MC: Exam 2 (End of ch. questions)

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MC CHP 12 The perinatal nurse describes for the student nurse the risks associated with a breech birth which include: A. Cord prolapse B. Birth trauma C. Shoulder dystocia D. Vaginal bleeding

MC CHP 12 The perinatal nurse knows to assess for the uterine relaxation that occurs between contractions. This period of uterine relaxation is important for: (SA) A. Fetal oxygenation B. Maternal rest C. Lactic acid production D. Oxytocin production

MCH CHP 18 Infant admission documentation completed by the perinatal nurse includes information concerning the following: (SA) A. Passage of meconium B. Vitamin K injection site C. Ballard score D. Rectal temperature recording

MC CHP 13 The perinatal nurse understands that the advantages to a spinal anesthetic for a woman in labor include:(SA) A. Easy administration B. Immediate pain relief C. Minimal blood loss D. Good voluntary maternal expulsive

ABC

MC CHP 12 The perinatal nurse describes for the student nurse the lettering used to designate fetal position. The correct use includes: A. "P" indicating fetal pelvis location B. "P" indicating posterior maternal pelvis C. "M" indicating fetal mandible D. "A" indicating maternal anus

MC CHP 15 The postpartum nurse expects a postpartum woman's bladder function to return to normal within which length of time: A. 4-6 hours B. 6-8 hours C. 2-4 hours D. 8-12 hours

MC CHP 16 The perinatal nurse is caring for Maria, a 23-year-old G2 TPAL 1011 woman, who experienced 14 hours of labor prior to a cesarean birth for failure to progress. She is now 48 hours postbirth and is complaining of abdominal pain that is not relieved with medication given two hours ago. Her temperature is 100.8°F (38.2°C). The perinatal nurse is expected to obtain: A. An accurate blood pressure B. Incisional swab for culture and sensitivity C. An accurate pain assessment D. Additional orders for pain management

MCH CHP 16 As part of a postpartum woman's assessment, the perinatal nurse observes for signs and symptoms of hematoma formation. The most common anatomical location is in the: A. Rectum B. Vulva C. Cervix D. Episiotomy site

MCH CHP 16 The perinatal nurse is providing information to a postpartum woman who is being discharged from the hospital on warfarin (Coumadin) therapy. Instructions would include restrictions of which drug due to concern about interactions: A. Acetaminophen B. Ibuprofen C. Prenatal vitamins D. Docusate sodium

ATI MN 14 1. A nurse is caring for a client and her partner during the second stage of labor. The client's partner asks the nurse to explain how he will know when crowning occurs. Which of the following is an appropriate response by the nurse? A. "The placenta will protrude from the vagina." B. "Your partner will report a decrease in the intensity of contractions." C. "The vaginal area will bulge as the baby's head appears." D. "Your partner will report less rectal pressure."

1. A. INCORRECT: The appearance of the placenta occurs after crowning and the birth of the neonate. B. INCORRECT: Crowning occurs with an increase in the intensity of contractions and the urge to push. C. CORRECT: Crowning is bulging of the perineum and the appearance of the fetal head. D. INCORRECT: Crowning occurs with an increase in rectal pressure as the fetal head descends onto the perineum.

ATI MN 25 1. A nurse is giving instructions to a mother about how to breastfeed her newborn. Which of the following actions by the mother indicates understanding of the teaching? A. The mother places a few drops of water on her nipple before feeding. B. The mother gently removes her nipple from the infant's mouth to break the suction. C. When she is ready to breastfeed, the mother gently strokes the newborn's cheek with her finger. D. When latched on, the infant's nose, cheek, and chin are touching the breast.

1. A. INCORRECT: The infant is enticed to suck when the mother spreads colostrum on the nipple. B. INCORRECT: The mother should insert a finger in the side of the newborn's mouth to break the suction before removing her nipple. C. INCORRECT: The mother should stroke the newborn's lips with her nipple to promote sucking. D. CORRECT: Effective latching-on includes the infant's nose, cheek and chin touching the mother's breast.

ATI MN 19 2. A nurse is providing discharge instructions for a client. At 4 weeks postpartum, the client should contact her provider for which of the following client findings? A. Scant, nonodorous white vaginal discharge B. Uterine cramping during breastfeeding C. Sore nipple with cracks and fissures D. Decreased response with sexual activity

2. A. INCORRECT: Lochia alba, a white vaginal discharge, is normal from the 11th day postpartum to approximately 6 weeks following birth. B. INCORRECT: Oxytocin, which is released with breastfeeding, causes the uterus to contract and may cause discomfort. C. CORRECT: A sore nipple that has cracks and fissures is an indication of mastitis. D. INCORRECT: Physiological reactions to sexual activity may be slower and less intense for the first 3 months following birth.

ATI MN 23 2. A nurse is completing a newborn assessment and observes small white nodules on the roof of the newborn's mouth. This finding is a characteristic of which of the following conditions? A. Mongolian spots B. Milia spots C. Erythema toxicum D. Epstein's pearls

2. A. INCORRECT: Mongolian spots are dark areas observed in dark-skinned newborns. B. INCORRECT: Milia are small white bumps that occur on the nose due to clogged sebaceous glands. C. INCORRECT: Erythema toxicum is a transient maculopapular rash seen in newborns. D. CORRECT: Epstein's pearls are small white nodules that appear on the roof of a newborn's mouth.

ATI MN 25 2. A nurse is teaching a group of new parents about proper techniques for bottle feeding. Which of the following instructions should the nurse provide? A. Burp the newborn at the end of the feeding. B. Hold the newborn close in a supine position. C. Keep the nipple full of formula throughout the feeding. D. Refrigerate any unused formula.

2. A. INCORRECT: The newborn should be burped after each ½ oz of formula. B. INCORRECT: The newborn should be cradled in a semi-upright position. C. CORRECT: The nipple should always be kept full of formula to prevent the newborn from sucking in air during the feeding. D. INCORRECT: Any unused formula should be discarded due to the possibility of bacterial contamination.

ATI MN 24 4. A nurse is preparing to administer a vitamin K (Aquamephyton) injection to a newborn. Which of the following is an appropriate response by the nurse to the newborn's mother regarding why this medication is given? A. "It assists with blood clotting." B. "It promotes maturation of the bowel." C. "It is a preventative vaccine." D. "It provides immunity."

4. A. CORRECT: Vitamin K is deficient in a newborn because the colon is sterile. Until bacteria are present to stimulate vitamin K production, the newborn is at risk for hemorrhagic disease. B. INCORRECT: Vitamin K does not assist the bowel to mature. C. INCORRECT: Vitamin K is not part of the vaccines that are administered. D. INCORRECT: Vitamin K does not provide immunity.

ATI MN 20 2. A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following should be included in the discussion? (Select all that apply.) A. Precipitous delivery B. Lacerations C. Inversion of the uterus D. Oligohydramnios E. Retained placental fragments

2. A. CORRECT: A rapid, precipitous delivery is a risk factor for postpartum hemorrhage. B. CORRECT: The presence of lacerations is a risk factor for postpartum hemorrhage. C. CORRECT: Inversion of the uterus in a risk factor for postpartum hemorrhage. D. INCORRECT: Oligohydramnios does not place a client at risk for postpartum hemorrhage. E. CORRECT: Retained placental fragments is a risk factor for postpartum hemorrhage.

ATI MN 16 2. A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress? A. Hands and knees B. Lithotomy C. Trendelenburg D. Supine with a rolled towel under one hip

2. A. CORRECT: Having the client assume a position on her hands and knees may help the fetus rotate from a posterior to an anterior position. B. INCORRECT: The lithotomy position is when the client lies on her back with her knees elevated and is not used to facilitate labor progress. C. INCORRECT: The Trendelenburg position requires the client to lie on her back and does not assist in the rotation of the fetus. D. INCORRECT: The supine position with a rolled towel under one hip can assist in preventing vena cava syndrome but does not assist in the rotation of the fetus.

ATI MN Ch. 11 2. A nurse in the labor and delivery unit is caring for a client in labor and applies an external fetal monitor and tocotransducer. The FHR is around 140/min. Contractions are every 8 min and 30 to 40 seconds in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station. Which of the following stages and phases of labor is this client experiencing? A. The first stage, latent phase B. The first stage, active phase C. The first stage, transition phase D. The second stage of labor

2. A. CORRECT: In stage 1, latent phase, the cervix dilates from 0 to 3 cm, and contraction duration ranges from 30 to 45 seconds. B. INCORRECT: In stage 1, active phase, the cervix dilates from 4 to 7 cm, and contraction duration ranges from 40 to 70 seconds. C. INCORRECT: In stage 1, transition phase, the cervix dilates from 8 to 10 cm, and contraction duration ranges from 45 to 90 seconds. D. INCORRECT: The second stage of labor consists of the expulsion of the fetus.

ATI MN 20 3. A nurse on the postpartum unit is performing a physical assessment of a client who is being admitted with a suspected deep-vein thrombosis (DVT). Which of the following clinical findings should the nurse anticipate the client will exhibit? (Select all that apply.) A. Calf tenderness to palpation B. Swelling of the extremity C. Elevated temperature D. Area of warmth E. Report of nausea

3. A. CORRECT: A client report of calf tenderness to palpation is an expected finding in a client who has a DVT. B. CORRECT: Swelling of the affected extremity is an expected finding in a client who has a DVT. C. CORRECT: Elevated temperature is an expected finding in a client who has a DVT. D. CORRECT: An area of warmth over the thrombus is an expected finding in a client who has a DVT. E. INCORRECT: A report of nausea is not an expected finding in a client who has a DVT.

ATI MN 22 3. A nurse is caring for a postpartum client who delivered her third infant 2 days ago. The nurse recognizes that which of the following findings are suggestive of postpartum depression? (Select all that apply.) A. Fatigue B. Insomnia C. Euphoria D. Flat affect E. Crying

3. A. CORRECT: Fatigue is a finding suggestive of postpartum depression. B. CORRECT: Insomnia is a finding suggestive of postpartum depression. C. INCORRECT: Euphoria is not associated with postpartum depression. D. CORRECT: A flat affect is a finding suggestive of postpartum depression. E. CORRECT: Crying is a finding suggestive of postpartum depression.

ATI MN 26 3. A nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following are contraindications? (Select all that apply.) A. Hypospadias B. Hydrocele C. Familiar history of hemophilia D. Hyperbilirubinemia E. Epispadias

3. A. CORRECT: Hypospadias involves a defect in the location of the urethral opening and is a contraindication to circumcision. B. INCORRECT: Hydrocele, a collection of fluid in the scrotal sac, is not a contraindication to circumcision. C. CORRECT: A family history of hemophilia is a contraindication for circumcision. D. INCORRECT: Hyperbilirubinemia is not a contraindication for circumcision. E. CORRECT: Epispadias involves a defect in the location of the urethral opening and is a contraindication to circumcision.

ATI MN 14 4. A nurse in labor and delivery is planning care for a newly admitted client who reports she is in labor and has been having vaginal bleeding for 2 weeks. Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapsed cord. B. Perform a test to identify the ferning pattern. C. Monitor station of the presenting part. D. Defer vaginal examinations.

4. A INCORRECT: Active vaginal bleeding is not an indication of ruptured membranes. Therefore, the nurse should not anticipate cord prolapse. B. INCORRECT: A test for ferning is performed if there is suspected amniotic fluid and there is no indication of ruptured membranes. C. INCORRECT: Station is monitored by vaginal examination, which should not be performed if there is vaginal bleeding, which may be related to placenta previa or placenta abruptio. D. CORRECT: Vaginal examinations should not be performed until placenta previa or placenta abruptio has been ruled out as the cause of vaginal bleeding.

ATI MN 12 4. A nurse in the labor and delivery unit is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine (Xylocaine) for pain relief and perform an episiotomy. The nurse should know that the type of regional anesthetic block that is to be administered is which of the following? A. Pudendal block B. Epidural block C. Spinal block D. Paracervical block

4. A. CORRECT: A pudendal block is a transvaginal injection of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus. B. INCORRECT: Epidural blocks are administered during labor and allow the client to participate in the second stage while remaining comfortable. C. INCORRECT: Spinal blocks are administered in the late second stage but most commonly preceding a cesarean birth. D. INCORRECT: Paracervical blocks are used early in labor to block pain of uterine contractions but are rarely used today.

AtI MN 21 4. A nurse is caring for a client who has mastitis. Which of the following is the typical causative agent of mastitis? A. Staphylococcus aureus B. Chlamydia trachomatis C. Klebsiella pneumonia D. Clostridium perfringens

4. A. CORRECT: Staphylococcus aureus, Escherichia coli, and streptococcus are usually the infecting agents that enter the breast due to sore or cracked nipples, which results in mastitis. B. INCORRECT: Chlamydia trachomatis is a STI but not the causative agent of mastitis. C. INCORRECT: Klebsiella pneumonia is a causative agent of pneumonia. D. INCORRECT: Clostridium perfringens can cause wound infections but is not a causative agent of mastitis.

ATI MN 17 5. A nurse is caring for a client who is 1 hr following a vaginal birth and experiencing uncontrollable shaking. The nurse should understand that the shaking is due to which of the following? (Select all that apply.) A. A change in body fluids B. The metabolic effort of labor C. Diaphoresis D. A decrease in body temperature E. A decrease in prolactin levels

5. A. CORRECT: A shift in body fluids during the first 2 hr puerperium can cause a postpartum chill. B. CORRECT: The work of labor can cause a postpartum chill during the first 2 hr puerperium. C. INCORRECT: Diaphoresis is the mechanism by which the excess fluid of pregnancy is removed from the body. It usually occurs within the first 2 to 3 days following delivery. D. INCORRECT: An increase in body temperature is associated with a postpartum chill, but it is not the cause of it. E. INCORRECT: Changes in prolactin levels affect ovulation and menses and are not the cause of a postpartum chill.

ATI MN 15 5. A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly hired nurses. Which of the following statements by a nurse indicates understanding of the teaching? A. "They are administered in an oral form." B. "They act by absorbing fluid from tissues." C. "They promote dilation of the os." D. "They include an amniotomy."

5. A. CORRECT: Chemical agents that promote cervical ripening include medications administered in oral form. B. INCORRECT: Hygroscopic sponges, which are a mechanical method to promote cervical ripening, act by absorbing fluid from surrounding tissues to enlarge the cervical opening. C. INCORRECT: Mechanical and physical methods promote cervical ripening by dilation. D. INCORRECT: An amniotomy is a mechanical method to promote cervical ripening.

ATI MN Ch. 11 5. A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a bowel movement. She states, "I've had enough. I can't do this anymore. I want to go home right now." The nurse knows that these signs indicate the client is in the A. second stage of labor. B. fourth stage of labor. C. transition phase of labor. D. latent phase of labor.

5. A. INCORRECT: The second stage of labor occurs with the expulsion of the fetus. B. INCORRECT: The fourth stage of labor is the recovery period, following the delivery of the placenta. C. CORRECT: The transition phase of labor occurs when the client becomes irritable, feels rectal pressure similar to the need to have a bowel movement, and can become nauseous with emesis. D. INCORRECT: The latent phase of labor occurs in stage one, and coincides with mild contractions. The client is more relaxed, talkative, and eager for labor to progress.

MC CHP 12 When describing the "powers" of labor to a new nurse, the perinatal nurse discusses the uterine contractions and the: A. Woman's pushing efforts B. Unique musculature of the uterus C. Position of the fetus D. Hormonal influences regulating labor

MC CHP 13 In the first stage of labor, the perinatal nurse is aware that pain impulses are transmitted via: A. T11, T12 spinal nerve segments B. T9, T10 spinal nerve segments C. L4, L5 spinal nerve segments D. Sacral spinal nerve segments

MC CHP 13 Marianne, a 29 year old multigravid woman, was given promethazine (Phenergan) and meperidine hydrochloride (Demerol) during labor as part of her pain management. The perinatal nurse is aware that during the first 24 hours after birth, Marianne's infant will have an increased risk for: A. Hyperbilirubinemia B. Tachypnea C. Irritability D. Tremors

MC CHP 13 The perinatal nurse assists Teresa, a laboring woman, and her partner between contractions to increase their knowledge and ability to use breathing methods during the contractions. Teresa's use of breathing techniques during a contraction may decrease pain by: A. Reducing the capacity of nerve pathways to transmit pain B. Increasing the capacity of nerve pathways to transmit endorphins C. Decreasing her anxiety about labor D. Decreasing her distraction during her contractions

MC CHP 12 The perinatal nurse assesses Diane, a 22-year-old primigravida who has just arrived at the birth facility for labor assessment. Diane describes contractions that are 7 to 10 minutes apart, and felt in the abdomen. She states that the contractions "feel better" when she is walking. This is most likely: A. True labor B. Transition C. Early labor D. False labor

MCH CHP 16 The perinatal nurse, when using the acronym "LARRY" to remember the common causes of postpartum hemorrhage, is aware that the "L" refers to: A. Lacerations B. Loss of blood > 500 mL C. Low platelet count D. Low hemoglobin

MCH CHP 18 The nurse's use of prewarmed blankets to wrap the newborn at birth is intended to decrease heat loss by which mechanism: A. Evaporation B. Convection C. Conduction D. Radiation

ATI MN 20 1. A nurse is caring for a postpartum client. The nurse should understand that which of the following findings are the earliest indication of hypovolemia caused by hemorrhage? A. Increasing pulse and decreasing blood pressure B. Dizziness and increasing respiratory rate C. Cool, clammy skin, and pale mucous membranes D. Altered mental status and level of consciousness

1. A. CORRECT: A rising pulse rate and decreasing blood pressure are often the first indications of inadequate blood volume. B. INCORRECT: Dizziness and increased respiratory rate are findings that occur in hypovolemia, but they are not the earliest indicators. C. INCORRECT: Skin that is cool, clammy, and pale along with pale mucous membranes are changes that occur in the physical status of a client who has decreased blood volume, but they are not the first indicators of inadequate blood volume. D. INCORRECT: Altered mental status and changes in level of consciousness are late manifestations of decreased blood volume, which leads to hypoxia and low oxygen saturation.

ATI MN 19 1. A nurse is conducting a home visit for a client who is 2 weeks postpartum and breastfeeding. The client reports breast engorgement. Which of the following recommendations should the nurse make? A. "Apply cold compresses between feedings." B. "Take a warm shower right after feedings." C. "Apply breast milk to the nipples and allow them to air dry." D. "Use the various infant positions for feedings."

1. A. CORRECT: Cold compresses applied to the breasts between feedings can help with breast engorgement. B. INCORRECT: Taking a warm shower prior to feedings, not immediately after, can assist with the letdown reflex and milk flow. C. INCORRECT: Applying breast milk to the nipples and air drying is recommended for the client who has sore nipples; it has no effect on breast engorgement. D. INCORRECT: Using the various positions for feedings helps to prevent nipple soreness but has no effect on breast engorgement.

ATI MN 12 1. A nurse is caring for a client at 40 weeks of gestation who is experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take at this time? (Select all that apply.) A. Encourage the use of patterned breathing techniques. B. Insert an indwelling urinary catheter. C. Administer opioid analgesic medication as prescribed. D. Suggest application of cold. E. Provide ice chips.

1. A. CORRECT: Encouraging the use of patterned breathing techniques can assist with pain management at this time. B. INCORRECT: There is no indication for the insertion of an indwelling urinary catheter at this time. C. CORRECT: An opioid analgesic can be safely administered at this time. D. CORRECT: The use of a nonpharmacological approach, such as the application of cold, is an appropriate intervention at this time. E. INCORRECT: This action does not address the client's request for assistance with pain management.

MC CHP 19 A 42-week gestational aged newborn is assessed 20 hours after delivery by the nurse. On assessment the nurse auscultates rales and rhonchi, notes the newborn is tachypneic and has meconium stained nails. The nurse suspects that the newborn has: A. Sepsis B. Meconium aspiration pneumonia C. Transient tachypnea of the newborn (TTN) D. Respiratory distress syndrome (RDS)

ATI MN 15 1. A nurse is caring for a client who is at 42 weeks of gestation and is admitted to the labor and delivery unit. During an ultrasound, it is noted that the fetus is large for gestational age. The nurse reviews the prescription from the provider to begin an amnioinfusion. The nurse should know that an amnioinfusion is indicated for which of the following reasons? (Select all that apply.) A. Oligohydramnios B. Hydramnios C. Fetal cord compression D. Hydration E. Fetal immaturity

1. A. CORRECT: Oligohydramnios is an indication for an amnioinfusion because inadequate amniotic fluid can contribute to intrauterine growth restriction of the fetus, restrict fetal movement, and cause fetal distress during labor. B. INCORRECT: Hydramnios is excessive amniotic fluid. C. CORRECT: Oligohydramnios results in fetal cord compression, which decreases fetal oxygenation. Amnioinfusion prevents cord compression. D. INCORRECT: Amnioinfusion does not increase hydration. IV fluids or oral intake would provide this. E. INCORRECT: Fetal immaturity is not a reason for performing an amnioinfusion.

ATI MN 17 1. A nurse is performing a fundal assessment for a client in her second postpartum day and observes the client's perineal pad for lochia. She notes the pad to be saturated approximately 12 cm with lochia that is bright red in color and contains small clots. The nurse knows that this finding is A. moderate lochia rubra. B. excessive lochia rubra. C. light lochia rubra. D. scant lochia serosa.

1. A. CORRECT: The client has moderate lochia rubra containing small clots, which is an expected finding for the second day postpartum. B. INCORRECT: Excessive lochia rubra is saturation of a perineal pad in 15 min or less or pooling of blood under the client's buttocks. C. INCORRECT: Light lochia rubra is a perineal pad that is saturated less than 10 cm with lochia. D. INCORRECT: Scant lochia serosa (less than 2.5 cm area on perineal pad) is pinkish brown in color and serosanguineous in consistency. It occurs on day 4 to 12 following delivery.

ATI MN 13 1. A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds, and have beat-to-beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following? (Select all that apply.) A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR E. Fetal tachycardia

1. A. CORRECT: There is moderate variability of 20 beats/min (6 to 25/min is expected). B. CORRECT: FHR accelerations are present with increases up to 150 to 155/min lasting for 25 seconds. C. INCORRECT: There are no FHR decelerations because the FHR does not slow down. D. CORRECT: There is a normal baseline FHR of 115 to 125/min (110 to 160/min is expected). E. INCORRECT: There is no evidence of fetal tachycardia because there is a normal baseline FHR of 115 to 125/min.

ATI MN 23 1. A nurse is caring for a newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight. Based on the weight and gestational age, the nurse should classify this neonate as A. low birth weight. B. appropriate for gestational age. C. small for gestational age. D. large for gestational age

1. A. INCORRECT: A newborn who has a low birth weight would weigh less than 2,500 g. B. CORRECT: This newborn is classified as appropriate for gestational age because the weight is between the 10th and 90th percentile. C. INCORRECT: A newborn who is small for gestational age would weigh below the 10th percentile. D. INCORRECT: A newborn who is large for gestational age would weigh above the 90th percentile.

AtI MN 21 1. A nurse on the postpartum unit is caring for several clients. The nurse should recognize that the greatest risk for development of a postpartum infection is the client who A. experienced a precipitous labor less than 3 hr in duration. B. had premature rupture of membranes and prolonged labor. C. delivered a large for gestational age infant. D. had a boggy uterus that was not well-contracted

1. A. INCORRECT: A precipitous labor places the client at risk for trauma and lacerations during delivery, but there is another client who is at greater risk for postpartum infection. B. CORRECT: Premature rupture of membranes with prolonged labor poses the greatest risk for developing a postpartum infection because the birth canal was open, allowing pathogens to enter. C. INCORRECT: Delivery of a large infant places the client at risk for a postpartum infection, but there is another client who is at greater risk. D. INCORRECT: A boggy uterus that did not remain well-contracted places the client at risk for a postpartum infection, but there is another client who is at greater risk.

ATI MN Ch. 11 1. A nurse in the labor and delivery unit receives a phone call from a client who reports that her contractions started about 2 hr ago, did not go away when she had two glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 min and last about 30 seconds. She hasn't had any fluid leak from her vagina. However, she saw some blood when she wiped after voiding. Based on this report, the nurse should recognize that the client is experiencing A. Braxton Hicks contractions. B. rupture of membranes. C. fetal descent. D. true contractions.

1. A. INCORRECT: Braxton Hicks contractions decrease with hydration and walking. B. INCORRECT: Rupture of membranes would be indicated by the presence of a gush of fluid that is unrelated to the client's activity. C. INCORRECT: Fetal descent is the downward movement of the fetus in the birth canal and cannot be evaluated based on the client's report. D. CORRECT: True contractions do not go away with hydration or walking. They are regular in frequency, duration, and intensity and become stronger with walking.

ATI MN 26 1. A nurse is reviewing care of the umbilical cord with the parent of a newborn. Which of the following should be included in the teaching? A. Cover the cord with a small gauze square. B. Trickle clean water over the cord with each diaper change. C. Apply hydrogen peroxide to the cord twice a day. D. Keep the diaper folded below the cord.

1. A. INCORRECT: Covering the cord with a gauze square prevents the cord from drying and encourages infection. B. INCORRECT: The cord should be kept clean and dry, and water should not be applied to the cord. C. INCORRECT: The cord should be kept clean and dry. Hydrogen peroxide is not applied to the cord site. D. CORRECT: Folding the diaper below the cord prevents urine from the diaper penetrating the cord site.

MC CHP 15 The perinatal nurse is assessing Ruth, who has given birth 2 hours ago. The nurse notes a discoloration of the perineum and Ruth complains of pain and rectal pressure. The most appropriate action for the nurse is to: A. Call the health care provider to assess immediately. B. Increase IV fluids and request an order for ergonovine (Ergotrate). C. Reassure Ruth and her family that postpartum pain is normal and medication is available. D. Apply ice packs to the perineum as quickly as possible.

ATI MN 18 1. A nurse concludes that the father of an infant is not showing positive signs of parent-infant bonding and appears to be very anxious and nervous when the infant's mother asks him to bring her the infant. Which of the following is an appropriate nursing intervention to promote father-infant bonding? A. Hand the father the infant, and suggest that he change the diaper. B. Ask the father why he is so anxious and nervous. C. Tell the father that he will grow accustomed to the infant. D. Provide education about infant care when the father is present.

1. A. INCORRECT: It is not helpful to push the father into infant care activities without first providing education. B. INCORRECT: This is a nontherapeutic statement and presumes the nurse knows what the father is feeling. C. INCORRECT: This is a nontherapeutic statement and offers the nurse's opinion. D. CORRECT: Nursing interventions to promote paternal bonding include providing education about infant care and encouraging the father to take a hands-on approach.

ATI MN 24 1. A nurse is preparing to administer prophylactic eye ointment to a newborn to treat ophthalmia neonatorum. Which of the following medications should the nurse anticipate administering? A. Ofloxacin (Floxin) B. Nystatin (Mycostatin) C. Erythromycin (Romycin) D. Ceftriaxone (Rocephin)

1. A. INCORRECT: Ofloxacin is an antibiotic, but it is not used for ophthalmia neonatorum. B. INCORRECT: Nystatin is used to treat Candida albicans, an oral yeast infection. C. CORRECT: One medication of choice for ophthalmia neonatorum is erythromycin ophthalmic ointment 0.5%. This antibiotic provides prophylaxis against Neisseria gonorrhoeae and Chlamydia trachomatis. D. INCORRECT: Ceftriaxone is an antibiotic, but it is not used for ophthalmia neonatorum.

ATI MN 22 1. A nurse is assessing a postpartum client who is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown. The nurse knows these findings are characteristics of A. postpartum fatigue. B. postpartum psychosis. C. the letting-go phase. D. postpartum depression.

1. A. INCORRECT: Postpartum fatigue results from the work of labor. It is normally self-limiting. B. INCORRECT: The client who has postpartum psychosis will exhibit pronounced feelings of sadness, confusion, disorientation, hallucinations, delusions, and paranoia, and may attempt to harm herself or her infant. C. INCORRECT: The letting-go phase is the phase in which the client assumes her position at home and her new maternal role, focusing on the forward movement of the family unit. D. CORRECT: Postpartum depression in the client is characterized by tearfulness, insomnia, lack of appetite, and feeling let down.

ATI MN 16 1. A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse recognizes the adverse effect of this contraction pattern is A. prolonged labor. B. reduced fetal oxygen supply. C. delayed cervical dilation. D. increased maternal stress.

1. A. INCORRECT: Precipitous labor, not prolonged labor, is often the result of hypertonic contractions and inadequate uterine relaxation between contractions. B. CORRECT: Inadequate uterine relaxation results in reduced oxygen supply to the fetus. C. INCORRECT: Hypertonic contractions and inadequate relaxation of the uterus between contractions does not delay cervical dilation. D. INCORRECT: A contraction pattern of hypertonic contractions and inadequate relaxation between contractions will increase maternal distress, but this is not an adverse effect.

MC CHP 16 The perinatal nurse promotes postpartum health and prevents infection with the inclusion of critical information about: A. Good hand washing B. Early ambulation C. Minimal fluid intake D. Restricted protein intake

ATI MN 15 2. A nurse is caring for a client who has been in labor for 12 hr, and her membranes are intact. The provider has decided to perform an amniotomy in an effort to facilitate the progress of labor. The nurse performs a vaginal examination to ensure which of the following prior to the performance of the amniotomy? A. Fetal engagement B. Fetal lie C. Fetal attitude D. Fetal position

2. A. CORRECT: Prior to the performance of an amniotomy, the amniotic membranes should have ruptured. It is also imperative that the fetus is engaged at 0 station and at the level of the maternal ischial spines to prevent prolapse of the umbilical cord. B. INCORRECT: Fetal lie pertains to the axis of the maternal spine in relation to the fetal spine and is determined by Leopold maneuvers. C. INCORRECT: Fetal attitude is the relationship of the fetal extremities and chin to the fetal torso. It is determined by Leopold maneuvers. D. INCORRECT: Fetal position refers to the direction of a reference point in the fetal presenting part to the maternal pelvis. It is not a criterion when performing an amniotomy.

ATI MN 14 2. A nurse is caring for a client in the third stage of labor. Which of the following findings indicate that placental separation has occurred? (Select all that apply.) A. Lengthening of the umbilical cord. B. Swift gush of clear amniotic fluid. C. Softening of the lower uterine segment. D. Appearance of dark blood from the vagina. E. Fundus is firm upon palpation.

2. A. CORRECT: The umbilical cord lengthens as the placenta is being expulsed. B. INCORRECT: A sudden gush of clear amniotic fluid occurs when membranes rupture. C. INCORRECT: Softening of the lower uterine segment is not an indication of placental separation. D. CORRECT: A gush of dark blood from the introitus is an indication of placental separation. E. CORRECT: The uterus contracts firmly with placental separation.

ATI MN 12 3. A nurse is caring for a client following the administration of an epidural block and is preparing to administer a prescribed IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response by the nurse? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C. "It is needed to counteract hypotension." D. "It is needed to prevent oligohydramnios."

3. A. INCORRECT: Urinary output is not affected by an epidural block. B. INCORRECT: Oxygen is administered to counteract respiratory depression that can occur following an epidural block. C. CORRECT: Maternal hypotension can occur following an epidural block and can be offset by administering an IV fluid bolus. D. INCORRECT: Oligohydramnios does not occur as a result of an epidural block.

ATI MN 17 2. During ambulation to the bathroom, a postpartum client experiences a gush of dark red blood that soon stops. On assessment, a nurse finds the client's uterus to be firm and midline and at the level of the umbilicus. The nurse interprets this finding as A. evidence of a possible vaginal hematoma. B. an indication of a cervical or perineal laceration. C. a normal postural discharge of lochia. D. abnormally excessive lochia rubra flow.

2. A. INCORRECT: A client who has a vaginal hematoma may report excessive pain or vaginal pressure. B. INCORRECT: Excessive spurting of bright red blood from the vagina indicates a possible cervical or perineal laceration. C. CORRECT: Lochia typically trickles from the vaginal opening but flows more steadily during uterine contractions. Massaging the uterus or ambulation may result in a gush of lochia with the expression of clots and dark blood that has been pooled in the vagina, but it should soon decrease back to a trickle of bright red lochia in the early puerperium. D. INCORRECT: Excessive blood loss consists of one pad saturated in 15 min or less or the pooling of blood under the buttocks, which is not affected by the client's postural changes.

ATI MN 12 2. A nurse is caring for a client who is in active labor. The client reports lower back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions is appropriate? A. Abdominal effleurage B. Sacral counterpressure C. Showering if not contraindicated D. Back rub and massage

2. A. INCORRECT: Abdominal effleurage is an appropriate pain management technique but does not address the pressure on the pelvis due to the fetal position. B. CORRECT: Sacral counterpressure to the lower back relieves the pressure exerted on the pelvis and spinal nerves by the fetus. C. INCORRECT: A shower is an appropriate pain management strategy but does not address the pressure on the pelvis due to the fetal position. D. INCORRECT: A back rub with massage is an appropriate pain management strategy but does not address the pressure on the pelvis due to the fetal position.

ATI MN 24 2. A newborn was not dried completely after delivery. The nurse should understand that which of the following mechanisms causes the newborn to lose heat? A. Conduction B. Convection C. Evaporation D. Radiation

2. A. INCORRECT: Conduction is the loss of heat from the body surface area to cooler surfaces that the newborn may be in contact with. B. INCORRECT: Convection is the flow of heat from the body surface area to cooler air. C. CORRECT: Evaporation is the loss of heat that occurs when a liquid is converted to a vapor. In a newborn, heat loss by evaporation occurs as a result of vaporization of the moisture from the skin. D. INCORRECT: Radiation is the loss of heat to a cooler surface that is not in direct contact with the newborn.

ATI MN 22 2. A nurse is caring for a client who has postpartum depression. Which of the following are expected findings? (Select all that apply.) A. Disappointment in the characteristics of the infant B. Concerns about lack of income to pay bills C. Anxiety about assuming a new role as a mother D. Rapid decline in estrogen and progesterone E. Postpartum physical discomfort and/or pain

2. A. INCORRECT: Disappointment in the characteristics of the infant would be an indication of impaired mother-infant bonding. B. CORRECT: Feelings of financial inadequacy to provide for family is a finding associated with postpartum depression. C. CORRECT: A client's anxiety about assuming a new role as a mother is a finding associated with postpartum depression. D. CORRECT: The rapid decline in estrogen and progesterone is a finding associated with postpartum depression. E. CORRECT: Physical discomfort and/or pain is a finding associated with postpartum depression.

AtI MN 21 2. A nurse is teaching a client who is breastfeeding and has mastitis. Which of the following is an appropriate statement by the nurse? A. "Limit the amount of time the infant nurses on each breast." B. "Nurse the infant only on the unaffected breast until resolved." C. "Completely empty each breast at each feeding or use a pump." D. "Wear a tight-fitting bra until lactation has ceased."

2. A. INCORRECT: Frequent, on-demand breastfeeding should be encouraged to promote milk flow. B. INCORRECT: The client should be instructed to continue breastfeeding, especially on the affected side. C. CORRECT: Instruct the client to completely empty each breast at each feeding to prevent milk stasis, which provides a medium for bacterial growth. D. INCORRECT: The client should wear a well-fitting bra, not one that is too tight or a binder.

ATI MN 13 2. A nurse is caring for a client who is having an induction of labor. Based on the use of external electronic fetal monitoring, the nurse notes that the FHR variability is decreased and resembles a straight line. The client has not received pain medication. Which of the following should occur first before the nurse can apply an internal scalp electrode? A. Dilation B. Rupture of the membranes C. Effacement D. Engagement

2. A. INCORRECT: The cervix must be dilated 2 to 3 cm before internal monitoring can be used, but this is not the first criterion to consider. B. CORRECT: The membranes must be ruptured prior to the insertion of an internal electrode or intrauterine pressure catheter. C. INCORRECT: Effacement of the cervix must occur before internal monitoring can be used, but this is not the first criterion to consider. D. INCORRECT: Engagement of the presenting part must occur before internal monitoring can be used, but this is not the first criterion to consider.

ATI MN 26 2. A nurse is providing discharge teaching to the parents of a newborn regarding circumcision care. Which of the following statements made by a parent indicates a need for further clarification? A. "His circumcision will heal within a couple of weeks." B. "I do not need to remove the yellow mucus that will form." C. "I will clean his penis with each diaper change." D. "I will give him a tub bath within a couple of days."

2. A. INCORRECT: The circumcision will heal within a couple of weeks. This statement reflects understanding of the teaching. B. INCORRECT: The yellow mucus should remain in place as part of the healing process. C. INCORRECT: The penis should be cleaned with warm water with each diaper change. D. CORRECT: A tub bath should not be given until the circumcision is healed, which occurs within a couple of weeks.

MC CHP 14 The perinatal nurse is caring for Christy, a 22-year-old G3 TPAL 1011, who is 9 cm. dilated and contracting every 2 to 3 minutes. Her labor has been rapid and she has been admitted in the last 30 minutes. Christy's membranes rupture spontaneously and the perinatal nurse is not able to auscultate the fetal heart. The most immediate nursing action is to: A. Check the perineum for the possibility of a prolapsed umbilical cord. B. Reposition the Doppler to attempt to auscultate the fetal heart rate. C. Reposition Christy to a left lateral position. D. Reassure Christy that her labor is progressing well.

ATI MN 18 2. A client in the early postpartum period is very excited and talkative. She is repeatedly telling the nurse every detail of her labor and birth. Because the client will not stop talking, the nurse is having difficulty completing the postpartum assessments. The appropriate action by the nurse is to A. come back later when the client is more cooperative. B. give the client time to express her feelings. C. tell the client she needs to be quiet so the assessment can be completed. D. redirect the client's focus so that she will become quiet.

2. A. INCORRECT: The nurse should not delay completing assessments, but continue her activities while encouraging the client to talk. B. CORRECT: The nurse should recognize that the client in is the taking-in phase, which begins immediately following birth and lasts a few hours to a couple of days. C. INCORRECT: It is not necessary for the client to stop talking while the nurse completes the needed assessments. D. INCORRECT: The client is in the taking-in phase, which includes talking about the birth experience. The client should be encouraged.

MC CHP 14 The perinatal nurse understands that one of the risks of oxytocin infusion includes fetal heart rate changes related to: A. Decreased placental perfusion B. Oligohydramnios C. Maternal hypotonic contractions D. Maternal hypotension

ATI MN 18 3. A nurse is caring for a client who is 1 day postpartum. The nurse is assessing for maternal adaptation and mother-infant bonding. Which of the following behaviors by the client indicates a need for the nurse to intervene? (Select all that apply.) A. Demonstrates apathy when the infant cries B. Touches the infant and maintains close physical proximity C. Views the infant's behavior as uncooperative during diaper changing D. Identifies and relates infant's characteristics to those of family members E. Interprets the infant's behavior as meaningful and a way of expressing needs

3. A. CORRECT: This behavior demonstrates a lack of interest in the infant and impaired maternal-infant bonding. B. INCORRECT: Touching the infant and maintaining close proximity are signs of effective maternal-infant bonding. C. CORRECT: A client's view of her infant as being uncooperative during diaper changing is a sign of impaired maternal-infant bonding. D. INCORRECT: Endowing the infant with family characteristics indicates effective maternal-infant bonding. E. INCORRECT: Recognizing the infant's behavior as meaningful and a way to express needs is an indication of effective maternal-infant bonding.

ATI MN 16 3. A nurse is caring for a client who is admitted to the labor and delivery unit. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? A. Precipitous labor B. Premature rupture of membranes C. Postmaturity syndrome D. Prolapsed umbilical cord

3. A. INCORRECT: Breech presentation would most likely cause dystocia (prolonged, difficult labor) rather than a precipitous labor. B. INCORRECT: Breech presentation has no effect on rupture of the membranes. C. INCORRECT: Breech presentation is not associated with postmaturity syndrome. D. CORRECT: A prolapsed umbilical cord is a potential complication for a fetus in a breech presentation.

ATI MN 23 3. A nurse is assessing the reflexes of a newborn. In checking for the Moro reflex, the nurse should perform which of the following? A. Make a loud noise such as clapping hands together over the newborn's crib. B. Stimulate the pads of the newborn's hands with stroking or massage. C. Stimulate the soles of the newborn's feet on the outer lateral surface of each foot. D. Hold the newborn in a semisitting position, then allow the newborn's head and trunk to fall backward.

3. A. INCORRECT: Clapping hands elicits the startle reflex. B. INCORRECT: Stimulating the pads of the newborn's hands elicits the grasp reflex. C. INCORRECT: Stimulating the outer lateral portion of the newborn's soles elicits Babinski's reflex. D. CORRECT: The Moro reflex is elicited by holding the newborn in a semi-sitting position and then allowing the head and trunk to fall backward.

ATI MN 13 3. A nurse is reviewing the electronic monitor tracing of a client who is in active labor. The nurse knows that a fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions

3. A. INCORRECT: Compression of the arteries to the uteroplacental intervillous spaces is most acute at the peak (acme) of the uterine contraction, resulting in a decrease in fetal circulation and oxygenation. B. INCORRECT: Moderate variability indicates fluctuations in the fetal heart and is not an indication the fetus is receiving more oxygen. C. INCORRECT: FHR accelerations indicate an intact fetal CNS and is not an indication the fetus is receiving more oxygen. D. CORRECT: A fetus is most oxygenated during the relaxation period between contractions. During contractions, the arteries to the uteroplacental intervillous spaces are compressed, resulting in a decrease in fetal circulation and oxygenation.

ATI MN 24 3. When performing nursing care for a newborn after birth, which of the following nursing interventions is the highest priority? A. Initiating breastfeeding B. Performing the initial bath C. Giving a vitamin K injection D. Covering the newborn's head with a cap

3. A. INCORRECT: Initiating breastfeeding is important following birth, but it is not the priority action. B. INCORRECT: Initial baths aren't given until the newborn's temperature is stable. It is not the priority action. C. INCORRECT: Vitamin K can be given immediately after birth, but it is not the priority action. D. CORRECT: The greatest risk to the newborn is cold stress. Therefore the highest priority intervention is to prevent heat loss. Covering the newborn's head with a cap prevents cold stress due to excessive evaporative heat loss.

AtI MN 21 3. A nurse is reviewing discharge teaching with a client who has a urinary tract infection. Which of the following statements by the client indicates understanding of the teaching? (Select all that apply.) A. "I will perform peri care and apply a perineal pad in a back-to-front direction." B. "I will drink cranberry and prune juices to make my urine more acidic." C. "I will drink large amounts of fluids to flush the bacteria from my urinary tract." D. "I will go back to breastfeeding after I have finished taking the antibiotic." E. "I will take Tylenol for any discomfort."

3. A. INCORRECT: Perineal cleansing and pad application should be done front to back, not back to front. B. CORRECT: Acidification of urine inhibits bacterial multiplication. C. CORRECT: Increased fluid intake can help to flush the bacteria from the urinary tract. D. INCORRECT: Breastfeeding does not have to be delayed until the course of antibiotics is completed. E. CORRECT: Acetaminophen (Tylenol) is taken to reduce discomfort and pain associated with a urinary tract infection.

ATI MN 17 3. A nurse is assessing a postpartum client for fundal height, location, and consistency. The fundus is found to be displaced laterally to the right, and there is uterine atony. Which of the following is the cause of the uterine atony? A. Poor involution B. Urinary retention C. Hemorrhage D. Infection

3. A. INCORRECT: Poor involution is the result of uterine atony and does not cause it. B. CORRECT: Urinary retention can result in a distention of the bladder. A distended bladder can cause uterine atony and lateral displacement from the midline, usually to the right. C. INCORRECT: Hemorrhage is the result of uterine atony and does not cause it. D. INCORRECT: Infection does not cause uterine displacement or atony and would be characterized by foul-smelling vaginal discharge and elevated temperature.

ATI MN 19 3. A nurse is conducting a home visit with a client who is 3 months postpartum and breastfeeding. Menses has not yet resumed. The client is discussing contraception with the nurse, stating that she does not want to have another child for a couple of years. The nurse understands that this client needs further instruction if the client makes which of the following statements? A. "I have already started using the mini pill for protection." B. "Because of our beliefs, we are going to use the rhythm method." C. "I am being refitted for a diaphragm by my doctor next week." D. "I will begin using birth control when I stop breastfeeding."

3. A. INCORRECT: Progesterone-only oral contraceptives (mini pills) are a good form of birth control once lactation has been established. B. INCORRECT: The rhythm method is a less effective method of birth control, but a client's choice based on personal beliefs should be supported. C. INCORRECT: The client is correct in having her diaphragm refitted by the provider, which should be done after a pregnancy and birth or a 7 kg (15 lb) weight change. D. CORRECT: Lactation does not prevent pregnancy, even if menses has not yet resumed.

ATI MN 15 3. A nurse is caring for client who had no prenatal care, is Rh-negative and will undergo an external version at 37 weeks of gestation. The nurse anticipates a prescription for which of the following medications to be administered prior to the version? A. Prostaglandin gel (Cervidil) B. Magnesium sulfate C. RhO(D) immune globulin (RhoGAM) D. Oxytocin (Pitocin)

3. A. INCORRECT: Prostaglandin gel is a cervical ripening agent and is not administered prior to an external version. B. INCORRECT: Magnesium sulfate is a tocolytic, which may be administered prior to the version. But because the client had no prenatal care and is Rh-negative, there is another medication the nurse should anticipate administering. C. CORRECT: RhO(D) immune globulin (RhoGAM) is administered to a Rh-negative client at 28 weeks of gestation. Because this client had no prenatal care, it should be given prior to the version to prevent isoimmunization. D. INCORRECT: Oxytocin is administered to increase contraction frequency, intensity and duration. It is not administered prior to an external version.

ATI MN 25 3. A nurse is caring for a newborn. Which of the following actions by the newborn indicates readiness to feed? A. Spits up clear mucus B. Attempts to place his hand in his mouth C. Turns his head toward sounds D. Lies quietly with his eyes open

3. A. INCORRECT: Spitting up, coughing, or gagging on mucus is an attempt by the newborn to clear his airway. B. CORRECT: Readiness-to-feed cues include the newborn making hand-to-mouth and hand-to-hand movements, sucking motions, rooting, and mouthing. C. INCORRECT: The infant turns his head toward sounds in the environment as a sensory response indicating normal central nervous system functioning. D. INCORRECT: Lying quietly with eyes open is an alerting behavior, indicating normal newborn reactivity.

ATI MN Ch. 11 3. A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. The nurse's first nursing action after establishing that the fluid is amniotic fluid should be to A. assess the amniotic fluid for meconium. B. monitor the FHR for distress. C. dry the client and make her comfortable. D. monitor the client's uterine contractions.

3. A. INCORRECT: The nurse assesses the color, clarity, odor, and amount of amniotic fluid, but this is not the first action the nurse should take. B. CORRECT: The greatest risk to the client and fetus is umbilical cord prolapse, leading to fetal distress following rupture of membranes. Therefore, the first action by the nurse is to monitor the FHR for signs of distress. C. INCORRECT: The nurse should provide comfort by drying the client following rupture of the membranes, but this is not the first action the nurse should take. D. INCORRECT: The nurse monitors the client's uterine contraction pattern after rupture of the membranes, but this is not the first action the nurse should take.

ATI MN 14 3. A nurse is caring for a client who is in the transition phase of labor and reports that she needs to have a bowel movement with the peak of contractions. Which of the following is an appropriate nursing intervention? A. Assist the client to the bathroom. B. Prepare for an impending delivery. C. Prepare to remove a fecal impaction. D. Encourage the client to take deep, cleansing breaths.

3. A. INCORRECT: The urge to have a bowel movement indicates fetal descent and complete dilation. Assisting the client to the bathroom is not an appropriate action in view of the impending delivery. B. CORRECT: The urge to have a bowel movement indicates fetal descent and complete dilation. Preparing for an imminent delivery is appropriate. C. INCORRECT: The nurse cleanses the perineal area to remove fecal matter that can be expelled due to the descent of the fetus. The nurse does not prepare to remove an impaction. D. INCORRECT: Deep cleansing breaths are encouraged between contractions. The client will be encouraged to push because the sensation of a bowel movement indicates complete dilation and fetal descent.

MC CHP 14 When reviewing hypotonic labor, the perinatal nurse explains to a student nurse that the leading cause of this dysfunctional labor pattern is: A. Fetal macrosomia B. Maternal android pelvis C. Inadequate uterine pacemakers D. Fetal occiput posterior position

ATI MN 13 4. A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position. B. Apply a fetal scalp electrode. C. Insert an IV catheter. D. Perform a vaginal exam.

4. A. CORRECT: The greatest risk to the fetus during late decelerations is uteroplacental insufficiency. The initial nursing action should be to place the client into the left-lateral position to increase uteroplacental perfusion. B. INCORRECT: The application of a fetal scalp electrode will assist in the assessment of fetal well-being, but this is not the first action the nurse should take. C. INCORRECT: Inserting an IV catheter is an intervention for late decelerations, but this is not the first action the nurse should take. D. INCORRECT: The nurse may perform a vaginal exam to assess dilation, but this is not the first action the nurse should take.

ATI MN 17 4. A nurse is completing postpartum discharge teaching to a client who had no immunity to varicella and was given varicella vaccine. Which of the following statements by the client indicates understanding of the teaching? A. "I will need to use contraception for 3 months before considering pregnancy." B. "I need a second vaccination at my postpartum visit." C. "I was given the vaccine because my baby is O-positive." D. "I will be tested in 3 months to see if I have developed immunity."

4. A. INCORRECT: A client is instructed to not get pregnant for 1 month following administration of varicella vaccine. B. CORRECT: A second varicella immunization is needed at 4 to 8 weeks following delivery by clients who had no history of immunity. C. INCORRECT: RHO(D) immune globulin is administered to a Rh-negative mother who has a Rh-positive newborn. D. INCORRECT: A client requires testing for immunity at 3 months following administration of rubella vaccine and RhoGAM.

ATI MN Ch. 11 4. A nurse in labor and delivery is completing an admission history for a client who is at 39 weeks of gestation. The client reports that she has been leaking fluid from her vagina for 2 days. The nurse knows that this client is at risk for A. cord prolapse. B. infection. C. postpartum hemorrhage. D. hydramnios.

4. A. INCORRECT: Although cord prolapse is a risk with rupture of membranes, it occurs when the fluid rushes out, rather than trickling or leaking out. B. CORRECT: Rupture of membranes for longer than 24 hr prior to delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus. C. INCORRECT: The risk for postpartum hemorrhage by this client is not any greater than other clients who are pregnant. D. INCORRECT: This client is more likely to have oligohydramnios or insufficient amniotic fluid, rather than hydramnios, or excess amniotic fluid.

ATI MN 19 4. A nurse is providing care to multiple clients on the postpartum unit. Which of the following clients is at greatest risk for developing a puerperal infection? A. A client who has an episiotomy that is erythematous and has extended into a third-degree laceration B. A client who does not wash her hands between perineal care and breastfeeding C. A client who is not breastfeeding and is using measures to suppress lactation D. A client who has a cesarean incision that is well-approximated with no drainage

4. A. INCORRECT: An episiotomy with a laceration is at risk for an infection, but there is a client who is at greater risk for a puerperal infection. B. CORRECT: The client who does not wash her hands between perineal care and breastfeeding is at an increased risk for developing mastitis. Therefore, she is most at risk for developing a puerperal infection. C. INCORRECT: A client who is suppressing lactation (increases the risk of milk stasis) is at risk for an infection, but there is a client who is at greater risk for a puerperal infection. D. INCORRECT: A client who has an abdominal incision is at risk for an infection, but there is a client who is at greater risk for a puerperal infection.

ATI MN 25 4. A nurse is reviewing formula preparation with parents who plan to bottle feed their newborn. Which of the following should be included in the teaching? (Select all that apply.) A. Use a disinfectant wipe to clean the lid of the formula can. B. Store prepared formula in the refrigerator for up to 72 hr. C. Place used bottles in the dishwasher. D. Check the nipple for appropriate flow of formula. E. Use tap water to dilute concentrated formula.

4. A. INCORRECT: Chemicals from the disinfectant wipe can remain on the lid during opening and mix with the formula. B. INCORRECT: Once formula is prepared, it can be refrigerated for up to 48 hr. C. CORRECT: Bottles can be placed in a dishwasher or washed by hand in hot soapy water using a good bottle brush. D. CORRECT: The flow of formula from the nipple should be checked to determine that it is not too fast or too slow. E. CORRECT: Tap water is used to mix concentrated or powder formula. If the water is from a questionable source, it should be boiled first.

ATI MN 23 4. A nurse is completing an assessment. Which of the following data indicate the newborn is adapting to extrauterine life? (Select all that apply.) A. Expiratory grunting B. Inspiratory nasal flaring C. Apnea for 10-second periods D. Obligatory nose breathing E. Crackles and wheezing

4. A. INCORRECT: Expiratory grunting is a manifestation of respiratory distress. B. INCORRECT: Nasal flaring is a manifestation of respiratory distress. C. CORRECT: Periods of apnea lasting less than 15 seconds are an expected finding. D. CORRECT: Newborns are obligatory nose breathers. E. INCORRECT: Crackles and wheezing are symptoms of fluid or infection in the lungs.

ATI MN 26 4. A nurse is caring for a newborn immediately following a circumcision using a Gomco procedure. Which of the following is an appropriate nursing intervention? A. Apply Gelfoam powder to the site. B. Place the newborn in the prone position. C. Apply petroleum gauze to the site. D. Avoid changing the diaper until the first voiding.

4. A. INCORRECT: Gelfoam powder is used to control bleeding when there is a risk for hemorrhage. B. INCORRECT: Newborns should not be placed in the prone position. C. CORRECT: Petroleum gauze is applied to the site for 24 hr to prevent the skin edges from sticking to the diaper. D. INCORRECT: Diapers are changed more frequently to inspect the site.

ATI MN 16 4. A nurse is caring for a client who is at 42 weeks of gestation and in active labor. The nurse should understand that the fetus is at risk for which of the following? A. Intrauterine growth restriction B. Hyperglycemia C. Meconium aspiration D. Polyhydramnios

4. A. INCORRECT: Intrauterine growth restriction occurs earlier in the pregnancy and not at this point. B. INCORRECT: A postterm neonate is at risk for hypoglycemia, not hyperglycemia. C. CORRECT: Postterm neonates are at risk for aspiration of meconium. D. INCORRECT: Postterm pregnancies result in oligohydramnios, not polyhydramnios.

ATI MN 20 4. A nurse on the postpartum unit is planning care for a client who has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care? A. Apply cold compresses to the affected extremity. B. Massage the affected extremity. C. Allow the client to ambulate. D. Measure leg circumferences.

4. A. INCORRECT: The nurse should plan to apply warm compresses to the affected extremity. B. INCORRECT: The nurse should not massage the affected extremity. This action may result in dislodgement of the clot. C. INCORRECT: The client should be encouraged to rest with the affected extremity elevated. D. CORRECT: The nurse should plan to measure the circumference of the leg to assess for changes in the client's condition.

ATI MN 15 4. A nurse is caring for a client who is receiving oxytocin (Pitocin) for induction of labor and has an intrauterine pressure catheter (IUPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? A. Frequency of every 2 min B. Duration of 90 to 120 seconds C. Intensity of 60 to 90 mm Hg D. Resting tone of 15 mm Hg

4. A. INCORRECT: This contraction pattern does not require discontinuing the infusion of oxytocin. B. CORRECT: Oxytocin is discontinued if uterine hyperstimulation occurs with contraction duration longer than 90 seconds. C. INCORRECT: This contraction pattern does not require discontinuing the infusion of oxytocin. D. INCORRECT: This contraction pattern does not require discontinuing the infusion of oxytocin.

MC CHP 15 In the preadmission clinic, the perinatal nurse describes the advantages to a short hospital stay as including: A. Decreased risk of nosocomial infection B. Increased rest and recuperation C. Increased opportunity to initiate successful breastfeeding D. Increased teaching about infant care

ATI MN 18 4. A home-health nurse is conducting a visit to the home of a client who has a 2-month-old infant and a 4-year-old son. The client expresses frustration about the behavior of the 4-year-old who was previously toilet trained and is now frequently wetting himself. The nurse should provide education and explains to the client that A. her son was probably not ready for toilet training and should wear training pants. B. her son is showing an adverse sibling response. C. this indicates the child requires counseling. D. this can be resolved by sending the child to preschool.

4. A. INCORRECT: This is not an appropriate intervention by the nurse because it overlooks the child's emotional response to a new family member. B. CORRECT: Adverse responses by a sibling to a new infant can include regression in toileting habits. C. INCORRECT: Recommending that the child receive counseling is not an appropriate nursing intervention for a child who is demonstrating an adverse sibling response. D. INCORRECT: Recommending that the child be sent to preschool is not an appropriate nursing intervention for a child who is demonstrating an adverse sibling response.

ATI MN 20 5. A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for this client? A. Preeclampsia B. Thrombophlebitis C. Placenta previa D. Hyperemesis gravidarum

5. A. CORRECT: DIC may occur secondary in a client who has preeclampsia. B. INCORRECT: Thrombophlebitis is not a risk factor for DIC. C. INCORRECT: Placenta previa is not a risk factor for DIC. D. INCORRECT: Hyperemesis gravidarum is not a risk factor for DIC.

ATI MN 23 5. A nurse is preparing to bathe a newborn and observes a bluish marking across the newborn's lower back. The nurse should understand that this mark is A. frequently seen in newborns who have dark skin. B. a finding indicating hyperbilirubinemia. C. a forceps mark from an operative delivery. D. related to prolonged birth or trauma during delivery.

5. A. CORRECT: Mongolian spots are commonly found over the lumbosacral area of newborns who have dark skin and are of African American, Asian, or Native American origin. B. INCORRECT: Hyperbilirubinemia would present as jaundice. C. INCORRECT: Forceps marks would most likely present as a cephalohematoma. D. INCORRECT: Birth trauma would present as ecchymosis.

ATI MN 14 5. A nurse is caring for a client who is in the first stage of labor and encourages the client to void every 2 hr. The nurse explains that a A. full bladder increases the risk for fetal trauma. B. full bladder increases the risk for bladder infections. C. distended bladder will be traumatized by frequent pelvic exams. D. distended bladder reduces pelvic space needed for birth.

5. A. INCORRECT: A full bladder does not place the fetus at risk for trauma. B. INCORRECT: Urinary stasis, which occurs due to long periods between voiding, increases the risk for bladder infections. C. INCORRECT: The urethra may be traumatized by frequent pelvic exams. D. CORRECT: A distended bladder reduces pelvic space, impedes fetal descent, and places the bladder at risk for trauma during the labor process.

ATI MN 25 5. A nurse is reviewing breastfeeding positions with the mother of a newborn. Which of the following is an appropriate position for the nurse to discuss? A. Over-the-shoulder position B. Supine position C. Chin-supported position D. Cradle position

5. A. INCORRECT: An over-the-shoulder position can be used when burping the newborn. B. INCORRECT: The supine position is appropriate for the sleeping newborn. C. INCORRECT: Holding the newborn upright with the chin supported is a position that can be used when burping the newborn. D. CORRECT: The cradle position for breastfeeding includes the mother laying the newborn across her forearm with her hand supporting the lower back and buttocks.

MC CHP 15 In the immediate postpartum period, the perinatal nurse knows that the postpartum woman most often has a: A. Bradycardia B. Tachycardia C. Pulse within the normal adult range D. Tachycardia then a pulse rate that returns to normal in 4 hours

ATI MN 24 5. A nurse is taking a newborn to a mother for breastfeeding. Which of the following is an appropriate action for the nurse to take for security purposes? A. Ask the mother to state her full name. B. Look at the name on the newborn's bassinet. C. Match the mother's identification band with the newborn's band. D. Compare name on the bassinet and room number

5. A. INCORRECT: Asking the mother to state her full name is not appropriate verification because two identifiers should be used. B. INCORRECT: Looking at the name on the bassinet is not appropriate verification because two identifiers should be used. C. CORRECT: Each time the newborn is taken to the mother, the identification band should be verified against the mother's identification band. D. INCORRECT: Comparing the name on the bassinet with the room number is not appropriate verification because it does not include two identifiers involving the mother and newborn.

ATI MN 19 5. A nurse is providing discharge instructions to a postpartum client following a cesarean birth. The client reports leaking urine every time she sneezes or coughs. Which of the following should the nurse suggest? A. Performing sit-ups B. Performing pelvic tilt exercises C. Doing Kegel exercises D. Doing abdominal crunches

5. A. INCORRECT: Sit-ups should not be performed until after the postpartum follow-up appointment. B. INCORRECT: Pelvic tilt exercises consist of the alternate arching and straightening of the back to strengthen the back muscles and relieve back discomfort. C. CORRECT: Kegel exercises consist of the voluntary contraction and relaxation of the pubococcygeal muscle to strengthen the pelvic muscles, which will assist the client in decreasing urinary stress incontinence that occurs with sneezing and coughing. D. INCORRECT: Abdominal crunches should not be performed until after the postpartum follow-up appointment.

ATI MN 12 5. A nurse in the labor and delivery unit is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min. B. Apply a warm blanket. C. Assist the client to a side-lying position. D. Place an oxygen mask over the client's nose and mouth.

5. A. INCORRECT: The client is experiencing hyperventilation caused by low levels of serum PCO2. Supplying additional oxygen will not resolve this issue. B. INCORRECT: The client is experiencing hyperventilation caused by low levels of serum PCO2. Applying a warm blanket will not resolve this issue. C. INCORRECT: The client is experiencing hyperventilation caused by low serum levels of PCO2. Assisting the client to a side-lying position will not resolve this issue. D. CORRECT: The client is experiencing hyperventilation caused by low serum levels of PCO2. Placing an oxygen mask over the client's nose and mouth or having the client breathe into a paper bag will reduce the intake of oxygen, allowing the PCO2 to rise and alleviate the numbness and tingling.

ATI MN 18 5. A nurse in the delivery room is planning to promote maternal-infant bonding for a client who just delivered. Which of the following is the priority action by the nurse? A. Encourage the parents to touch and explore the neonate's features. B. Limit noise and interruption in the delivery room. C. Place the neonate at the client's breast. D. Place the neonate skin-to-skin on the client's chest.

5. A. INCORRECT: This is an appropriate action, but there is another priority nursing intervention. B. INCORRECT: This is an appropriate action, but there is another priority nursing intervention. C. INCORRECT: This is an appropriate action, but there is another priority nursing intervention. D. CORRECT: Placing the neonate in the en face position on the client's chest immediately after birth is the priority nursing intervention to promote maternal-infant bonding.

ATI MN 26 5. A nurse is reviewing car seat safety with the parents of a newborn. The nurse instructs the parents to restrain the newborn in a car seat in the A. front seat, rear-facing position. B. front seat, forward-facing position. C. back seat, rear-facing position. D. back seat, forward-facing position.

5. A. INCORRECT: This is not an appropriate position for the car seat. B. INCORRECT: This is not an appropriate position for the car seat. C. CORRECT: The newborn should be restrained in a car seat in a rear-facing position in the back seat until 2 years of age. D. INCORRECT: This is not an appropriate position for the car seat.

ATI MN 16 5. A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states "my water broke." The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. Which of the following actions should the nurse perform first? A. Place the client in the Trendelenburg position. B. Apply pressure to the presenting part with her fingers. C. Administer oxygen at 10 L/min via a face mask. D. Call for assistance.

5. A. INCORRECT: This is not the first action the nurse should take. There is another action the nurse should perform first. B. INCORRECT: This is not the first action the nurse should take. There is another action the nurse should perform first. C. INCORRECT: This is not the first action the nurse should take. There is another action the nurse should perform first. D. CORRECT: Calling for assistance is the first action the nurse should take.

ATI MN 13 5. A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus. B. Palpate the fundus of the uterus. C. Grasp lower uterine segment between thumb and fingers. D. Stand facing client's feet with fingertips outlining cephalic prominence.

5. A. INCORRECT: Using the palms of the hands on the sides of the uterus to identify the fetal back and small body parts verifies the presenting part. B. CORRECT: Palpating the fundus of the uterus identifies the fetal part that is present, indicating the fetal lie (longitudinal or transverse). C. INCORRECT: The descent of the presenting part into the pelvis is determined by gently grasping the lower uterine segment between the thumb and fingers. D. INCORRECT: Fetal attitude is identified by facing the client's feet and outlining the cephalic prominence (fetal head) using the fingertips of both hands.

AtI MN 21 5. A nurse is preparing to administer clindamycin hydrochloride (Cleocin) 600 mg IV intermittent bolus in 50 mL of 0.9% sodium chloride over 30 min. The nurse should set the IV infusion pump to deliver how many mL/hr? (Round the answer to the nearest whole number.)

5. The nurse should set the IV pump to deliver 100 mL/hr.

MC CHP 18 The perinatal nurse understands that soft tissue diffuse edema of the infant's head is a condition best described as: A. Caput succedaneum B. Cephalhematoma C. Subperiosteal hemorrhage D. Periorbital edema

MC CHP 12 The perinatal nurse describes the latent phase of labor to the new nurse. Characteristics of this phase include: (SA) A. Cervical dilation from 0 to 3 cm B. Excitement and nervousness C. Moderate to strong contractions D. Admission to the hospital

MC CHP 13 The perinatal nurse is aware that one of the Healthy People 2010 goals is to: (SA) A. Educate women in the use of nonpharmacological pain management in labor. B. Decrease mortality related to pharmacological methods of pain relief in labor. C. Increase informed use of pharmacological methods of pain relief in labor. D. Increase availability of pharmacological pain relief in labor.

MC CHP 18 During Baby G.'s initial examination, the nurse observes a two-vessel cord. The nurse's immediate response is to notify the health care provider as this finding can be a sign of abnormality in which system? (SA) A. Renal B. Cardiac C. Neurological D. Musculoskeletal

MC CHP 17 The perinatal nurse describes a typical newborn breathing pattern to the new parents as: (SA) A. Shallow B. Irregular C. About 40 to 60 breaths per minute D. About 60 to 80 breaths per minute

ABC

MC CHP 17 The perinatal nurse explains to the new nurse that some infants have increased surfactant production prior to birth that facilitates their transition including: (SA) A. Infants of mothers with gestational hypertension B. Infants of mothers with placental insufficiency C. Infants of mothers with abruptio placentae D. Infants of mothers with a multiple gestation

ABC

MC CHP 17 The perinatal nurse recognizes that the infant that develops respiratory distress syndrome is at risk for further complications such as: (SA) A. Loss of functional residual capacity B. Atelectasis C. Poor lung compliance D. Hypoglycemia

ABC

MC CHP 17 The perinatal nurse understands that many factors stimulate the newborn to begin breathing including: (SA) A. Hypercarbia, acidosis, and hypoxia B. Sensory stimuli C. Decreased temperature in the environment D. Cutting the umbilical cord

ABC

MC CHP 18 The perinatal nurse observes for behaviors reflective of the early expression of parent-infant attachment, which include: (SA) A. Assuming an en face position with the infant B. Examining the infant's fingertips C. Stroking the infant's trunk D. Exploring the infant's extremities

ABCD

MC CHP 15 The perinatal nurse teaches a new nurse about the Healthy People 2010 initiative, which includes postpartum teaching that focuses on: (SA) A. Warning signs during the postpartum period B. Benefits of breastfeeding C. Use of infant soothers D. Contraceptive methods

ABD

MCH CHP 15 The postpartum nurse recognizes that after birth, the patient is at risk for decreased bladder tone and function if her labor/birth included: (SA) A. Forceps B. Vacuum extraction C. Prodromal labor D. Prolonged second stage

ABD

MC CHP 17 The perinatal nurse is caring for Sarah, a primigravid antenatal patient at 32 weeks' gestation. Betamethasone 12 mg IM q24h X 2 is ordered. Appropriate nursing care includes: (SA) A. Assessing Sarah's temperature and white blood count B. Conducting continuous fetal monitoring for 30 minutes pre and post injection C. Providing information to Sarah and her family about the benefits of this medication as well as information about the signs and symptoms of pulmonary edema D. Monitoring Sarah's intake and output

ACD

MC CHP 18 During the reflex assessment, the nurse places the infant in the prone position and strokes one side of the vertebral column. The nurse is assessing which reflex? A. Moro B. Galant C. Babinski D. Stepping

MC CHP 13 The perinatal nurse is aware that a woman's history of past painful experiences with labor and birth are part of which neural pathway process for pain? A. Transduction B. Transmission C. Perception D. Modulation

MC CHP 16 Julia, a G4, TPAL 4004, experienced a normal vaginal birth approximately 60 minutes ago. No episiotomy was made at the time of birth. Her daughters, 5, 3, and 2 years of age have now come to visit. Julia states that her pad feels "very wet." As the perinatal nurse, you assess the tone of Julia's uterus and it is firm. Your next action would be to: A. Massage her uterus to ensure that it remains firm B. Change and weigh her pads to accurately determine her blood loss C. Request that the physician come and check for internal lacerations D. Request that her family members leave immediately

MC CHP 19 A 24-hour-old newborn is being treated for hyperbilirubinemia with phototherapy bilirubin lights. The patient is in an incubator fully undressed. All EXCEPT which of the following measures should be included in the nursing plan of care? A. Apply eye patches to prevent retinal damage and a covering over the genital area. B. Receive proper nutrition to ensure the clearance of bilirubin. C. Apply a head covering (stockinet hat) to prevent heat loss. D. Maintain adequate hydration to promote excretion.

MC CHP 19 A 30-week gestational aged neonate has anemia of prematurity. The neonatologist has ordered recombinant human erythropoietin 250 U/kg subcutaneous 3 times a week. The nursing implication related to this medication include: A. Administering the medication prior to feedings B. Applying pressure to the injection site for 5 min C. Assessing hematocrit levels as per hospital policy D. Assessing electrolyte levels weekly

MCH CHP 14 The perinatal nurse is aware that the minimal amount of fluid that would be infused for an amnioinfusion is: A. 500 mL B. 300 mL C. 250 mL D. 800 mL

MCH CHP 19 Upon assessing the newborn, the nurse notes shallow rapid respirations, palmar sweating, decreased oxygen saturation, and a high-pitched cry. These clinical assessments are indicative of which of the following? A. A neurological problem B. Hypoglycemia C. Pain D. Transient tachypnea of the newborn (TTN)

MCH CHP 19 Immediate conditions that pose nursing concerns for the small for gestational age (SGA) newborn include which of the following? A. Long-term chronic or end of life care B. Bronchopulmonary dysplasia and ischemia C. Muscle contractures and hyperthermia D. Hypothermia and pain management

MC: Exam 2 (End of ch. questions)

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