be having difficulty accepting this pregnancy. c. The woman must see a nutritionist as soon as possible. d. The woman will likely miscarry the conceptus.

ANS: a Feedback a. The patient is experiencing a normal pregnancy. b. Quickening is not felt until 16 to 20 weeks' gestation. c. There is no apparent need for a nutritionist to see this patient. d. There is no indication in the scenario that this patient is at high risk for a miscarriage. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

9. A 26-year-old woman at 29 weeks' gestation experienced epigastric pain following the consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is: a. Cholelithiasis b. Influenza c. Urinary tract infection d. Indigestion

ANS: a Feedback a. The progesterone-induced prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, may predispose the pregnant woman to gallstone formation (cholelithiasis). Pain in the epigastric region following ingestion of a high-fat meal constitutes the major symptom of these conditions. The pain is self-limiting and usually resolves within 2 hours. b. The symptoms described are not associated with influenza. c. The symptoms described are not associated with urinary tract infection. d. Prolonged emptying time of bile from the gallbladder, combined with elevated blood cholesterol levels, make cholelithiasis a more probable diagnosis than indigestion. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

36. Metabolic changes during pregnancy __________ glucose tolerance. a. lower b. increase c. maintain d. alter

ANS: a Metabolic changes during pregnancy lower glucose tolerance.

Taboos are cultural restrictions that: a. Have serious supernatural consequences b. Have serious clinical consequences c. Have superstitious consequences d. Are functional and neutral practices

ANS: a Taboos are believed to have serious supernatural consequences. Taboos are not known to have clinical or superstitious consequences and are not functional or neutral practices.

An example of a cultural prescriptive belief during pregnancy is: a. Remain active during pregnancy b. Coldness in any form should be avoided c. Do not have your picture taken d. Avoid sexual intercourse during the third trimester

ANS: a The belief that the patient should remain active during pregnancy is the only example of a cultural prescriptive belief. All of the other answers are examples of cultural restrictive beliefs.

35. Your antepartal patient is 38 weeks' gestation, has a history of thrombosis, and has been on strict bed rest for the last 12 hours. She is now experiencing shortness of breath. What about the patient may be a contributing factor for her shortness of breath? a. Physiologic changes in pregnancy result in vasodilation, which increases the tendency to form blood clots. b. Physiologic changes in pregnancy result in vasoconstriction, which increases the tendency to form blood clots. c. Physiologic changes in pregnancy result in anemia, which increases the tendency to form blood clots. d. Physiologic changes in pregnancy result in decreased perfusion to the lungs, which increases the tendency to form blood clots.

ANS: a The patient's shortness of breath, bed rest, and history of thrombosis indicate possible pulmonary embolism. Her pregnant state also increases the potential for thrombosis resulting from increased levels of coagulation factors and decreased fibrinolysis, venous dilation, and obstruction of the venous system by the gravid uterus. Thromboembolitic diseases occurring most frequently in pregnancy include deep vein thrombosis and pulmonary embolism.

A first-time father is experiencing couvade syndrome. He is likely to exhibit which of the following symptoms or behaviors? a. Urinary frequency b. Hypotension c. Bradycardia d. Prostatic hypertrophy

ANS: a Urinary frequency is a common symptom of couvade.

44. Asking the pregnant woman about her use of recreational drugs is an essential component of the prenatal history. Harmful fetal effects that may occur from recreational drugs include (select all that apply): a. Miscarriage/spontaneous abortion b. Low birth weight c. Macrosomia d. Post-term labor/birth

ANS: a, b Illegal or recreational drug use can have a number of detrimental effects on maternal and fetal health, including spontaneous abortion, low birth weight, placental abruption, and preterm labor. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

45. The clinic nurse schedules Tracy for her first prenatal appointment with the certified nurse-midwife (CNM) in the clinic. Tracy has appropriate questions for her potential health-care provider that include (select all that apply): a. Complementary and alternative methods used during labor and birth b. An opportunity to meet other providers in the practice c. Beliefs and practices concerning an episiotomy and an epidural anesthetic d. Whether the nurse-midwife will be continually available for support during labor

ANS: a, b, c A woman's journey through the pregnancy experience can have long-term effects on her self-perception and self-concept. Therefore, it is especially important that the patient choose a care provider and group with whom she can openly relate and who shares the same philosophical views on the management of pregnancy. At the first prenatal visit, it is not common to explore whether the nurse-midwife will be continually available for support during labor. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

47. An overweight or obese pre-pregnancy weight increases the risk for which poor maternal outcomes? (Select all that apply.) a. Preeclampsia b. Hemorrhage c. Difficult delivery d. Vaginal infections

ANS: a, b, c Being overweight or obese can substantially increase perinatal risk; however, no data support an increase in vaginal infections for the obese pregnant population. KEY: Integrated Process: Knowledge | Cognitive Level: Complication | Content Area: Maternity | Client Need: Health Promotion and Maintenance: Antepartum Care | Difficulty Level: Moderate

40. The clinic nurse describes the respiratory system changes common to pregnancy to the new nurse. These changes include (select all that apply): a. An increased tidal volume b. A decreased airway resistance c. An increased chest circumference d. An increased airway resistance

ANS: a, b, c During pregnancy, a number of changes occur to meet the woman's increased oxygen requirements. The tidal volume (amount of air breathed in each minute) increases 30% to 40%. The enlarging uterus creates an upward pressure that elevates the diaphragm and increases the subcostal angle. The chest circumference may increase by as much as 6 centimeters, and airway resistance decreases. Although the "up and down" capacity of diaphragmatic movement is reduced, lateral movement of the chest and intercostal muscles accommodates for this loss of movement and keeps pulmonary functions stable. There is no increase in airway resistance during pregnancy. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

42. The clinic nurse describes possible interventions for the pregnant woman who is experiencing pain and numbness in her wrists. The nurse suggests (select all that apply): a. Elevating the arms and wrists at night b. Reassessment during the postpartum period c. The use of "cock splints" to prevent wrist flexion d. Massaging the hands and wrists with alcohol

ANS: a, b, c Edema from vascular permeability can lead to a collection of fluid in the wrist that puts pressure on the median nerve lying beneath the carpal ligament, leading to carpal tunnel syndrome. Elevation of the hands at night may help to reduce the edema. Occasionally, a woman may need to wear a "cock splint" to prevent the wrist from flexing. Reassessment in the postpartum period is indicated because although carpal tunnel syndrome usually subsides after the pregnancy has ended, some women may require surgical treatment if symptoms persist. Massaging the hands and wrists with alcohol does not improve pain and numbness. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

43. The perinatal nurse describes risk factors for placenta previa to the student nurse. Placenta previa risk factors include (select all that apply): a. Cocaine use b. Tobacco use c. Previous caesarean birth d. Previous use of medroxyprogesterone (Depo-Provera)

ANS: a, b, c Feedback a. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years. b. Placenta previa may be associated with risk factors including smoking, cocaine use, a prior history of placenta previa, closely spaced pregnancies, African or Asian ethnicity, and maternal age greater than 35 years. c. Placenta previa may be associated with conditions that cause scarring of the uterus such as a prior cesarean section, multiparity, or increased maternal age. d. Previous use of medroxyprogesterone (Depo-Provera) is not a risk factor for placenta previa.

46. The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply): a. Encouraging regular, ongoing prenatal care b. Reporting symptoms of urinary frequency and burning to the health-care provider c. Coming to the labor triage unit if back pain or cramping persist or become regular d. Lying on the right side, withholding fluids, and counting fetal movements if contractions occur every 5 minutes

ANS: a, b, c Feedback a. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur. b. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider repeatedly if symptoms of preterm labor occur. c. Educating all women of childbearing age about preterm labor is a crucial component of prevention. The nurse should encourage all pregnant women to obtain prenatal care and screen for vaginal and urogenital infections and treat appropriately, and remind pregnant women to call their provider if symptoms of preterm labor occur. d. Lying on the right side; drinking fluids, not withholding fluids; and counting fetal movements if contractions occur every 5 minutes are recommended if a woman thinks she is contracting.

The perinatal nurse screens all pregnant women early in pregnancy for maternal attachment risk factors, which include (select all that apply): a. Adolescence b. Low educational level c. History of depression d. A strong support system for the pregnancy

ANS: a, b, c Maternal attachment to the fetus is an important area to assess and can be useful in identifying families at risk for maladaptive behaviors. The nurse should assess for indicators such as unintended pregnancy, domestic violence, difficulties in the partner relationship, sexually transmitted infections, limited financial resources, substance use, adolescence, poor social support systems, low educational level, the presence of mental conditions, or adolescence that might interfere with the patient's ability to bond with and care for the infant. A strong support system can facilitate the patient's ability to bond with and care for the infant.

49. Marked hemodynamic changes in pregnancy can impact the pregnant woman with cardiac disease. Signs and symptoms of deteriorating cardiac status include (select all that apply): a. Orthopnea b. Nocturnal dyspnea c. Palpitations d. Irritation

ANS: a, b, c Signs and symptoms of deteriorating cardiac status with cardiac disease include orthopnea, nocturnal dyspnea, and palpitations, but do not include irritation.

49. Physiologic changes that occur in the renal system during pregnancy predispose the pregnant woman to urinary tract infections (UTIs). Symptoms of a UTI include (select all that apply): a. Dysuria b. Hematuria c. Urgency d. Delayed urination

ANS: a, b, c Urinary tract infection (UTI) symptoms include dysuria, hematuria, and urgency. KEY: Integrated Process: Knowledge | Cognitive Level: Complication | Content Area: Maternity | Client Need: Physiologic Adaptation | Difficulty Level: Moderate

52. Jorgina is a 24-year-old pregnant woman at 26 weeks' gestation. This is Jorgina's third pregnancy, and her obstetrical history includes one full-term birth, one preterm birth, and two living children. Today Jorgina arrives at the clinic with complaints of fatigue, insomnia, and backache. She reports that she is a nurse on an oncology unit and is worried about continuing with working her 12-hour shifts. The perinatal nurse identifies concerns in Jorgina's history and work environment including (select all that apply): a. Risk of preterm birth b. Presence of chemotherapeutic agents c. Requirement for heavy lifting d. History of diabetes

ANS: a, b, c Women who are currently experiencing pregnancy complications and those who have a history of pregnancy complications (such as history of preterm birth) or other preexisting health disorders may be required to reduce their hours or stop working. The potential for maternal exposure to toxic substances such as chemotherapeutic agents, lead, and ionizing radiation (found in laboratories and health-care facilities); heavy lifting; and use of heavy machinery and other hazardous equipment should prompt reassignment to a different work area. If reassignment is not possible, Jorgina may need to stop working until the pregnancy has been completed. In this scenario there is no history of diabetes. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

34. The perinatal nurse teaches the student nurse about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections. These changes include (select all that apply): a. Relaxation of the smooth muscle of the urinary sphincter b. Relaxation of the smooth muscle of the bladder c. Inadequate emptying of the bladder d. Increased incidence of bacteriuria

ANS: a, b, c, d Ascension of bacteria into the bladder can cause asymptomatic bacteriuria (ASB), or urinary tract infections (UTIs). These infections occur more frequently in pregnancy due to relaxation of the smooth muscle of the bladder and urinary sphincter and inadequate emptying of the bladder, changes that allow bacterial ascent into the bladder. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

38. The clinic nurse encourages all pregnant women to increase their water intake to at least 8 to 10 glasses per day in order to (select all that apply): a. Decrease the risk of constipation b. Decrease the risk of bile stasis c. Decrease their feelings of fatigue d. Decrease the risk of urinary tract infections

ANS: a, b, c, d Patients should be encouraged to drink at least 8 to 10 glasses of water each day and empty their bladders at least every 2 to 3 hours and immediately after intercourse. These measures will help prevent stasis of urine and the bacterial contamination that leads to infection, as well as constipation. Some women experience symptoms of fatigue that can be alleviated by remaining adequately hydrated. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

55. During the initial antenatal visit, the clinic nurse asks questions about the woman's nutritional intake. Specific questions should include information pertaining to (select all that apply): a. Preferred foods b. The presence of cravings c. Use of herbal supplements d. Aversions to certain foods and odors

ANS: a, b, c, d The nurse should obtain a nutritional history on all pregnant patients and patients of childbearing age to gain specific information related to the pregnancy, including foods that are preferred while pregnant (which may provide information about cultural and environmental dietary factors), special diets (which will assist the nurse in planning for education or interventions for risk factors associated with dietary practices), cravings or aversions to specific foods, and use of herbal supplements. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

48. Betamethasone is a steroid that is given to a pregnant woman with signs of preterm labor. The purpose of giving steroids is to (select all that apply): a. Stimulate the production of surfactant in the preterm infant b. Be given between 24 and 34 weeks' gestation c. Increase the severity of respiratory distress d. Accelerate fetal lung maturity

ANS: a, b, d Betamethasone is a steroid that is given to pregnant women with signs of preterm labor between 24 and 34 weeks' gestation. It stimulates the production of surfactant in the preterm infant and accelerates fetal lung maturity.

47. The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes. These risks include (select all that apply): a. Chorioamnionitis b. Abruptio placentae c. Operative birth d. Cord prolapse

ANS: a, b, d Even though maintaining the pregnancy to gain further fetal maturity can be beneficial, prolonged PPROM has been correlated with an increased risk of chorioamnionitis, placental abruption, and cord prolapse.

44. Kerry, a 30-year-old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks' gestation. An appropriate nursing action would be to (select all that apply): a. Assess the fetal heart rate b. Obtain urine for culture and sensitivity c. Assess Kerry's blood pressure and pulse d. Palpate Kerry's abdomen for contractions

ANS: a, b, d Feedback a. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patient's abdomen should be palpated to assess for contractions, and the fetus's heart rate should be monitored. b. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity (C & S) should be obtained on all patients who present with signs of preterm labor, and the nurse must remember that signs of UTI often mimic normal pregnancy complaints (i.e., urgency, frequency). The patient's abdomen should be palpated to assess for contractions, and the fetus's heart rate should be monitored. c. Assessment of blood pressure and pulse is not an important nursing action in this scenario. d. Women experiencing preterm labor may complain of backache, pelvic aching, menstrual-like cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. The patient's abdomen should be palpated to assess for contractions and the fetus's heart rate should be monitored.

51. Interventions for low back pain during pregnancy should include (select all that apply): a. Utilizing proper body mechanics b. Applying ice or heat to affected area c. Avoiding pelvic rock and pelvic tilt d. Using additional pillows for support during sleep

ANS: a, b, d Interventions for back pain during pregnancy include utilizing proper body mechanics, applying heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt, but encouraging pelvic rock/tilt. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Intrapartum care | Client Need: Health Promotion and Maintenance: Intrapartum Care | Difficulty Level: Moderate

48. Presumptive signs of pregnancy include (select all that apply): a. Nausea b. Fatigue c. Ballottement d. Amenorrhea

ANS: a, b, d Nausea and vomiting, fatigue, and amenorrhea are all common during pregnancy and are the presumptive signs of pregnancy. Ballottement is a probably sign, noted during a vaginal exam. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

33. An 18-year-old woman at 23 weeks' gestation tells the nurse that she has fainted two times. The nurse teaches about the warning signs that often precede syncope so that she can sit or lie down to prevent personal injury. Warning signs include (select all that apply): a. Sweating b. Nausea c. Chills d. Yawning

ANS: a, b, d Sweating is a warning sign that often precedes syncope. Syncope (a trandient loss of consciousness and postural tone with spontaneous recovery) during pregnancy is frequently attributed to orthostatic hypotension or inferior vena cava compression by the gravid uterus. Nausea and yawning are warning signs that often precede syncope. Lightheadedness, sweating, nausea, yawning, and feelings of warmth are warning signs that often precede syncope. Chills are not a warning sign that often precede syncope. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

39. The perinatal nurse examines the thyroid gland as part of the physical examination of Savannah, a pregnant woman who is now at 16 weeks' gestation. The perinatal nurse informs Savannah that during pregnancy (select all that apply): a. Increased size of the thyroid gland is normal b. Increased function of the thyroid gland is normal c. Decreased function of the thyroid gland is normal d. The thyroid gland will return to its normal size and function during the postpartal period

ANS: a, b, d The thyroid gland changes in size and activity during pregnancy. Enlargement is caused by increased circulation from the progesterone-induced effects on the vessel walls, and by estrogen-induced hyperplasia of the glandular tissue. The thyroid gland increases not decreases in size and activity during pregnancy. The thyroid gland returns to normal size and activity postpartum. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

54. Teera is a 22-year-old woman who is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. The perinatal nurse discusses Teera's diet with her as she may be deficient in (select all that apply): a. Iron b. Magnesium c. Zinc d. Vitamin B12

ANS: a, c Semi-vegetarian diets include fish, poultry, eggs, and dairy products but no beef or pork and have adequate intake of magnesium. Pregnant women who adhere to this diet may consume inadequate amounts of iron and zinc. Because strict vegetarians (vegans) consume only plant products, their diets are deficient in vitamin B12, found only in foods of animal origin. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

53. The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-year-old pregnant woman. Kim-Ly's hemoglobin is 9.8 g/dL. This laboratory finding places Kim-Ly's pregnancy at risk for (select all that apply): a. Preterm birth b. Placental abruption c. Intrauterine growth restriction d. Thrombocytopenia

ANS: a, c True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction (IUGR) and preterm birth. There is not a risk factor for abruption or thrombocytopenia. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Difficult

41. The clinic nurse teaches the new nurse about pregnancy-induced blood clotting changes. The nurse explains that a pregnant woman is at risk for venous thrombosis due to (select all that apply): a. Increased fibrinogen volume b. Increased blood factor V c. Increased blood factor X d. Venous stasis

ANS: a, c, d Although the platelet cell count does not change significantly during pregnancy, fibrinogen volume has been shown to increase by as much as 50%. This alteration leads to an increase in the sedimentation rate. Blood factors VII, VIII, IX, and X are also increased, and this change causes hypercoagulability. The hypercoagulability state, coupled with venous stasis (poor blood return from the lower extremities) places the pregnant woman at an increased risk for venous thrombosis, embolism, and, when complications are present, disseminated intravascular coagulation (DIC). Blood factor V does not increase. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

50. Urinary tract infection (UTI) prevention measures during pregnancy include counseling the pregnant woman to (select all that apply): a. Delay urination until bladder is full b. Limit hydration c. Wipe from front to back d. Urinate after intercourse

ANS: a, c, d Anticipatory guidance for urinary tract infection prevention includes delaying urination, wipe front to back, and maintaining adequate hydration. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

56. The perinatal nurse talks to the prenatal class attendees about guidelines for exercise in pregnancy. Recommended guidelines include (select all that apply): a. Stopping if the woman is tired b. Bouncing and slowly arching the back c. Increasing fluid intake throughout the physical activity d. Maintaining the ability to walk and talk during exercise

ANS: a, c, d Women should adhere to some basic safety guidelines when formulating their exercise program, including monitoring the breathing rate and ensuring that the ability to walk and talk comfortably is maintained during physical activity, stopping exercise when the woman becomes tired, and maintaining adequate fluid intake. Pregnant women should avoid exercises that can cause any degree of trauma to the abdomen or those that include rigorous bouncing, arching of the back, or bending beyond a 45-degree angle. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

Which statement best exemplifies adaptation to pregnancy in relation to the adolescent? a. Adolescents adapt to motherhood in a similar way to other childbearing women. b. Social support has very little effect on adolescent adaptation to pregnancy. c. The pregnant adolescent faces the challenge of multiple developmental tasks. d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions.

ANS: c Correct. Pregnant adolescents face conflicting and multiple developmental tasks of pregnancy and adolescence at the same time.

43. The clinic nurse advocates for smoking cessation during pregnancy. Potential harmful effects of prenatal tobacco use include (select all that apply): a. Preterm birth b. Gestational hypertension c. Gestational diabetes d. Low birth weight

ANS: a, d Nurses can help to improve the fetal environment by educating women about the dangers of direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well documented and predispose to premature rupture of the membranes, preterm labor, placental abruption, placenta previa, and infants who are low birth weight or small for gestational age (SGA). Gestational hypertension and diabetes are not associated with smoking during pregnancy. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

1. Folic acid supplementation during pregnancy is to: a. Improve the bone density of pregnant women b. Decrease the incidence of neural tube defects in the fetus c. Decrease the incidence of Down syndrome in the fetus d. Improve calcium uptake in pregnant women

ANS: b

A woman presents for prenatal care at 6 weeks' gestation by LMP. Which of the following findings would the nurse expect to see? a. Multiple pillow orthopnea b. Maternal ambivalence c. Fundus at the umbilicus d. Pedal and ankle edema

ANS: b Ambivalence is a common feeling of women during the first trimester.

Cathy is pregnant for the second time. Her son, Steven, has just turned 2 years old. She asks you what she should do to help him get ready for the expected birth. What is the nurse's most appropriate response? a. Steven will probably not understand any explanations about the arrival of the new baby, so Cathy should do nothing. b. If Steven's sleeping arrangements need to be changed, it should be done well in advance of the birth. c. Steven should come to the next prenatal visit and listen to the fetal heartbeat to encourage sibling attachment. d. Steven should be encouraged to plan an elaborate welcome for the newborn.

ANS: b Children still sleeping in a crib should be moved to a bed at least 2 months before the baby is due, as this age group is particularly sensitive to disruptions of the physical environment.

Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country? a. Help her develop a realistic, detailed birth plan. b. Identify her support system. c. Teach her about expected emotional changes of pregnancy. d. Refer her to a doula for labor support.

ANS: b Correct, because lack of social support has been correlated with an increased risk of pregnancy complications and difficult adaptation to pregnancy. Pregnant women who are recent immigrants face many challenges in obtaining needed social support, and the nurse should first identify her support system to plan further interventions and referrals.

Jane's husband Brian has begun to put on weight. What is this a possible sign of? a. Culturalism syndrome b. Couvade syndrome c. Moratorium phase d. Attachment

ANS: b Correct. Couvade syndrome has symptoms that mimic changes of pregnancy.

A pregnant client asks the nurse why she should attend childbirth classes. The nurse's response would be based on which of the following information? a. Attending childbirth class is a good way to make new friends. b. Childbirth classes will help new families develop skills to meet the challenges of childbirth and parenting. c. Attending childbirth classes will help a pregnant woman have a shorter labor. d. Childbirth classes will help a pregnant woman decrease her chance of having a cesarean delivery.

ANS: b Correct. These are the stated goals of childbirth education (ICEA, Lamaze).

28. The nurse notes each of the following findings in a woman at 10 weeks' gestation. Which of the findings would enable the nurse to tell the woman that she is probably pregnant? a. Fetal heart rate via Doppler b. Positive pregnancy test c. Positive ultrasound assessment d. Absence of menstrual period

ANS: b Feedback a. A fetal heart rate is a positive sign of pregnancy. b. A positive pregnancy test is a probable sign of pregnancy. It is not a positive sign because the hormone tested for—human chorionic gonadatropin (hCG)—may be being produced by, for example, a hydatidiform mole. c. A positive ultrasound is a positive sign of pregnancy. d. Amenorrhea is a presumptive sign of pregnancy. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Comprehension | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

7. At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to: a. Reassure woman/couple of normalcy of response b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse c. Recommend cessation of intercourse until after delivery due to advanced gestation d. Suggest woman discuss this with her care provider at her next appointment

ANS: b Feedback a. Although this is a normal response, providing reassurance is not enough. Further intervention is indicated. b. Although shy to discuss this, she wants to maintain a sexual relationship with her partner. Suggesting alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse provides the woman with information to maintain sexual relations. c. She wants to maintain a sexual relationship with her partner, and there are no contraindications to intercourse during a healthy pregnancy. d. The patient is seeking out information and to defer her to her care provider at her next appointment is inappropriate. Additionally, she may not be comfortable discussing this with anyone else. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Complication | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

30. The nurse who is assessing a G2 P1 palpates the fundal height at the location noted on the picture below. The nurse concludes that the fetus is equal to which of the following gestational ages? a. 12 weeks b. 20 weeks c. 28 weeks d. 36 weeks

ANS: b Feedback a. At 12 weeks' gestation, the fundus should be felt at the level of the symphysis pubis. b. The fundus at the level of the umbilicus indicates 20 weeks' gestation. In this question, the fact that this patient is a multigravida is not relevant. Uterine growth should be consistent for both primigravidas and multigravidas. c. At 28 weeks' gestation, the fundus should be felt 8 cm above the level of the umbilicus. d. At 36 weeks' gestation, the fundus should be felt at the xiphoid process. KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

24. Which of the following findings, seen in pregnant women in the third trimester, would the nurse consider to be within normal limits? a. Diplopia b. Epistaxis c. Bradycardia d. Oliguria

ANS: b Feedback a. Diplopia is sometimes seen in patients with pregnancy-induced hypertension (PIH). b. Epistaxis is commonly seen in pregnant patients. The bleeding is related to the increased vascularity of the mucous membranes. Unless the blood loss is significant, it is a normal finding. c. Bradycardia is often seen immediately after delivery but not during the third trimester. d. Oliguria is seen in patients with PIH. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

9. While educating the client with class II cardiac disease, at 28 weeks' gestation, the nurse instructs the client to notify the physician if she experiences which of the following conditions? a. Emotional stress at work b. Increased dyspnea while resting c. Mild pedal and ankle edema d. Weight gain of 1 pound in 1 week

ANS: b Feedback a. Emotional stress increases cardiac workload; however, without symptoms of cardiac decompensation, this is not immediately concerning. b. Increasing dyspnea, at rest, can be a sign of cardiac decompensation leading to increased congestive heart failure. c. Mild edema during the third trimester is normal. However, increasing edema and pitting edema should be reported as they can be a sign of increasing CHF. d. A weight gain of 1 pound per week is expected during the third trimester.

15. A woman presents to a prenatal clinic appointment at 10 weeks' gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? a. Occipital headache b. Urinary frequency c. Diarrhea d. Leg cramps

ANS: b Feedback a. Headaches may be benign or, especially if noted after 20 weeks' gestation, may be a symptom of pregnancy-induced hypertension (PIH). b. Urinary frequency is a common complaint of women during their first trimester. c. Diarrhea is rarely seen in pregnancy. Constipation is a common complaint. d. Leg cramps are commonly seen during the second and third trimesters. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Comprehension | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

5. Intimate partner violence (IPV) against women consists of actual or threatened physical or sexual violence and psychological and emotional abuse. Screening for IPV during pregnancy is recommended for: a. Pregnant women with a history of domestic violence b. All pregnant women c. All low-income pregnant women d. Pregnant adolescents

ANS: b Feedback a. Intimate partner violence is underreported by women, necessitating universal screening. b. Correct. AWHONN advocates for universal screening for domestic violence for all pregnant women. Homicide is the most likely cause of death for pregnant or recently pregnant women, and a significant portion of those homicides are committed by their intimate partners. One in six pregnant women reported physical or sexual abuse during pregnancy, seriously impacting maternal and fetal health and infant birth weight. c. IPV crosses all ethnic, racial, religious, and socioeconomic levels. d. IPV crosses all ethnic, racial, religious, and socioeconomic levels. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Psychosocial Integrity | Difficulty Level: Moderate

29. A labor nurse is caring for a patient, 39 weeks' gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? a. Type and cross-match her blood. b. Insert an internal fetal monitor electrode. c. Administer an oral stool softener. d. Assess her complete blood count.

ANS: b Feedback a. It would be appropriate to type and cross-match the patient for a blood transfusion. b. This action is inappropriate. When a patient has a placenta previa, nothing should be inserted into the vagina. c. To prevent constipation, it is appropriate for a patient to take a stool softener. d. It is appropriate to monitor the patient for signs of anemia.

27. A 34-weeks' gestation multigravida, G3 P1 is admitted to the labor suite. She is contracting every 7 minutes and 40 seconds. The woman has several medical problems. Which of the following of her comorbidities is most consistent with the clinical picture? a. Kyphosis b. Urinary tract infection c. Congestive heart failure d. Cerebral palsy

ANS: b Feedback a. Kyphosis is unrelated to preterm labor. b. Urinary tract infections often precipitate preterm labor. c. It is unlikely that the congestive heart failure precipitated the preterm labor. d. Cerebral palsy is unrelated to preterm labor.

5. During pregnancy, poorly controlled asthma can place the fetus at risk for: a. Hyperglycemia b. IUGR c. Hypoglycemia d. Macrosomia

ANS: b Feedback a. Maternal asthma does not place the fetus at risk for hyperglycemia. b. Compromised pulmonary function can lead to decompensation and hypoxia that decrease oxygen flow to the fetus and can cause intrauterine growth restriction (IUGR). c. Asthma does not directly affect glycemic control. d. A fetus experiencing hypoxia would be small for gestational age, not large for gestational age.

8. Which of the following medications administered to the pregnant client with GDM and experiencing preterm labor requires close monitoring of the client's blood glucose levels? a. Nifedipine b. Betamethasone c. Magnesium sulfate d. Indomethacin

ANS: b Feedback a. Nifedipine does not affect maternal blood glucose levels. b. Beta-sympathomimetics may stimulate hyperglycemia which will require an increased need for insulin. c. Magnesium sulfate does not affect blood glucose levels. d. Indomethacin does not affect blood glucose levels.

The clinic nurse encourages paternal attachment during pregnancy by including the father in (select all that apply): a. Prenatal visits b. Ultrasound appointments c. Prenatal class information d. History taking and obtaining prenatal screening information

ANS: b, c, d Pregnancy is psychologically stressful for men; some enjoy the role of nurturer, but others feel alienated and begin to stray from the relationship. The nurse can be instrumental in promoting early paternal attachment. Involvement of the father during examinations and tests and prenatal classes, along with thorough explanations of the need for them, can minimize the father's feelings of being left out. A history and prenatal screening should be conducted at the first prenatal visit with the woman alone to ensure confidentiality and an open discussion of any problems or concerns she may have. The history should include information about the current pregnancy; the obstetric and gynecologic history; and a cultural assessment, and a medical, nutritional, social, and family (including the father's) medical history.

13. The clinic nurse talks with Kathy about her possible pregnancy. Kathy has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as: a. Positive signs of pregnancy b. Presumptive signs of pregnancy c. Probable signs of pregnancy d. Possible signs of pregnancy

ANS: b Feedback a. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. b. Presumptive signs of pregnancy include amenorrhea, nausea and vomiting, frequent urination, breast tenderness, perception of fetal movement, skin changes, and fatigue. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. Positive signs include fetal heartbeat, visualization of the fetus, and fetal movements palpated by the examiner. c. Probable signs of pregnancy include abdominal enlargement, Piskacek sign, Hegar sign, Goodell sign, Braxton Hicks sign, positive pregnancy test, and ballottement. d. Possible signs of pregnancy may vary widely. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

23. A pregnant woman informs the nurse that her last normal menstrual period was on July 6, 2007. Using Naegele's rule, which of the following would the nurse determine to be the patient's estimated date of delivery (EDC)? a. January 9, 2008 b. April 13, 2008 c. April 20, 2008 d. September 6, 2008

ANS: b Feedback a. The EDC is calculated as April 13, 2008. b. The EDC is calculated as April 13, 2008. Naegele's rule: subtract 3 months and add 7 days to the first day of the last normal menstrual period. c. The EDC is calculated as April 13, 2008. d. The EDC is calculated as April 13, 2008. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

7. Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension? a. Total urine protein of 200 mg/dL b. Total platelet count of 40,000 mm c. Uric acid level of 8 mg/dL d. Blood urea nitrogen 24 mg/dL

ANS: b Feedback a. The client's urine protein is elevated. A urine protein of ≥300 mg/dL in a 24-hour collection is considered concerning. b. Correct. A platelet count of £50,000 is a critical value and should be reported to the health-care provider immediately. This client is at increased risk of hemorrhage. c. The uric acid level is only slightly elevated. d. The BUN is only slightly elevated.

23. A woman at 10 weeks' gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). Which of the following findings would the nurse expect to see? a. Platelet count of 550,000/ mm3 b. Dark brown vaginal bleeding c. White blood cell count 17,000/ mm3 d. Macular papular rash

ANS: b Feedback a. The nurse would not expect to see an elevated platelet count. b. The nurse would expect to see dark brown vaginal discharge c. The nurse would not expect to see an elevated white blood cell count. d. The nurse would not expect to see a rash.

10. The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks' gestation. Tamara's hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks' gestation

ANS: b Feedback a. The values are low normal for adults but represent normal findings for pregnant women. b. During pregnancy the woman's hematocrit values may appear low due to the increase in total plasma volume (on average, 50%). Because the plasma volume is greater than the increase in erythrocytes (30%), the hematocrit decreases by about 7%. This alteration is termed "physiologic anemia of pregnancy," or "pseudo-anemia." The hemodilution effect is most apparent at 32 to 34 weeks. The mean acceptable hemoglobin level in pregnancy is 11 to 12 g/dL of blood. c. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. d. The values are not increased; they are low normal for adults but represent normal findings for pregnant women. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Difficult

The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as: a. Influenza b. Couvade syndrome c. Acid reflux d. Cholelithiasis

ANS: b In preparation for parenthood, the male partner moves through a series of developmental tasks. During the first trimester, the father begins to deal with the reality of the pregnancy and may worry about financial strain and his ability to be a good father. Feelings of confusion and guilt often surface with the recognition that he is not as excited about the pregnancy as his partner, and couvade syndrome, the experience of maternal signs and symptoms, may develop.

36. A 32-year-old woman now at 32 weeks' gestation is complaining of right-sided sharp abdominal pain. The patient is examined by the clinic nurse and given information about abdominal discomfort in pregnancy. She is also instructed to seek immediate attention if she (select all that apply): a. Has heartburn b. Has chills or a fever c. Feels decreased fetal movements d. Has increased abdominal pain

ANS: b, c, d Heartburn is a common discomfort throughout pregnancy. Because the appendix is pushed upward and posterior by the gravid uterus, the typical location of pain is not a reliable indicator for a ruptured appendix during pregnancy. The pain should gradually subside, but if it persists or is accompanied by fever, a change in bowel habits, or decreased fetal movement, the patient should promptly contact her medical provider. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

73. The clinic nurse is aware of the importance of chlamydia screening during pregnancy. Chlamydia transmission to the infant at __________ may result in __________.

ANS: birth; ophthalmia neonatorum Chlamydia trachomatis is a bacteria that causes infection that is prevalent in sexually active populations, especially those in the under-25 age group. Complications of chlamydia infections include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature rupture of the membranes, and preterm birth. Transmission to the neonate may occur during birth and results in ophthalmia neonatorum and chlamydial neonatal pneumonia. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

19. The nurse is working in a prenatal clinic caring for a patient at 14 weeks' gestation, G2 P1001. Which of the following findings should the nurse highlight for the nurse midwife? a. Body mass index of 23 b. Blood pressure of 100/60 c. Hematocrit of 29% d. Pulse rate of 76 bpm

ANS: c Feedback a. A body mass index of 23 is normal. b. A blood pressure of 100/60 is normal. c. A hematocrit of 29% indicates that the patient is anemic. The nurse should highlight the finding for the nurse-midwife. d. A pulse rate of 76 bpm is a normal rate. KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Potential for Alterations in Body Systems; Reduction of Risk Potential: Laboratory Values | Client Need: Health Promotion and Maintenance: Antepartum Care; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Easy

21. A woman at 32 weeks' gestation is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will identify which of the following as a positive patient care outcome? a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia

ANS: c Feedback a. A rise in serum creatinine indicates that the kidneys are not effectively excreting creatinine. It is a negative outcome. b. A drop in serum protein indicates that the kidneys are allowing protein to be excreted. This is a negative outcome. c. Resolution of thrombocytopenia is a positive sign. It indicates that the platelet count is returning to normal. d. Polycythemia is not related to HELLP syndrome. Rather one sees a drop in red cell and platelet counts with HELLP. A positive sign, therefore, would be a rise in the RBC count.

31. A patient at 28 weeks' gestation was last seen in the prenatal clinic at 24 weeks' gestation. Which of the following changes should the nurse bring to the attention of the Certified Nurse Midwife? a. Weight change from 128 pounds to 132 pounds b. Pulse change from 88 bpm to 92 bpm c. Blood pressure change from 110/70 to 140/90 d. Respiratory change from 16 rpm to 20 rpm

ANS: c Feedback a. A weight change of approximately 4 pounds in 4 weeks is normal in the second and third trimesters of pregnancy. b. This pulse rate change is within normal limits. c. A blood pressure elevation to 140/90 is a sign of mild preeclampsia. d. This respiratory rate change is within normal limits. KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Reduction of Risk Potential—Potential for Alterations in Body Systems | Client Need: Health Promotion and Maintenance; Physiological Integrity: Reduction of Risk Potential | Difficulty Level: Easy

11. The clinic nurse is aware that the pregnant woman's blood volume increases by: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55%

ANS: c Feedback a. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not 20% to 25%. b. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45, not 30% to 35%. c. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45% and is primarily due to an increase in plasma and erythrocyte volume. Additional erythrocytes, needed because of the extra oxygen requirements of the maternal and placental tissue, ensure an adequate supply of oxygen to the fetus. The elevation in erythrocyte volume remains constant during pregnancy. d. An increase in maternal blood volume begins during the first trimester and peaks at term. The increase approaches 40% to 45%, not as high as 50% to 55%. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Peds/Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

33. A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner? a. Presence of chloasma b. Presence of severe heartburn c. 10-pound weight gain in a month d. Patellar reflexes +1

ANS: c Feedback a. Chloasma is a normal pregnancy finding. b. Heartburn is an expected finding during the third trimester. c. The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified. d. Although slightly hyporeflexic, patellar reflexes of +1 are within normal limits.

2. A pregnant client with a history of multiple sexual partners is at highest risk for which of the following complications: a. Premature rupture of membranes b. Gestational diabetes c. Ectopic pregnancy d. Pregnancy-induced hypertension

ANS: c Feedback a. Multiple partners do not increase a woman's risk of premature rupture of membranes. b. Genetics and client diet and weight are contributing factors to gestational diabetes. c. Correct. A history of multiple sexual partners places the client at a higher risk of having contracted a sexually transmitted disease that could have ascended the uterus to the fallopian tubes and caused fallopian tube blockage, placing the client at high risk for an ectopic pregnancy. d. Multiple sexual partners are not a risk factor for pregnancy-induced hypertension.

25. A primigravida patient is 39 weeks pregnant. Which of the following symptoms would the nurse expect the patient to exhibit? a. Nausea b. Dysuria c. Urinary frequency d. Intermittent diarrhea

ANS: c Feedback a. Nausea is usually not seen in the third trimester. b. Dysuria is not a normal finding at any time during a pregnancy. The possibility of a urinary traction infection (UTI) should be considered. c. Urinary frequency recurs at the end of the third trimester. As the uterus enlarges, it again compresses the bladder causing urinary frequency. d. Diarrhea is not a normal finding at any time during a pregnancy. KEY: Integrated Process: Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

16. A woman who has had no prenatal care was assessed and found to have hydramnios on admission to the labor unit and has since delivered a baby weighing 4500 grams. Which of the following complications of pregnancy likely contributed to these findings? a. Pyelonephritis b. Pregnancy-induced hypertension c. Gestational diabetes d. Abruptio placentae

ANS: c Feedback a. Pyelonephritis does not lead to the development of hydramnios or macrosomia. b. Pregnancy-induced hypertension does not lead to the development of hydramnios or macrosomia. c. Untreated gestational diabetics often have hydramnios and often deliver macrosomic babies. d. Abruptio placentae does not lead to the development of hydramnios or macrosomia.

A 32 week gestation client states that she thinks she is leaking amniotic fluid. Which of the following tests could be performed to determine whether the membranes had ruptured? a. fern test b. biophysical profile c. amniocentesis d. kernig assessment

26. The nurse has taken a health history on four multigravida patients at their first prenatal visits. It is high priority that the patient whose first child was diagnosed with which of the following diseases receives nutrition counseling? a. Development dysplasia of the hip b. Achondroplastic dwarfism c. Spina bifida d. Muscular dystrophy

ANS: c Feedback a. The etiology of developmental dysplasia of the hip is unrelated to the mother's nutritional status. b. Achondroplasia is an inherited defect. Its etiology is unrelated to the mother's nutritional status. c. The incidence of spina bifida is much higher in women with poor folic acid intakes. It is a priority that this patient receives nutrition counseling. d. Most forms of muscular dystrophy are inherited. Their etiologies are unrelated to the mother's nutritional status. KEY: Integrated Process: Nursing Process: Implementation | Cognitive Level: Application | Content Area: Antepartum Care; Collaboration with Interdisciplinary Team; Management of Care: Referrals | Client Need: Health Promotion and Maintenance; Safe and Effective Care Environment: Management of Care | Difficulty Level: Moderate

13. A patient is receiving magnesium sulfate for severe preeclampsia. The nurse must notify the attending physician immediately of which of the following findings? a. Patellar and biceps reflexes of +4 b. Urinary output of 50 mL/hr c. Respiratory rate of 10 rpm d. Serum magnesium level of 5 mg/dL

ANS: c Feedback a. The magnesium sulfate has been ordered because the patient has severe pregnancy-induced hypertension. Patellar and biceps reflexes of +4 are symptoms of the disease. b. The urinary output must be above 25 mL/hr. c. The drop in respiratory rate may indicate that the patient is suffering from magnesium toxicity. The nurse should report the finding to the physician. d. The therapeutic range of magnesium is 4 to 7 mg/dL.

25. A woman who is admitted to labor and delivery at 30 weeks' gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? a. Temperature b. Pulse c. Respiratory rate d. Blood pressure

ANS: c Feedback a. The temperature should be monitored, but it is not the most important vital sign. b. The pulse rate should be monitored, but it is not the most important vital sign. c. The respiratory rate is the most important vital sign. Respiratory depression is a sign of magnesium toxicity. d. The blood pressure should be monitored, but it is not the most important vital sign.

22. A nurse is performing an assessment on a pregnant woman during a prenatal visit. Which of the following findings would lead the nurse to report to the obstetrician that the patient may be experiencing intrauterine growth restriction (IUGR)? a. Leopold's maneuvers: Hard round object in the fundus, flat object on left of uterus, small parts on right of uterus, soft round object above the symphysis b. Weight gain: 6-pound increase over 4-week period c. Fundal height measurement: 22 cm at 26 weeks' gestation d. Alpha-fetoprotein assessment: level is one-half normal, accompanied by complaints of severe nausea and vomiting

ANS: c Feedback a. This baby is in the breech position. This is not a sign of IUGR. b. This weight gain is slightly above normal. This is not a sign of IUGR. c. The fundal height at 26 weeks should be approximately 26 cm. The fundal height, therefore, is below expected. This patient may be experiencing intrauterine growth restriction. d. A low AFP level is seen in patients whose babies have spina bifida and other central nervous system defects. KEY: Integrated Process: Nursing Process: Analysis | Cognitive Level: Application Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

3. During a routine prenatal visit in the third trimester, a woman reports she is dizzy and lightheaded when she is lying on her back. The most appropriate nursing action would be to: a. Order an EKG. b. Report this abnormal finding immediately to her care provider. c. Teach the woman to avoid lying on her back and to rise slowly because of supine hypotension. d. Order a nonstress test to assess fetal well-being.

ANS: c Feedback a. This is a normal occurrence in pregnancy and does not indicate pathology. The probable cause of the problem is supine hypotension. b. This is a normal finding that does not warrant immediate notification to her care provider. c. Correct. Teaching the woman to avoid lying on her back because of occlusion of the vena cava with the gravid uterus causes supine hypotension syndrome. d. Antenatal testing is not indicated with supine hypotension. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

17. While performing Leopold's maneuvers on a woman in early labor, the nurse palpates a flat area in the fundal region, a hard round mass on the left side, a soft round mass on the right side, and small parts just above the symphysis. The nurse concludes which of the following? a. The fetal position is right occiput posterior. b. The fetal attitude is flexed. c. The fetal presentation is scapular. d. The fetal lie is vertical.

ANS: c Feedback a. This is a shoulder presentation. b. It is not possible to determine whether the attitude is flexed or not when doing Leopold's maneuvers. c. This is a shoulder presentation. d. The lie is transverse or horizontal. KEY: Integrated Process: Nursing Process: Analysis; Nursing Process: Assessment | Cognitive Level: Application | Content Area: Antepartum Care | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

24. After an education class, the nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that additional teaching about sexually transmitted infection (STI) control issues is needed? a. "I could get an STI even if I just have oral sex." b. "Girls over 16 are less likely to get STDs than younger girls." c. "The best way to prevent an STI is to use a diaphragm." d. "Girls get human immunodeficiency virus (HIV) easier than boys do."

ANS: c Feedback a. This statement is true. Organisms that cause sexually transmitted infections can invade the respiratory and gastrointestinal tracts. b. This statement is true. Young women are especially high risk for becoming infected with sexually transmitted diseases. c. This statement is untrue. The young woman needs further teaching. Condoms protect against STDs and pregnancy. In addition, condoms can be kept in readiness for whenever sex may occur spontaneously. Using condoms does not require the teen to plan to have sex. A diaphragm is not an effective infection-control method. Plus, it would require the teen to plan for intercourse. d. This statement is true. Young women are higher risk for becoming infected with HIV than are young men.

A gravid client with 4+ proteinuria and 4+ reflexes is admitted to the hospital. The nurse must closely monitor the woman for which of the following? a. grand mal seizure b. high platelet count c. explosive diarrhea d. fractured pelvis

26. You are caring for a patient who was admitted to labor and delivery at 32 weeks' gestation and diagnosed with preterm labor. She is currently on magnesium sulfate, 2 gm per hour. Upon your initial assessment you note that she has a respiratory rate of 8 with absent deep tendon reflexes. What will be your first nursing intervention? a. Elevate head of the bed b. Notify the MD c. Discontinue magnesium sulfate d. Draw a serum magnesium level

ANS: c Initial nursing intervention needs to be discontinuing magnesium sulfate because the patient is exhibiting signs of magnesium toxicity with absent deep tendon reflexes and decreased respiratory rate.

45. The perinatal nurse knows that tocolytic agents are most often used to (select all that apply): a. Prevent maternal infection b. Prolong pregnancy to 40 weeks' gestation c. Prolong pregnancy to facilitate administration of antenatal corticosteroids d. Allow for transport of the woman to a tertiary care facility

ANS: c, d Feedback a. Tocolytics are not used to treat maternal infection. b. Tocolytics are generally only effective in delaying delivery for several days. c. Presently, it is believed that the best reason to use tocolytic drugs is to allow an opportunity to begin the administration of antenatal corticosteroids to accelerate fetal lung maturity. d. Delaying the birth provides time for maternal transport to a facility equipped with a neonatal intensive care unit.

37. The clinic nurse talks with Suzy, a pregnant woman at 9 weeks' gestation who has just learned of her pregnancy. Suzy's nausea and vomiting are most likely caused by (select all that apply): a. Increased levels of estrogen b. Increased levels of progesterone c. An altered carbohydrate metabolism d. Increased levels of human chorionic gonadotropin

ANS: c, d Nausea and vomiting during the first trimester most likely are related to rising levels of human chorionic gonadotropin (hCG) and altered carbohydrate metabolism. Changes in taste and smell, due to alterations in the oral and nasal mucosa, can further aggravate the gastrointestinal discomfort. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

46. The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10 weeks' gestation, that her rubella titer indicates that she is not immune. Margaret should be advised to (select all that apply): a. Avoid contact with all children b. Be retested in 3 months c. Receive the rubella vaccine postpartum d. Report signs or symptoms of fever, runny nose, and generalized red rash to the health-care provider

ANS: c, d Testing for rubella (German measles) is not necessary as titers are reliable indicators of immunity. Rubella (German measles) is one of the most commonly recognized viral infections known to cause congenital problems. If a woman contracts rubella during the first 12 weeks of pregnancy, the fetus has a 90% chance of being adversely affected. A maternity patient who is not immune to rubella should be offered the rubella immunization following childbirth, ideally prior to hospital discharge. The patient should report signs or symptoms of rubella during pregnancy to her health-care provider. It is not realistic for a woman to avoid contact with all children. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

2. The positive signs of pregnancy are: a. All physiological and anatomical changes of pregnancy b. All subjective signs of pregnancy c. All those physiological changes perceived by the woman herself d. The objective signs of pregnancy that can only be attributed to the fetus

ANS: d

Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks' gestation? a. Sexual activity should be avoided from now until 6 weeks postpartum. b. Sexual desire may be affected by nausea and fatigue. c. Sexual desire may be increased due to increased pelvic congestion. d. Sexual activity may require different positions to accommodate the woman's comfort.

ANS: d Correct. An enlarging abdomen creates feelings of awkwardness and bulkiness and may require couples to modify intercourse positions for the pregnant woman's comfort.

22. A 16-year-old patient is admitted to the hospital with a diagnosis of severe preeclampsia. The nurse must closely monitor the woman for which of the following? a. High leukocyte count b. Explosive diarrhea c. Fractured pelvis d. Low platelet count

ANS: d Feedback a. High leukocyte count is not associated with severe pregnancy-induced hypertension (PIH) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. b. Explosive diarrhea is not associated with severe PIH or HELLP syndrome. c. A fractured pelvis is not associated with severe PIH or HELLP syndrome. d. Low platelet count is one of the signs associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

4. Blood volume expansion during pregnancy leads to: a. Iron-deficiency anemia b. Maternal iron stores being insufficient to meet the demands for iron in fetal development c. Plasma fibrin increase of 40% and fibrinogen increase of 50% d. Physiological anemia of pregnancy

ANS: d Feedback a. Iron-deficiency anemia is treated with iron supplementation. Iron-deficiency anemia is defined as hemoglobin of less than 11 g/dL and hematocrit less than 33%. b. Maternal iron stores that are insufficient to meet the demands for iron in fetal development result in iron-deficiency anemia. c. Hypercoagulation that occurs during pregnancy is to decrease the risk of postpartum hemorrhage. These changes taking place are not related to blood volume expansion. d. Correct. Physiological anemia of pregnancy, also referred to as pseudo-anemia of pregnancy, is due to hemodilution. The increase in plasma volume is relatively larger than the increase in RBCs that results in decreased hemoglobin and hematocrit values. KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

1. A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety. a. Assess uterine contractions continuously. b. Assess fetal heart rate continuously. c. Assess urinary output. d. Assess respiratory rate.

ANS: d Feedback a. Monitoring contractions does not indicate magnesium toxicity. b. Magnesium sulfate will decrease fetal variability and not provide an accurate assessment of magnesium toxicity. c. Urinary output does not correlate to decreased deep tendon reflexes. d. Correct. Respiratory effort and deep tendon reflexes (DTRs) are involuntary, and a decrease in DTRs could indicate the risk of magnesium sulfate toxicity and the risk for decreased respiratory effort.

18. The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia

ANS: d Feedback a. Patients with placenta previa are not especially high risk for placental abruption. b. Patients colonized with group B streptococci are not especially high risk for placental abruption. c. Patients who are hepatitis B surface antigen positive are not especially high risk for placental abruption. d. Patients with eclampsia are high risk for placental abruption.

12. The perinatal nurse knows that the term to describe a woman at 26 weeks' gestation with a history of elevated blood pressure who presents with a urine showing 2+ protein (by dipstick) is: a. Preeclampsia b. Chronic hypertension c. Gestational hypertension d. Chronic hypertension with superimposed preeclampsia

ANS: d Feedback a. Preeclampsia is a multisystem, vasopressive disease process that targets the cardiovascular, hematologic, hepatic, and renal and central nervous systems. b. Chronic hypertension is hypertension that is present and observable prior to pregnancy or hypertension that is diagnosed before the 20th week of gestation. c. Gestational hypertension is a nonspecific term used to describe the woman who has a blood pressure elevation detected for the first time during pregnancy, without proteinuria. d. The following criteria are necessary to establish a diagnosis of superimposed preeclampsia: hypertension and no proteinuria early in pregnancy (prior to 20 weeks' gestation) and new-onset proteinuria, a sudden increase in protein—urinary excretion of 0.3 g protein or more in a 24-hour specimen, or two dipstick test results of 2+ (100 mg/dL), with the values recorded at least 4 hours apart, with no evidence of urinary tract infection; a sudden increase in blood pressure in a woman whose blood pressure has been well controlled; thrombocytopenia (platelet count lower than 100,000/mmC); and an increase in the liver enzymes alanine transaminase (ALT) or aspartate transaminase (AST) to abnormal levels.

11. The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions

ANS: d Feedback a. Preterm labor (PTL) is defined as regular uterine contractions and cervical dilation before the end of the 36th week of gestation. Many patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor. b. Term labor occurs after 37 weeks' gestation. c. There is no indication in this scenario that this is back labor. d. Braxton-Hicks contractions are regular contractions occurring after the third month of pregnancy. They may be mistaken for regular labor, but unlike true labor, the contractions do not grow consistently longer, stronger, and closer together, and the cervix is not dilated. Some patients present with preterm contractions, but only those who demonstrate changes in the cervix are diagnosed with preterm labor.

19. The nurse is caring for a woman at 28 weeks' gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? a. Human relaxin levels b. Amniotic fluid levels c. Alpha-fetoprotein levels d. Fetal fibronectin levels

ANS: d Feedback a. Relaxin levels are rarely assessed. In addition, they are unrelated to the incidence of preterm labor. b. Amniotic fluid levels are not directly related to the incidence of preterm labor. c. Alpha-fetoprotein levels are not related to the incidence of preterm labor. d. A rise in the fetal fibronectin levels in cervical secretions has been associated with preterm labor.

31. According to agency policy, the perinatal nurse provides the following intrapartal nursing care for the patient with preeclampsia: a. Take the patient's blood pressure every 6 hours b. Encourage the patient to rest on her back c. Notify the physician of a urine output greater than 30 mL/hr d. Administer magnesium sulfate according to agency policy

ANS: d Feedback a. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The blood pressure is taken every 1 hour or more frequently according to physician orders or institutional protocol. b. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The patient should be encouraged to assume a side-lying position to enhance uterine perfusion. c. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. A urine output less than 30 mL/hr is indicative of oliguria and the physician must be notified. d. The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion.

14. A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? a. Serum potassium level increases b. Diarrhea c. Urticaria d. Complaints of nervousness

ANS: d Feedback a. The nurse would not expect to see a rise in the mother's serum potassium levels. b. The beta agonists are not associated with diarrhea. c. The beta agonists are not associated with urticaria. d. Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists.

30. A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia

ANS: d Feedback a. The patient is not especially high risk for a postpartum hemorrhage. b. The nurse would expect to see neonatal hypoglycemia, not hyperglycemia. c. The nurse would expect to see postpartum polyuria. d. The nurse would expect to see neonatal macrosomia.

A nurse remarks to a 38 week gravid client, "It looks like your face and hands are swollen." The client responds, "Yes, you're right. Why do you ask?" The nurse's response is based on the fact that the changes may be caused by which of the following? a. altered glomerular filtration b. cardiac failure c. hepatic insufficiency d. altered splenic circulation

A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women to prevent which of the following high-risk complications of pregnancy? a. preterm birth b. gestational diabetes c. macrosomic babies d. polycythemia

10. The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the physician? a. 15 weeks, denies feeling fetal movement b. 20 weeks, fundal height at the umbilicus c. 25 weeks, complains of excess salivation d. 30 weeks, states that her vision is blurry

ANS: d Feedback a. This finding is normal. Quickening is usually felt between 16 and 20 weeks' gestation. b. This finding is normal. The fundal height at 20 weeks' gestation is usually at the level of the umbilicus. c. Excess salivation is a normal, albeit annoying, finding. d. Blurred vision is a sign of pregnancy-induced hypertension (PIH). This finding should be reported to the woman's health-care practitioner.

20. Which of the following statements is most appropriate for the nurse to say to a patient with a complete placenta previa? a. "During the second stage of labor you will need to bear down." b. "You should ambulate in the halls at least twice each day." c. "The doctor will likely induce your labor with oxytocin." d. "Please promptly report if you experience any bleeding or feel any back discomfort."

ANS: d Feedback a. This response is inappropriate. This patient will be delivered by cesarean section. b. This response is inappropriate. Patients with placenta previa are usually on bed rest. c. This response is inappropriate. This patient will be delivered by cesarean section. d. Labor often begins with back pain. Labor is contraindicated for a patient with complete placenta previa.

8. The clinic nurse talks to a 30-year-old woman at 34 weeks' gestation who complains of having difficulty sleeping. Jayne has noticed that getting back to sleep after she has been up at night is difficult. The nurse's best response is: a. "This is abnormal; it is important that you describe this problem to the doctor." b. "This is normal, and many women have this same problem during pregnancy; try napping for several hours each morning and afternoon." c. "This is abnormal; tell the doctor about this problem because diagnostic testing may be necessary." d. "This is normal in pregnancy, particularly during the third trimester when you also feel fetal movement at night; try napping once a day."

ANS: d Feedback a. This sleep pattern is a normal finding. b. Sleeping for several hours in the morning and afternoon would contribute to further sleep disturbances at night. c. This sleep pattern is a normal finding. d. Pregnancy sleep patterns are characterized by reduced sleep efficiency, fewer hours of night sleep, frequent awakenings, and difficulty going to sleep. Nurses can advise patients that afternoon napping may help alleviate the fatigue associated with the sleep alterations. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. The clinic nurse's most appropriate statement is: a. "Jenny, it is late in your pregnancy to be having your first appointment, but it is nice to meet you and I will try to help you get caught up in your care." b. "Jenny, have you had care in another clinic? I can't believe this is your first appointment!" c. "Jenny, by the date of your last menstrual period, you are 31 weeks and now that you are finally here, we need you to come monthly for the next two visits and then weekly." d. "Jenny, by your information, you are 31 weeks' gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?"

ANS: d The initial interview time with the patient should be used to build a positive, nonthreatening relationship and to gain her confidence by respecting her choices and advocating for continued prenatal care. The prenatal nurse's objective is to provide a user-friendly service that is efficient, effective, caring, and patient centered.

When providing a psychosocial assessment on a pregnant woman at 21 weeks' gestation, the nurse would expect to observe which of the following signs? a. Ambivalence b. Depression c. Anxiety d. Happiness

ANS: d The nurse would expect the patient to exhibit signs of happiness at this time.

34. The single most important risk factor for preterm birth includes: a. Uterine and cervical anomalies b. Infection c. Increased BMI d. Prior preterm birth

ANS: d The single most important factor is prior preterm birth with a reoccurrence rate of up to 40%.

20. The more prepared a pregnant woman feels for the birth of her baby will lower her anxiety and fear. The behavior is referred to as ____________________.

ANS: nesting behavior The nurse recognizes that completing preparations for the birth of a child can lower the anxiety and fear a pregnant woman feels about the impending birth. The flurry of activity the woman initiates to finish preparations for the arrival of the neonate is referred to as nesting behavior.

79. The perinatal nurse knows that __________, which is the eating of nonnutritive substances, is a common __________.

ANS: pica; eating disorder Pica, the consumption of nonnutritive substances or food, is a common eating disorder that can affect pregnancy. Substances that are most often ingested include clay, dirt, cornstarch, and ice. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

72. The clinic nurse monitors the blood pressure and assesses a woman's urine at each prenatal visit to assess for signs or symptoms of __________. A previous history or the presence of a __________ are also risk factors.

ANS: preeclampsia; new partner A previous history of preeclampsia increases the woman's likelihood of a recurrence during subsequent pregnancies. If a woman did not experience preeclampsia with previous pregnancies but has a new partner for her current pregnancy, her risk of developing preeclampsia is similar to that of a woman who is pregnant for the first time. Although preeclampsia is a systemic disorder that occurs only during pregnancy, it is generally recognized by two classic symptoms: elevated blood pressure and proteinuria. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

78. The clinic nurse understands that the physiological changes of pregnancy include vascular relaxation from the effects of __________ and impaired venous circulation from pressure exerted by the enlarged uterus, predisposing the pregnant woman to __________.

ANS: progesterone; varicose veins Progesterone results in vascular relaxation which combined with impaired venous return increases the incidence of varicose veins in pregnant women. KEY: Integrated Process: Nursing Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Easy

69. During the prenatal class, the perinatal nurse describes factors that may initiate the process of labor. One of these factors is the production of __________, which are found in the uterine __________ and are released from the __________ at term as it softens and dilates.

ANS: prostaglandins; decidua or lining; cervix Prostaglandins are lipid substances found in high concentrations in the female reproductive tract and in the uterine decidua during pregnancy. Their exact function in pregnancy is unknown, although they may maintain a reduced placental vascular resistance. A decrease in prostaglandin levels may contribute to hypertension and preeclampsia. At term, an increased release of prostaglandins from the cervix as it softens and dilates may contribute to the onset of labor. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

76. The clinic nurse describes to the student nurse that __________ is excessive saliva production in pregnancy. This condition is most likely caused by increased __________ levels.

ANS: ptyalism; hormone Ptyalism, or excessive salivation, can be quite distressing for the pregnant woman who must frequently wipe her mouth or spit into a cup. Although the cause of ptyalism is unknown, it is most likely related to increased hormone levels. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

75. The prenatal nurse cautions a pregnant woman about Caesar salad consumption during pregnancy or any source of __________ or __________ milk.

ANS: raw eggs; unpasteurized A word of caution should be provided by health-care providers to pregnant women with regard to microbial food-borne illness. Raw, or unpasteurized, milk as well as partially cooked eggs and foods containing raw or partially cooked eggs should be avoided. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

74. The prenatal nurse describes the need for __________ and __________ screening at the first antenatal visit. If the pregnant woman is not immune, she will be counseled to avoid contact with young children who have a rash and could be infectious.

ANS: rubella; varicella Some of the routine maternal laboratory tests screen for childhood diseases that are known to cause congenital anomalies or other pregnancy complications if contracted during early pregnancy. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

77. The clinic nurse talks with the newly diagnosed pregnant woman about the nausea that the woman is experiencing in this pregnancy. The clinic nurse suggests eating __________ meals more often, remaining __________ after eating, and the using __________ techniques.

ANS: smaller; upright; relaxation Nausea is often one of the first symptoms of pregnancy experienced. Nurses can suggest strategies to help offset the nausea, such as the avoidance of "trigger foods" (foods that cause nausea from sight or smell) and tight clothing that constricts the abdomen. The use of relaxation techniques (i.e., slow, deep breathing, mental imagery) can also help to decrease nausea. Other techniques that are often helpful include consuming plain, dry crackers or sucking on peppermint candy before arising; adhering to small, frequent meals; and remaining in an upright position after eating. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Safe and Effective Care Environment | Difficulty Level: Moderate

70. The perinatal nurse describes common complaints of pregnancy to the prenatal class attendees. Nasal __________, medically termed "__________ of pregnancy," is caused by increased levels of estrogen and progesterone.

ANS: stuffiness; rhinitis Nasal stuffiness and congestion (rhinitis of pregnancy) are common complaints during pregnancy. The nurse should educate the patient about these normal changes and offer reassurance. Increasing oral fluid intake helps to keep the mucus thin and easier to mobilize. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Application | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Moderate

68. The clinic nurse explains to the new nurse that during pregnancy, the maternal metabolism is altered to support the pregnancy by the hormones __________ and __________, which are produced by the anterior __________ gland.

ANS: thyrotropin; adrenotropin; pituitary Maternal metabolism is altered to support the pregnancy by thyrotropin and adrenotropin. These hormones, produced by the anterior pituitary gland, exert their effects on the thyroid and adrenal glands. Thyrotropin causes an increased basal metabolism, and adrenotropin alters adrenal gland function to increase fluid retention by the kidneys. KEY: Integrated Process: Teaching and Learning | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Health Promotion and Maintenance | Difficulty Level: Easy

A nurse is attending to two pregnant clients. The first client was assessed as "early term." The second was assessed as "full term." In order for the nurse to make such assessments, how mature are the clients' pregnancies? 1. The first client is between 37 0/7 weeks and 38 6/7 weeks. The second client is between 39 0/7 weeks and 40 6/7 weeks. 2. The first client is between 41 0/7 weeks and 41 6/7 weeks. The second client is between 42 0/7 weeks and beyond. 3. The first client is between 39 0/7 weeks and 40 6/7 weeks. The second client is between 37 0/7 weeks and 38 6/7 weeks. 4. The first client is between 42 0/7 weeks and beyond. The second client is between 41 0/7 weeks and 41 6/7 weeks.

Answer: 1 Option 1: A client who is between 37 0/7 and 38 6/7 weeks gestation is classified as early term. A client who is between 39 0/7 through 40 6/7 weeks gestation is classified as full term. Option 2: A client who is between 41 0/7 and 41 6/7 weeks gestation is classified as late term. A client who is between 42 0/7 weeks gestation and beyond is classified as post term. Option 3: A client who is between 39 0/7 through 40 6/7 weeks gestation is classified as full term. A client between 37 0/7 and 38 6/7 weeks gestation is classified as early term. Option 4: A client who is between 42 0/7 weeks gestation and beyond is classified as post term. A client who is between 41 0/7 weeks and 41 6/7 weeks gestation is classified as late term.

The nurse is preparing to measure a client's fundal height. which would the nurse do to obtain the most accurate measurement? 1. Instruct the client to empty her bladder. 2. Place the measuring tape just below the umbilicus. 3. Use the millimeter markings on the measuring tape to record fundal height. 4. Instruct the client to take a deep breath and hold it during the measurement.

Answer: 1 Option 1: A full bladder may falsely increase the fundal height measurement. By having the client empty her bladder, the nurse can obtain the most accurate measurement. Option 2: To obtain fundal height, the nurse should put the zero point of the tape on the symphysis pubis. Option 3: Fundal height is measured using a centimeter measuring tape. Option 4: Maternal respiration does not alter the fundal height measurement. The mother should breathe normally during the examination.

At her 14-week prenatal appointment, the client reports experiencing a moderate amount of white vaginal discharge. Which teaching would the nurse provide? 1. Wear a panty-liner and change it often. 2. Use a vaginal douche to cleanse the vagina of discharge. 3. Change the type of bath soap she is using. 4. Explain that the loss of the mucus plug is normal.

Answer: 1 Option 1: An increase of estrogen during pregnancy causes leukorrhea. The client can wear a panty-liner to keep her undergarments dry. It should be changed regularly to prevent bacterial growth. Option 2: Douching is not recommended during pregnancy, as it alters vaginal pH. Vaginal pH during pregnancy is naturally more acidic to prevent bacterial growth. Option 3: While some women are sensitive to soaps with lots of dye or perfumes, it should not cause vaginal discharge. Option 4: The loss of the mucus plug is a sign of impending labor. This is not a normal occurrence at 14 weeks gestation.

A nurse is caring for a 16-week pregnant client whose obstetrical history includes 5-year-old twins born at 38 weeks gestation and an abortion at 24-weeks after the twins were born. How would the nurse document the client's obstetrical status? 1. G3P2 2. G3P3 3. G2P3 4. G3P4

Answer: 1 Option 1: Client has 3 pregnancies, a term delivery of twins counted as 1 para and an abortion at 24-weeks counted as another para. Gravida and Para (G/P) is a two-digit system to denote pregnancy and birth history. While Gravida refers to the total number of times a woman has been pregnant, Para refers to the number of births after 20-week gestation whether live or stillbirth. Option 2: Client has 3 pregnancies, a term delivery of twins counted as 1 para and a stillbirth at 24-weeks counted as another para. The current pregnancy is not counted until delivery after 20 weeks of gestation. Option 3: Client has 3 pregnancies not two. The current pregnancy, the twins, and the stillbirth delivery. Option 4: Client is para 2 not 4. Current pregnancy is not counted, the twins are counted as 1 para plus the stillbirth delivery at 24-weeks.

A pregnant client at term visits the clinic and tells the nurse that she is feeling tired all the time. A review of her laboratory results show that her hematocrit level is low. The nurse documented "Fatigue" in the client's health records. Which recommendations by the nurse is correct? 1. "Eat iron-rich foods, ask for assistance from family, and get adequate rest." 2. "Wear loose fitting clothes, elevate legs when sitting, and position yourself on your side when lying." 3. "Maintain adequate hydration, rise slowly from sitting to standing, and avoid lying on your back." 4. "Avoid lying on your back, keep your feet moving when standing, and avoid standing for prolonged periods."

Answer: 1 Option 1: Eating iron-rich foods, asking for assistance from family, and getting adequate rest are relief measures for a pregnant client who is fatigued. Option 2: Wearing loose fitting clothes, elevating legs when sitting, and lying on the side are relief measures for a pregnant client with dependent edema in the lower extremities. Option 3: Maintaining adequate hydration, rising slowly from sitting to standing, and avoiding lying on dorsal are relief measures for a pregnant client who has headaches and syncope. Option 4: Avoid lying on dorsal, keeping moving when standing, and avoiding standing for prolonged periods are relief measures for a pregnant client who has orthostatic hypotension.

A pregnant client with four living children, one preterm infant, and one abortion visits the clinic. How is the nurse expected to record the client's data? 1. G 6 T 3 P 1 A 1 L 4 2. G 5 T 2 P 1 A 1 L 4 3. G 4 T 4 P 1 A 1 L 4 4. G 3 T 1 P 1 A 1 L 4

Answer: 1 Option 1: G 6 T 3 P 1 A 1 L 4 means that this is the sixth pregnancy; three infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive Option 2: G 5 T 2 P 1 A 1 L 4 means that this is the fifth pregnancy; two infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive Option 3: T 4 G 4 P 1 A 1 L 4 means that this is the fourth pregnancy; four infants were born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive. Option 4: G 3 T 1 P 1 A 1 L 4 means that this is the third pregnancy; one infant was born between 38 and 42 weeks; one infant was born between 20 and 37 6/7 weeks; the client had one abortion; four children are alive

A nurse reads the client's history and physical, which lists the GTPAL as 3-1-1-0-2. How would the nurse interpret this? 1. The client has been pregnant three times, delivered once at term, once at preterm, and has two living children. 2. The client has been pregnant three times, delivered once at term, once at preterm, and had one miscarriage. She now has two living children. 3. The client has been pregnant three times, had one set of twins, one delivery after 20 weeks, and two children are living. 4. The client has been pregnant three times, had one therapeutic abortion, one delivery after 20 weeks, no miscarriages, and two living children.

Answer: 1 Option 1: Gravidity refers to the number of times the woman has been pregnant. Term deliveries (which include early, full, late, and post term gestations) are counted under "T." Preterm deliveries are counted under "P." The "A" stands for abortion, which includes therapeutic/induced and spontaneous. The "L" includes living children. Option 2: According to the GTPAL, the client has had no miscarriages. This would be denoted under the "A" category, which states zero. Option 3: The "T" and "P" in GTPAL stand for term and preterm, not twins and para. Option 4: The "T" in GTPAL stands for term. If the client had an abortion, it would be denoted under the "A" column.

A patient, 32 weeks pregnant with severe headache, is admitted to the hospital with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the physician ordered the following four items. Which of the orders should the nurse perform first? a. assess deep tendon reflexes b. obtain complete blood count c. assess baseline weight d. obtain routine urinalysis

A pregnant diabetic has been diagnosed with hydramnios. Which of the following would explain this finding? a. excessive fetal urination b. recurring hypoglycemic episodes c. fetal sacral agenesis d. placental vascular damage

During a physical examination, the nurse observed that a client in her late pregnancy has hemorrhoids and varicosities in her legs. Which statement by the nurse explains the cause for these two conditions in a pregnant client? 1. "Increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava." 2. "Increased action of adrenocorticosteroids leads to cutaneous elastic tissues becoming fragile." 3. "The stretching of the abdominal muscle, due to the enlarging uterus." 4. "Increased plasma fibrin by 40% and the fibrinogen by 50%."

Answer: 1 Option 1: Hemorrhoids and varicosities occur as a result of increased venous pressure and decreased blood flow to the extremities, due to compression of the iliac veins and inferior vena cava. Option 2: Striae gravidarum occurs as a result of the increased action of adrenocorticosteroids, which leads to the cutaneous elastic tissues becoming fragile. Option 3: Diastasis recti occurs due to the stretching of the abdominal muscle as a result of the enlarging uterus. Option 4: Hypercoagulability occurs due to an increase of plasma fibrin by 40% and the fibrinogen by 50%.

The nurse obtains a fundal height measurement of 32 cm on a client experiencing a healthy, low-risk pregnancy. How does the nurse interpret this measurement? 1. The client is approximately 32-week gestation. 2. The weight of the fetus is approximately 3200 grams. 3. The amniotic fluid volume is 3.2 cm. 4. The distance from the fundus to the xiphoid process is 32 cm.

Answer: 1 Option 1: In a normally growing singleton pregnancy, the fundal height in centimeters should be approximately the same as the gestational age in weeks, give or take 2 weeks. Option 2: Fetal weight cannot be determined through fundal height measurement. A gross estimate can be determined by ultrasound. Option 3: An accurate determination of amniotic fluid volume is obtained through ultrasound imaging, not fundal height measurement. Option 4: Fundal height is measured as the distance from the symphysis pubis to the top of the fundus.

A multiparous client asks the nurse what she can do to help with leaking urine when she coughs or sneezes. Which intervention would the nurse recommend? 1. Perform Kegel exercises 2. See a urology specialist for surgery 3. Empty her bladder every hour 4. Obtain a specimen for urinalysis

Answer: 1 Option 1: Kegel exercises promote pelvic floor muscle strength and decrease the risk of urinary incontinence. Option 2: Urine leaking in a multiparous client is a common problem. Simple, less invasive interventions, such as Kegel exercises, should be encouraged before surgical intervention Option 3: Urinating hourly would be inconvenient to the client. Small amounts of urine contained in the bladder may still leak if pelvic floor muscles are weak. Option 4: Symptoms of urinary tract infection include frequency, urgency, and pain while urinating. These symptoms were not included in the question stem.

The nurse is educating a 32-weeks-pregnant client on how to perform kick counts. Which statement by the client would indicate a need for further teaching? 1. "I will perform the kick counts at a different time every day." 2. "I should call my doctor right away if the baby is not moving as much as usual." 3. "It is normal for the baby to move about 10 times or more in 2 hours." 4. "A kick, flutter, or roll counts as movements."

Answer: 1 Option 1: Kick counts should be performed at the same time every day. Option 2: Decreased or absent fetal movement is a sign of hypoxia and should be reported immediately. Option 3: Feeling 10 movements or more in 2 hours is considered reassuring. Option 4: Kicks, flutters, swishes, and rolls are all considered types of fetal movement that should be counted by the mother.

The nurse is providing preconception counseling to a client. Which topic is most important to educate the client on at this time? 1. Adequate intake of folic acid 2. Common discomforts of pregnancy 3. Infant safety at home 4. Gaining an appropriate amount of weight during pregnancy

Answer: 1 Option 1: Preconception nutrition counseling is important at this time because nutritional deficits at the beginning of pregnancy can affect the development of the fetus. Inadequate folic acid has been linked to an increased risk of neural tube defects. Option 2: The client is seeking preconception counseling and is not yet pregnant. This would be an important topic in her early prenatal care. Option 3: The client is seeking preconception counseling and is not yet pregnant. This would be an important topic in the second or third trimester. Option 4: The client is seeking preconception counseling and is not yet pregnant. Ensuring she has a healthy BMI before pregnancy would be important, but weight gain during pregnancy can be discussed later.

The nurse is planning care for a group of clients. Which client would need to receive Rho (D) Immune Globulin (RhoGAM)? 1. A client whose blood type is O-negative 2. A client whose white blood cell count was below normal 3. A client with an autoimmune disorder 4. A client whose blood type is O-positive

Answer: 1 Option 1: RhoGAM is given to women who have Rh-negative blood to prevent isoimmunization. Option 2: RhoGAM does not increase white blood cell count or provide immunity to disease. Option 3: RhoGAM does not provide immunity to disease or alter the symptoms of an autoimmune disorder. Option 4: RhoGAM is not needed in women with Rh-positive blood. There are no Rh-antibodies to perceive the fetus as foreign tissue.

A mother who had a stillbirth 2 months ago stated that she has been trying to get pregnant. The nurse determines that she may be at risk for iron-deficiency anemia. Which advice would the nurse give to this woman? 1. "Take iron supplements." 2. "Continue taking megadoses of vitamins and minerals." 3. "Increase your intake of calcium and magnesium." 4. "Take Folic acid 0.6mg once per day."

Answer: 1 Option 1: Taking iron supplements will replace the iron stores she lost in the recent pregnancy. Option 2: Taking megadoses of vitamins and minerals may be toxic to the anticipated pregnancy. Option 3: Taking calcium and magnesium contributes to bone health, and does not reduce the risk for iron-deficiency anemia. Option 4: Taking Folic acid 0.6mg once per day reduces the risk for neural tube defects, not iron- deficiency anemia.

The nurse is educating a 34-week gestation client about danger signs to report to her health care provider. Which symptom would be added to the nursing care? 1. Blurry vision or seeing "floaters" 2. Edema in her feet and ankles after being on her feet at work 3. Frequent urination 4. Occasional nausea and vomiting

Answer: 1 Option 1: Visual changes can be indicative of hypertensive disorders and should be reported to the health care provider. Option 2: Dependent edema is common in the third trimester due to the pressure of the fetus slowing venous return from the lower half of the body. Option 3: Urinary frequency (with the absence of pain or urgency) reappears in the third trimester due to increasing weight of the fetus and lightening. Option 4: Occasional nausea and vomiting is unlikely to cause significant dehydration or nutritional deficits. Prolonged nausea and vomiting should be reported.

A client in her second trimester presented at the clinic with a history of vaginal bleeding. She has no history of trauma. Which condition in the client's history would assist the nurse to determine the cause for the bleeding? Select all that apply. 1. Friable cervix 2. Placenta previa 3. Urinary frequency 4. Hyperemesis gravidarum 5. Absence of fetal movement

Answer: 1,2 Option 1: Vaginal bleeding may indicate a friable cervix. Option 2: Vaginal bleeding may indicate placenta previa. Option 3: Urinary frequency is an indication of a urinary tract infection. Option 4: Prolonged nausea and vomiting indicates possible hyperemesis gravidarum. Option 5: Absence of fetal movement may be an indication of fetal distress.

A woman visits the clinic and states that she has missed four menstrual periods and is unsure if she is pregnant. The nurse informs her that a ballottement test will be done to diagnose pregnancy. How can a ballottement test assist the nurse in confirming a pregnancy? 1. Softening of the cervix and vagina 2. Softening of the lower uterine segment 3. Brownish pigmentation over the client's forehead 4. Bluish-purplish coloration of the vaginal mucosa 5. A dark line that runs from the umbilicus to the pubis

Answer: 1,2,4 Option 1: Goodell's sign is the softening of the cervix and vagina, which are probable signs that may not be obvious to the woman. Option 2: Hegar's sign is the softening of the lower uterine segment, and is a probable sign that may not be obvious to the woman. Option 3: Brownish pigmentation over the client's forehead is a probable sign that the woman would have observed. Option 4: Chadwick's sign is the bluish-purplish coloration of the vaginal mucosa that can be seen by the nurse, and not the woman. Option 5: Linea nigra is the dark line that runs from the umbilicus to the pubis, and is a probable sign that the woman would have observed.

A couple that recently emigrated from another country visited the prenatal clinic for the first time. The nurses decided to conduct a cultural assessment of the couple. Which assessment by the nurse could assist in planning a culture-specific prenatal care for this couple? Select all that apply. 1. The couple's expectation of the health care system 2. The couple's need for one-on-one prenatal care 3. The couple's beliefs relating to pregnancy 4. History of intimate partner violence 5. A review of systems

Answer: 1,3 Option 1: Assessing the couple's expectations of the health care system allows the nurse to plan culture-specific care. Option 2: Joining a small group will provide a sense of community instead of a one-on-one prenatal care for this couple. Option 3: Assessing the couple's beliefs relating to pregnancy allows the nurse to plan culture- specific care. Option 4: All women should be assessed for intimate partner violence regardless of their nationality. Option 5: The nurse should conduct a review of systems for all women visiting the clinic for the first time.

During a prenatal appointment, the nurse assesses the client's blood pressure and obtains a reading of 152/94 mmHg. The nurse should assess for which additional symptoms? Select all that apply. 1. Facial edema 2. Dyspnea 3. Vision changes 4. Severe headache 5. Pelvic pressure

Answer: 1,3,4 Option 1: Facial and generalized edema are likely present in clients with hypertensive disorders. Option 2: Difficulty breathing is not likely associated with hypertensive disorders. Option 3: Hypertensive disorders may cause swelling and pressure on the optic nerve resulting in visual changes Option 4: Headache not relieved by usual measure (such as acetaminophen) are associated with hypertensive disorders. Option 5: Pelvic pressure would be present in a patient who could be experiencing preterm labor. It is not associated with increased blood pressure.

A pregnant woman asked the nurse why her home is being assessed for the Aedes albopictus mosquitoes. The nurse responded by saying, "I intentionally assessed your home because you are pregnant." Which other reason given by the nurse is correct? Select all that apply. 1. "Your spouse has the Zika virus and can transmit it to you during sexual intercourse." 2. "You have been non-compliant with the vaccination to prevent Zika virus infection." 3. "You have been reporting fever, rash, headache, and muscle pain for the past week." 4. "We do not want the Zika virus to increase the growth of your baby too much." 5. "The Zika virus is an infection that is spread by infected Aedes albopictus mosquitos."

Answer: 1,3,5 Option 1: The Zika virus can be sexually transmitted from an infected partner. Option 2: There is no vaccine to prevent the Zika virus. Option 3: Some symptoms of the Zika virus are fever, rash, headache, and muscle pain. These symptoms can last up to a week. Option 4: The Zika virus impairs fetal growth. Option 5: The Zika virus is an infection spread by infected Aedes albopictus mosquitos.

The nurse will be focusing on 'self-care' during a preconception counseling session with women who are seeking to get pregnant. Which advice should the nurse include in the counseling session? Select all that apply. 1. Discontinue the use of herbal supplements before pregnancy. 2. Avoid aerobic and regular weight-bearing exercise before pregnancy. 3. Continue with the same megadoses of vitamins and minerals as prescribed. 4. Ensure that smoke alarms and carbon monoxide detectors are in working order. 5. Maintain optimal oral health and treat any periodontal disease before pregnancy.

Answer: 1,4,5 Option 1: Using herbal supplements is contraindicated during pregnancy. Option 2: Aerobic and regular weight-bearing exercise provide overall body conditioning, help with weight management and can enhance psychological well-being. Option 3: Megadoses of vitamins and minerals may be toxic to the developing fetus. Option 4: Ensuring that smoke alarms and carbon monoxide detectors are in working order is important for safety reasons. Option 5: Maintaining optimal oral health and treating any periodontal disease before pregnancy may prevent preterm birth.

A woman who is planning to get pregnant started 0.4 mg/day of folic acid. She visited her primary physician and the dose was later increased to 0.8 mg/day because she had an infant with neural tube defect (NTD). The stock volume for folic acid is 0.4 mg. The nurse is expected to instruct the woman to take _____ tablets per day? Fill in the blank.

Answer: 2 Correct Feedback The nurse would have to calculate the number of tablets the client should take: 0.8 mg ÷ 0.4 mg x 1 = 2 tablets per day.

A type 1 diabetic gravida has developed polyhydramnios. The client should be taught to report which of the following? a. uterine contractions b. reduced urinary output c. marked fatigue d. puerperal rash

A type 1 diabetic is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? a. need for less insulin than she normally injects b. an increased risk for hyperglycemic episodes c. signs and symptoms of hydramnios d. a need to be hospitalized for fetal testing

The nurse is admitting a client whose blood type is A-negative and had a miscarriage at 5-weeks gestation. which is the appropriate nursing intervention? 1. Prepare the client for a dilation and curettage (D&C) 2. Administer Rho (D) Immune Globulin (RhoGAM) 3. Instruct the client to use contraception for the next 6 months 4. Perform an ultrasound to confirm all products of conception have been expelled

Answer: 2 Option 1: A D&C is performed when products of conception remain inside the uterus. This information was not included in the question stem. Option 2: Rho (D) Immune Globulin is administered to Rh-negative women with likely exposure to Rh-positive blood such as with pregnancy loss. Option 3: Health care providers typically encourage the client to wait for 2-3 normal menstrual cycles before trying to conceive following a pregnancy loss. Option 4: Performing an ultrasound is not within the nurse's scope of practice. This would be done by a physician/midwife or radiological technician.

A 19-year-old primigravida client's initial prenatal laboratory results show that she has Rh negative blood. Which action by the nurse is correct? 1. Provide antiretroviral therapy during pregnancy and around the time of delivery. 2. Rescreen the client in the second trimester and give RhoGAM at 28-weeks. 3. Monitor for signs and symptoms of anemia and give the client iron supplements. 4. Request a cytology screening every 3 years.

Answer: 2 Option 1: Antiretroviral therapy during pregnancy and around the time of delivery is for clients who are HIV positive. Option 2: Rescreening the client in second trimester and giving RhoGAM will prevent isoimmunization if the baby's blood is Rh positive. Option 3: Monitoring for signs and symptoms of anemia is done for clients whose Hgb blood volume increases more than their red cell volume, and if so, iron supplements should be given. Option 4: Requesting cytology screening every 3 years is done to assess change in the cervical cells.

The nurse is obtaining a 24-hour diet history from a pregnant client. which food consumed by the client would indicate the need for further teaching by the nurse? 1. Pasteurized milk 2. Alfalfa sprouts 3. Cheddar cheese 4. A cup of coffee

Answer: 2 Option 1: Pasteurized milk is safe to drink. Unpasteurized dairy products should be avoided due to bacterial contamination. Option 2: Raw sprouts of any kind should be avoided during pregnancy. Option 3: Cheddar cheese is safe to eat. Soft cheese, such as brie, camembert, or feta should be avoided. Option 4: Pregnant women should limit caffeine intake to 200mg per day, which is approximately one cup of coffee.

The nurse used Naegele's rule to calculate the expected date of delivery (EDD) for a primigravida whose last menstrual period (LMP) was September 7. How did the nurse arrive at June 14? 1. The nurse subtracted 3 months from September 7 and then added 14 days. 2. The nurse subtracted 3 months from September 7 and then added 7 days. 3. The nurse added 3 months to September 7 and then subtracted 14 days. 4. The nurse added 3 months to September 7 and then subtracted 7 days

Answer: 2 Option 1: Subtracting 3 months from September 7 and then adding 14 days would calculate the EDD to be June 21. Option 2: Using Naegele's rule, the correct calculation to calculate the EDD of June 14 is to subtract 3 months from September 7 and then add 7 days. Option 3: Adding 3 months to September 7 and then subtracting 14 days would calculate the EDD to be November 23. Option 4: Adding 3 months to September 7 and then subtracting 7 days would calculate the EDD to be November 30.

An immigrant from Asia who has being living in the shelter for more than a month visits the prenatal clinic. Which laboratory screening would the nurse consider to be priority for this client? 1. Tay-Sachs 2. Tuberculosis skin test 3. Hepatitis B surface antigen 4. Cystic fibrosis carrier screening

Answer: 2 Option 1: Tay-Sachs would be a consideration for persons of eastern European Jewish ancestry. Option 2: Tuberculosis skin test is used for clients at risk, such as recent immigrants and those living in group homes. Option 3: Hepatitis B surface antigen is a consideration to identify women whose infants need immunoprophylaxis post-delivery. Option 4: Cystic fibrosis carrier screening is mainly a consideration for Caucasians.

In the clinic, the nurse is discussing the recommendations for standard precaution against Zika virus infection. Which advice by the nurse will help clients avoid exposure to the virus? 1. "Sleep under mosquito nets since the Aedes albopictus mosquitos only bite at night." 2. "Avoid going to communities that have active mosquito transmission of the virus." 3. "The Zika virus may cause negative pregnancy so remember to take your vaccination by the seventh week of your pregnancy." 4. "It is unnecessary to use protection with an infected spouse."

Answer: 2 Option 1: The Aedes albopictus mosquitos bite at night as well as during the daytime. Option 2: The Zika virus has may have negative pregnancy outcomes. Therefore, pregnant women should avoid going to communities that have active mosquito transmission of the virus. Option 3: There is no vaccine to prevent the Zika virus. Option 4: Using a condom with an infected spouse is a standard precaution against infection.

To avoid supine hypotensive syndrome while measuring fundal height, where would a nurse position a pillow under a client? 1. Head 2. Hip 3. Feet 4. Knees

Answer: 2 Option 1: The client must remain supine while having a fundal height measurement. The pillow cannot go under her head to elevate her. Option 2: The client must remain supine while having a fundal height measurement. To displace the uterus, a pillow should be placed under her hip. Option 3: The client must remain supine while having a fundal height measurement. The pillow cannot go under her feet to elevate her Option 4: The client must remain supine while having a fundal height measurement. The pillow cannot go under her knees to elevate her.

A client states to the nurse, "This is my fourth pregnancy. Do I really need to have all these appointments?" Which is the most appropriate response by the nurse? 1. "I'm sure you are very busy with your other children." 2. "Early and regular prenatal care can catch problems early and reduce complications." 3. "Do you need assistance with transportation or have financial concerns?" 4. "Of course. Skipping appointments will jeopardize the health of you and your baby."

Answer: 2 Option 1: The nurse acknowledges the client's situation, but this response does not answer her question. Option 2: This is a factual response that answers the client's question regarding why she does need to receive prenatal care. Option 3: Transportation and finances can be a barrier to receiving prenatal care and should be addressed. However, this response does not answer the client's question. Option 4: This response by the nurse is non-therapeutic. It assumes the client would willingly place herself or child in danger.

In anticipation of a complication that may develop in the second half of pregnancy, the nurse teaches an 18 week gravid client to call the office if she experiences which of the following? a. headache and decreased output b. puffy feet c. hemorrhoids and vaginal discharge d. backache

A client states, "I think I might be pregnant. My period is late and I've been feeling really nauseous." Which would be the best response by the nurse? 1. "That's great! I am so happy for you." 2. "These are presumptive signs of pregnancy. You could be pregnant." 3. "These are positive signs of pregnancy. You are absolutely pregnant." 4. "You should schedule an appointment to make sure you do not have an ectopic pregnancy."

Answer: 2 Option 1: The symptoms reported by the client do not confirm pregnancy. It is also unknown how the client feels about this situation. Option 2: Amenorrhea and nausea are presumptive signs of pregnancy (subjective signs experienced by the patient). Option 3: Positive signs of pregnancy include auscultating fetal heart tones or observing the fetus on an ultrasound. Option 4: The symptoms reported do not confirm pregnancy, nor do they support diagnosis of possible ectopic pregnancy, which could include abdominal pain and vaginal bleeding.

A spouse calls the birthing center stating that his wife who is 36 weeks gestation is going into premature labor. Which data from the spouse would assist the nurse in determining that premature labor is imminent? Select all that apply. 1. "Her headache is not responding to the medication." 2. "She is having abdominal cramps every 6 minutes." 3. "She is having low back pain with pelvic pressure." 4. "Her bag of membranes has just ruptured." 5. "She has generalized edema."

Answer: 2,3,4 Option 1: Severe headache that does not respond to usual relief measures is a symptom of hypertensive disorder. Option 2: Rhythmic lower abdominal cramping means that labor is imminent. Option 3: Low back pain with pelvic pressure is a symptom of preterm labor. Option 4: Leaking of amniotic fluid is a sign that the client is going into preterm labor. Option 5: Generalized edema is a sign of hypertensive disorder.

The nurse is admitting a client who is 10-weeks pregnant. An ultrasound has been scheduled and the client asks the nurse why this test is necessary. which are the appropriate responses from the nurse? Select all that apply. 1. "To determine the sex of your baby." 2. "To verify your gestational age." 3. "To make sure the baby has a strong heartbeat." 4. "To make sure the baby is inside your uterus and not in the fallopian tube." 5. "To see if you are carrying more than one baby."

Answer: 2,3,4,5 Option 1: External genitalia are not developed enough at 10-week gestation to determine infant sex via ultrasound Option 2: First trimester ultrasound can be used to verify gestational age along with last menstrual period. Option 3: First trimester ultrasound can be used to determine viability Option 4: First trimester ultrasound can be used to identify ectopic pregnancies Option 5: Multifetal gestation can be identified in the first trimester via ultrasound.

The nurse educator is teaching a class of pregnant teenagers about the importance of receiving regular prenatal care. which are the maingoals of prenatal care that the nurse would include in the teaching? Select all that apply. 1. To complete a one-time assessment of health risk status of the pregnancy 2. To provide referrals to resources 3. To maintain maternal fetal health 4. To build rapport with the physician and nursing staff 5. To determine the gestational age of the fetus

Answer: 2,3,5 Option 1: Prenatal care is an ongoing assessment of risk factors and risk-appropriate interventions. It is not a one-time visit. Option 2: Referrals to appropriate resources may be implemented during prenatal care visits. Option 3: Ongoing assessment throughout the pregnancy helps identify abnormalities early. Early intervention improves health outcomes for mother and infant. Option 4: A goal of prenatal care is to build rapport with the patient and her family. Option 5: Prenatal care helps determine accurate gestational age. This is important in monitoring the growth and development of the fetus as well as guiding teaching during the pregnancy.

A student nurse in developing a plan of care documented, "Altered pattern of elimination" for a pregnant client who complained of not having regular bowel movements. Which nursing action by the student nurse is appropriate for the client to resume regular bowel patterns? Select all that apply. 1. Advise the client to avoid high-fat and spicy food. 2. Assist the client to establish regular time for bowel movement. 3. Suggest the client eat small, frequent meals instead of large meals. 4. Encourage the client to eat high-fiber foods and fresh vegetables. 5. Discuss with the client prior strategies used successfully to relieve constipation.

Answer: 2,4,5, Option 1: Advising the client to avoid high-fat and spicy food will decrease nausea and vomiting. Option 2: Establishing a regular time for bowel movement will help the client to resume regular bowel patterns. Option 3: Suggesting to the client they eat small, frequent meals, instead of large meals, will decrease nausea and vomiting. Option 4: Encourage the client to eat high-fiber foods and fresh vegetables to resume regular bowel patterns. Option 5: Discussing prior strategies used successfully to relieve constipation with the client will help to resume regular bowel patterns.

After completing a physical examination of a pregnant women, the nurse states, "You are definitely pregnant." Which positive finding would have prompted the nurse to make that statement? 1. An enlarged abdomen 2. Hyperpigmentation of the skin 3. The palpation of fetal movement 4. An increase in the vascularity of the breasts

Answer: 3 Option 1: An enlarged abdomen is a probable sign of pregnancy. Option 2: Hyperpigmentation of the skin is a probable sign of pregnancy. Option 3: The palpation of fetal movement is a positive sign of pregnancy. Option 4: An increase in the vascularity of the breasts is a presumptive sign of pregnancy.

A client asks the nurse about the importance of preconception counseling. In responding, the nurse states that preconception counseling helps women lessen risky behaviors and eliminate exposure to harmful substances. Which statement made by the nurse about contraception cessation would be included in the preconception counseling? 1. "Women taking contraception up to a month before pregnancy will be better able to conceive and date the pregnancy." 2. "Women using hormonal contraception need to discontinue its use at least one menstrual period before conception." 3. "It may take several months or up to a year to conceive after discontinuing Depo-Provera." 4. "Women using an intrauterine device (IUD) will have it removed during labor."

Answer: 3 Option 1: Continuing with contraception a month before pregnancy is not safe and will not aid in facilitating conception and dating the pregnancy. Option 2: Women using hormonal contraception need to discontinue its use few months instead of a month before conception. Option 3: It may take a woman several months or up to a year to conceive after discontinuing Depo-Provera. Option 4: An intrauterine device (IUD) should be removed before the woman becomes pregnant.

The laboratory reported the L/S ratio results from an amniocentresis as 1:1. How should the nurse interpret the result? a. the baby is premature b. the mother is high risk for hemorrhage c. the infant has kernicterus d. the mother is high risk for eclampsia

A pregnant woman calls the clinic in a panic, stating that she is packing to leave her partner who has just assaulted her. Which is the most appropriate response by the nurse? 1. "Have you taken out a restraining order as you were advised to do?" 2. "What have you done for your partner to do this to you?" 3. "Call the police and consider alerting your neighbor." 4. "I will have to document this new development."

Answer: 3 Option 1: Educating her on taking out a restraining order is best practice for patient care, but is not the most appropriate response by the nurse in this present situation. Option 2: The nurse should articulate her belief in the woman so the woman knows the abuse is not her fault. Option 3: Safety is a priority, especially when the woman decided to leave the abusive relationship. Option 4: Documenting in order to accurately capture and record the nature of the injuries is important, but can be done after the woman's safety has been assured.

The nurse is teaching a pregnant client about positioning to avoid supine hypotensive syndrome. Which positioning would be effective? 1. Elevate her feet while she is sitting. 2. Dangle her feet over the edge of the bed for 30 seconds before getting up. 3. Sleep in a side-lying position. 4. Place a pillow under her knees while she is in bed.

Answer: 3 Option 1: Elevation of the feet will help with dependent edema, but not supine hypotension. Option 2: Sitting on the edge of the bed before rising would help with orthostatic hypotension, but not supine hypotension. Option 3: Sleeping in a side-lying position displaces the uterus so that it does not compress the vena cava. Option 4: This may help increase the client's general comfort, but does not affect the positioning of the uterus. A pillow placed under one side of her hip would be beneficial.

A nurse is providing prenatal education to a group of primigravida clients with gestational diabetes. Which is the nurse's best explanation for increased maternal insulin needed during the second trimester? 1. "Placental hormone human chorionic gonadotropin (hCG) causes maternal insulin resistant." 2. "Placental hormone progesterone causes maternal insulin resistant." 3. "Placental hormone human chorionic somatomammotropin (hCS) causes maternal insulin resistant." 4. "Placental hormone oxytocin causes maternal insulin resistant."

Answer: 3 Option 1: Placental hormone hCG does not cause maternal insulin resistant. It is detected by a pregnancy test, maintains corpus luteum until placenta becomes fully functional. Option 2: Placental hormone progesterone does not cause maternal insulin resistant. It maintains pregnancy by relaxation of smooth muscles leading to decreased uterine activity. Option 3: Placental hormone hCS produced in the second trimester facilitates fetal growth by acting as an insulin antagonist thereby altering maternal glucose metabolism. Option 4: Oxytocin is a posterior pituitary hormone. It stimulates uterine contraction.

During prenatal appointments, the nurse provides teaching to the client. When providing teaching, which action would the nurse include? 1. Provide teaching about all procedures the client will need in one sitting. 2. Avoid teaching to the family to assure client privacy. 3. Assess the client's understanding of teaching. 4. Inform the client that if she has questions, they can be answered at the next visit.

Answer: 3 Option 1: Teaching about procedures can be provided as needed. Teaching everything at once can be overwhelming for the client. Option 2: Providing teaching to significant support persons is an important aspect of family-centered care. Option 3: Following teaching, the nurse should assess the client's level of understanding and clarify items if needed. Option 4: Adequate time should be given during the appointment to allow for client questions.

A client from a shelter for battered woman stated, "It is my fault, as I should have not stayed in the situation for so long." Which statement by the nurse is the best response? 1. "Did you alert your neighbors to call the police?" 2. "Tell your partner that you will be taking out a restraining order." 3. "The abuse was not your fault. No one deserves to be mistreated." 4. "Whether or not you give me consent, I will be reporting this to the police."

Answer: 3 Option 1: The shelter can be a lifesaving community resource; therefore, she is not in any immediate danger. Option 2: A restraining order is a lifesaving resource, and telling her partner will jeopardize her safety. Option 3: The nurse is to articulate her belief in the woman by reassuring her that the abuse was not her fault and she does not deserve to be mistreated. Option 4: Reporting the abuse to the police without the woman's consent is a breach of confidentiality.

The urine culture of a client who is at 36 weeks gestation revealed a urinary tract infection. The client's medical records also show that this is the third occurrence since the onset of pregnancy. which advice should the nurse give her on preventing a reoccurrence? Select all that apply. 1. "It is time that you explore different sexual positions." 2. "Practice doing Kegel exercises while urinating." 3. "Urinate immediately before and after sexual intercourse." 4. "Wipe from back to front after passing urine." 5. "Drink at least 8 glasses of liquid each day."

Answer: 3,4 Option 1: Exploring different sexual positions will accommodate the changes of pregnancy. Option 2: Practicing Kegel exercises while urinating will help to strengthen the pelvic floor muscle. Option 3: Urinating immediately before and after sexual intercourse will decrease the risk for a UTI. Option 4: Wiping from back to front after passing urine will increase the risk of having a UTI. Option 5: Drinking at least 8 glasses of liquid each day will decrease the risk for a UTI.

The nurse has decided to implement the Centering Pregnancy model for prenatal care instead of the conventional antenatal care. which is the focus of this model of care? Select all that apply. 1. The nurse spends more time dealing with the complications of pregnancy. 2. The nurse will be better able to take responsibility for the clients' health. 3. The clients will be spending more time with the nurse in antenatal care. 4. More social support will be available for clients. 5. The clients will get one-on-one prenatal care

Answer: 3,4 Option 1: The focus will be on normalcy of pregnancy. Option 2: The focus is to promote individual responsibility for health in pregnancy. Option 3: The focus is to increase the time the clients spend in antenatal care. Option 4: The focus is to provide more social support for clients in antenatal care. Option 5: The focus is on having a small group of women to meet with the nurse.

The nurse is evaluating the effectiveness of bed rest for a client with mild preeclampsia. Which of the following signs/symptoms would the nurse determine is a positive finding? a. weight loss b. 2+ proteinuria c. decrease in plasma proteins d. 3+ patellar reflexes

Which of the following clients is at highest risk for developing a hypertensive illness of pregnancy? a. G1 P0000, age 44 with history of DM b. G2 P0101, age 27 with history of rheumatic fever c. G3 P1102, age 25 with history of scoliosis d. G3 P1011, age 20 with history of celiac disease

During preconception counseling, the nurse is teaching a client about diagnosing pregnancy. Which signs are considered probable signs of pregnancy? Select all that apply. 1. Fetal heart tones 2. Quickening 3. Uterine growth 4. Frequent urination 5. Positive home pregnancy test

Answer: 3,5 Option 1: This is an objective sign of pregnancy that is only caused by the presence of a fetus, which makes it a positive sign of pregnancy. Option 2: Quickening is fetal movement felt by the mother. This is subjective and could be caused by something other than pregnancy, such as intestinal gas. Option 3: This is an objective measure that could be caused by something other than pregnancy, such as uterine fibroids or tumors, which makes it a probable sign of pregnancy. Option 4: Frequent urination can be caused by multiple factors other than pregnancy, such as bladder infection, increased water intake, diabetes, etc. It is a presumptive sign of pregnancy. Option 5: This is an objective measure that could produce false-positive or false-negative results, therefore making it a probable sign of pregnancy.

The nurse is documenting the obstetrical history of a client using the GTPAL system. The client is currently pregnant with her third child. Her first pregnancy resulted in the birth of a daughter at 38 weeks and 1-day gestation. Her second pregnancy resulted in the birth of a son at 35 weeks and 5 days gestation. Both are still living. What does the nurse document as the GTPAL?

Answer: 3-1-1-0-2 Correct Feedback Each pregnancy counts as a gravidity (two previous children + current pregnancy). The daughter born at 38 + 1 was term (T) and the son born at 35 + 5 was preterm (P). She had no abortions/miscarriages (A), and both her children are still living (L). Test Taking Tip: With GTPAL questions, it is helpful to write tally marks as you work through the question. If the patient is currently pregnant, remember to add that pregnancy in the gravidity column.

The nurse is conducting a presentation on the prevention of food-borne illnesses with the clients of the prenatal clinic. Which advice would the nurse emphasize? 1. Warm cooked food should be taken out of the refrigerator for more than two hours before consuming. 2. Drink plenty herbal teas such as peppermint and chamomile. 3. Refrigerate smoked seafood before consuming. 4. Wash hands before and after handling food.

Answer: 4 Option 1: Cooked food taken out of the refrigerator for more than two hours should be discarded. Option 2: Teas, such as peppermint and chamomile, can cause food-borne illnesses and should be avoided during pregnancy. Option 3: Refrigerated smoked seafood should be avoided in pregnancy. Option 4: Washing hands before and after handling food prevents the transmission of food-borne illness.

During the nursing assessment, a pregnant client reports that her spouse has been verbally abusive and slapped her recently. which is the priority nursing intervention at this time? 1. Document the statement in the woman's chart. 2. Call the police to report the incident. 3. Bring in another staff member as a witness to the statement. 4. Reassure her that she is not alone and help is available.

Answer: 4 Option 1: Documentation of the client's statement is important but is not the priority. Option 2: States may have mandatory reporting laws. However, the phone call can be made later and is not the priority. Option 3: Confidentiality is important when screening for intimate partner violence. The woman may feel a violation of privacy if other people are in the room. Option 4: Reassuring the client that she is not alone and that they are is believed is the nurse's first action.

A woman diagnosed with Gestational Diabetes Mellitus (GDM) was referred to have a Group B Streptococcus (GBS) screening done. At which stage of the pregnancy would the nurse recommend the client to have this screening done? 1. 10 to 12 weeks of gestation 2. 15 to 23 weeks of gestation 3. 24 to 28 weeks of gestation 4. 35 to 37 weeks of gestation

Answer: 4 Option 1: Doppler ultrasound is recommended between 10 to 12 weeks of gestation to assess the fetal heart tones. Option 2: Screening for neural tube defect and Trisomy 21 screening are recommended between 15 to 23 weeks of gestation. Option 3: Screening for Gestational Diabetes Mellitus is recommended between 24 to 28 weeks of gestation. Option 4: Screening for Group B Streptococcus is recommended between 35 to 37 weeks of gestation.

The nurse is discussing the physiological changes of pregnancy with a group of adolescent mothers. One clients ask the nurse if her skin will be affected also. Which statement by the nurse is correct about the changes that will take place in the integumentary system? 1. "You will have some skin changes such as gingivitis, bleeding gums, and periodontal disease." 2. "You will have some skin changes such as the Goodell's, Hegar's, and Chadwick signs." 3. "You will have some skin changes, such as edema of the limbs, varicosities, and hemorrhoids." 4. "You will have some skin changes, such as linea nigra, melasma, and striae gravidarum."

Answer: 4 Option 1: Gingivitis, bleeding gums, and periodontal disease are changes that take place in the gastrointestinal system. Option 2: Goodell's, Hegar's, and Chadwick signs are changes that take place in the reproductive system. Option 3: Edema of the limbs, varicosities, and hemorrhoids are changes that take place in the cardiovascular system. Option 4: Linea nigra, melasma, and striae gravidarum are changes that take place in the integumentary system.

A woman visits the clinic and stated that she has missed four menstrual periods and remains unsure whether or not she is pregnant. The nurse informs her that a ballottement test will be done to diagnose whether or not she is pregnant. How can a ballottement test assist the nurse in confirming a pregnancy? 1. By using a transvaginal ultrasound the nurse will be able to visualize the gestational sac. 2. By detecting the presence of the human chorionic gonadotropin in the urine sample in a laboratory. 3. By detecting the presence of the human chorionic gonadotropin in the blood sample in a laboratory. 4. By tapping on the cervix the fetus will rise in the amniotic fluid and then rebound to its original position.

Answer: 4 Option 1: Transvaginal ultrasound involves using a vaginal probe to visualize the gestational sac as early as 5- weeks gestation. Option 2: Doing a laboratory test can detect human chorionic gonadotropin in the maternal urine. Option 3: Doing a laboratory test can detect human chorionic gonadotropin in the maternal blood. Option 4: Tapping on the cervix causes the fetus to rise in the amniotic fluid, and then rebound to its original position.

Which of the following long-term goals is appropriate for a client, 10 weeks gestation, who is diagnosed with gestational trophoblastic disease (hydatidiform mole)? a. client will be cancer free 1 year from diagnosis b. client will deliver her baby at full term without complications c. client will be pain free 3 months after diagnosis d. client will have normal hemoglobin and hematocrit at delivery

The nurse is providing education regarding exercise and pregnancy. Which response by the client indicates an understanding of the teaching? 1. "I should start a new exercise routine to keep in shape." 2. "I will perform non-weight-bearing exercises." 3. "Exercise will help me lose weight during the pregnancy." 4. "Walking and stretching exercises will help with overall body conditioning."

Answer: 4 Option 1: Women should confer with their health care provider before starting any new exercise routine. It is best to start such a program several months in advance, so exercise is already comfortable and routine. Option 2: Weight-bearing exercises are recommended to enhance muscle tone and bone health. Option 3: Weight loss should not be a goal during pregnancy. Preconception weight loss is advisable if BMI is over normal. Option 4: Aerobic exercise and stretching helps condition the entire body, helps with weight management, and can enhance psychological well-being.

A client's first day of last menstrual period (LMP) was April 6, 2018. Using the Naegele's rule, what estimated date of delivery (EDD) will the nurse communicate to the client?

Answer: January 13, 2019 Test Taking Tip: To complete this problem, you need to know Naegele's formula and how to adjust the year as necessary.

10. A nurse is suspended for refusal to participate in the performance of an elective termination of a pregnancy. Which specific group's standards does the nurse use for job reinstatement? 1. American Nurses Association (ANA) 2. Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) 3. State board of nursing 4. Facility ethics committee

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) This is correct. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) supports the protection of an individual nurse's right to choose to participate or decline in any reproductive health care service or research. The nurse needs to seek specific support from this group.

The leading cause of infant death in 2010 was _______. A. Sudden infant death syndrome (SIDS) B. Congenital malformations C. Respiratory distress syndrome of newborns D. Accidents

B. Congenital malformations

True or False: Very low birth weight (VLBW) neonates account for 1.45% of births but account for 45% of all infant deaths. A. True B. False

B. False Very low birth weight (VLBW) neonates account for 1.45% of births but account for *54%* of all infant deaths.

A maternal and infant goal stated in Healthy People2020 is: A. Increase abstinence from smoking during pregnancy to 100%. B. Reduce cesarean birth for first-time mothers to 23.9%. C. Increase the proportion of infants who are breastfed at 6 months to 50%. D. Reduce the rate of maternal mortality to 5%.

B. Reduce cesarean birth for first-time mothers to 23.9%.

Infant mortality is defined as a death before _________. A. 28 days of age B. 6 months of age C. 1 year of age D. 18 months of age

C. 1 year of age

Very low birth weight (VLBW) is defined as a birthweight less than __________. A. 500 grams B. 1,000 grams C. 1,500 grams D. 2,000 grams

C. 1,500 grams

The population with the lowest birthrate but highest premature birthrate is: A. Non-Hispanic white B. Non-Hispanic black C. American Indian or Alaska Native D. Asian or Pacific Islanders E. Hispanic

C. American Indian or Alaska Native

Moderately premature neonates are neonates born: A. At less than 28 weeks of gestation B. Between 28 weeks and 30 weeks of gestation C. Between 30 and 32 weeks of gestation D. Between 32 and 34 weeks of gestation E. Between 34 and 36 weeks of gestation

D. Between 32 and 34 weeks of gestation

Using Naegele's Rule, calculate the estimated due date (EDD) if the woman's last menstrual period (LMP) was June 11.

March 11 Correct Feedback Using Naegele's Rule, subtract 3 months and add 7 days to the LMP.

A nurse is caring for four prenatal clients at the clinic. Which of the clients is high risk for placenta previa? (select all that apply) a. jogger with low body mass index b. primigravida who smokes 1 pack of cigarettes a day c. infertility client who is carrying in vitro triplets d. registered nurse who works 12 hour shifts e. police officer on foot patrol

a b

5. The nurse is experiencing an ethical dilemma when confronted with a situation in which either the mother or fetus is predicted to die. The nurse feels bound by the ANA Code of Ethics to protect both patients. Which aspect of care during an ethical dilemma will guide the nurse? 1. Maternity nurses are bound to advocate first and foremost for the well-being of the mother. 2. The nurse is ethically bound to provide the best care for both the mother and fetus. 3. If the fetus is viable and healthy, its survival is the priority of the maternity nurse. 4. Survival of the mother is solely based on both patient and family decision making.

Maternity nurses are bound to advocate first and foremost for the well-being of the mother. This is correct. Practice dictates that the primary advocacy role of maternity nurses is on the behalf of the mother.

11. The nurse in an OB's office is evaluating a patient who exhibits vaginal bleeding at 30 weeks gestation. The patient is prescribed bedrest at home and instructed to avoid lifting. The patient states, "I cannot go to bed, I have an 18-month-old at home." On which topic of the Jonsen model for ethical decision making will the nurse focus? 1. Contextual features 2. Quality of life 3. Patient preferences 4. Medical indications

Medical indications. This is correct. Medical indications involve medical facts, including diagnosis, prognosis, treatment options, and how the patient can benefit, if at all, from the prescribed treatment. Of all four topics, this is the one that specifically addresses the well-being of the patient and the fetus.

____ 13. The nurse manager in the labor and delivery unit decides that all unit nurses are to take a course in electronic fetal monitoring (EFM) as recommended by AWHONN. Which is the most important issue related to EFM the nurse manager is expecting to address? 1. Eliminate the amount of litigation related to fetal injury. 2. Strengthen the staff's level of confidence with monitoring. 3. Reduce failure to accurately assess maternal and fetal status. 4. Improve the lack of communication with health care providers.

Reduce failure to accurately assess maternal and fetal status. This is correct. The most important issue the nurse manager expects to address with an EFM course is to reduce or eliminate the failure of nursing staff to accurately assess maternal and fetal status.

9. The nurse in an obstetrician's office is discussing a patient's request for legally terminating an unwanted pregnancy after the fetus tests positive for Down syndrome. The woman and her spouse have five children from ages 11 to 17 years, and the family lives in an isolated rural area. Which action does the nurse take? 1. Inform the patient of programs to meet the needs of special children. 2. Share that children with Down syndrome can be high functioning. 3. Tell the physician of contextual factors identifying an ethical dilemma. 4. Inquire about the presence of an extended family support system

Tell the physician of contextual factors identifying an ethical dilemma. This is correct. The situation includes conditions that cause an ethical dilemma. The nurse will inform the health care provider about the patient's request in regard to the ethical decision-making model related to contextual features.

A 24 week gravid client is being seen in the prenatal clinic. She states, "I have had a terrible headache for the past 2 days." Which of the following is the most appropriate action for the nurse to perform next? a. inquire whether or not the client has allergies b. take the woman's blood pressure c. assess the woman's fundal height d. ask the woman about stressors at work

A 29 week gestation woman diagnosed with severe preeclampsia is noted to have blood pressure of 170/112, 4+ proteinuria, and a weight gain of 10 pounds over the past 2 days. Which of the following signs/symptoms would the nurse also expect to see? a. fundal height of 32cm b. papilledema c. patellar reflex of +2 d. nystagmus

A client being seen in the ED has an admitting medical diagnosis of: third-trimester bleeding: rule out placenta previa. Each time a nurse passes by the client's room, the woman asks, "Please tell me, do you think the baby will be alright?" Which of the following is an appropriate nursing diagnosis for this client? a. hopelessness related to possible fetal loss b. anxiety related to inconclusive diagnosis c. situational low self-esteem related to blood loss d. potential for altered parenting related to inexperience

A client has been admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders written by the primary health care provider is highest priority for the nurse to complete? a. obtain complete blood count b. start intravenous with multivitamins c. check admission weight d. obtain urine for urinalysis

A client is being admitted to the labor suite with a diagnosis of eclampsia. The fetal heart rate tracing shows moderate variability with early decelerations. Which of the following actions by the nurse is appropriate at this time? a. tape a tongue blade to the head of the bed b. pad the side rails and head of the bed c. provide the client with needed stimulaton d. provide the client with grief counseling

A client, G2 P1001, telephones the gynecology office complaining of left-sided pain. Which of the following questions by the triage nurse would help to determine whether the one sided pain is due to an ectopic pregnancy> a. "when did you have your pregnancy test done?" b. "when was the first day of your last menstrual period?" c. "did you have any complications with your first pregnancy?" d. "how old were you when you first got your period?"

A client, G8 P3406, 14 weeks gestation, is being seen in the prenatal clinic. During the nurse's prenatal teaching session, the nurse will emphasize that the woman should notify the obstetric office immediately if she notes which of the following? a. change in fetal movement b. signs and symptoms of labor c. swelling of feet and ankles d. appearance of spider veins

A gravid client is admitted with a diagnosis of third-trimester bleeding. It is priority for the nurse to assess for a change in which of the following vital signs? a. temperature b. pulse c. respirations d. blood pressure

A gravid client, 27 weeks gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? a. oral hypoglycemic agents b. diet control with exercise c. regular insulin injections d. inhaled insulin

A lecithin:sphingomyelin (L/S) ratio has been ordered by a pregnant woman's obstetrician. Which of the following data will the nurse learn from this test? a. coagulability of maternal blood b. maturation of fetal lungs c. potential for fetal development of erythroblastosis fetalis d. potential for maternal development of gestational diabetes

In analyzing the need for health teaching in a client, G5 P4004 with gestational diabetes, the nurse should ask which of the following questions? a. "how old were you at your first pregnancy?" b. "do you exercise regularly?" c. "is your partner diabetic?" d. "do you work outside the home?"

A 14 year old woman is seeking obstetric care. Which of the following is an appropriate nursing care goal for this young woman? The young woman will: a. bring her partner to all prenatal visits b. terminate the pregnancy c. continue her education d. undergo prenatal chromosomal analysis

A 14 year old woman is seeking obstetric care. Which of the following vital signs must be monitored very carefully during this woman's pregnancy? a. heart rate b. respiratory rate c. blood pressure d. temperature

A client is admitted to the hospital with severe preeclampsia. The nurse is assessing for clonus. Which of the following actions should the nurse perform? a. strike the woman's patellar tendon b. palpate the woman's ankle c. dorsiflex the woman's foot d. position the woman's feet flat on the floor

A client with mild preeclampsia who has been advised to be on bed rest at home asks why doing so is necessary. Which of the following is the best response for the nurse to give to the client? a. "bed rest will help you to conserve energy for your labor" b. "bed rest will help to relieve your nausea and anorexia" c. "reclining will increase the amount of oxygen that your baby gets" d. "the position change will prevent the placenta from separating"

A gravid woman, who is 42 weeks gestation, had just had a 20 minute nonstress test. Which of the following results would the nurse interpret as a reactive test? a. moderate fetal heart baseline variability b. maternal heart rate accelerations to 140 bpm lasting atleast 20 seconds c. two fetal heart accelerations of 15 bpm lasting at least 15 seconds d. absence of maternal premature ventricular contractions

A nurse is counseling a preeclamptic client about her diet. Which should the nurse encourage the woman to do? a. restrict sodium intake b. increase intake of fluids c. eat a well-balanced diet d. avoid simple sugars

A patient who is 24 weeks pregnant has been diagnosed with syphilis. She asks the nurse how the infection will affect the baby. The nurse's response should be based on which of the following? a. she is high risk for premature rupture of the membranes b. the baby will be born with congenital syphilis c. penicillin therapy will reduce the risk to the fetus d. the fetus will likely be born with a cardiac defect

A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis? a. dark brown rectal bleeding b. severe nausea and vomitting c. sharp unilateral pain d. marked hyperthermia

A woman is recovering at the gynecologist's office following a late first-trimester spontaneous abortion. At this time, it is essential for the nurse to check which of the following? a. maternal rubella titer b. past obstetric history c. maternal blood type d. cervical patency

The nurse has assessed four primigravid clients in the prenatal clinic. Which of the women would the nurse refer to the nurse midwife for further assessment? a. 10 weeks gestation, complains of fatigue with nausea and vomitting b. 26 weeks gestation, complains of ankle edema and chloasma c. 32 weeks gestation, complains of epigastric pain and facial edema d. 37 weeks gestation, complains of bleeding gums and urinary frequency

The nurse is grading a woman's reflexes. Which of the following grades would indicate reflexes that are slightly brisker than normal? a. +1 b. +2 c. +3 d. +4

A 25 year old client is admitted with the following history: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the doctor to write an order to prepare the client for which of the following? a. cervical cerclage b. amniocentresis c. nonstress testing d. dilation and curettage

A 26 week gestation woman is diagnosed with severe preeclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? a. low serum creatinine b. high serum protein c. bloody stools d. epigastric pain

A client has severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following? a. severe anemia b. hypoprothrombinemia c. craniosynostosis d. intrauterine growth restriction

A nurse is caring for a 25 year old client who has just had a spontaneous first trimester abortion. Which of the following comments by the nurse is appropriate? a. "you can try again very soon" b. "it is probably better this way" c. "at least you weren't very far along" d. "i'm here to talk if you like"

An insulin-dependent diabetic woman will require higher doses of insulin as which of the following pregnancy hormones increases in her body? a. estrogen b. progesterone c. human chorionic gonadotropin d. human placental lactogen

The nurse is caring for a client who was just admitted to the hospital to rule out ectopic pregnancy. Which of the following orders is the most important for the nurse to perform? a. take the client's temperature b. document the time of the client's last meal c. obtain urine for urinalysis and culture d. assess for complaint of dizziness or weakness

The nurse is providing health teaching to a group of women of childbearing age. One woman, who states that she is a smoker, asks about smoking's impact on the pregnancy. The nurse responds that which of the following fetal complications can develop if the mother smokes? a. genetic changes in the fetal reproductive system b. extensive central nervous system damage c. addiction to the nicotine inhaled from the cigarettes d. fetal intrauterine growth restriction

exam 1 maternal newborn

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