Exam 2 Practice Questions

A pregnant woman who is at 21 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. On the basis of this information, the nurse would classify this patient as having: Preeclampsia. Gestational hypertension. Superimposed preeclampsia. Chronic hypertension.

Superimposed preeclampsia. *Because this patient already has a medical history of hypertension and is now exhibiting hypertension after to the 20th week of gestation, she would be considered to have superimposed preeclampsia. Preeclampsia would be the classification in a patient without a history of hypertension who was hypertensive following the 20th week of pregnancy. Gestational hypertension occurs after the 20th week of pregnancy in a patient who was previously normotensive. Even though the patient has chronic hypertension, the fact that she is now pregnant determines that she would be classified as having superimposed preeclampsia.

Which of these medications would be classified as a Category X substance that is not to be used during pregnancy? Lorazepam (Ativan) Alprazolam (Xanax) Chlordiazepoxide (Librium) Temazepam (Restoril)

Temazepam (Restoril) *Restoril is classified as a Category X drug and is contraindicated during pregnancy on the basis of clinical studies. Ativan, Xanax, and Librium are classified as Category D drugs and as such would not be given during pregnancy unless a benefits to risks ratio was established.

A newborn male, estimated to be 39 weeks of gestation, exhibits: Testes descended into the scrotum. Extended posture when at rest. Abundant lanugo over his entire body. Ability to move his elbow past his sternum.

Testes descended into the scrotum. *A full-term male infant has both testes descended into his scrotum and rugae appear on the anterior portion. A full-term infant's good muscle tone results in a more flexed posture when at rest. A full-term infant exhibits only a moderate amount of lanugo, usually on the shoulders and back. Preterm infants have an abundance of lanugo over the entire body. The muscle tone of a full-term newborn prevents him from being able to move his elbow past midline.

In planning for an expected cesarean birth for a woman who has given birth by cesarean section previously and who has a fetus in the transverse presentation, the nurse includes which information? "Because this is a repeat procedure, you are at the lowest risk for complications." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." "Because this is your second cesarean birth, you will recover faster." "You will not need preoperative teaching because this is your second cesarean birth."

"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." *The statement in B is most appropriate. The statements in A, C, and D are not accurate. Maternal and fetal risks are associated with every cesarean section. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement indicates her correct understanding of the test? "I will need to have a full bladder for the test to be done accurately." "I should have my husband drive me home after the test because I may be nauseated." "This test will help to determine whether the baby has Down syndrome or a neural tube defect." "This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

"This test observes for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby." *The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements. An ultrasound requires a full bladder. An amniocentesis is the test after which a pregnant woman should be driven home. A maternal serum alpha-fetoprotein test is used in conjunction with unconjugated estriol levels and human chorionic gonadotropin helps to detect Down syndrome.

Which ratio would be used to restore effective circulating volume in a postpartum patient who is experiencing hypovolemic shock? 4:1 2:1 1:1 3:1

3:1 *A 3:1 ratio, of 3 ml fluid infused for every 1 ml of estimated blood loss, is recommended to restore circulating volume.

In most healthy newborns, blood glucose levels stabilize at _________ mg/dL during the first hours after birth: 80 to 100 Less than 40 50 to 60 60 to 70

50 to 60 *In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dL during the first several hours after birth. 80 to 100 mg/dL is the normal plasma glucose level in the adult. A blood glucose level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. An infant with this level can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life the blood glucose levels should be approximately 60 to 70 mg/dL.

Which statement is accurate regarding the ABO blood typing system in the body? If you have type O blood, then you have antigens. If you have type AB blood, then you have antibodies. A person with type O blood has no antibodies. A person with type O blood has antibodies to type A and type B.

A person with type O blood has antibodies to type A and type B. *A person with type O blood has antibodies to both type A and type B, but no antigens. With type AB blood, you do not have antibodies.

The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume that generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct? A common practice among Mexican women is known as las dos cosas. Muslim cultures do not encourage breastfeeding because of modesty concerns. Latino women born in the United States are more likely to breastfeed. East Indian and Arab women believe that cold foods are best for a new mother.

A common practice among Mexican women is known as las dos cosas. *Las dos cosas refers to combining breastfeeding and commercial infant formula. It is based on the belief that combining the two feeding methods gives the mother and infant the benefits of breastfeeding along with the additional vitamins from formula. In the Muslim culture, breastfeeding for 24 months is customary; Muslim women may, however, choose to bottle-feed formula or expressed breast milk while in the hospital. Latino women born in the United States are less likely to breastfeed. East Indian and Arab women believe that hot foods, such as chicken and broccoli, are best for the new mother. The cultural descriptor hot has nothing to do with the temperature or spiciness of the food.

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: Uterine contractions occurring every 8 to 10 minutes. A fetal heart rate (FHR) of 180 with absence of variability. The client needing to void. Rupture of the client's amniotic membranes.

A fetal heart rate (FHR) of 180 with absence of variability. *A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring; the oxytocin should be immediately discontinued and the physician should be notified. The oxytocin should also be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The client needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. The oxytocin does not need to be discontinued when the membranes rupture, but the physician should be notified.

Concerning congenital abnormalities involving the central nervous system, nurses should be aware that: Although the death rate from most congenital anomalies has decreased over the past several decades, that from neural tube defects (NTDs) has gone up in the last few years. Spina bifida cystica usually is asymptomatic and may not be diagnosed unless associated problems are present. A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury. Microcephaly can be corrected with timely surgery.

A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury. *The nurse protects the infant by laying the baby on his or her side. Most congenital anomalies have had a stable neonatal death rate since the 1930s; rates of NTDs are declining because of mandatory fortification of foods with folic acid. Spina bifida occulta often is asymptomatic; spina bifida cystica has a visible sac. Microcephaly is a tiny head; there is no treatment.

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: A sleepy, sedated affect. A respiratory rate of 10 breaths/min. Deep tendon reflexes of 2+. Absence of ankle clonus.

A respiratory rate of 10 breaths/min. *A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2+ are a normal finding, as is absence of ankle clonus.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs are: Hypertonia, tachycardia, and metabolic alkalosis. Abdominal distention, temperature instability, and grossly bloody stools. Hypertension, absence of apnea, and ruddy skin color. Scaphoid abdomen, no residual with feedings, and increased urinary output.

Abdominal distention, temperature instability, and grossly bloody stools. *Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall.

Which of the following is the most common kind of placental adherence seen in pregnant women? Accreta Placenta previa Percreta Increta

Accreta *Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient's risk for painless vaginal bleeding during the pregnancy and/or delivery process. Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Placenta increta leads to deep penetration of the myometrium.

An Rh-negative woman has a miscarriage during the 8th week of pregnancy and a D&C is required. Which priority intervention would be required in the recovery period following the surgical procedure? Type and screen for two units of blood. Maintain hydration level by increasing fluids by mouth. Administer RhoGAM. Perform fundal massage.

Administer RhoGAM. *Administering RhoGAM would be a priority intervention because the patient is Rh negative and there is no way to determine the Rh status of the fetus. Type and screen would not be indicated as if the patient were to require a blood transfusion; this would not reflect holding blood. Although it would be important to maintain the patient's hydration level, it could be done if needed via the parenteral route. Fundal massage would not be indicated at 8 weeks of gestation.

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? Administration of blood Preparation of the woman for invasive hemodynamic monitoring Restriction of intravascular fluids Administration of steroids

Administration of blood *Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement (not volume restriction), blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a woman with DIC because it could contribute to more areas of bleeding. Steroids are not indicated for the management of DIC.

A pregnant patient experiences thyroid storm following delivery of her infant. What interventions would the nurse anticipate to be ordered by the physician? (Select all that apply.) Restriction of intravenous fluids to prevent fluid overload Administration of oxygen Antipyretics Synthroid PTU

Administration of oxygen Antipyretics PTU *Oxygen would be provided, antipyretics would be given to reduce fever, and PTU would be administered. IV fluids would be administered to the patient in order to reverse the hypotension that the patient would be experiencing. Synthroid would not be given because it is used to treat hypothyroidism, and with thyroid storm, the patient is suffering from hyperthyroidism.

In caring for a mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that: The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over. Two thirds of newborns with fetal alcohol syndrome (FAS) are boys. Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school. Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time.

Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school. *Some learning problems do not become evident until the child is in school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident with growth, the mental capacities never become normal.

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: Tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. Alerts the physician that the infant has a dislocated hip. Informs the parents and physician that molding has not taken place. Suggests that if the condition does not change, surgery to correct vision problems might be needed.

Alerts the physician that the infant has a dislocated hip. *The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified. The statement in B is inappropriate and may result in unnecessary anxiety for the new parents. Molding refers to movement of the cranial bones and has nothing to do with the infant's hips.

A thrombosis results from the formation of a blood clot or clots inside a blood vessel and is caused by inflammation or partial obstruction of the vessel. Three thromboembolic conditions are of concern during the postpartum period; which of the following is not? Amniotic fluid embolism (AFE) Superficial venous thrombosis Deep vein thrombosis Pulmonary embolism

Amniotic fluid embolism (AFE) *An AFE occurs during the intrapartum period, when amniotic fluid containing particles of debris enters the maternal circulation. Although AFE is rare, the mortality rate is as high as 80%. A superficial venous thrombosis includes involvement of the superficial saphenous venous system. With deep vein thrombosis, the involvement varies but can extend from the foot to the iliofemoral region. A pulmonary embolism is a complication of deep vein thrombosis, occurring when part of a blood clot dislodges and is carried to the pulmonary artery, where it occludes the vessel and obstructs blood flow to the lungs.

The majority of ectopic pregnancies are located in the: Uterine fundus. Cervical os. Ampulla. Fimbriae.

Ampulla. *A pregnancy within the uterus would be considered a normal pregnancy. Implantation of the pregnancy at the cervical os would be a significant abnormality. The majority of ectopic pregnancies, approximately 80%, are located in the ampulla or largest portion of the tube.

An Apgar score of 10 at 1 minute after birth indicates: An infant having no difficulty adjusting to extrauterine life and needing no further testing. An infant in severe distress that needs resuscitation. A prediction of a future free of neurologic problems. An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.

An infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth. *A score of 10 at 1 minute of life indicates excellent transition to extrauterine life; however, the assessment needs to be repeated at 5 minutes of life. An infant in need of resuscitation has a very low Apgar score. Apgar scores do not predict neurologic outcome but are useful for describing the newborn's transition to extrauterine environment.

Thalassemia is a relatively common anemia in which: An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). RBCs have a normal life span but are sickled in shape. Folate deficiency occurs. There are inadequate levels of vitamin B12.

An insufficient amount of hemoglobin is produced to fill the red blood cells (RBCs). *Thalassemia is a hereditary disorder that involves the abnormal synthesis of the alpha or beta chains of hemoglobin. An insufficient amount of hemoglobin is produced to fill the RBCs. The statement in B is the underlying description for sickle cell anemia. Folate deficiency is the most common cause of megaloblastic anemias during pregnancy. Deficiency of vitamin B12 must also be considered if the pregnant woman presents with anemia.

A patient who has cystic fibrosis (CF) is pregnant. Which weight gain recommendation should be given her? The amount of weight is not as important as maintaining a well-balanced diet. Between 30 and 35 pounds Approximately 25 pounds Between 10 and 20 pounds

Approximately 25 pounds *Recommendations for weight gain during pregnancy in a patient with CF range between 24 and 26 pounds. A well-balanced diet is important, but the patient with CF is encouraged to be at 90% of her IBW prior to pregnancy.

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae: Are benign if they disappear within 48 hours of birth. Result from increased blood volume. Should always be further investigated. Usually occur with forceps delivery.

Are benign if they disappear within 48 hours of birth. *Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face. They usually occur with a breech presentation vaginal birth, although in this case they are soft-tissue injury resulting from the nuchal cord at birth. These lesions are benign if they disappear within 2 days of birth and no new lesions appear. Unless they do not dissipate in 2 days, there is no reason to alarm the family. Petechiae may also result from decreased platelet formation.

The 5 As screening intervention tool is used to implement smoking cessation strategies on the basis of patient response. What do the 5 As stand for? Ask, advise, administer, approve, and admit Ask, assess, advise, assist, and arrange follow-up Assess, assist, advise, apply, and arrange Assess, apply, advise, ask, and arrange follow-up

Ask, assess, advise, assist, and arrange follow-up *The 5 As stand for ask, assess, advise, assist, and arrange follow-up.

During pregnancy, alcohol withdrawal may be treated using: Disulfiram (Antabuse). Corticosteroids. Benzodiazepines. Aminophylline.

Benzodiazepines. *Symptoms that occur during alcohol withdrawal can be managed with short-acting barbiturates or benzodiazepines. Disulfiram is contraindicated in pregnancy because it is teratogenic. Corticosteroids and aminophylline are not used to treat alcohol withdrawal.

When would the best timeframe be to establish gestational age based on ultrasound? At term 8 weeks Between 14 and 22 weeks 36 weeks

Between 14 and 22 weeks *Ultrasound determination of gestational age dating is best done between 14 and 22 weeks. It is less reliable after that period because of variability in fetal size. Standard sets of measurements relative to gestational age are noted around 10 to after 12 weeks and include crown-rump length (after 10), biparietal diameter (after 12), femur length, and head and abdominal circumferences.

The severity of symptoms associated with asthma during pregnancy usually peaks: In the first trimester. Between 17 and 24 weeks of gestation. During the last 4 weeks of pregnancy. Immediately postpartum.

Between 17 and 24 weeks of gestation. *The severity of asthma symptoms peaks between 17 and 24 weeks of gestation. Asthma appears to be associated with intrauterine growth restriction and preterm birth. Women often have few symptoms of asthma during the first trimester, and during the last 4 weeks of pregnancy, symptoms often subside. Issues have often resolved by the time the woman delivers.

The concept of tandem feeding is based on: Adequate nutritional stores for the mother and infant. Using both breasts to nurse the baby. Breastfeeding an infant and an older sibling during the same period. Supplementing breastfeeding with bottle feeding to maintain adequate weight gain.

Breastfeeding an infant and an older sibling during the same period. *In tandem feeding, a mother nurses both an infant and an older child during the same period.

Which statement is not accurate regarding the effect of breastfeeding on the family or society at large? Breastfeeding requires fewer supplies and less cumbersome equipment. Breastfeeding saves families money. Breastfeeding costs employers in terms of time lost from work. Breastfeeding benefits the environment.

Breastfeeding costs employers in terms of time lost from work. *Less time is lost from work by breastfeeding mothers, in part because infants are healthier than bottle-fed infants. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment, and it saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Also, breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is: An on-demand feeding schedule. Breastfeeding. Lower-calorie infant formula. Smaller, more frequent feedings.

Breastfeeding. *Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also helps the woman return to her prepregnant weight sooner. All breastfed infants should be fed on demand. Use of lower-calorie formula is an inappropriate strategy that does not meet the infant's nutritional needs. Breastfeeding is the most appropriate choice for infant feeding. Smaller feedings are not necessary. Infants should continue to be fed every 2 to 3 hours in the newborn period.

Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are: Suffering from sleep or wakeful apnea. Experiencing severe swings in blood pressure. Trying to maintain a neutral thermal environment. Breathing in a respiratory pattern common to premature infants.

Breathing in a respiratory pattern common to premature infants. *The pattern of 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of rapid respiration is called periodic breathing, which is common to premature infants. It may require nursing intervention such as oxygen and/or ventilation. Apnea is a cessation of respirations for 20 seconds or longer. An infant who presents with fluctuation in systemic blood pressure may have experienced a central nervous system injury. An infant attempting to maintain body temperature is likely to present with hypoglycemia, shivering, and mottled color.

During a physical assessment of an at-risk client, the nurse notes generalized edema, crackles at the bases of the lungs, and some pulse irregularity. These are most likely signs of: Euglycemia. Rheumatic fever. Pneumonia. Cardiac decompensation.

Cardiac decompensation. *Symptoms of cardiac decompensation may appear abruptly or gradually. Euglycemia is a condition of normal glucose levels. Rheumatic fever can cause heart problems, but it does not manifest with these symptoms. Pneumonia is an inflammation of the lungs and would not likely generate these symptoms.

Which of the following would be considered to be an intrapartum risk factor for neonatal sepsis? Mechanical ventilation Chorioamnionitis Galactosemia Meconium aspiration

Chorioamnionitis *Chorioamnionitis would be considered to be an intrapartum risk factor. The other conditions described are neonatal risk factors.

Which of the following presentations is associated with early pregnancy loss, occurring in less than 12 weeks gestation? (Select all that apply.) Chromosomal abnormalities Infection Cystitis Antiphospholipid syndrome Hypothyroidism Caffeine use

Chromosomal abnormalities Antiphospholipid syndrome Hypothyroidism *50% of early pregnancy loss results from genetic abnormalities. Hypothyroidism and antiphospholipid syndrome are associated with early pregnancy loss. Caffeine use is associated with second-trimester losses as a result of maternal behavior. Infection is not a likely source of early pregnancy loss. Cystitis in not associated with early pregnancy loss.

A nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should: Instill within 15 minutes of birth for maximum effectiveness. Cleanse eyes from inner to outer canthus before administration if necessary. Apply directly over the cornea. Flush eyes 10 minutes after instillation to reduce irritation.

Cleanse eyes from inner to outer canthus before administration if necessary. *The newborn's eyes should be cleansed if necessary before the administration of erythromycin ointment. Instillation of the ointment can be delayed for up to 2 hours to facilitate eye-to-eye contact between the newborn and parents, an activity that fosters bonding and attachment, especially for fathers. Erythromycin ointment should be applied into the conjunctival sac to avoid accidental injury to the eye. The eyes should not be flushed after instillation.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. *Gentle cleansing with warm water, not wipes, and application of petroleum jelly at each diaper change are appropriate care for an infant who has had a circumcision. If bleeding occurs, gentle pressure should be applied to the site of the bleeding with a sterile gauze square. Yellow exudate covers the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudate should not be removed.

Which finding supports the diagnosis of pathologic jaundice? Serum bilirubin concentrations greater than 2 mg/dL in cord blood Serum bilirubin levels increasing more than 1 mg/dL in 24 hours Serum bilirubin levels greater than 10 mg/dL in a full-term newborn Clinical jaundice evident within 24 hours of birth

Clinical jaundice evident within 24 hours of birth *Clinical jaundice evident within 24 hours of birth supports a diagnosis of pathologic jaundice. This diagnosis is also supported by serum bilirubin concentrations greater than 4 mg/dL in cord blood; total serum bilirubin levels that increase by more than 5 mg/dL in 24 hours; and a serum bilirubin level in a preterm newborn that exceeds 10 mg/dL.

Where do most deliveries for pregnant women who have mental health issues take place? Mental health hospital setting Midwife assisted births Community hospital settings Psychiatric hospitals on locked units

Community hospital settings *Unless there is some specific psychiatric mental health issue that requires that a patient remain in a locked unit, most pregnant women who have mental health issues deliver in community settings. Although midwives are trained to provide obstetric care, they typically do not take care of complex patients, and a woman who had a diagnosed mental health issue would be classified as a complex patient.

A nurse is performing a pulse oximetry reading on a newborn to test for: PKU. Congenital heart disease. Sickle cell disease. Thalassemia.

Congenital heart disease. *Pulse oximetry can be used to determine the presence of congenital heart disease in healthy newborns. Routine screening of newborns is done via the Guthrie heelstick test to look for certain metabolic diseases such as PKU, sickle cell disease, and thalassemia.

A pregnant woman with cardiac disease is informed about signs of cardiac decompensation. She should be told that the earliest sign of decompensation is most often: Orthopnea. Decreasing energy levels. Moist frequent cough and frothy sputum. Crackles (rales) at the bases of the lungs on auscultation.

Decreasing energy levels. *Decreasing energy level (fatigue) is an early finding in heart failure. Care must be taken to recognize it as a warning rather than a typical change of the third trimester. Cardiac decompensation is most likely to occur early in the third trimester, during childbirth, or during the first 48 hours following birth. Orthopnea, moist frequent cough, and crackles and rales appear later, when a failing heart reduces renal perfusion and fluid accumulates in the pulmonary interstitial space, leading to pulmonary edema.

With regard to the respiratory development of the newborn, nurses should be aware that: Crying increases the distribution of air in the lungs. Newborns must expel the fluid at uterine life from the respiratory system within a few minutes of birth. Newborns are instinctive mouth breathers. Seesaw respirations are no cause for concern in the first hour after birth.

Crying increases the distribution of air in the lungs. *Respirations in the newborn can be stimulated by mechanical factors such as changes in intrathoracic pressure resulting from the compression of the chest during vaginal birth. With birth, the pressure on the chest is released, helping draw air into the lungs. The positive pressure created by crying helps keep the alveoli open and increases distribution of air throughout the lungs. Newborns continue to expel fluid for the first hour of life. They are natural nose breathers and may not have the mouth-breathing response to nasal blockage for 3 weeks. Seesaw respirations instead of normal abdominal respirations are not normal and should be reported.

In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that the most important factor affecting pregnancy outcome is the: Mother's age. Number of years since diabetes was diagnosed. Amount of insulin required prenatally. Degree of glycemic control during pregnancy.

Degree of glycemic control during pregnancy. *Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Although advanced maternal age may pose some health risks, the most important factor for the woman with pregestational diabetes remains the degree of glycemic control during pregnancy. The number of years since diagnosis and the amount of insulin required are not as relevant to outcomes as the degree of glycemic control.

Despite popular belief, there is a rare type of hemophilia that affects women of childbearing age. Von Willebrand disease is the most common of the hereditary bleeding disorders and can affect males and females alike. It results from a factor VIII deficiency and platelet dysfunction. Although factor VIII levels rise naturally during pregnancy, there is an increased risk for postpartum hemorrhage from birth until 4 weeks postpartum as levels of von Willebrand factor (vWf) and factor VIII fall. The treatment that should be considered first for the client with von Willebrand disease who experiences a postpartum hemorrhage is: Cryoprecipitate Factor VIII and vWf Desmopressin Hemabate

Desmopressin *Desmopressin is the primary treatment of choice. This hormone, which can be administered orally, nasally, and intravenously, promotes the release of factor VIII and vWf from storage. Treatment with cryoprecipitate or with plasma products such as factor VIII and vWf is acceptable, but because of the associated risk of possible viruses from donor blood products, other modalities are considered safer. Although the administration of the synthetic prostaglandin in Hemabate is known to promote contraction of the uterus during postpartum hemorrhage, it is not effective for the client who presents with a bleeding disorder.

A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this client understands that: Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. Dietary modifications and insulin are both required for adequate treatment. Glucose levels are monitored by testing urine four times a day and at bedtime. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

Dietary management involves distributing nutrient requirements over three meals and two or three snacks. *Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control

A nurse is working with a diabetic patient who recently found out she is pregnant. In coordinating an interdisciplinary team to help manage the patient throughout the pregnancy, the nurse would include: (Select all that apply.) Family practice physician Dietician Perinatologist Occupational therapist Nephrologist Speech therapist

Dietician Perinatologist Nephrologist *An internal medicine practitioner rather than family practice physician would be included on the interdisciplinary care team. A dietician would be included to help the patient with dietary planning, a perinatologist to take care of the maternal-fetal unit, and a nephrologist to monitor renal function. There is no need for an occupational therapist or a speech therapist unless other issues arise.

The nurse is providing discharge instructions related to the baby's respiratory system. Which statement should not be included as part of discharge teaching? Prevent exposure to people with upper respiratory tract infections. Keep the infant away from secondhand smoke. Avoid loose bedding, waterbeds, and beanbag chairs. Don't let the infant sleep on his or her back.

Don't let the infant sleep on his or her back. *The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome. Infants are vulnerable to respiratory infections, so infected people must be kept away. Secondhand smoke can damage lungs. Infants can suffocate in loose bedding, and furniture that can trap them.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what would be another tool useful in confirming the diagnosis? Doppler blood flow analysis Contraction stress test (CST) Amniocentesis Daily fetal movement counts

Doppler blood flow analysis *Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and the placenta. It is a helpful tool in the management of high risk pregnancy due to intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed in a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although it may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

Which factor increases the risk of complications for infants of diabetic mothers? Glycemic control Hemoglobin A1c level of 7 Duration of maternal disease Hemoglobin A1c level of 7 prior to pregnancy

Duration of maternal disease *The duration and severity of maternal disease are significant factors in increasing the risk for complications in infants of diabetic mothers. Glycemic control would be a positive factor indicating that blood glucose levels were maintained within normal range. A hemoglobin A1c level of 7 is within normal range.

A nurse is examining a patient who has been admitted for possible ectopic pregnancy who is approximately 8 weeks pregnant. Which finding would be a priority concern? No FHT heard via Doppler Scant vaginal bleeding noted on peri pad Ecchymosis noted around umbilicus Blood pressure 100/80

Ecchymosis noted around umbilicus *Because this patient is most likely in the early stages of pregnancy, FHT would not be able to be auscultated at this time. Scant vaginal bleeding would not be a priority concern but should still be monitored by the nurse. Ecchymosis around the umbilicus indicates Cullen sign, which indicates hematoperitoneum, and may also develop in an undiagnosed, ruptured intraabdominal ectopic pregnancy.

The birth weight of a breastfed newborn was 8 lb, 4 oz. On the third day the newborn's weight is 7 lb, 12 oz. On the basis of this finding, the nurse should: Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. Suggest that the mother switch to bottle feeding because breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. Notify the physician because the newborn is being poorly nourished. Refer the mother to a lactation consultant to improve her breastfeeding technique.

Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. *Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz. The infant is not undernourished, and the physician does not need to be notified. Breastfeeding is effective, and bottle feeding does not need to be initiated at this time.

Vitamin K is given to the newborn to: Reduce bilirubin levels. Increase the production of red blood cells. Enhance the ability of blood to clot. Stimulate the formation of surfactant.

Enhance the ability of blood to clot. *Newborns have a deficiency of vitamin K until intestinal bacteria that produce it are formed. Vitamin K is required for the production of certain clotting factors. Vitamin K does not reduce bilirubin levels, increase the production of red blood cells, or stimulate the formation of surfactant.

Following a vaginal delivery, the patient tells the nurse that she intends to breastfeed her infant but she is very concerned about returning to her prepregnancy weight. On the basis of this interaction, the nurse would advise the patient that: (Select all that apply.) She should join Weight Watchers as soon as possible to ensure adequate weight loss. Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period. Weight loss diets are not recommended for women who breastfeed. If breastfeeding, she should regulate her fluid consumption in response to her thirst level. If she decreases her calorie intake by 100-200 calories a day she will lose weight more quickly.

Even though more calories are needed for lactation, typically women who breastfeed lose weight more rapidly than women who bottle feed in the postpartum period. Weight loss diets are not recommended for women who breastfeed. If breastfeeding, she should regulate her fluid consumption in response to her thirst level *Weight loss diet plans are not recommended for women who are breastfeeding because they can lead to depletion of reserves and nutrient stores and decreased milk production. Breastfeeding mothers need to increase their caloric intake by 400-500 calories/day to ensure adequate nutritional stores and milk production. Breastfeeding women lose weight faster postpartum than women who bottle feed their infants. Regulating fluid consumption in response to her thirst level will ensure that a breastfeeding woman has adequate hydration without overhydration.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black. She asks the nurse whether something is wrong. The nurse should respond to this mother's concern by: Telling the mother not to worry because all breastfed babies have this type of stool. Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns. Asking the mother what she ate for her last meal. Suggesting to the mother that she ask her pediatrician to explain normal newborn stooling patterns to her.

Explaining to the mother that this stool is called meconium and is expected for the first few bowel movements of all newborns. *The majority of healthy term infants pass meconium during the first 12 to 24 hours after birth. Meconium is composed of amniotic fluid, intestinal secretions, shed mucosal cells, and possibly blood, resulting in the dark green to black color. At this early age this type of stool is typical of both bottle- and breastfed newborns. The mother's nutritional intake is not responsible for the appearance of a meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns.

Appendicitis is more difficult to diagnose during pregnancy because the appendix is: Covered by the uterus. Displaced to the left. Low and to the right. High and to the right.

High and to the right. *The appendix is not hidden by the uterus; rather, it is pushed upward and to the right from its usual anatomic location, making diagnosis of appendicitis difficult.

Which statement is most likely to be associated with a breech presentation? Least common malpresentation Descent rapid Diagnosis by ultrasound only High rate of neuromuscular disorders

High rate of neuromuscular disorders *Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as the fetal head. Diagnosis is made by abdominal palpation and vaginal examination, and is confirmed by ultrasound.

Nurses should be aware that HELLP syndrome: Is a mild form of preeclampsia. Can be diagnosed by a nurse alert to its symptoms. Is characterized by hemolysis, elevated liver enzymes, and low platelets. Is associated with preterm labor but not perinatal mortality.

Is characterized by hemolysis, elevated liver enzymes, and low platelets. *The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. It is difficult to identify, because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased with HELLP syndrome, and so is perinatal mortality.

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: Hydralazine. Magnesium sulfate bolus. Diazepam. Calcium gluconate.

Hydralazine. *Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: Hypertension. Hyperemesis gravidarum. Hemorrhagic complications. Infections.

Hypertension. *Preeclampsia and eclampsia are two noted, deadly forms of hypertension, which is the most common medical complication of pregnancy. A large percentage of pregnant women have nausea and vomiting, but a relative few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy.

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of: Birth injury. Hypocalcemia. Hypoglycemia. Seizures.

Hypoglycemia. *The description is indicative of a macrocosmic infant. Hypoglycemia is common in the infant with macrosomia. The tremors are jitteriness that is associated with hypoglycemia. Other signs of hypoglycemia are apnea, tachypnea, and cyanosis.

A nurse providing care to preterm infants should understand that nasogastric and orogastric tubes are used to: Help maintain body temperature. Provide oxygen and ventilation. Replace surfactants. Feed the infants.

Feed the infants. *Nasogastric and orogastric tubes are used in gavage feeding, providing breast milk or formula directly to an infant unable to nipple feed. To help maintain body temperature, preterm infants should be placed on warmers. Oxygen, continuous positive airway pressure (CPAP), and a ventilator are used for O2 and ventilation. Surfactants are not replaced by using nasogastric or orogastric tubes.

In the past, factors to determine whether a woman was likely to have a high risk pregnancy were evaluated primarily from a medical point of view. A broader, more comprehensive approach to high risk pregnancy has been adopted. There are now four categories based on threats to the health of the woman and the outcome of pregnancy. Which of the options listed here is not included as a category? Biophysical Psychosocial Geographic Environmental

Geographic *The fourth category is correctly referred to as the sociodemographic risk category. The factors stem from the mother and her family. Ethnicity may be one of the risks to pregnancy; however, it is not the only factor in this category. Low income, lack of prenatal care, age, parity, and marital status are included. Biophysical is one of the broad categories used for determining risk. It includes genetic considerations, nutritional status, and medical and obstetric disorders. Psychosocial risks include smoking, caffeine, drugs, alcohol, and psychologic status. All of these adverse lifestyles can have a negative effect on the health of the mother or fetus. Environmental risks are those that can affect fertility and fetal development. They include infections, chemicals, radiation, pesticides, illicit drugs, and industrial pollutants.

A nurse is working in the nursery and observes a nursing student repeatedly performing an Ortolani test. What priority action should the nurse take? Help the nursing student with performing the test to make sure that it is being done accurately. Document the findings of the test as performed by the nursing student after the test has been repeated three times. Have the nursing student explain what the test is used for in terms of clinical assessment. Have the student stop performing the test immediately.

Have the student stop performing the test immediately. *The Ortolani test should be performed by an experienced practitioner so as to avoid any possible damage. It should not be performed repetitively. Although it would be important to ascertain whether the nursing student knew the clinical implication for the test, the priority safety action would be to intervene and stop further testing.

With regard to the classification of neonatal bacterial infection, nurses should be aware that: Congenital infection progresses slower than health care-associated infection. Health care-associated infection can be prevented by effective handwashing; early-onset infection cannot. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher. The clinical sign of a rapid, high fever makes infection easier to diagnose.

Health care-associated infection can be prevented by effective handwashing; early-onset infection cannot. *Handwashing is an effective preventive measure for late-onset (health care-associated) infections because these infections come from the environment around the infant. Early-onset (congenital) infections are caused by the normal flora at the maternal vaginal tract. Congenital (early-onset) infections progress more rapidly than health care-associated (late-onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult.

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At present she is at the greatest risk for: Hemorrhage. Infection. Urinary retention. Thrombophlebitis.

Hemorrhage *Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention or thrombophlebitis than does a normally implanted placenta.

Which opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? Heroin Alcohol Phencyclidine palmitate (PCP) Cocaine

Heroin *The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. Alcohol, PCP, and cocaine are not opiates.

With regard to injuries to the infant's plexus during labor and birth, nurses should be aware that: If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months. Erb palsy is damage to the lower plexus. Parents of children with brachial palsy are taught to pick up the child from under the axillae. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.

If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months. *If the ganglia are disconnected completely from the spinal cord, the damage is permanent. Erb palsy is damage to the upper plexus and is less serious than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated in facial nerve paralysis, but both mother and infant will need help from the nurse at the start.

Preterm infants are more likely to become septic because: IgG and IgA levels are adequate at birth. Immune function is suppressed because of increased IgG levels. IgG level is directly proportional to gestational age. Serum complement levels are adequate.

IgG level is directly proportional to gestational age. *IgG levels are directly proportional to gestational age, being decreased in preterm infants, and reflect immune function. Levels of IgG and IgA are not adequate at birth and require time to become optimal. Serum complement levels are decreased at birth in preterm infants.

While caring for the newborn, the nurse must be alert for any signs of cold stress. This would include which symptom? Decreased activity level Increased respiratory rate Hyperglycemia Shivering

Increased respiratory rate *In an infant who is cold, the respiratory rate rises in response to the increased need for oxygen. Signs of cold stress include increased activity level and crying (increased basal metabolic rate [BMR] and heat production). A cold infant is at risk for hypoglycemia as the glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production.

With regard to small-for-gestational age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that: In the first trimester, diseases or abnormalities result in asymmetric IUGR. Infants with asymmetric IUGR have the potential for normal growth and development. In asymmetric IUGR, weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA. Symmetric IUGR occurs in the later stages of pregnancy.

Infants with asymmetric IUGR have the potential for normal growth and development. *The infant with asymmetric IUGR has the potential for normal growth and development. IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester, as a result of disease or abnormalities; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile, but the head circumference is greater than the 10th percentile (within normal limits).

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: Bleeding. Intense abdominal pain. Uterine activity. Cramping.

Intense abdominal pain. *Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding, uterine activity, and cramping may be present in varying degrees for both placental conditions.

Which priority intervention would be needed if the nurse suspected that an infant was septic? Administration of oxygen Electronic monitoring of vital signs Intravenous access Recorded intake and output

Intravenous access *Establishing intravenous access for the administration of antibiotics would be a priority intervention. The other actions described might be required but are not the priority intervention.

Which PPH conditions are considered medical emergencies that require immediate treatment? Inversion of the uterus and hypovolemic shock Hypotonic uterus and coagulopathies Subinvolution of the uterus and idiopathic thrombocytopenic purpura (ITP) Uterine atony and disseminated intravascular coagulation (DIC).

Inversion of the uterus and hypovolemic shock *Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin; coagulopathies should have been identified prior to delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment; ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications but are not medical emergencies requiring immediate intervention.

A nurse providing care for the antepartum woman should understand that the contraction stress test (CST): Sometimes uses vibroacoustic stimulation. Is an invasive test; however, contractions are stimulated. Is considered to have a negative result if no late decelerations are observed with the contractions. Is more effective than nonstress test (NST) if the membranes have already been ruptured.

Is considered to have a negative result if no late decelerations are observed with the contractions. *No late decelerations indicate a positive CST result. Vibroacoustic stimulation is sometimes used with NST. CST is invasive if stimulation is performed by IV oxytocin but not if by nipple stimulation. CST is contraindicated if the membranes have ruptured.

A nurse providing care to a woman in labor should be aware that cesarean birth: Is declining in frequency in the United States. Is more likely to be performed in the poor in public hospitals who do not receive the nurse counseling that wealthier clients do. Is performed primarily for the benefit of the fetus. Can be either elected or refused by women as their absolute legal right.

Is performed primarily for the benefit of the fetus. *The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) with psychotic features: Is more likely to occur in women with more than two children. Is rarely delusional and is usually about someone trying to harm her (the mother). Although serious, is not likely to need psychiatric hospitalization. Is typified by auditory or visual hallucinations.

Is typified by auditory or visual hallucinations. *Hallucinations are present in 25% of women with this disorder; paranoid or grandiose delusions (present in 50%), elements of delirium or disorientation, and extreme deficits in judgment accompanied by high levels of impulsivity may contribute to risks of suicide or infanticide. PPD is more likely to occur in first-time mothers. PPD with psychosis is a psychiatric emergency that requires hospitalization.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. There are no important maternal (as opposed to fetal) contraindications. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. If pulmonary edema develops while the client is receiving tocolytics, IV fluids should be given.

Its most important function is to afford the opportunity to administer antenatal glucocorticoids. *Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.

A nurse examining a newborn infant notes that the infant is jaundiced. Which observation would lead the nurse to continue to monitor but not to intervene and contact the physician? Jaundice appeared within the first 24 hours of life. Jaundice appeared on the third day of life. Preterm infant who is 12 hours old. Infant is being bottle fed and within the first 24 hours of life.

Jaundice appeared on the third day of life. *Physiologic jaundice can be seen in a large percentage of newborns, 60% of term and 80% of preterm, but typically resolves without immediate intervention. The critical factor here is the time of appearance, being within the first 24 hours of life. Jaundice appearing at this time is considered pathological and requires further investigation. The timing in C combined with prematurity also requires further investigation.

The priority assessment in evaluating a pregnant woman with severe nausea and vomiting is: Fasting blood glucose level. Ketonuria. Bilirubin. White blood cell count.

Ketonuria. *Determination of ketonuria would be a critical assessment that would lead towards determination of hyperemesis. A pregnant patient with severe nausea and vomiting may have hyperemesis gravidarum and as such requires critical monitoring to determine the nature of the problem. An FBS measurement, although informative, would not be the priority assessment at this time, nor would a bilirubin measurement. A WBC count would indicate the possibility of an infectious source but it would not be a priority assessment in terms of the patient's presentation.

Which action of a breastfeeding mother indicates the need for further instruction? Holds breast with four fingers along bottom and thumb at top. Leans forward to bring breast toward the baby. Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth. Puts her finger into newborn's mouth before removing breast.

Leans forward to bring breast toward the baby. *To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby. The mother would need further demonstration and teaching to correct the ineffective action. The other actions described are correct.

For diagnostic and treatment purposes, nurses should know the birth weight classifications of high risk infants. For example, extremely low birth weight (ELBW) is the designation for an infant whose weight is: Less than 1500 g. Less than 1000 g. Less than 2000 g. Dependent on the gestational age.

Less than 1000 g. *ELBW is defined as less than 1000 g. At such weights, problems are so numerous that ethical issues regarding when to treat arise. Less than 1500 g is the designation for very low birth rate (VLBW). Less than 2000 g is less than LBW but too high for VLBW. Gestational age is a factor with weight in the condition of the preterm birth, but it is not part of the birth weight categorization.

A male infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturation values of 80%. The prescribed saturation value is 92%. The nurse's most appropriate action is to: Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician. Continue to observe and make no changes until the saturations are 75%. Continue with the admission process to ensure that a thorough assessment is completed. Notify the parents that their infant is not doing well.

Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician. *The actions described in A are appropriate nursing interventions to assist in optimal O2 saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained at more than 92%, and the nurse should delay other tasks to stabilize the infant. The action described in D is not appropriate. Further assessment and intervention are warranted prior to determination of fetal status.

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. Screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. Percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

MSAFP is a screening tool only; it identifies candidates for more definitive procedures. *CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal result.

Which of the following findings is not likely to be seen in a pregnant patient who has hypothyroidism? Miscarriage Macrosomia Gestational hypertension Placental abruption

Macrosomia *Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm; these outcomes can be improved with early diagnosis and treatment. Hypothyroidism is often associated with both infertility and an increased risk of miscarriage. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism.

Which clinical factor could be associated with the development of adult respiratory distress syndrome (ARDS) during pregnancy? Pitocin induction Cholecystitis Hyperemesis gravidarum Magnesium sulfate

Magnesium sulfate *The use of tocolytics, such as magnesium sulfate, can be associated with the development of ARDS. Pitocin induction, cholecystitis, and hyperemesis gravidarum are not associated with ARDS.

A nurse is caring for a woman with mitral stenosis who is in the active stage of labor. Which action should the nurse take to promote cardiac function? Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. Prepare the woman for delivery by cesarean section because this is the recommended delivery method to sustain hemodynamics. Encourage the woman to avoid the use of narcotics or epidural regional analgesia because these measures alter cardiac function. Promote the use of the Valsalva maneuver during pushing in the second stage to improve diastolic ventricular filling.

Maintain the woman in a side-lying position with the head and shoulders elevated to facilitate hemodynamics. *The side-lying position with the head and shoulders elevated helps facilitate hemodynamics during labor. A vaginal delivery is the preferred method for a woman with cardiac disease because it sustains hemodynamics better than a cesarean section. The use of supportive care, medication, and narcotics or epidural regional analgesia is not contraindicated for a woman with heart disease. Using the Valsalva maneuver during pushing in the second stage should be avoided because it reduces diastolic ventricular filling and obstructs left ventricular outflow.

During rounds, a nurse suspects that a patient who has recently delivered via vaginal route is having excessive postpartum bleeding. Which intervention would be the priority action taken by the nurse at this time? Call the physician. Massage the uterine fundus. Increase the rate of intravenous fluids. Monitor pad count and perform catheterization.

Massage the uterine fundus. *Massaging of the uterine fundus would be a priority action to help expel clots and stimulate uterine contractions to constrict blood flow. The other actions described, as well as catheterization (if bladder distention is noted) and lochia flow monitoring, may be needed, but none of them is the priority action required at this time.

Which postpartum infection is most often contracted by first-time mothers who are breastfeeding? Endometritis Wound infections Mastitis Urinary tract infections (UTIs)

Mastitis *Mastitis is infection in a breast, usually confined to a milk duct. Most women who get it are first-timers who are breastfeeding. Endometritis is the most common postpartum infection. Its incidence is higher after a cesarean birth, not in first-time mothers. Wound infections are also a common postpartum complication. Sites of infection include both a cesarean incision and the episiotomy or repaired laceration. The gravidity of the mother and her feeding choice are not factors in the development of a wound infection. UTIs occur in 2% to 4% of all postpartum women. Risk factors include catheterizations, frequent vaginal exams, and epidural anesthesia.

What is an appropriate indicator for performing a contraction stress test? Increased fetal movement and small for gestational age Maternal diabetes mellitus and postmaturity Adolescent pregnancy and poor prenatal care History of preterm labor and intrauterine growth restriction

Maternal diabetes mellitus and postmaturity *Decreased fetal movement is an indicator for performing a contraction stress test; the size (small for gestational age) is not an indicator. Although adolescent pregnancy and poor prenatal care are risk factors for poor fetal outcomes, they are not indicators for performing a contraction stress test. Intrauterine growth restriction is an indicator; history of a previous stillbirth, not preterm labor, is another indicator.

Which findings would lead to increased bilirubin levels in the newborn? (Select all that apply.) Cord clamped immediately following delivery of newborn Meconium passed after 24 hours Initiation of newborn feedings delayed following birth Hyperglycemia Twin-to-twin transfusion syndrome

Meconium passed after 24 hours Initiation of newborn feedings delayed following birth Twin-to-twin transfusion syndrome *Delay in passage of meconium or in newborn feedings could lead to increased bilirubin levels because of increased enterohepatic circulation. Twin-to-twin transfusion syndrome could lead to increased bilirubin levels as a result of an increased amount of hemoglobin. An increase in bilirubin levels would be seen if cord clamping were delayed following birth. Hypoglycemia could lead to increased bilirubin levels because of alterations in hepatic function and perfusion.

Nurses must be cognizant of the growing problem of methamphetamine use during pregnancy. When caring for a woman who uses methamphetamines, it is important for the nurse to be aware of which factor related to the abuse of this substance? Methamphetamine is a depressant. All methamphetamines are vasodilators. Methamphetamine users are extremely psychologically addicted. Rehabilitation is usually successful.

Methamphetamine users are extremely psychologically addicted. *"Meth" users are extremely psychologically addicted. Typically these women display poor control over their behavior and a low threshold for pain. This substance is relatively inexpensive and easy to obtain. Methamphetamine is a stimulant and a vasoconstrictor. The rate of relapse for methamphetamine users is very high.

Which of the following antihypertensive medications would cause a pregnant woman to have a positive Coombs test result? Nifedipine (Procardia) Methyldopa (Aldomet) Labetalol hydrochloride (Trandate) Hydralazine (Apresoline)

Methyldopa (Aldomet) *A positive Coombs test result can occur in about 20% of patients taking methyldopa (Aldomet). None of the other drugs listed would have this effect.

A pregnant woman with cystic fibrosis (CF) wants to breastfeed her infant. Which assessments would have to be performed in order to make sure that the breastfeedings were safe and effective? (Select all that apply.) Monitor maternal weight Monitor maternal urine for ketones Monitor sodium levels in breast milk Monitor total fat levels in breast milk Monitor infant growth pattern

Monitor sodium levels in breast milk Monitor total fat levels in breast milk Monitor infant growth pattern *Breast milk should be monitored for sodium, total fat, and chloride levels in order to establish its safety. Monitoring of the infant's growth pattern would provide evidence that breastfeeding is adequate. Maternal weight monitoring and urinalysis would not be indicated with regard to the safety of breastfeeding in this case.

While evaluating the reflexes of a male newborn, the nurse notes that with a loud noise, the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. The nurse documents this finding as a positive: Tonic neck reflex response Glabellar (Myerson) reflex response Babinski reflex response Moro reflex response

Moro reflex response *The characteristics displayed by the infant are associated with a positive Moro reflex response. The tonic neck reflex occurs when the infant extends the leg on the side to which the infant's head simultaneously turns. The glabellar reflex is elicited by tapping on the infant's head while the eyes are open; a characteristic response is blinking for the first few taps. The Babinski reflex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot; a positive response occurs when all the toes hyperextend, with dorsiflexion of the big toe.

Which statement is incorrect regarding bathing of a new baby? Newborns should be bathed every day, for the bonding as well as the cleaning. Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed. Only plain warm water should be used to preserve the skin's acid mantle. Powders are not recommended because the infant can inhale powder.

Newborns should be bathed every day, for the bonding as well as the cleaning. *Newborns do not need a bath every day, even if the parents enjoy it. The diaper area and creases under the arms and neck need more attention. Tub baths may be given as soon as an infant's temperature has stabilized. Unscented mild soap is appropriate to use to wash the infant. Powder is not recommended because of the risk of inhalation. Should a parent elect to use baby powder, it should never be sprinkled directly onto the baby's skin. The parent can apply a small amount of powder to his or her own hand and then apply it to the infant.

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? (Select all that apply.) Perform ultrasound to determine fetal positioning. Observe the patient for possible uterine contractions. Administer RhoGAM to the patient if she is Rh negative. Perform a minicatheterization to obtain a urine specimen to assess for bleeding.

Observe the patient for possible uterine contractions. Administer RhoGAM to the patient if she is Rh negative. *Ultrasound is used prior to the procedure as a visualization aid to assist with insertion of transabdominal needle. There is no need to assess the urine for bleeding as this is not considered to be a typical presentation or complication.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? Fetal heart rate of 116 beats/min Cervix dilated 2 cm and 50% effaced Score of 8 on the biophysical profile One fetal movement noted in 1 hour of assessment by the mother

One fetal movement noted in 1 hour of assessment by the mother *Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If she feels fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. The findings described in the other choices are normal at 42 weeks of gestation.

The first and most important nursing intervention when a nurse observes profuse postpartum bleeding is to: Call the woman's primary health care provider. Administer the standing order for an oxytocic. Palpate the uterus and massage it if it is boggy. Assess maternal blood pressure and pulse for signs of hypovolemic shock.

Palpate the uterus and massage it if it is boggy. *The initial management of excessive postpartum bleeding is firm massage of the uterine fundus to stop the bleeding. This is the most important nursing intervention. Then the primary health care provider should be notified or the nurse can delegate this task to another staff member. Administering an oxytocic and ascertaining vital signs are appropriate after assessment has been made and immediate steps have been taken to control the bleeding.

Antidepressant medication is the mainstay treatment for maternal depression, with selective serotonin reuptake inhibitors (SSRIs) being the first line of pharmacotherapy. Reports of cardiac defects have been associated with the use of which SSRI? Citalopram Fluoxetine Sertraline Paroxetine

Paroxetine *The American College of Obstetricians and Gynecologists (ACOG) has issued a recommendation that paroxetine be avoided both during pregnancy and in women considering pregnancy. There have also been reports linking paroxetine to other abnormalities, such as omphalocele, craniosynostosis, and anencephaly. The absolute risk of any congenital abnormality associated with use of citalopram, fluoxetine, or sertraline is small.

Which indicator would lead the nurse to suspect that a postpartum patient experiencing hemorrhagic shock is getting worse? Restoration of blood pressure levels to normal range Capillary refill brisk Patient complaint of headache and increased reaction time to questioning Patient statement that she sees "stars"

Patient complaint of headache and increased reaction time to questioning * Patient complaint of a headache accompanied by an increased reaction (response) time indicates that cerebral hypoxia is getting worse. Return of blood pressure to normal range would indicate resolving symptoms. Brisk capillary refill is a normal finding. The patient may see "stars" early on in decreased blood flow states.

In which situations would the use of Methergine or prostaglandin be contraindicated even if the patient was experiencing a postpartum significant bleed? (Select all that apply.) Patient has delivered twin pregnancies. Patient's blood pressure postpartum is 180/90. Patient has a history of asthma. Patient has a mitral valve prolapse. Patient is a grand multip.

Patient's blood pressure postpartum is 180/90. Patient has a history of asthma. Patient has a mitral valve prolapse. *Twin pregnancies successfully delivered and grand multiparity are not contraindications to the use of these medications. If a patient is hypertensive or has cardiovascular disease, these medications would not be used. If a patient has a history of asthma, prostaglandin medication would not be used.

A patient who is pregnant also has a history of psoriasis. What information can the nurse provide to the patient relative to this disease process? Pregnancy has no effect on psoriasis. As long as the patient stays out of direct sunlight, there will be no progression of disease. Psoriasis typically worsens during pregnancy in approximately 50% of patients. Patients who have psoriasis during pregnancy experience a varied response.

Patients who have psoriasis during pregnancy experience a varied response. *Psoriasis responds variably to pregnancy; in some women there is no change, in some the disease gets better, and in about 20% of women it gets worse. There is no direct correlation between sunlight and psoriasis.

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should: Place the thermistor probe on the left side of the chest. Cover the probe with a nonreflective material. Recheck temperature by periodically taking a rectal temperature. Perform all examinations and activities under the warmer.

Perform all examinations and activities under the warmer. *During all procedures, heat loss must be avoided or minimized for the newborn. All examinations and activities are performed with the infant under the heat panel. The thermistor probe should be placed on the upper abdomen away from the ribs and should be covered with reflective material. Rectal temperature measurements should be avoided because rectal thermometers can perforate the intestine, and the rectal temperature may remain normal until cold stress is advanced.

Which factor would contribute to depletion of weight and metabolic stores in the high risk newborn? Frequent breast feedings Core temperature within normal range Phototherapy Bathing

Phototherapy *The use of phototherapy could lead to insensible heat loss and as a result lead to decreased weight and metabolic stores in the high risk newborn. Frequent breastfeedings and bathing would not have these effects. Maintaining a core temperature would help maintain weight and metabolic stores in the high risk newborn.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? Place the woman in the knee-chest position. Cover the cord in a sterile towel saturated with warm normal saline. Prepare the woman for a cesarean birth. Start oxygen by face mask.

Place the woman in the knee-chest position. *The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. Relieving pressure on the cord is the nursing priority. The nurse may also use her gloved hand or two fingers to lift the presenting part off the cord. If the cord is protruding from the vagina it may be covered with a sterile towel soaked in saline. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency to every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: Eclamptic seizure. Rupture of the uterus. Placenta previa. Placental abruption.

Placental abruption. *Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests with hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain, and placenta previa with bright red, painless vaginal bleeding.

Which laboratory values would be found in a patient diagnosed with preeclampsia? (Select all that apply.) Hemoglobin 8g/dL Platelet count of 75,000 LDH 100 units/L Burr cells BUN 25 mg/dL

Platelet count of 75,000 LDH 100 units/L BUN 25 mg/dL *Thrombocytopenia below 100,000, an increase in LDH, and an increase in BUN would be noted. Hemoglobin levels would be increased, but 8 g/dL reflects a decreased level. Burr cells would not be present in preeclampsia but would in HELLP syndrome.

A nurse is performing an assessment on a newborn and notes 6 digits on each foot. This finding is an example of: Congenital hip dysplasia. Hypospadias. Polydactyly. Clubfoot.

Polydactyly. *Polydactyly is a congenital deformity associated with extra digits. Congenital hip dysplasia indicates a dislocated hip. Hypospadias indicates an abnormality of the external genitalia. Clubfoot can be positional or congenital in nature and is a foot deformity.

A nurse is monitoring a patient's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? Bilateral DTRs noted at 2+ DTRs response has been noted at 1+ since onset of therapy Positive clonus response elicited unilaterally Patient reports no pain upon examination of DTRs by nurse

Positive clonus response elicited unilaterally *Positive clonus response elicited unilaterally is a cause for concern as it suggests a hyperactive response. Typically, there is no pain associated with determination of DTRs so this finding would be considered to be normal, as would bilateral DTRs noted at 2+. Even though DTRs at 1+ indicate a sluggish or decreased response, this finding is unchanged since the initiation of therapy. The nurse would continue to monitor.

With regard to preeclampsia and eclampsia, nurses should be aware that: Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. The causes of preeclampsia and eclampsia are well documented. Severe preeclampsia is defined as preeclampsia plus proteinuria.

Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain. *Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs. Preeclampsia occurs after week 20 of gestation and can run the duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown, although several have been suggested. Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions.

A patient who is pregnant already has Type 2 diabetes with a hemoglobin A1c value of 7. The nurse would categorize this patient as having: Gestational diabetes. Insulin-dependent diabetes complicated by pregnancy. Pregestational diabetes mellitus. Non-insulin-dependent diabetes with complications.

Pregestational diabetes mellitus. *Pregestational diabetes mellitus is a term used to describe patients with type 1 or type 2 diabetes in whom diabetes existed prior to pregnancy. Gestational diabetes occurs when a woman becomes diabetic during the pregnancy state. Type 2 diabetes is non-insulin-dependent. None of the information presented indicates complications at this point, because the hemoglobin A1c is within normal range, signifying adequate glycemic control.

A nurse is advising a pregnant patient who has a substance abuse problem about a contingency management program. Which statement identifies an aspect of this type of program? Pregnant woman are confined to an inpatient treatment method during their pregnancy. Pregnant woman are given biofeedback modalities as stimulus responses to control their addiction. Pregnant woman are given motivational incentives as a primary approach to stop their drug abuse problem. Pregnant woman must follow a strict medication nutritional program during the course of pregnancy.

Pregnant woman are given motivational incentives as a primary approach to stop their drug abuse problem. *A contingency management program utilizes a motivational incentive approach with patients to support their efforts to maintain abstinence. The incentives may include small cash amounts, privileges, or prizes. Contingency management programs are not limited to inpatient settings and do not involve biofeedback modalities or medication nutritional programs.

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? Prepare the woman for a dilation and curettage (D&C). Put the woman on bed rest for at least 1 week and reevaluate. Prepare the woman for an ultrasound and blood work. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

Prepare the woman for an ultrasound and blood work. *Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine whether the fetus is alive and within the uterus. Bed rest is recommended for 48 hours initially. D&C is not considered until signs of the progress to inevitable abortion are noted or the contents are expelled and incomplete. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.

Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps-Plus is a screening tool designed specifically to identify when there is a need for a more in-depth assessment. Which of the following is not included in the 4 Ps-Plus screening tool? Present Partner Past Pregnancy

Present *The first P is Parents: The woman should be asked, "Did either of your parents have a problem with alcohol or drugs?" The second P is Partner: "Does your partner have a problem with alcohol or drugs?" The third P is Past: "Have you ever had any beer, wine, or liquor?" The fourth P is Pregnancy: "In the month before you knew you were pregnant, how many cigarettes did you smoke? How much beer, wine, or liquor did you drink?"

A nurse is evaluating several obstetric patients for their risk for cervical insufficiency. Which patient would be considered to be most at risk? Primipara Grandmultip who has previously had all vaginal deliveries without a problem Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy Multip who had her previous delivery via C section due to cephalopelvic disproportion (CPD)

Primip who undergoes a cervical cone biopsy for cervical dysplasia prior to the pregnancy *Any patient who has had previous surgical interventions (cone biopsy) is at greater risk for cervical insufficiency. There is no indication that a primip is at risk for cervical insufficiency. A grandmultip who has previously had vaginal deliveries without incidence is not necessarily at an increased risk for cervical insufficiency. A multip who has delivered via C section as a result of CPD would not necessarily be at an increased risk as the issue involves pelvic adequacy as determined by pelvic measurements in relationship to the fetus.

Which of the following processes or findings increase the risk of preterm infants in which hematologic problems are developing? (Select all that apply.) Decrease in size of red blood cells Decreased capillary fragility Prolonged PT time Decreased red blood cell survival time Decrease in erythropoiesis

Prolonged PT time Decreased red blood cell survival time Decrease in erythropoiesis *Prolonged PT reflects an increased tendency to bleed in preterm infants. Decrease in red blood cell survival time is seen in such infants. So is decreased functional ability of erythropoietin, which limits red blood cell synthesis. One sees an increase in the size of red blood cells in preterm infants, which affects their survival time. Increased capillary fragility also occurs in preterm infants.

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time is to: Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours. Reduce emotional distress by encouraging the woman to discuss her feelings. Reverse fluid, electrolyte, and acid-base imbalances. Restore the woman's ability to take and retain oral fluid and foods.

Reverse fluid, electrolyte, and acid-base imbalances. *Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the mother and fetus and should be corrected as soon as possible. Resting the GI tract and discussing her feelings are components of treatment but are not immediate goals for this client. The ability to retain oral fluid and foods is a longer-term goal of treatment for this condition.

In terms of Rh incompatibility, which situations would cause a potential problem? Select all that apply: Rh-negative mom having an Rh-positive baby Rh-negative mom having an Rh-negative baby The infant of an Rh-negative mom with Rh-positive father who is homozygous for the trait Rh-positive baby born to an Rh-positive mom

Rh-negative mom having an Rh-positive baby The infant of an Rh-negative mom with Rh-positive father who is homozygous for the trait *An Rh-negative mom having an Rh-positive baby is the classic presentation for isoimmunization or Rh incompatibility. The infant of an Rh-negative mom with an Rh positive father who is homozygous for the trait would have a potential problem because the infant would be Rh-positive. The other two situations would not cause a problem.

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: Blood pressure is reduced to prepregnant baseline. Seizures do not occur. Deep tendon reflexes become hypotonic. Diuresis reduces fluid retention.

Seizures do not occur. *Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur but is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.

Which factors would lead to an increased likelihood of uterine rupture? (Select all that apply.) Preterm singleton pregnancy G3P3 with all vaginal deliveries Short interval between pregnancies Patient receiving a trial of labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classic incision

Short interval between pregnancies Patient receiving a trial of labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classic incision *The shorter the interval between pregnancies/deliveries, the higher the risk of uterine rupture. A patient who is having a TOL following a VBAC and a patient who has had a C section with a classic incision into the uterus are at increased risk for uterine rupture. A pregnant woman with a singleton pregnancy (one fetus), even if preterm, is not considered to be at increased risk for uterine rupture; nor is a multipara who has delivered all her infants vaginally.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? Estriol is not found in maternal saliva. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm.

The cervix is effacing and dilated to 2 cm. *Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Irregular, mild contractions that do not cause cervical change are not considered a threat. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes.

With regard to hemolytic diseases of the newborn, nurses should be aware that: Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. Exchange transfusions are frequently required in the treatment of hemolytic disorders. The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.

The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth. *An indirect Coombs test may be performed on the mother a few times during pregnancy. Only the Rh-positive offspring of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.

When providing an infant with a gavage feeding, what should the nurse document each time? The infant's abdominal circumference after the feeding The infant's heart rate and respirations The infant's suck and swallow coordination The infant's response to the feeding

The infant's response to the feeding *Documentation of a gavage feeding should include the size of the feeding tube, the amount and quality of the residual from the previous feeding, the type and quantity of the fluid instilled, and the infant's response to the procedure. Some older infants may be learning to suck, but the important factor to document is the infant's response to the feeding (including attempts to suck). Abdominal circumference is not measured after a gavage feeding. Vital signs may be obtained prior to feeding, but the infant's response is more important.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that: With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. At birth, the neonate of a diabetic mother is no longer in any greater risk.

The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. *Congenital malformations account for 30% to 50% of perinatal deaths in diabetic pregnancies. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome, and the transition to extrauterine life is often marked by hypoglycemia and other metabolic abnormalities.

A nurse is providing instruction for an obstetrical patient to perform a daily fetal movement count (DFMC). Which instructions could be included in the plan of care? (Select all that apply.) The fetal alarm signal is reached when there are no fetal movements noted for 5 hours. The patient can monitor fetal activity once daily for a 60-minute period and note activity. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted.

The patient can monitor fetal activity once daily for a 60-minute period and note activity. Monitor fetal activity two times a day either after meals or before bed for a period of 2 hours or until 10 fetal movements are noted. Count all fetal movements in a 12-hour period daily until 10 fetal movements are noted. *The fetal alarm signal is reached when no fetal movements are noted for a period of 12 hours.

A pregnant woman has maternal phenylketonuria (PKU) and is interested in whether or not she will be able to breastfeed her baby. Which reaction by the nurse indicates accurate information? The patient can breastfeed the baby as long as she continues to maintain a PKU-restricted diet. The patient should alternate breastfeeding with bottle feeding in order to reduce PKU levels provided to the baby. The patient should be advised to not breastfeed the infant because her breast milk will contain large amounts of phenylalanine. The patient can breastfeed for the first 3 months without any untoward effects on the infant.

The patient should be advised to not breastfeed the infant because her breast milk will contain large amounts of phenylalanine. *Breastfeeding is not advised for a patient who has maternal PKU, because phenylalanine levels are high in such a patient's breast milk. Dietary restriction will not limit the amount of this substance in breast milk. Alternating feeding sources is not advised either.

With regard to umbilical cord care, nurses should be aware that: The stump can easily become infected. A nurse noting bleeding from the vessels of the cord should immediately call for assistance. The cord clamp is removed at cord separation. The average cord separation time is 5 to 7 days.

The stump can easily become infected. *The cord stump is an excellent medium for bacterial growth. If bleeding occurs, the nurse should first check the clamp (or tie) and apply a second one; if the bleeding does not stop, then the nurse calls for assistance. The cord clamp is removed after 24 hours when it is dry. The average cord separation time is 10 to 14 days.

A woman presents to the emergency department complaining of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary health care provider finds that the cervix is closed. The anticipated plan of care for this woman is based on a probable diagnosis of which type of spontaneous abortion? Incomplete Inevitable Threatened Septic

Threatened *A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. Heavy bleeding, mild to severe cramping, and cervical dilation are the presentation for both incomplete abortion and inevitable abortion. A woman with a septic abortion presents with malodorous bleeding and, typically, a dilated cervix.

Which TORCH infection could be contracted by the infant because the mother owned a cat? Toxoplasmosis Varicella-zoster Parvovirus B19 Rubella

Toxoplasmosis *Cats that eat birds infected with the Toxoplasma gondii protozoan excrete infective oocysts. Humans (including pregnant women) can become infected if they fail to wash their hands after cleaning a cat's litter box. The infection is passed through the placenta. The varicella-zoster virus is responsible for chickenpox and shingles. Approximately 90% of childbearing women are immune. During pregnancy, infection with parvovirus can result in abortion, fetal anemia, hydrops, intrauterine growth restriction (IUGR), and stillbirth; this virus is spread by vertical transmission, not by felines. Since vaccination for rubella was begun in 1969, cases of congenital rubella infection have been reduced significantly. Vaccination failures, lack of compliance, and the migration of nonimmunized persons result in periodic outbreaks of rubella (German measles).

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? Biophysical profile Amniocentesis Maternal serum alpha-fetoprotein (MSAFP) Transvaginal ultrasound

Transvaginal ultrasound *An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

Which of the following statements about the prevalence of perinatal mental health problems is true? (Select all that apply.) The World Health Organization (WHO) recognizes postpartum depression as the leading cause of disability in women. Up to a ¼ of pregnant women will experience some aspect of depression during their pregnancies. Income status plays a significant role in the presentation of perinatal mental health problems. A higher incidence of postpartum depression (PPD) is found in about 50% of the population. Between 30 and 50 billion dollars accounts for productivity and direct medical costs related to depression in women.

Up to a ¼ of pregnant women will experience some aspect of depression during their pregnancies. Income status plays a significant role in the presentation of perinatal mental health problems. Between 30 and 50 billion dollars accounts for productivity and direct medical costs related to depression in women. *The WHO recognizes depression as the leading cause of disability in women. Between 14% and 23% of women will experience some aspect of depression during their pregnancies. Low income plays a significant factor in the presentation of perinatal mental health problems. Higher incidence of PPD is found in about 25% of women. The economic costs related to depression treatment in women are extremely high, ranging between 30 and 50 billion dollars.

Congenital heart defects (CHDs) are anatomic abnormalities in the heart that are present at birth, although they may not be diagnosed immediately. The most common type of CHD is: Tetralogy of Fallot. Ventricular septal defect (VSD). Pulmonary stenosis. Transposition of the great vessels.

Ventricular septal defect (VSD). *VSD with increased pulmonary blood flow is the most common type of heart defect, with a prevalence of 27 per 10,000 births, and accounts for about 30% to 35% of all congenital heart defects. Tetralogy of Fallot has an incidence of 4.7 per 10,000 births and is the most common cardiac defect with decreased blood flow. Pulmonary stenosis, a defect that causes obstruction to blood flow out of the heart, is less common. Transposition of the great vessels is a complex cardiac anomaly that involves a flow of mixed saturated and desaturated blood in the heart or great vessels.

Which factors predispose an infant to birth injuries? (Select all that apply.) Multip between the ages of 25 and 30 Vertex presentation Application of an internal fetal scalp electrode Vacuum-assisted birth

Vertex presentation Application of an internal fetal scalp electrode *The use of an internal fetal scalp electrode could result in a scalp injury, which would be evident upon birth. The use of vacuum extraction could lead to a birth injury. Very young age (less than 16) and older age (more than 35) in a primipara are more likely to predispose an infant to birth injuries. Vertex presentation is a normal finding and as such would not typically lead to a birth injury.

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is: Vision Hearing Smell Taste

Vision *The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant's hearing is similar to that of an adult. Newborns have a highly developed sense of smell and can distinguish and react to various tastes.

The nurse taught new parents the guidelines to follow regarding the bottle feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they: Wash the top of can and can opener with soap and water before opening the can. Adjust the amount of water added according to weight gain pattern of the newborn. Add some honey to sweeten the formula and make it more appealing to a fussy newborn. Warm formula in a microwave oven for a couple of minutes prior to feeding.

Wash the top of can and can opener with soap and water before opening the can. *Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for parents to get into to prevent contamination. Directions on the can for dilution should be followed exactly and not adjusted according to weight gain to prevent nutritional and fluid imbalances. Honey is not necessary and could contain botulism spores. The formula should be warmed in a container of hot water because a microwave can easily overheat it.

Which statement regarding infant weaning is correct? Weaning should proceed from breast to bottle to cup. The feeding of most interest should be eliminated first. Abrupt weaning is easier than gradual weaning. Weaning can be mother or infant initiated.

Weaning can be mother or infant initiated. *Weaning is initiated by the mother or the infant. With infant-led weaning, the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother's milk supply. In mother-led weaning, the mother decides which feedings to drop. Infants can be weaned directly from the breast to a cup. Bottles are usually offered to infants younger than 6 months. If the infant is weaned prior to 1 year of age, iron-fortified formula rather than cow's milk should be offered. The feeding of least interest to the baby or the one through which the infant is likely to sleep should be eliminated first. Every few days thereafter the mother drops another feeding. Gradual weaning over a period of weeks or months is easier for both the mother and the infant than an abrupt weaning.

When weighing a newborn, the nurse should: Leave its diaper on for comfort. Place a sterile scale paper on the scale for infection control. Keep a hand on the newborn's abdomen for safety. Weigh the newborn at the same time each day for accuracy.

Weigh the newborn at the same time each day for accuracy. *Weighing a newborn at the same time each day allows for the most accurate weight. The baby should be weighed without a diaper or clothes. Clean scale paper is acceptable; it does not need to be sterile. The nurse's hand should be above, not on, the abdomen for safety.

In helping the breastfeeding mother position the baby, the nurse should keep in mind that: The cradle position is usually preferred by mothers who had a cesarean birth. Women with perineal pain and swelling prefer the modified cradle position. Whatever the position used, the infant is "belly to belly" with the mother. While supporting the head, the mother should push gently on the occiput.

Whatever the position used, the infant is "belly to belly" with the mother. *The infant inevitably faces the mother, belly to belly. The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head, because doing so might cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

With regard to dysfunctional labor, nurses should be aware that: Women who are underweight are more at risk. Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. Abnormal labor patterns are most common in older women.

Women experiencing precipitous labor are about the only women experiencing dysfunctional labor who are not exhausted *Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years.