OB Bulk 1

A laboring woman is lying in the supine position. The most appropriate nursing action at this time is to:

Ask her to turn to one side

The nurse notices a soft swollen area over the 1-day-old newborn's skull. It is approximately 3 by 2 cm and has clear edges that stop at the suture line. The nurse may document this finding as being:

cephalohematoma. Cephalhematoma does not cross the suture line; caput succedaneum will cross the suture line.

Before excretion of bilirubin can occur, it must be changed by the liver to a water-soluble form. This process is called ________________.

conjugation

The nurse obtains a fetal heart rate (FHR) of 150 beats per minute. The normal baseline range for a FHR is which of the following? Question options: a) 80 to 160 beats per minute. b) 130 to 180 beats per minute. c) 120 to 160 beats per minute. d) 110 to 220 beats per minute.

c) 120 to 160 beats per minute. 80 BPM is considered bradycardia & would require in utero rescutation by means of nursing intervention or medical intervention.

A pregnant woman informs the nurse that her last normal menstrual period was on September 20, 2006. Using Nagele's rule, the nurse calcuates the client's estimated date of delivery as: Question options: a) May 30, 2007 b) June 20, 2007 c) June 27, 2007 d) July 3, 2007

c) June 27, 2007

The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive

devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as

Postpartum hemorrhage that occurs within the first 24 hours after childbirth is termed _______________.

early

Ice causes vasoconstriction and is most effective if applied soon after the birth to the perineal area to prevent ______________.

edema

Vitamin K is given to the newborn to:

enhance ability of blood to clot. Newborns have a deficiency of vitamin K until intestinal bacteria that produce the vitamin are formed. Vitamin K is required for the production of certain clotting factors.

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is

evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. is likely to be caused by which physiologic alteration. Compression of the fetal head Maternal supine hypotension

- epidurals:

fluid bolus before 1000ccs, monitor BP (vasodilation), decreased O2 to baby. positioning: fetal position. Epidural anesthesia or analgesia (block) Relief from the pain of uterine contractions and birth (vaginal and cesarean) can be relieved by injecting a suitable local anesthetic agent (e.g., bupivacaine, ropivacaine), an opioid analgesic (e.g., fentanyl, sufentanil), or both into the epidural (peridural) space. Injection is made between the fourth and fifth lumbar vertebrae for a lumbar epidural block (see Figs. 10-8, B, and 10-10, A). Depending on the type, amount, and number of medications used, an anesthetic or analgesic effect will occur with varying degrees of motor impairment. The combination of an opioid with the local anesthetic agent reduces the dose of anesthetic required, thereby preserving a greater degree of motor function. Epidural anesthesia and analgesia is the most effective pharmacologic pain-relief method for labor that is currently available. As a result, it is the most commonly used method for relieving pain during labor in the United States and its use has been increasing. Nearly two thirds of American women giving birth choose epidural analgesia (AAP & ACOG, 2007; Bucklin et al., 2005; Hawkins et al., 2007). For relieving the discomfort of labor and vaginal birth, a block from T10 to S5 is required. For cesarean birth, a block from at least T8 to S1 is essential. The diffusion of epidural anesthesia depends on the location of the catheter tip, the dose and volume of the anesthetic agent used, and the woman's position (e.g., horizontal or head-up position). The woman must cooperate and maintain her position without moving during insertion of the epidural catheter so as to prevent misplacement, neurologic injury, or hematoma formation (Cunningham et al., 2005). NURSING ALERT Epidural anesthesia effectively relieves the pain caused by uterine contractions. For most women, however, it does not completely remove the pressure sensations that occur as the fetus descends in the pelvis. For the induction of an epidural block, the woman is positioned as for a spinal block. She may sit with her back curved or she may assume a modified Sims position with her shoulders parallel, legs slightly flexed, and back arched (see Fig. 10-11). A large-bore needle is inserted into the epidural space. A catheter is then threaded through the needle until its tip rests in the epidural space. Then the needle is removed and the catheter is taped in place. After the epidural catheter is inserted, a small amount of medication, called a test dose, is injected to be sure that the catheter has not been accidentally placed in the subarachnoid (spinal) space or in a blood vessel (Hawkins et al., 2007). After the epidural has been initiated the woman is positioned preferably on her side so that the uterus does not compress the ascending vena cava and descending aorta, which can impair venous return, reduce cardiac output and blood pressure, and decrease placental perfusion. Her position should be alternated from side to side every hour. Upright positions and ambulation may be possible, depending on the degree of motor impairment. Oxygen should be available if hypotension occurs despite maintenance of hydration with IV fluid and displacement of the uterus to the side. Ephedrine or phenylephrine (vasopressors used to increase maternal blood pressure) and increased IV fluid infusion may be needed (see Emergency box). The FHR, contraction pattern, and progress in labor must be monitored carefully because the woman may not be aware of changes in the strength of the uterine contractions or the descent of the presenting part. Several methods can be used for an epidural block. An intermittent block is achieved by using repeated injections of anesthetic solution; it is the least common method. The most common method is the continuous block, achieved by using a pump to infuse the anesthetic solution through an indwelling plastic catheter. Patient-controlled epidural analgesia (PCEA) is the newest method; it uses an indwelling catheter and a programmed pump that allows the woman to control the dosing. This method has been found to provide optimal analgesia with better maternal satisfaction during labor while decreasing the amount of local anesthetic used (Saito et al., 2005). The advantages of an epidural block are numerous: The woman remains alert and is more comfortable and able to participate, good relaxation is achieved, airway reflexes remain intact, only partial motor paralysis develops, gastric emptying is not delayed, and blood loss is not excessive. Fetal complications are rare but may occur in the event of rapid absorption of the medication or marked maternal hypotension. The dose, volume, type, and number of medications used can be modified to allow the woman to push and to assume upright positions and even to walk, to produce perineal anesthesia, and to permit forceps-assisted, vacuum-assisted, or cesarean birth if required (Cunningham et al., 2005). The disadvantages of epidural block also are numerous. The woman's ability to move freely and to maintain control of her labor is limited, related to the use of numerous medical interventions (e.g., an IV infusion and electronic monitoring) and the occurrence of orthostatic hypotension and dizziness, sedation, and weakness of the legs. CNS effects (Box 10-4) can occur if a solution containing a local anesthetic agent is accidentally injected into a blood vessel or if excessive amounts of local anesthetic are given. High spinal or "total spinal" anesthesia, resulting in respiratory arrest, can occur if the relatively high dose of local anesthetic used with an epidural block is accidentally injected into the subarachnoid space. Women who receive an epidural have a higher rate of fever (i.e., intrapartum temperature of 38° C or higher), especially when labor lasts longer that 12 hours; the temperature elevation most likely is related to thermoregulatory changes, although infection cannot be ruled out. The elevation in temperature can result in fetal tachycardia and neonatal workup for sepsis, whether or not signs of infection are present (see Box 10-4). Severe hypotension (more than a 20% decrease in baseline blood pressure) as a result of sympathetic blockade can be an outcome of an epidural block (Anim-Somuah, Smyth, & Howell, 2005) (see Emergency box). It can result in a significant decrease in uteroplacental perfusion and oxygen delivery to the fetus. Urinary retention and stress incontinence can occur in the immediate postpartum period. Pruritus (itching) is a side effect that often occurs with the use of an opioid, especially fentanyl. A relationship between epidural analgesia and longer second-stage labor, use of oxytocin, and forceps-assisted or vacuum-assisted birth has been documented. Research findings have been unable to demonstrate a significant increase in cesarean birth associated with epidural analgesia (Anim-Somuah et al.). For some women, the epidural block is not effective, and a second form of analgesia is required to establish effective pain relief. When women progress rapidly in labor, pain relief may not be obtained before birth occurs. BOX 10-4 Side Effects of Epidural and Spinal Anesthesia • Hypotension • Local anesthetic toxicity • Light-headedness • Dizziness • Tinnitus (ringing in the ears) • Metallic taste • Numbness of the tongue and mouth • Bizarre behavior • Slurred speech • Convulsions • Loss of consciousness • High or total spinal anesthesia • Fever • Urinary retention • Pruritus (itching) • Limited movement • Longer second stage labor • Increased use of oxytocin • Increased likelihood of forceps- or vacuum-assisted birth Combined spinal-epidural analgesia In the combined spinal-epidural (CSE) analgesia technique, sometimes called a "walking epidural," an epidural needle is inserted into the epidural space. Before the epidural catheter is placed, a smaller-gauge spinal needle is inserted through the bore of the epidural needle into the subarachnoid space. A small amount of opioid or combination of opioid and local anesthetic is then injected intrathecally to provide analgesia rapidly. Afterward the epidural catheter is inserted as usual. The CSE technique is an increasingly popular approach that can be used to block pain transmission without compromising motor ability. The concentration of opioid receptors is high along the pain pathway in the spinal cord, in the brainstem, and in the thalamus. Because these receptors are highly sensitive to opioids, a small quantity of an opioid-agonist analgesic produces marked pain relief lasting for several hours. If additional pain relief is needed, medication can be injected through the epidural catheter (see Fig. 10-10, A). The most common side effects of CSE are pruritus and nausea (Hawkins et al., 2007). CSE analgesia may also be associated with fetal bradycardia, necessitating close assessment of fetal heart rate (Cunningham et al., 2005). Although women can walk, they often choose not to do so because of sedation and fatigue, abnormal sensations perceived in their legs, weakness of the legs, and a feeling of insecurity. Health care providers are often reluctant to encourage or assist women to ambulate for fear of injury. However, women can be assisted to change positions and use upright positions during labor and birth. Upright positioning is associated with less pain, more efficient labor progress, and a lower incidence of forceps- or vacuum-assisted birth (Albers, 2007; Berghella et al., 2008). Laboring upright also conveys a sense of normalcy, autonomy, and personal control (Albers). Epidural and intrathecal (spinal) opioids Opioids also can be used alone, eliminating the effect of a local anesthetic altogether. The use of epidural or intrathecal opioids without the addition of a local anesthetic agent during labor has several advantages. Opioids administered in this manner do not cause maternal hypotension or affect vital signs. The woman feels contractions but not pain. Her ability to bear down during the second stage of labor is preserved because the pushing reflex is not lost, and her motor power remains intact. Fentanyl, sufentanil, or preservative-free morphine may be used. Fentanyl and sufentanil produce short-acting analgesia (i.e., 1.5 to 3.5 hours), and morphine may provide pain relief for 4 to 7 hours. Morphine may be combined with fentanyl or sufentanil. Using short-acting opioids with multiparous women and morphine with nulliparous women or women with a history of long labor would be appropriate. For most women, intrathecal opioids do not provide adequate analgesia for second-stage labor pain, episiotomy, or birth (Cunningham et al., 2005). Pudendal nerve blocks or local perineal infiltration anesthesia may be necessary. A more common indication for the administration of epidural or intrathecal analgesics is the relief of postoperative pain. For example, women who give birth by cesarean can receive fentanyl or morphine through a catheter. The catheter may then be removed, and the women are usually free of pain for 24 hours. The catheter is occasionally left in place in the epidural space in case another dose is needed. Women receiving epidurally administered morphine after a cesarean birth may ambulate sooner than women who do not. The early ambulation and freedom from pain also facilitate bladder emptying, enhance peristalsis, and prevent clot formation in the lower extremities (e.g., thrombophlebitis). Women may require additional medication for pain during the first 24 hours after surgery. If so, they will usually be given oral analgesics (e.g., oxycodone/acetaminophen [Percocet]), rather than IV or IM narcotics. Side effects of opioids administered by the epidural and intrathecal routes include nausea, vomiting, pruritus, urinary retention, and delayed respiratory depression. These side effects are more common when morphine is administered. Antiemetics, antipruritics, and opioid antagonists are used to relieve these symptoms. For example, naloxone (Narcan), nalbuphine (Nubain), or metoclopramide (Reglan) may be administered. Hospital protocols or detailed physician orders should provide specific instructions for the treatment of these side effects. Use of epidural opioids is not without risk. Respiratory depression is a serious concern; for this reason the woman's respiratory rate should be assessed and documented every hour for 24 hours, or as designated by hospital protocol. Naloxone should be readily available for use if the respiratory rate decreases to less than 10 breaths per minute or if the oxygen saturation rate decreases to less than 89%. Administration of oxygen by facemask also may be initiated, and the anesthesia care provider should be notified. Contraindications to epidural blocks Some contraindications to epidural analgesia include the following (Cunningham et al., 2005; Hawkins et al., 2007): • Active or anticipated serious maternal hemorrhage (Acute hypovolemia leads to increased sympathetic tone to maintain the blood pressure. Any anesthetic technique that blocks the sympathetic fibers can produce significant hypotension that can endanger the mother and baby.) • Coagulopathy (If a woman is receiving anticoagulant therapy or has a bleeding disorder, injury to a blood vessel may cause the formation of a hematoma that may compress the cauda equina or the spinal cord and lead to serious CNS complications.) • Infection at the injection site (Infection can be spread through the peridural or subarachnoid spaces if the needle traverses an infected area.) • Increased intracranial pressure caused by a mass lesion. • Maternal refusal. • Some types of maternal cardiac conditions. Epidural block effects on the neonate Analgesia or anesthesia during labor and birth has little or no lasting effect on the physiologic status of the neonate. Currently, no evidence has been found that the administration of analgesia or anesthesia during labor and birth has a significant effect on the child's later mental and neurologic development (AAP & ACOG, 2007).

Define vulnerable populations

groups at higher risk for developing physical, mental, or social health problems

aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of: HELLP syndrome.

hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).

If the meatus is located on the underside of the penis, it is called _______________.

hypospadias

A woman must have general anesthesia for a planned cesarean birth because of a previous back surgery. The nurse should therefore expect to administer:

naltrexone (Trexan). - During general anesthesia there is a risk for maternal aspiration. In order to prevent lung injury if aspiration occurs drugs may be given that will raise the gastric pH and make secretions less acidic such as ranitidine. Naltrexone is an opioid antagonist, Promethazine is used to relieve nausea, and barbiturates are sedating.

A shrill, high-pitched cry in a newborn may indicate:

neurologic disorder. Newborn cries that are shrill, high-pitched, hoarse, or catlike are abnormal. These may indicate neurologic disorders or other problems.

The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because

of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the patient's history, bleeding is normally described as brownish.

After change-of-shift report the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks and down her thighs. Before implementing a

plan of care, the nurse should understand that this type of pain is: Referred.

The ruddy, reddish color of the newborn skin caused by polycythemia is called _________________.

plethora

The nurse should tell a primigravida that the definitive sign indicating labor has begun is:

progressive uterine contractions. - Regular, progressive uterine contractions that increase in intensity and frequency are a sign of true labor.

A potentially fatal complication of pregnancy that occurs when the pulmonary artery is obstructed by a blood clot that was swept into circulation from a vein or by amniotic fluid is called a _______________.

pulmonary embolism

When the mother strokes the side of a newborn's mouth, the newborn will turn the head to the side touched. This reflex is called ______________.

rooting

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-

stained fluid was noted. The nurse caring for the infant after birth should anticipate: Meconium aspiration, hypoglycemia, and dry, cracked skin.

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 at abdominal wall. display hypotonia, bradycardia, and metabolic acidosis.

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 of every 1 to 2 minutes; dark red vaginal bleeding; and a

tense, painful abdomen. The nurse suspects the onset of: Placental abruption.

A client is being discharged, having been diagnosed with false labor. The nursing diagnosis for her is Deficient Knowledge: characteristics of true labor. An appropriate expected outcome for this diagnosis is that:

the client will describe reasons for returning to the hospital for evaluation. - The client may not be able to determine true from false labor; however, she should be made aware of what signs to look for that may indicate the need for evaluation.

A new mother expresses concern to the nurse that her 8-hour-old newborn has developed some edema in both eyes. The best response would be based on the fact that:

the eye medication given at birth may cause a mild inflammation and edema. Some infants develop a mild inflammation a few hours after prophylactic eye treatment.

The unit manager of the newborn nursery is orienting a group of student nurses. Infection control is one of the manager's major topics. When comparing infection control in a nursery with an adult medical unit, one major difference is:

the newborns have a decreased ability to localize infections. Newborns do have a decreased ability to localize infections; therefore they will develop sepsis. This fact makes infection control in a nursery extremely important.

A 2-day-old newborn passes a greenish brown stool. This stool can be called ___________________.

transitional

The thick white substance that resembles cream cheese and provides a protective covering for the fetal skin in utero is called ______________.

vernix caseosa

During labor a fetus with an average heart rate of 175 beats/min over a 15-minute period would be considered to have: A) A normal baseline heart rate. B) Bradycardia. C) Hypoxia. D) Tachycardia.

D) Tachycardia. p. 429

LM Ch1: What is the leading cause death in the neonatal period?

Congenital anomalies

What are the causes of death for infant (1-12 month)?

Congenital anomalies Gestational problems SIDS

thermoregulation

Control of temperature; a balance between heat loss and heat production

Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock

Cool extremities and decreased skin turgor Confusion and somnolence Tachypnea and poor capillary refill time

Labor pain management may include which of the following interventions?

Cool, damp washcloths on the face and neck.

Perinatal nurses are legally responsible for:

Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes

The lactating women should be advised to consume how many calories per day?

At least 1800 kcal/day

Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins:

At the time of admission to the nurse's unit.

What are the causes of death for teens (>15 years)

Accidents Homicides Suicides Cancer

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?

Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours

When caring for a newly delivered woman, the nurse is aware that the best measure to prevent abdominal distention after a cesarean birth is:Early and frequent ambulation.

Activity will aid the movement of accumulated gas in the gastrointestinal tract

Less pain intensity, decreased use of analgesia, fewer instrumental births

Acupuncture

An infant is brought to the emergency department with poor skin turgor, weight loss, lethargy, and tachycardia. This is suggestive of: Dehydration.

Acute diarrhea is often caused by: Antibiotic therapy.

Instruct the patient and partner in the use of specific relaxation techniques.

Acute pain related to contractions

A community women's health nurse knows that which groups of people are considered vulnerable populations? (Select all that apply.) Caucasian Americans Adolescent girls Women with underlying health conditions Refugee women Incarcerated women

Adolescent girls. Women with underlying health conditions, Refugee women, Incarcerated women

What factors are strongly r/t maternal death?

Age <20 yrs and 35 or older Lack of prenatal care low educational attainment Unmarried status Non-Caucasian race

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: Amenorrhea Positive pregnancy test Hegar's sign Chadwick's sign

Amenorrhea

Cardiopulmonary resuscitation is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible? Carotid

Abdominal thrusts (the Heimlich maneuver) are recommended for airway obstruction in children older than: 1 year.

If an excessive increase of fundal height is noted, what could be indicated?

Polyhydramnios or multifetal gestation

Drug use in pregnancy has contributed to higher incidences of... in infants?

Prematurity LBW Congenital defects Learning disabilities Withdrawal sxs

Belief in the rightness of one's culture's way of doing things

ETHNOCENTRISM

one

Engagement

- breast engorgement: read in book. lymphatic

Engorgement Engorgement is a common response of the breasts to the sudden change in hormones and the onset of significantly increased milk volume. It usually occurs 3 to 5 days after birth when the milk "comes in" and lasts approximately 24 hours. Blood supply to the breasts increases and causes swelling of tissues surrounding the milk ducts. The milk ducts may be pinched shut so that milk cannot flow from the breasts. The breasts are firm, tender, and hot and may appear shiny and taut. The areolae are firm, and the nipples may flatten, creating difficulty for the infant in latching on to the breast. Because back pressure on full milk glands inhibits milk production, if milk is not removed from the breasts, the milk supply may diminish. When engorgement occurs, it is a temporary condition that is usually resolved within 24 hours. The mother is instructed to feed every 2 hours, softening at least one breast, and pumping the other breast as needed to soften it. Pumping during engorgement will not cause a problematic increase in milk supply. Because of the swelling of breast tissue surrounding the milk ducts, ice packs are recommended in a 15 to 20 minutes on, 45 minutes off rotation between feedings. The ice packs should cover both breasts. Large bags of frozen peas or niblet corn make easy packs and can be refrozen between uses. Fresh, raw cabbage leaves placed over the breasts between feedings may help reduce the swelling. The cabbage leaves are washed, chilled in the refrigerator or freezer, and then placed over the breasts for 15 to 20 minutes (Fig. 18-14). This treatment can be repeated for two or three sessions. Frequent application of cabbage leaves can decrease milk supply. Cabbage leaves are often very effective for formula-feeding mothers who want their milk to "dry up"; they are advised to wear the cabbage leaves constantly while engorged, replacing the leaves with fresh ones as they become wilted. Cabbage leaves should not be used if the mother is allergic to cabbage or sulfa drugs or develops a skin rash. Antiinflammatory medications, such as ibuprofen, may help reduce the pain and swelling associated with engorgement. Ibuprofen also helps reduce fever and aching in the breasts that are often associated with engorgement. Because heat increases blood flow, application of heat to an already congested breast is usually counterproductive. Occasionally, however, standing in a warm shower will start the milk leaking, or the mother may be able to manually express enough milk to soften the areola sufficiently to allow the baby to latch on and feed. Estrogen and progesterone levels drop markedly after expulsion of the placenta and reach their lowest levels 1 week after childbirth. Decreased estrogen levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy. In nonlactating women, estrogen levels begin to rise by 2 weeks after birth and by postpartum day 17 are significantly higher than in women who breastfeed (Katz, 2007). • If breasts are engorged, have woman apply ice packs to breasts (15 minutes on, 45 minutes off), and apply cabbage leaves in same manner to relieve discomfort (use only two to three times). Use warm compresses or take a warm shower before breastfeeding to stimulate milk flow and relieve stasis. Hand express milk or pump milk to relieve discomfort if infant is unable to latch on and feed. • If pain is from breast and woman is not breastfeeding, encourage the use of a well-fitted, supportive bra or breast binder and application of ice packs and cabbage leaves to suppress milk production and decrease discomfort.

Muslim countries Will not eat pork or pork products

Korean or other South East Asian countries Prefer not to give babies colostrum

What are the key components of a cultural assessment?

Language Diet Childbearing/Childcare Childrearing (Discipline, Training, Decisions) Healing Beliefs Religious/beliefs/rituals

Which fetal heart rate (FHR) finding would concern the nurse during labor? Accelerations with fetal movement Late decelerations An average FHR of 126 beats/min Early decelerations

Late decelerations

Which fetal heart rate (FHR) finding would concern the nurse during labor? Late decelerations

Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected.

What correctly matches the type of deceleration with its likely cause? Prolonged deceleration—cause unknown Early deceleration—umbilical cord compression Late deceleration—uteroplacental inefficiency Variable deceleration—head compression

Late deceleration—uteroplacental inefficiency

If a woman complains of back labor pain, the nurse could best suggest that she:

Lean over a birth ball with her knees on the floor.

and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse's most appropriate action would be to:

Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.O2 saturation should be maintained above 92%

The slight overlapping of cranial bones or shaping of the fetal head during labor is called:

Molding.

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g 9 pounds, 6 ounces. The nurse's most appropriate action is to:

Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia

With regard to nerve block analgesia and anesthesia, nurses should be aware that:

Most local agents are related chemically to cocaine and end in the suffix -caine.

5. Do alternative perspectives to your conclusion exist?

Most postpartum women are eager to regain their nonpregnant figures quickly. It can be discouraging when diet and exercise efforts fail to produce the desired results immediately.

Rho immune globulin will be ordered postpartum if which situation occurs?

Mother Rh?2-, baby Rh+

What are some reasons that greater-than-expected weight gain may occur during pregnancy?

Multiple gestation, edema, gestational htn, & overeating

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? Lecithin/sphingomyelin (L/S) ratio Biophysical profile Type and crossmatch of maternal and fetal serum Multiple-marker screening

Multiple-marker screening

The nurse's most appropriate action would be to: Go to the parents, introduce himself or herself, and gently encourage the parents to come meet their infant; explain the equipment first, and then focus on the newborn.

Necrotizing enterocolitis is an inflammatory disease of the gastrointestinal mucosa. signs of NEC are nonspecific. Some generalized signs include:Abdominal distention, temperature instability, grossly bloody stools.

Name the developmental groups from neonatal to adolescent?

Neonatal (birth to 1 month) Infant (1 month to 1 year) Toddler (1 year to 3 years) Preschooler (3 years to 6 years) School-Age (6 years to 11-12 years) Adolescent (12 years to 18 years)

It is important for the nurse to develop a realistic birth plan with the pregnant woman in her care. The nurse can explain that a major advantage of nonpharmacologic pain management is:

No side effects or risks to the fetus are involved.

rooting reflex

Normal response of the newborn to move toward whatever touches the area around the mouth and to attempt to suck; usually disappears by 3 to 4 months of age

Apgar score

Numeric expression of the condition of a newborn obtained by rapid assessment at 1 and 5 minutes of age; developed by Dr. Virginia Apgar

Why do you think it is important for pediatric nurses to understand family function?

Nurses need to assess: Communication Flexibility and adaptability Support systems Respect and value of members Coping mechanisms Family rules Common activities

Examples of outcome-oriented care systems?

OASIS NOC

What are probable indicators?

Objective, signs detected by an exam & are related to mainly physical changes in the uterus

Elevated levels of MSAFP are associated with what?

Open neural tube defects & multiple gestations

What is an expected characteristic of amniotic fluid?

Pale, straw color with small white particles

anesthesia

Partial or complete absence of sensation with or without loss of consciousness

To prevent or relieve backache associated with pregnancy related changes, the women should be educated to do what?

Pelvic tilt & abdominal breathing

Number of stillbirths and the number of neonatal deaths per 1000 live births?

Perinatal mortality rate

puerperium

Period between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state; fourth trimester of pregnancy

transition period

Period from birth to 4 to 6 hours later in which the infant passes through a period of reactivity, sleep, and a second period of reactivity

Obese women are more likely than normal-weight omen to have which two complications during pregnancy?

Preeclampsia & gestational diabetes

Magnesium sulfate is given to women with preeclampsia and eclampsia to: Prevent and treat convulsions.

Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: Nulligravida. Primigravida. Multipara. Primipara.

Primipara

Average of 10 mm Hg

Resting tone

involution

Return of the uterus to a nonpregnant state after birth

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement:Are reassuring.

Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being

cold stress

Excessive loss of heat that results in increased respirations and nonshivering thermogenesis to maintain core body temperature

circumcision

Excision of the prepuce (foreskin) of the penis, exposing the glans

A goiter is an enlargement or hypertrophy of which gland? Thyroid

Exophthalmos protruding eyeballs may occur in children with:Hyperthyroidism. Exophthalmos is a clinical manifestation of hyperthyroidism

Step 6

Explain findings to the patient.

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: Increase amniotic fluid volume. Enhance uteroplacental perfusion in an aging placenta. Stimulate the amniotic membranes to rupture. Ripen the cervix in preparation for labor induction

Ripen the cervix in preparation for labor induction

seven

Expulsion

five

Extension

subinvolution

Failure of the uterus to reduce to its normal size and condition after pregnancy

A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the _____ phase of the endometrial cycle. Proliferative Secretory Ischemic Menstrual

Secretory

9. Changes in the maternal immune system during the postpartum period account for the profuse diaphoresis that new mothers experience. True or False?

False

What are the responsibilities of a Pediatric Nurse?

Family Centered Care Promoting health and well being of child and family Therapeutic Relationship Embrace cultural diversity

Currently what is the focus of childbirth practices?

Family and alternatives

diastasis recti abdominis

Separation of the two rectus muscles along the median line of the abdominal wall

Group care activities as much as possible.

Fatigue related to energy expenditure during labor and birth

demand feeding

Feeding in response to feeding cues exhibited by the infant that indicate the presence of hunger

A nulliparous woman who has just begun the second stage of her labor would most likely:

Feel tired yet relieved that the worst is over.

Number of births per 1000 women between the ages of 15-44 yrs (inclusive), calculated on a yearly basis?

Fertility rate

c (Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, viral infections such as cytomegalovirus, CMV, maternal hypothermia, and maternal hypothermia.)

Fetal bradycardia is most common during: A. Maternal hyperthyroidism B. Fetal anemia C. Viral infection D. Tocolytic treatment using ritodrine

b (Sexual assault encompasses a wide range of sexual victimization, including unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts.)

Sexual assault is: A. Limited to rape B. An act of force in which an unwanted and uncomfortable sexual act occurs C. A legal term for sexual violence D. An act of violence in which the partner is unknown

three

Flexion

For the labor nurse, care of the expectant mother begins with any or all of these situations, with the exception of:

Formulation of the woman's plan of care for labor.

While providing care to a patient in active labor, the nurse should instruct the woman that:

Frequent changes in position will help relieve her fatigue and increase her comfort.

What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole? Fundal height measurement of 18 cm History of bright red spotting for 1 day, weeks ago Blood pressure of 120/80 mm Hg Complaint of frequent mild nausea

Fundal height measurement of 18 cm

Pictorial representation of family relationships and health history

GENOGRAM

Leopold maneuvers would be an inappropriate method of assessment to determine:

Gender of the fetus.

effleurage

Gentle stroking used in massage, usually on the abdomen

Name the progression of fine motor development?

Grasp Transfer Pincer Color Write Draw person

What are the 2 most frequently reported maternal medical risk factors?

HTN & Diabetes (both are assoc with OBESITY)

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman:

Has not given the baby a name.

In the recovery room, if a woman is asked either to raise her legs off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she:

Has recovered from epidural or spinal anesthesia.If the numb or prickly sensations are gone from her legs after these movements, she has likely recovered from the epidural or spinal anesthesia.

What is an essential part of nursing care for the laboring woman?

Helping the woman manage the pain

Complications and risks associated with cesarean births include (Select all that apply): Hemorrhage Fetal injuries Urinary tract infections Wound dehiscence Placental abruption

Hemorrhage Fetal injuries Urinary tract infections Wound dehiscence

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

Hypertension.

Spastic cerebral palsy is characterized by:Hypertonicity and poor control of posture, balance, and coordinated motion.

Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with:

Hypoxemia.Nonreassuring heart rate patterns are associated with fetal hypoxemia

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to:

Show the mother how the infant initiates interaction and pays attention to her.

Infants of mothers with diabetes (IDMs) are at higher risk for developing: Respiratory distress syndrome.

IDMs are at risk for macrosomia, birth injury, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia.

Complementary and alternative therapies in combination with conventional Western modalities of treatment

INTEGRATIVE HEALTH CARE

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve: IV therapy to correct fluid and electrolyte imbalances. An antiemetic, such as pyridoxine, to control nausea and vomiting. Enteral nutrition to correct nutritional deficits. Corticosteroids to reduce inflammation.

IV therapy to correct fluid and electrolyte imbalances.

The laboring woman who imagines her body opening to let the baby out is using a mental technique called:

Imagery.

A new father states, "I know nothing about babies," but he seems to be interested in learning. This is an ideal opportunity for the nurse to:

Include him in teaching sessions.

feeding-readiness cues

Infant behaviors (mouthing motions, sucking fist, awakening, and crying) indicating that the infant is interested in feeding

Number of deaths of infants younger than 1 year of age per 1000 live births?

Infant mortality rate

mastitis

Inflammation of the breast, often associated with infection, characterized by influenza-like symptoms and redness and tenderness in the affected breast

lactose intolerance

Inherited absence of the enzyme lactase

- how to calculate APGAR score

Initial Assessment and Apgar Scoring The initial assessment of the neonate is performed immediately after birth using the Apgar score (Table 17-1) and a brief physical examination (Box 17-1). A gestational age assessment is completed within the first hours of birth in a stable newborn. A more comprehensive physical assessment is completed within 24 hours of birth (see Table 16-4). TABLE 17-1 Apgar Score Heart rate: 0: Absent 1: Slow (<100) 2: >100 Respiratory rate 0: Absent 1: Slow, weak cry 2: Good cry Muscle tone 0: Flaccid 1: Some flexion of extremities 2: Well flexed Reflex irritability 0: No response 1: Grimace 2: Cry Color 0: Blue, pale 1: Body pink, extremities blue 2: Completely pink Apgar score The Apgar score permits a rapid assessment of the newborn's transition to extrauterine existence based on five signs that indicate the physiologic state of the neonate: (1) heart rate, based on auscultation with a stethoscope or palpation of the umbilical cord; (2) respiratory rate, based on observed movement of respiratory efforts; (3) muscle tone, based on degree of flexion and movement of the extremities; (4) reflex irritability, based on response to bulb syringe or catheter inserted in the nasopharynx; and (5) generalized skin color, described as pallid, cyanotic, or pink (see Table 17-1). Evaluations are made at 1 and 5 minutes after birth and can be completed by the nurse or birth attendant. Scores of 0 to 3 indicate severe distress, scores of 4 to 6 indicate moderate difficulty, and scores of 7 to 10 indicate that the infant is having minimal or no difficulty adjusting to extrauterine life. Apgar scores do not predict future neurologic outcome but are useful for describing the newborn's transition to extrauterine environment (Box 17-2). If resuscitation is required, it should be initiated before the 1-minute Apgar score (American Academy of Pediatrics [AAP] and American College of Obstetricians and Gynecologists [ACOG], 2007). BOX 17-2 Significance of the Apgar Score The Apgar score was developed to provide a systematic method of assessing an infant's condition at birth. Researchers have tried to correlate Apgar scores with various outcomes such as development, intelligence, and neurologic development. In some instances, researchers have attempted to attribute causality to the Apgar score, that is, to suggest that the low Apgar score caused or predicted later problems. This use of the Apgar score is inappropriate. Instead the score should be used to ensure that infants are systematically observed at birth to ascertain the need for immediate care. Either a physician or a nurse may assign the score; however, to avoid the real or perceived appearance of bias, the person assisting with the birth should not assign the score. Lack of consistency in the assigned scores limits studies of the Apgar's long-term predictive value. Prospective parents and the public need education on the significance of the Apgar score, as well as its limits. Because infants often do not receive the maximal score of 10, parents need to know that scores of 7 to 10 are within normal limits. Attorneys involved in litigation related to injury of an infant at birth or negative outcomes, either short term or long term, also need education about the Apgar score, its significance, and its limits. This useful tool needs to be used appropriately; health care providers, parents, and the public may need education to ensure appropriate use of the score.

Normal prenatal visit schedule

Initial visit during first trimester, ideally soon after first missed period Moly visits through wk 28 Every 2 wks until wk 36 Every wk until birth (37-40)

pudendal nerve block

Injection of a local anesthetic at the pudendal nerve root to produce numbness of the genital and perianal region

What are the causes of death for child (1-14 year)

Injuries Motor Vehicle Drowning Burns Cancer Congenital anomalies

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should: Document the findings because they reflect the expected contraction pattern for the active phase of labor. Notify the woman's primary health care provider immediately. Prepare the woman for the onset of the second stage of labor. Prepare to administer an oxytocic to stimulate uterine activity.

Document the findings because they reflect the expected contraction pattern for the active phase of labor.

Low level of MSAFP are associated with what?

Down syndrome

The nurse recognizes that a woman is in true labor when she states:

The contractions in my uterus are getting stronger and closer together."Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor.

Myelosuppression associated with chemotherapeutic agents or some malignancies such as leukemia can cause bleeding tendencies because of a/an: Decrease in blood platelets.

The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding

A new father of 1 day expresses concern to the nurse that his wife, who is normally very independent, is asking him to make all of the decisions. The nurse can best explain this as:

a normal occurrence because the mother is in the taking-in phase. During the taking-in phase the mother is focused primarily on her own need for fluid, food, and sleep. She may be passive and dependent. This is normal and lasts about 2 days.

A pregnant woman reports that she is still playing tennis competitively at 32 weeks of gestation. The nurse would be most concerned that this woman consume which of the following during and after tennis matches? Question options: a) Several glasses of fluid b) Extra protein sources such as peanut butter c) Salty foods to replace lost sodium d) Easily digested sources of carbohydrate

a) Several glasses of fluid no rationale but page 239 states "wear loose comfortable clothes, drink plenty of fluids, and avoid prolonged overheating -> Hyperthermia is teratogenic"

When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that

The examiner's hand should be placed over the fundus before, during, and after contractions

An adolescent being seen by the nurse practitioner for a sports physical is identified as having hypertension. On further testing, it is discovered the child has a cardiac abnormality.

The initial treatment of secondary hypertension initially involves:Treating the underlying disease.

With regard to dysfunctional labor, nurses should be aware that: Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted.

The least common cause of long, difficult, or abnormal labor dystocia is: Disproportion of the pelvis.

Continue to perform the clean intermittent catheterizations (CIC) at home. Administer the oxybutynin chloride (Ditropan) as prescribed.Monitor for signs of a recurrent UTI.

The nurse in the neonatal intensive care unit is caring for an infant with myelomeningocele scheduled for surgical repair in the morning. Which early signs of infection should the nurse monitor on this infant

asks why a CT scan is required when she "seems fine." nurse should explain that the toddler: history of the fall, brief loss of consciousness, and vomiting four times necessitate evaluation of a potential brain injury.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. The most essential part of the nursing assessment to detect early signs of a worsening condition is:Level of consciousness.

"I should administer all the prescribed medication."

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? Complete obstruction

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? Cluster care to conserve energy Administration of antibiotics

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care

An important nursing consideration when suctioning a young child who has had heart surgery is to: Administer supplemental oxygen before and after suctioning.

The nurse is caring for a child after heart surgery. What should she or he do if evidence is found of cardiac tamponade? Immediately report this to the physician.

The primary clinical manifestations of acute renal failure are: Oliguria and hypertension.

The nurse is caring for a child with acute renal failure. What clinical manifestation should he or she recognize as a sign of hyperkalemia? Cardiac arrhythmia

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? Intravenous infusion

The nurse is caring for a child with aplastic anemia. Which nursing diagnoses are appropriate Risk for Infection related to inadequate secondary defenses or

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include: Monitor pulse oximetry.

The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What is essential in this child's care? Monitor arterial blood gases.

How much folic acid is recommended for women of childbearing age? 0.4 mg

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him:

Temperature above 37.7° C (100° F) New, frequent coughing Turning blue or bluer than normal

The nurse is conducting discharge teaching about signs and symptoms of heart failure to parents of an infant with a repaired tetralogy of Fallot. Which signs and symptoms should the nurse include

Administer trimethoprim-sulfamethoxazole (Bactrim) as prescribed. Notify the physician if the child develops a cough or congestion.

The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child

A review of the literature on the various recreational and illicit drugs reveals that: More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs.

To provide optimal care of infants born to mothers who are substance abusers, nurses should be aware that:Mothers who abuse one substance likely will use or abuse another, thus compounding the infant's difficulties.

8. Although all other joints return to their normal prepregnancy state, those in the parous woman's feet do not. The new mother may notice a permanent increase in her shoe size. True or False?

True

epidural block

Type of regional anesthesia produced by injection of a local anesthetic alone or in combination with a narcotic analgesic into the epidural (peridural) space

When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that:

Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing is necessary for which?

Urine testing is still performed to detect evidence of ketonuria.

Children receiving long-term systemic corticosteroid therapy are most at risk for: Growth delays.

Which child should the nurse document as being anemic? 14-year-old child with a hemoglobin of 10 g/dL Anemia is defined as a hemoglobin level below 10 or 11 g/dL

If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place.

Which consideration is the most important in managing tuberculosis (TB) in children? Pharmacotherapy

The most appropriate initial nursing action is to:Apply direct pressure above the catheterization site.

Which defect results in increased pulmonary blood flow? Atrial septal defect Blood flows from the left atrium higher pressure into the right atrium lower pressure and then to the lungs via the pulmonary artery

The most common clinical manifestation of brain tumors in children is: Headaches and vomiting.

Which statement best describes a neuroblastoma? Diagnosis is usually made after metastasis occurs.

A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend:Swimming.

Which statement expresses accurately the genetic implications of cystic fibrosis (CF)? If it is present in a child, both parents are carriers of this defective gene.

d (Women bearing twins need to gain more weight, usually 16 to 20 kg, but not necessarily twice as much.)

Which suggestion about weight gain is not an accurate recommendation? A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.

Maternity nursing focuses on...

Women & their infants & families during the childbearing cycle.

As relates to rubella and Rh issues, nurses should be aware that:

Women should be warned that the rubella vaccination is teratogenic, and that they must avoid pregnancy for 1 month after vaccination.

Reduced length of labor, increased satisfaction of pain relief

Yoga

List the progression of auditory

Startle, localize 7 months Follow directions 18 months

The nurse expects to administer an oxytocic , Pitocin, Methergine to a woman after expulsion of her placenta to:

Stimulate uterine contraction.

hypothermia

Temperature that falls below the normal range, that is, below 35° C, usually caused by exposure to cold

Which structural defects constitute tetralogy of Fallot? Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Tetralogy of Fallot has these four characteristics: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

What is an expected assessment finding in a child with coarctation of the aorta?Disparity in blood pressure between the upper and lower extremities

The classic finding in children with coarctation of the aorta is a disparity in pulses and blood pressures between the upper and lower extremities.

Birth position of children affects their personalities. Which of the following is considered characteristic of children who are the youngest in their family? A) More dependent than firstborn children B) More affectionate than firstborn children C) Identify more with parents than with peers D) Are subject to greater parental expectations

B) More affectionate than firstborn children

What is an expected characteristic of amniotic fluid? A) Deep yellow color B) Pale, straw color with small white particles C) Acidic result on a Nitrazine test D) Absence of ferning

B) Pale, straw color with small white particles

With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that: A) Even mild anxiety must be treated. B) Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on. C) Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. D) Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

B) Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

Vaginal examinations should be performed by the nurse under all of these circumstances EXCEPT: A) An admission to the hospital at the start of labor. B) When accelerations of the fetal heart rate (FHR) are noted. C) On maternal perception of perineal pressure or the urge to bear down. D) When membranes rupture.

B) When accelerations of the fetal heart rate (FHR) are noted.

Which of the following is the leading cause of death from unintentional injuries in children? A) Poisoning B) Drowning C) Motor vehicles D) Fires and burns

C) Motor vehicles

Magnesium sulfate is given to women with preeclampsia and eclampsia to: A) Improve patellar reflexes and increase respiratory efficiency. B) Shorten the duration of labor. C) Prevent and treat convulsions. D) Prevent a boggy uterus and lessen lochial flow.

C) Prevent and treat convulsions.

A newborn has just been circumcised. The nurse's first priority would be to:

assess the penis for bleeding. - observation for bleeding is the priority.

opioid (narcotic) agonist analgesics

Medications that relieve pain by activating opioid receptors

opioid (narcotic) antagonists

Medications used to reverse the central nervous system depressant effects of an opioid, especially respiratory depression

When implementing care, the nurse would anticipate that a woman from which country would have the father of the baby in attendance?

Mexico

The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is: Reactive Positive Nonreactive Negative

Reactive

The nurse thoroughly dries the infant immediately after birth primarily to:

Reduce heat loss from evaporation.

Providing treatment and rehabilitation for people who have developed disease is part of: A. Primary preventive care B. Secondary preventive care C. Tertiary preventive care D. Primordial preventive care

C

"Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."

When providing an infant with a gavage feeding, which of the following should be documented each time? The infant's response to the feeding

Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern? A. FHR does not change as a result of fetal activity. B. Average baseline rate ranges between 100 and 140 beats/min. C. Mild late deceleration patterns occur with some contractions. D. Variability averages between 6 to 10 beats/min.

D. Variability averages between 6 to 10 beats/min. RATIONAL: Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings.

- pain: individualized response. culturally expressive. visceral and somatic pain.

DISCOMFORT DURING LABOR AND BIRTH Neurologic Origins The pain and discomfort of labor have two origins, visceral and somatic. During the first stage of labor, uterine contractions cause cervical dilation and effacement. Uterine ischemia (decreased blood flow and therefore local oxygen deficit) results from compression of the arteries supplying the myometrium during uterine contractions. Pain impulses during the first stage of labor are transmitted via the T-1 to T-12 spinal nerve segment and accessory lower thoracic and upper lumbar sympathetic nerves. These nerves originate in the uterine body and cervix (Blackburn, 2007). The pain from cervical changes, distention of the lower uterine segment, stretching of cervical tissue as it dilates, and pressure on adjacent structures and nerves during the first stage of labor is visceral pain. It is located over the lower portion of the abdomen. Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, gluteal area, thighs, and lower back (Blackburn, 2007; Zwelling et al., 2006). During the second stage of labor the woman has somatic pain, which is often described as intense, sharp, burning, and well localized. Pain results from stretching and distention of perineal tissues and the pelvic floor to allow passage of the fetus, from distention and traction on the peritoneum and uterocervical supports during contractions, and from lacerations of soft tissue (e.g., cervix, vagina, perineum). Other physical factors related to pain during second stage labor include fetal position, rapidity of fetal descent, maternal position, interval and duration of contractions, and fatigue (Zwelling et al., 2006). Pain impulses during the second stage of labor are transmitted via the pudendal nerve through S2 to S4 spinal nerve segments and the parasympathetic system (Blackburn, 2007). Pain experienced during the third stage of labor and the afterpains of the early postpartum period are uterine, similar to the pain experienced early in the first stage of labor. Areas of discomfort during labor are shown in Fig. 10-1. Perception of Pain Although the pain threshold is remarkably similar in all persons regardless of gender, social, ethnic, or cultural differences, these differences play a definite role in the person's perception of and behavioral responses to pain. The effects of factors such as culture, counterstimuli, and distraction in coping with pain are not fully understood. The meaning of pain and the verbal and nonverbal expressions given to pain are apparently learned from interactions within the primary social group. Cultural influences impose certain behavioral expectations regarding acceptable and unacceptable behavior when experiencing pain. Expression of Pain Pain results in physiologic effects and sensory and emotional (affective) responses. During childbirth, pain gives rise to identifiable physiologic effects. Sympathetic nervous system activity is stimulated in response to intensifying pain, resulting in increased catecholamine levels. Blood pressure and heart rate increase. Maternal respiratory patterns change in response to an increase in oxygen consumption. Hyperventilation, sometimes accompanied by respiratory alkalosis, can occur as pain intensifies. Pallor and diaphoresis may be seen. Gastric acidity increases, and nausea and vomiting are common in the active phase of labor. Placental perfusion may decrease, and uterine activity may diminish, potentially prolonging labor and affecting fetal well-being. Certain emotional (affective) expressions of pain are often seen. Such changes include increasing anxiety with lessened perceptual field, writhing, crying, groaning, gesturing (hand clenching and wringing), and excessive muscular excitability throughout the body. Factors Influencing Pain Response Pain during childbirth is unique to each woman. How she perceives or interprets that pain is influenced by a variety of physical, emotional, psychosocial, cultural, and environmental factors (Zwelling et al., 2006). Physiologic factors A variety of physiologic factors can affect the intensity of pain that women experience during childbirth. Women with a history of dysmenorrhea may experience increased pain during childbirth as a result of higher prostaglandin levels. Back pain associated with menstruation also may increase the likelihood of contraction-related low back pain. Other physical factors include fatigue, the interval and duration of contractions, fetal position, rapidity of fetal descent, and maternal position (Zwelling et al., 2006). Endorphins are endogenous opioids secreted by the pituitary gland that act on the central and peripheral nervous systems to reduce pain. Beta-endorphin is the most potent of the endorphins. Endorphin levels increase during pregnancy and birth in humans. Endorphins are associated with feelings of euphoria and analgesia. Increased endorphin levels may increase the pain threshold and enable women in labor to tolerate acute pain (Blackburn, 2007). Culture The obstetric population reflects the increasingly multicultural nature of U.S. society. As nurses care for women and families from a variety of cultural backgrounds, they must have knowledge and understanding of how culture mediates pain. Although all women expect to experience at least some pain and discomfort during childbirth, their culture and religious belief system determines how they will perceive, interpret, and respond to and manage the pain. For example, women with strong religious beliefs often accept pain as a necessary and inevitable part of bringing a new life into the world (Callister, Khalaf, Semenic, Kartchner, & Vehvilainen-Julkunen, 2003). An understanding of the beliefs, values, and practices of various cultures will narrow the cultural gap and help the nurse to assess the woman's pain experience more accurately. The nurse can then provide appropriate culturally sensitive care by using pain-relief measures that preserve the woman's sense of control and self-confidence (see Cultural Considerations box). Recognize that although a woman's behavior in response to pain may vary according to her cultural background, it may not accurately reflect the intensity of the pain she is experiencing. Assess the woman for the physiologic effects of pain and listen to the words she uses to describe the sensory and affective qualities of her pain. Cultural Considerations Some Cultural Beliefs about Pain The following examples demonstrate how women of different cultural backgrounds may react to pain. Because they are generalizations the nurse must assess each woman experiencing pain related to childbirth. • Chinese women may not exhibit reactions to pain, although exhibiting pain during childbirth is acceptable. They consider accepting something when it is first offered as impolite; therefore pain interventions must be offered more than once. Acupuncture may be used for pain relief. • Arab or Middle Eastern women may be vocal in response to labor pain. They may prefer medication for pain relief. • Japanese women may be stoic in response to labor pain, but they may request medication when pain becomes severe. • Southeast Asian women may endure severe pain before requesting relief. • Hispanic women may be stoic until late in labor, when they may become vocal and request pain relief. • Native American women may use medications or remedies made from indigenous plants. They are often stoic in response to labor pain. • African-American women may express pain openly. Use of medication for pain relief varies. Anxiety Anxiety is commonly associated with increased pain during labor. Mild anxiety is considered normal for a woman during labor and birth. However, excessive anxiety and fear cause additional catecholamine secretion, which increases the stimuli to the brain from the pelvis because of decreased blood flow and increased muscle tension; this action, in turn, magnifies pain perception (Zwelling et al., 2006). Thus, as fear and anxiety heighten, muscle tension increases, the effectiveness of uterine contractions decreases, the experience of discomfort increases, and a cycle of increased fear and anxiety begins. Ultimately this cycle will slow the progress of labor. The woman's confidence in her ability to cope with pain will be diminished, potentially resulting in reduced effectiveness of pain-relief measures being used. Previous experience Previous experience with pain and childbirth may affect a woman's description of her pain and her ability to cope with the pain. Childbirth, for a healthy young woman, may be her first experience with significant pain, and as a result, she may not have developed effective pain-coping strategies. She may describe the intensity of even early labor pain as a "10" on a 10-point scale. The nature of previous childbirth experiences also may affect a woman's responses to pain. For women who have had a difficult and painful previous birth experience, anxiety and fear from this past experience may lead to increased pain perception. COMMUNITY ACTIVITY Visit a birthing center and a high risk hospital labor and birth unit in your community. Compare the types of pain management used in each facility for laboring mothers, including both nonpharmacologic and pharmacologic methods. Describe how information about pain management is taught. Is the information culturally appropriate? If not, state how teaching might be improved. Sensory pain for nulliparous women is often greater than that for multiparous women during early labor (dilation less than 5 cm) because their reproductive tract structures are less supple. During the transition phase of the first stage of labor and during the second stage of labor, multiparous women may experience greater sensory pain than nulliparous women because their more supple tissue increases the speed of fetal descent and thereby intensifies pain. The firmer tissue of nulliparous women results in a slower, more gradual descent. Affective pain is usually increased for nulliparous women throughout the first stage of labor but decreases for both nulliparous and multiparous women during the second stage of labor (Lowe, 2002). Parity may affect perception of labor pain because nulliparous women often have longer labors and therefore greater fatigue. Because fatigue magnifies pain, the combination of increased pain, fatigue, and reduced ability to cope may lead to more use of pharmacologic support. Gate-control theory of pain Even particularly intense pain stimuli can, at times, be ignored. This phenomenon is possible because certain nerve cell groupings within the spinal cord, brainstem, and cerebral cortex have the ability to modulate the pain impulse through a blocking mechanism. This gate-control theory of pain helps explain the way hypnosis and the pain-relief techniques taught in childbirth preparation classes work to relieve the pain of labor. According to this theory, pain sensations travel along sensory nerve pathways to the brain, but only a limited number of sensations, or messages, can travel through these nerve pathways at one time. Using distraction techniques such as massage or stroking, music, focal points, and imagery reduces or completely blocks the capacity of nerve pathways to transmit pain. These distractions are thought to work by closing down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished. In addition, when the laboring woman engages in neuromuscular and motor activity, activity within the spinal cord itself further modifies the transmission of pain. Cognitive work involving concentration on breathing and relaxation requires selective and directed cortical activity that activates and closes the gating mechanism as well. As labor intensifies, more complex cognitive techniques are required to maintain effectiveness. The gate-control theory underscores the need for a supportive birth setting that allows the laboring woman to relax and use various higher mental activities.

Step 5

Determine dilation, presenting part, status of membranes, and characteristics of amniotic fluid.

A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" The nurse responds:

"Erythromycin is given prophylactically to prevent a gonorrheal infection."

What is Infant mortality?

# of deaths in infants <1 yr /1000 births (Note racial differences in statistics)

Which of the following tests assess for developmental hip dysplasia and instability?

- Barlow's test - Ortolani's test - Bending the knees and comparing height - Comparing gluteal creases - Comparing leg lengths

• The benefits of breast milk continue after weaning and extend beyond childhood.

...

The first trimester lasts from wks? second? third?

1st- 1-13 2nd- 14-26 3rd- 27-40

Screening blood tests on the newborn are best performed after _____________ hours.

24

A glucose screen is obtained for women who are at high risk for gestational diabetes. B/w what wks is this usually done?

24-28 wks

How many g of protein per day are recommended for pregnant women?

25

The risks of morbidity and mortality increase for newborns weighing less than ______ (LBW) infants.

2500 g (5lb, 8 oz)

What does the US rank among industrialized nations in infant mortality rates despite HP2020 goals?

27th (book 29th), this is r/t LBW

How much ferrous iron should be supplemented daily starting at 12 wks gestation?

30 mg

A mother's household consists of her husband, his mother, and another child. She is living in a/an: A. Extended family B. Single-parent family C. Married-blended family D. Trinuclear family

A

From the RN's perspective, what measure should be the focus of the health care system in order to reduce the rate of infant mortality further? A. Implementing programs to ensure women's early participation in ongoing prenatal care B. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days C. Expanding the number of NICUs D. Mandating that all pregnant women receive care from an obstetrician

A

The nurse caring for the woman in labor should understand that maternal hypotension can result in: A) Uteroplacental insufficiency. B) Spontaneous rupture of membranes C) Fetal dysrhythmias. D) Early decelerations.

A) Uteroplacental insufficiency.

Which time span delineates the appropriate length for a normal pregnancy? A. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days B. 10 lunar months, 9 calendar months, 40 weeks, 280 days C. 9 calendar months, 10 lunar months, 42 weeks, 294 days D. 9 calendar months, 38 weeks, 266 days

B. 10 lunar months, 9 calendar months, 40 weeks, 280 days

plugged milk duct

Blockage of milk duct causing ineffective emptying of breast

Appendicitis may be difficult to diagnose in pregnancy because the appendix is: Displaced upward and laterally, high and to the left. Displaced downward and laterally, low and to the right. Deep at McBurney point. Displaced upward and laterally, high and to the right.

Displaced upward and laterally, high and to the right.

- care of circumcision

Procedural pain management Circumcision is painful. The pain is characterized by both physiologic and behavioral changes in the infant (see discussion that follows). Four types of anesthesia and analgesia are used in newborns who undergo circumcisions: ring block, dorsal penile nerve block (DPNB), topical anesthetic such as eutectic mixture of local anesthetic (EMLA) (prilocaine-lidocaine) or LMX4 (4% lidocaine), and concentrated oral sucrose. Nonpharmacologic methods such as nonnutritive sucking, containment, and swaddling may be used to enhance pain management. The Cochrane group exploring pain relief for neonatal circumcision (Brady-Fryer, Wiebe, & Lander, 2004) found that DPNB was the most effective intervention for decreasing the pain of circumcision. Studies exploring the use of several strategies concurrently, such as that conducted by Razmus, Dalton, and Wilson (2004), which included groups receiving both concentrated oral sucrose and ring block compared with ring block alone, have the most potential to clarify optimal strategies. A ring block is the injection of buffered lidocaine administered subcutaneously on each side of the penile shaft. A DPNB includes subcutaneous injections of buffered lidocaine at the 2 o'clock and 10 o'clock positions at the base of the penis. The circumcision should not be performed for at least 5 minutes after these injections. A topical cream containing prilocaine-lidocaine such as EMLA can be applied to the base of the penis at least 1 hour before the circumcision. The area where the prepuce attaches to the glans is well coated with 1 g of the cream and then covered with a transparent occlusive dressing or finger cot. Just before the procedure the cream is removed. Blanching or redness of the skin may occur. After the circumcision the infant is comforted until he is quieted. If the parents were not present during the procedure, the infant is returned to them. The infant can be fussy for several hours and can have disturbed sleep-wake states and disorganized feeding behaviors. Oral acetaminophen may be administered after the procedure every 4 hours (as ordered by the practitioner) for a maximum of five doses in 24 hours or a maximum of 75 mg/kg/day. Care of the newly circumcised infant Post-circumcision protocols vary. In many settings, the circumcision site is assessed for bleeding every 30 minutes for the first hour and then hourly for the next 4 to 6 hours. The nurse monitors the infant's urinary output, noting the time and amount of the first voiding after the circumcision. If bleeding is noted from the circumcision, the nurse applies gentle pressure to the site of bleeding with a folded sterile gauze square. A hemostatic agent such as Gelfoam® powder or sponge may be applied to the circumcision site to help control the bleeding. If bleeding is not easily controlled, a blood vessel may need to be ligated. In this event, one nurse notifies the physician and prepares the necessary equipment (i.e., circumcision tray and suture material), while another nurse maintains intermittent pressure until the physician arrives. If the parents take the baby home before the end of the observation period, they must be taught proper home care (Teaching Guidelines box). TEACHING GUIDELINES Care of the Circumcised Newborn at Home • Wash hands before touching the newly circumcised penis. CHECK FOR BLEEDING • Check circumcision for bleeding with each diaper change. • If bleeding occurs, apply gentle pressure with a folded sterile gauze square. If bleeding does not stop with pressure, notify primary health care provider. OBSERVE FOR URINATION • Check to see that the infant urinates after being circumcised. • Infant should have a wet diaper 2 to 6 times per 24 hours the first 1 to 2 days after birth, then 6 to 10 times per 24 hours after 3 to 4 days. KEEP AREA CLEAN • Change the diaper and inspect the circumcision at least every 4 hours. • Wash the penis gently with warm water to remove urine and feces. Apply petrolatum to the glans with each diaper change (omit petrolatum if a PlastiBell was used). • Use soap only after the circumcision is healed (5 to 6 days). • Apply the diaper to prevent pressure on the circumcised area. CHECK FOR INFECTION • Glans penis is dark red after circumcision then becomes covered with yellow exudate in 24 hours, which is normal and will persist for 2 to 3 days. Do not attempt to remove it. • Redness, swelling, discharge, or odor indicates infection. Notify the primary health care provider if you think the circumcision area is infected. PROVIDE COMFORT • Circumcision is painful. Handle the area gently. • Provide extra holding, feeding, and opportunities for nonnutritive sucking for a day or two. Nursing actions are planned and implemented to prevent infection. Prepackaged commercial wipes for cleaning the diaper area should not be used because they contain alcohol, which delays healing and causes discomfort. Instead, the nurse washes the penis gently with water to remove urine and feces and, if necessary, applies fresh petrolatum around the glans after each diaper change. The glans penis, normally dark red during healing, becomes covered with a yellow exudate in 24 hours, which is part of normal healing, not an infective process. No attempt should be made to remove the exudate, which persists for 2 to 3 days. Parents should be taught to apply the diaper so that it does not press on the circumcised area. They should be encouraged to change the diaper at least every 4 hours to prevent it from sticking to the penis.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is: "The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor." "The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are." "Your doctor will explain all of that later." "Don't worry about that machine; that's my job."

"The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor."

A cleansing breath at the beginning and end of contractions is important for many reasons because

- Helps the woman release tension - Provides oxygen to reduce myometrial hypoxia

LM Ch1: Name the "never events" pertaining to maternal and child health?

- Infant discharged to the wrong person - Maternal death or serious disability associated with labor or birth in a low risk pregnancy while being cared for in a health care facility - Death or serious disability (kernicterus) associated with failure to identify and treat hyperbilirubinemia neonates - Artificial insemination with the wrong donor sperm or donor egg

Select all of the following situations that may accelerate fetal lung maturation.

- Intrauterine growth restriction - Maternal hypertension - Prolonged rupture of membranes - Maternal administration of steroids

Critical Thinking/Clinical Decision Making Sudden Infant Death Syndrome and Infant Sleep Position Marlys gave birth to a full-term male infant named Daniel. They are being discharged today. The nurse has given her instructions about placing the baby on his back for sleep. Marlys said that she had noticed that the nurses placed Daniel on his side in the nursery and wondered why they did that when she was instructed to place Daniel on his back. Michelle gave birth to Michael at 32 weeks. During the stay in the nursery the nurses placed Michael on his abdomen to sleep. At discharge, Michelle was instructed to place Michael on his back to sleep. Michelle asked why she had to place Michael on his back to sleep when he was used to sleeping on his abdomen. How should the nurses respond to these questions?

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Critical Thinking/Clinical Decision Making Weight Loss after Birth Wendy, a primipara, is postpartum 3 days after giving birth by cesarean to a 9-pound son. She has had an uncomplicated recovery thus far, and breastfeeding is going well. During a discharge teaching session, Wendy expresses concern to the nurse about regaining her figure after childbirth and states that she is worried that she cannot fit into her business clothes when she returns to her job as an administrative assistant in 6 weeks. Before pregnancy, her weight was appropriate for her height. However, during pregnancy, she gained 46 pounds.

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• A healthy infant must accomplish behavioral and biologic tasks to develop normally.

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• A woman who experiences a prolonged latent phase of labor and needs to decrease anxiety or promote sleep may be given a sedative.

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• A woman's cultural background strongly influences her behavior during the postpartum period.

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• After childbirth, total blood volume declines by about 16%, resulting in transient anemia.

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• After placental expulsion, estrogen and progesterone levels decrease dramatically, triggering anatomic and physiologic changes.

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• After uncomplicated vaginal births, women are commonly scheduled for a 6-week postpartum follow-up examination.

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• All parents should be taught infant cardiopulmonary resuscitation.

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• Analgesic drugs used for the pain of childbirth include opioid (narcotic) agonists and opioid (narcotic) agonist-antagonists.

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• As the baby begins sucking on the nipple, the milk ejection, or let-down, reflex is stimulated.

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• At birth, a full-term infant's anatomic and physiologic systems allow extrauterine life.

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• At birth, a protective covering, called vernix caseosa, is fused with the epidermis.

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• At birth, the lower intestine is filled with meconium, which is formed from amniotic fluid and its constituents, intestinal secretions including bilirubin, and cells shed from the mucosa.

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• Baseline measurements include weight, head circumference, and body length.

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• Common problems in neonates include soft tissue injuries, skeletal injuries, physiologic jaundice, hypoglycemia, and hypocalcemia.

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• Common tests for neonates include newborn screening tests and measurements of blood glucose, bilirubin, and drug serum levels.

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• Depending on gestational age and physical condition, many preterm infants can breastfeed for some of their daily feedings.

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• During phototherapy, the unclothed infant is placed under a bank of lights.

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• During pregnancy, physiologic changes influence the need for additional nutrients.

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• During spinal and epidural nerve blocks, the mother's fluid balance must be maintained.

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• During the first 2 hours after birth, the amount of uterine discharge, called lochia, should be similar to the amount during a heavy menstrual period.

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• During the first 6 to 8 hours after birth, newborns go through a transition period between intrauterine and extrauterine life.

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• During the first year of life, the infant's skeletal system undergoes rapid development.

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• During the prenatal period, expectant parents should be taught the benefits of breastfeeding for infants, mothers, families, and society.

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• Early ambulation is associated with a reduced incidence of venous thromboembolism.

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• Early discharge classes, telephone follow-up, home visits, warm lines, and support groups can facilitate physiologic and psychologic adjustments in the postpartum period.

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• Effective nonpharmacologic techniques for managing discomfort include focusing and relaxation, breathing techniques, and water therapy.

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• Engorgement typically occurs 3 to 5 days after birth and lasts about 24 hours.

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• Ensuring a protective environment for the neonate includes following identification procedures and taking precautions to prevent infection.

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• Feeding-readiness cues include hand-to-mouth or hand-to-hand movements, sucking motions, the rooting reflex, and mouthing.

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• From birth, infants have sensory capabilities that indicate a state of readiness for social interaction.

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• General anesthesia is rarely used for vaginal birth but may be used for cesarean birth.

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• Gestational age and birth weight are related to perinatal morbidity and mortality rates.

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• Good nutrition before and during pregnancy helps prevent neonatal problems, such as low birth weight and prematurity.

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• Immediately after birth, nursing care includes maintaining an open airway, preventing heat loss, instilling a prophylactic agent into the eyes, administering vitamin K intramuscularly, providing umbilical cord care, and promoting parent-infant interaction.

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• In appropriate doses, opioid agonist-antagonist analgesics provide adequate analgesia without causing significant respiratory depression in the mother or neonate.

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• In the healthy term newborn, heat loss may exceed the capacity to produce heat, leading to metabolic and respiratory complications.

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• In the newborn, heat loss results from convection, radiation, evaporation, and conduction.

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• In the postpartum period, nursing interventions include preventing excessive bleeding, bladder distention, and infection; relieving pain and discomfort; and promoting or suppressing lactation.

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• In women who breastfeed, ovulation may be delayed for a long period of time.

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• Initially, preterm milk contains higher concentrations of energy, fat, protein, sodium, chloride, potassium, iron, and magnesium than term milk.

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• Involution, the process of returning the uterus to its nonpregnant state, begins immediately after placental expulsion.

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• Kidney function returns to normal within 1 month after birth.

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• Milk production is a supply-meets-demand system; as the baby removes milk from the breast, more milk is produced.

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• Nursing care in the early postpartum period includes helping the mother rest and recover, assessing her physiologic and psychologic adaptation, preventing complications, teaching self-care and infant care, and supporting the mother and her partner as they make the transition to parenthood.

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• Nutrition-related discomforts of pregnancy include nausea and vomiting, constipation, and heartburn. Dietary adaptation can help ease these discomforts.

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• Nutritional care during the preconception period and pregnancy includes nutrition assessment, diagnosis of nutrition-related problems or risk factors (such as diabetes, phenylketonuria, and obesity), intervention based on the dietary goals and plan, and evaluation.

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• Nutritional risk factors include adolescent pregnancy, multifetal pregnancy, frequent pregnancies, previous poor fetal outcome, poverty, nicotine use, alcohol or drug use, poor diet habits, problems with weight gain, and weight loss.

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• Opioid agonist analgesics relieve severe, persistent, or recurrent pain.

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• Opioid agonist-antagonist analgesics are not suitable for women with an opioid dependence because the antagonist activity could precipitate withdrawal symptoms in both the mother and her newborn.

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• Opioid antagonists, such as naloxone (Narcan), can reverse opioid effects, especially respiratory depression.

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• Pregnancy-induced hypervolemia allows most women to tolerate considerable blood loss during childbirth.

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• Prolactin and oxytocin are called the mothering hormones because they affect the mother's emotions as well as her physical state.

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• Signs of respiratory distress include nasal flaring, intercostal or subcostal retractions, and grunting with respirations.

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• Sleep-wake states and other factors influence the newborn's behavior.

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• Suggested benefits of circumcision include a decreased incidence of urinary tract infection and decreased risks of sexually transmitted infection, penile cancer, and human papillomavirus infection.

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• The American Academy of Pediatrics (AAP) recommends breast milk only for the first 6 months of life and breast milk as the only source of milk for the second 6 months.

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• The Apgar score is based the nurse's assessment of the neonate's heart rate, respiratory rate, muscle tone, reflex irritability, and skin color.

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• The cardiovascular system changes significantly after birth.

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• The care plan includes periodic assessments to detect deviations from normal physical changes, measures to relieve discomfort, and safety measures to prevent injury and infection.

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• The composition of breast milk changes with each stage of lactation, during each feeding, and as the infant grows.

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• The four basic positions for breastfeeding are the football or clutch-hold, cradle, modified cradle or across-the-lap, and side-lying positions.

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• The four main categories of infant formulas are cow's milk-based formulas, soy-based formulas, casein- or whey-hydrolysate formulas, and amino-acid formulas.

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• The gate-control theory of pain helps explain how the pain-relief techniques taught in childbirth preparation classes work.

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• The goals of neonatal pain management are to minimize the intensity, duration, and physiologic cost of the pain and to maximize the neonate's ability to cope with and recover from the pain.

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• The most common causes of subinvolution, the failure of the uterus to return to a nonpregnant state, are retained placental fragments and infection.

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• The most critical adjustment a newborn makes at birth is establishing respirations.

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• The most important interventions for preventing excessive bleeding are maintaining good uterine tone and preventing bladder distention.

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• The newborn's average systolic blood pressure is 60 to 80 millimeters of mercury (mm Hg); the average diastolic pressure is 40 to 50 mm Hg.

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• The nurse must understand the expected effects, adverse reactions, and methods of administration of the drugs given to the mother.

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• The nurse should teach inexperienced parents who are using formula feedings about the types of formulas, formula preparation, and correct feeding technique.

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• The nurse should teach parents the signs of illness in newborns, especially jaundice in newborns discharged early.

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• The nurse starts preparing the new mother for discharge at their first postpartum contact.

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• The only nutrition-related laboratory test most women need is a hematocrit or hemoglobin measurement to screen for anemia.

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• Using epidural anesthesia and analgesia is the most effective pharmacologic method for relieving the pain of labor. In the United States, it is the most commonly used method.

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• Vessel damage, immobility, and elevated levels of coagulation factors during the immediate postpartum period predispose the woman to thromboembolism, especially after a cesarean birth.

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• Within 24 hours of birth, the newborn undergoes a complete physical examination.

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Notify the health care provider if a fever of 38.5° C 101.3° or greater occurs. Give penicillin as prescribed.Notify the health care provider if your child begins to develop symptoms of a cold

.recognize signs and symptoms of splenic sequestration, as well as respiratory problems that can lead to hypoxia; and (4) treat the child normally.

During the second postpartum day, a woman asks the nurse, "Why are my afterpains so much worse this time than after the birth of my other child?" The best answer by the nurse would be:

"Afterpains are more severe for women that have already had babies." Afterpains are more acute for multiparas because repeated stretching of muscle fibers leads to low muscle tone that results in repeated contraction and relaxation of the uterus. Breastfeeding increases the severity of afterpains. The afterpains are self-limiting and will decrease rapidly after 48 hours.

A pregnant woman at 25 weeks' gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? "Let me know if it happens again; we need to report that to your midwife." "The fetus is demonstrating the aural reflex." "Babies respond to sound starting at about 24 weeks of gestation." "That must have been a coincidence; babies can't respond like that."

"Babies respond to sound starting at about 24 weeks of gestation."

A new mother is bottle feeding her newborn for the first time. The mother expresses concern to the nurse that the newborn is only drinking ½ ounce. The nurse can best answer the mother's concerns by stating:

"His stomach just holds about ½ ounce right now. By the end of the week it will have expanded and he will be drinking more." At birth the stomach capacity of a newborn is about 6 ml, but will expand to about 90 ml within the first week.

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the client states:

"I will need to increase my insulin dosage during the first 3 months of pregnancy."

A postpartum woman overhears the nurse tell the obstetrics clinician that she has a positive Homans sign and asks what it means. The nurse's best response is:

"You have calf pain when the nurse flexes your foot."Discomfort in the calf with sharp dorsiflexion of the foot may indicate deep vein thrombosis.

milestones on time, as did her son who was born at term. The nurse's most appropriate response is:

"Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing."

What is Mortality?

# of individuals who have died over time

Major signs of uterine atony include:

- uterine fundus that is difficult to locate. - a soft fundus. - excessive lochia. - excessive clots.

During the labor process the client's membranes rupture. Select all of the assessments that are necessary for the nurse to carry out at this time.

-Color of amniotic fluid - Odor of amniotic fluid - Fetal heart rate - Time the membranes ruptured

c (This represents the lowest acceptable value during the first and the third trimesters.)

. Which hematocrit (HCT) and hemoglobin (HGB) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% HCT; 14 g/dl HGB B. 35% HCT; 13 g/dl HGB C. 33% HCT; 11 g/dl HGB D. 32% HCT; 10.5 g/dl HGB

- bladder distention can affect fundus: boggy, bleed more. empty bladder

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- breastfeeding benefits: helps with antibody, readily available, free

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- normal amount of wet diapers for babies to see if breastfeeding is effective: 6-8/day

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- when in doubt, massage the fundus

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Chapter 10: Management of Discomfort

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Chapter 13: Maternal Physiologic Changes

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Chapter 14: Nursing Care of the Family during the Fourth Trimester

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Chapter 16: Physiologic and Behavioral Adaptations of the Newborn

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• A complete physical examination is performed within 24 hours of birth.

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• Chronic conditions, such as diabetes mellitus, renal disease, liver disease, cystic fibrosis, seizure disorders, hypertension, and phenylketonuria, may affect a woman's nutritional status and dietary needs.

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• Habituation is a protective mechanism that allows the infant to become accustomed to environmental stimuli.

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• If the mother is significantly underweight or overweight when pregnancy begins, maternal and fetal risks are increased.

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• Immediately after birth, the nurse focuses on assessing and stabilizing the newborn's condition, while the physician or midwife focuses on care of the mother.

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• Moderate exercise during pregnancy improves muscle tone, which may shorten the course of labor, and promotes a sense of well-being.

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• Mothers commonly use breast milk expression to obtain breast milk that someone else can feed to the baby.

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• Newborns need to breastfeed 8 to 12 times a day.

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• Normally, few changes in vital signs occur after birth.

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• The immediate assessment includes Apgar scoring and a general evaluation of physical status.

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• The initial physical assessment includes a brief review of systems.

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• The optimal rate of weight gain depends on the stage of pregnancy. Total maternal weight gain and the pattern of weight gain affect the pregnancy outcome.

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• The time between birth and the return of the reproductive organs to their nonpregnant state is called the postpartum period, the puerperium, or the fourth trimester of pregnancy.

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• The way each woman perceives or interprets the pain of childbirth is influenced by physical, emotional, psychosocial, cultural, and environmental factors.

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• To help meet the psychosocial needs of a new mother, the nurse assesses the parents' reactions to the birth experience, feelings about themselves, and interactions with the baby and other family members.

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• To set priorities for discharge teaching, the nurse follows parental cues.

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• Used together, pharmacologic and nonpharmacologic measures increase pain relief and create a more positive labor experience for the woman and her family.

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Nurses play a critical role in educating parents regarding measures to prevent infant abduction. Which instructions contribute to infant safety and security?The mother should check the photo ID of any person who comes to her room

.Parents should use caution when posting photos of their infant on the Internet. The mom should request that a second staff member verify the identity of any questionable person.

All women capable of becoming pregnant are advised to consume how many mg of folic acid daily in fortified foods? What are some fortified foods?

0.4 mg ready-to-eat cereal & enriched grain products green leafy vegs whole grains fruit

Screening for chromosomal abnormalities is offered as an option b/w what wks?

11-14 WKS

pyrosis

A burning sensation in the epigastric and sternal region from stomach acid (heartburn)

Which collection of risk factors most likely would result in damaging lacerations including episiotomies ?

A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: A gravida 4 who has had all cesarean births. A gravida 3 who has had two low-segment transverse cesarean births. A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant. A gravida 5 who had two vaginal births and two cesarean births.

A gravida 4 who has had all cesarean births.

b (Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing.)

A group of fetal monitoring experts (National Institute of Child Health and Human Development, 2008) recommends that fetal heart rate (FHR) tracings demonstrate certain characteristics to be described as reassuring or normal (category I). This includes: A. Bradycardia not accompanied by baseline variability B. Early decelerations, either present or absent C. Sinusoidal pattern D. Tachycardia

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called:

A pudendal.

Name some health risks found in childbearing women?

Age Socioeconomic Substance use and abuse Nutrition Physical fitness and exercise Stress Sexual practices Medical conditions Gynecologic conditions Environmental and workplace hazards **Violence against women: women are more abused during the time of pregnancy**

Parents have understood teaching about prevention of childhood otitis media if they make which statement? "We will be sure to keep immunizations up to date."

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which statement made by the parent indicates a correct understanding of the instructions?

Missed abortion refers to retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions.

An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

A newborn's pulse should be assessed using which pulse point?

Apical. The brachial, radial, and femoral pulses may be felt but are difficult to count. The apical pulse can be assessed not only for the heart rate but also heart sounds. The nurse should assess for arrhythmias, murmurs, and other abnormal sounds.

In documenting labor experiences, nurses should know that a uterine contraction is described according to all these characteristics except:

Appearance shape and height

2. Assumptions—What assumptions can be made about the following issues? a. Culturally appropriate diet, activity, and hygiene for the postpartum Asian woman b. Providing appropriate care for the newborn, including breastfeeding, in the Asian culture c. Role of other family members and friends in providing care to the postpartum woman and newborn d. Difficulty in establishing lactation if breastfeeding is not begun immediately

Assumptions. a. In the postpartum period, Asian women are concerned with maintaining balance between hot and cold within the body and in the environment. Blood is considered "hot," so when blood is lost through childbirth, she is considered to be in a "cold" state. A major focus in the postpartum period is keeping the new mother warm. Asian women typically prefer warm foods and hot drinks after giving birth and refuse anything cold. Warm food and drinks help to restore balance in the woman's body by facilitating the return of the "hot" state. The environmental temperature is kept warm; even in summer, the air conditioning is turned off and windows are closed. The postpartum woman is expected to stay in bed to prevent cold air from entering her body. Baths, showers, or washing hair are not permitted. During the 30-day confinement period after birth, the new mother is not to be walking about and cannot leave her home. She is expected to take a passive role. Household tasks are done by female relatives or live-in helpers. b. Because of the prevalent belief among Asians that the mother should rest and remain in bed to protect herself immediately after childbirth, routine baby care is usually provided by another female. In several cultures, including Asian cultures, colostrum is viewed as unnecessary and unhealthy for newborns. Breastfeeding is begun only several days after birth, when the "true milk" has come in. Before that time, babies may be fed prelacteal food. Asian parents often request infant formula for their infant while they are in the hospital. c. In many cultures, female family members and friends play an essential role in providing care for the new mother and baby immediately after birth. In the Asian culture, new mothers observe specific diet and activity restrictions for several weeks. Following these traditional cultural practices in a different country may prove to be extremely difficult if family members or friends are not available. In the home country, males are often not expected to assist in caring for new mothers and babies. Even if a woman's husband is willing to do so, he may need much instruction and encouragement to provide even minimal care for his wife and baby. d. Women are routinely taught that the ideal time to initiate breastfeeding is within the first hour after birth. During this time the baby is usually in the quiet alert state. However, women from cultures that wait hours or days to initiate breastfeeding are able to do so successfully.

For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately she may become a passive player and emotionally absent herself from the process. The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can implement a number of care measures to help her client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care? A) Telling the client to relax and that it won't hurt much B) Limiting the number of procedures that invade her body C) Reassuring the client that as the nurse you know what is best D) Allowing unlimited care providers to be with the client

B) Limiting the number of procedures that invade her body

Number of live births in 1 yr per 1000 population?

Birth rate

The nurse caring for the postpartum woman understands that breast engorgement is caused by:Congestion of veins and lymphatics.

Breast engorgement is caused by the temporary congestion of veins and lymphatics

While doing client teaching the woman tells the nurse, "I don't have to worry about contraception because I am breastfeeding." The nurse should base her answer on the fact that:

Breastfeeding is not a reliable contraceptive method. Menses in a breastfeeding mother may resume between 12 weeks and 18 months. Normally the first few cycles of menses are without ovulation; however, ovulation may occur before the first menses. Therefore, other contraceptive measures are important considerations for this mother.

Which method of pain management is safest for a gravida 3 para 2 admitted at 8 cm cervical dilation?

Breathing and relaxation techniques

With regard to breathing techniques during labor, maternity nurses should understand that:

Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction.

The nurse is assessing a newborn for gestational age. Which technique should be used when performing the scarf sign?

Bring the arm across the body to the opposite side and note the position of the elbow in relation to the midline.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: A) Notify the care provider. B) Assist with amnioinfusion C) Change the woman's position D) Insert a scalp electrode.

C) Change the woman's position p. 431-432; see box 17-4

Your patient is a nulliparous woman, requesting pain relief. You examine her and she is 8 cm. What is the best option for pain relief at this point? A) Demerol B) Spinal C) Epidural D) Stadol

C) Epidural

Which of the following newly delivered mothers are at greater risk for lacerations of the cervical area of vagina? A) Primigravida with 10-hour labor, 1-hour pushing stage, unassisted delivery B) Gravida 2 with an 8-hour labor, 30-minute pushing stage, unassisted delivery C) Gravida 2 with a 1-hour labor, 10-minute pushing stage, unassisted delivery D) Gravida 3 with a 5-hour labor, 30-minute pushing stage, unassisted delivery

C) Gravida 2 with a 1-hour labor, 10-minute pushing stage, unassisted delivery. Cervical lacerations occur frequently when the cervix dilates rapidly during the first stage of labor. Lacerations of the vagina, perineum, and periurethral area usually occur during the second stage of labor when the fetal head descends rapidly.

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations with loss of variability is nonreassuring and is associated with A) Cord compression B) Hypotension C) Hypoxemia/acidemia D) Maternal drug use.

C) Hypoxemia/acidemia

Leading cause of death in the neonatal period?

Congenital anomalies

thermogenesis

Creation or production of heat, especially in the body

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: A) Increase amniotic fluid volume. B) Stimulate the amniotic membranes to rupture. C) Enhance uteroplacental perfusion in an aging placenta. D) Ripen the cervix in preparation for labor induction.

D) Ripen the cervix in preparation for labor induction.

13. Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: A. Uses soap and warm water to wash the vulva and perineum. B. Washes from symphysis pubis back to episiotomy. C. Changes her perineal pad every 2 to 3 hours. D. Uses the peribottle to rinse upward into her vagina.

D. Uses the peribottle to rinse upward into her vagina. Washing the vulva and perineum with soap and water is an appropriate measure. Washing from symphysis pubis back toward episiotomy is an appropriate measure. Changing the perineal pad every 2 to 3 hours in an appropriate measure. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina because debris would be forced upward into the uterus through the still-open cervix.

The nurse recognizes that these symptoms are characteristic of which respiratory condition? Sinusitis

Decongestant nose drops are recommended for a 10-month infant with an upper respiratory tract infection. Instructions for nose drops should include Avoiding use for more than 3 days. to avoid rebound congestion

What conditions or practices are contraindications for breast feeding?

Deep-seated aversion to breast feeding, the woman's need for certain meds or use of street drugs, certain life-threatening illnesses & medical conditions such as HIV

two

Descent

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that:Diabetic ketoacidosis can lead to fetal death at any time during pregnancy.

Diabetes in pregnancy puts the fetus at risk in several ways. Nurses should be aware that:The most important cause of perinatal loss in diabetic pregnancy is congenital malformations.

Step 7

Document findings and report to the provider.

a (Many states have mandatory reporting laws for health care providers. It is important to inform the woman that you may need to report this. Nurses should be knowledgeable about the reporting requirements of the state in which they practice.)

During a health history interview, a woman tells the nurse that her husband physically abuses her. The nurse's first response should be to: A. Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality B. Reassure the woman that the abuse is not her fault C. Give the woman referrals to local agencies and shelters where she can obtain help D. Formulate an escape plan for the woman that she can use the next time her husband abuses her

Which heart condition is not a contraindication for pregnancy? Heart transplant

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

Family that includes the nuclear family and other people related by blood

EXTENDED FAMILY

What is the millennium development goals & what are they in place for?

Eight goals to be achieved by 2015 that respond to the world's main development challenges Signed by 189 nations & 147 heads of state & governments Goals 3-5 all relate to women & children specifically

In assisting with the two factors that have an effect on fetal status pushing and positioning , nurses should:

Encourage the woman's cooperation in avoiding the supine position.

six

External rotation

cephalhematoma

Extravasation of blood from ruptured vessels between a skull bone and its external covering, the periosteum; swelling is limited by the margins of the cranial bone affected (usually parietals)

Interaction and communication among family members

FAMILY DYNAMIC

A school-age child has been admitted to the hospital with an exacerbation of nephrotic syndrome. Which clinical manifestations should the nurse expect to assess

Facial edema Fatigue Frothy-appearing urine proteinuria Weight gain

A newborn has been assessed as high risk for hypoglycemia. The nurse assesses the newborn's blood glucose and it is 38 mg/dl. What should be the nurse's next action?

Feed the newborn a small amount of glucose water followed by breast milk or formula. - Glucose water alone is not recommended for newborns because the rapid rise in glucose results in increased insulin production, causing a further drop in blood glucose. Milk provides a longer-lasting supply of glucose. Action should be taken prior to notifying the pediatrician or health care provider.

Firm sacral pressure is likely to be most helpful in which situation?

Fetal occiput posterior position. - A posterior position of the vertex will cause pressure against the sacrum. This pressure increases back pain during contractions and between contractions. Firm sacral pressure may help relieve some of the pressure.

intrauterine growth restriction (IUGR)

Fetal undergrowth from any cause

A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed? Follicle-stimulating hormone (FSH) level Testicular biopsy Antisperm antibodies Examination for testicular infection

Follicle-stimulating hormone (FSH) level

What are the physical parameters for nutritional assessment?

General Growth most sensitive Skin Hair Mouth Abdomen Musculoskeletal Neuro

The nurse must be cognizant that an individual's genetic makeup is known as his or her: Chromotype. Karyotype. Genotype. Phenotype.

Genotype.

What are the causes of death for neonatal (0-1 month)?

Gestation Birth Weight

3 MAJOR causes of maternal mortality in the US that attribute to pregnancy?

Gestational HTN PE Hemorrhage

What is the difference between growth and development?

Growth is orderly process and occurs in a systematic fashion. Development more complex and subtle, proceeds from simple to complex and general to specific.

Which statement best describes hypopituitarism? Skeletal proportions are normal for age.

Growth is within normal limits for the first year of life. Height is usually more delayed than weight. Intelligence is not affected by hypopituitarism.

Chinese Have an IUD inserted after the first child

Haitian take the placenta home to bury

Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment: Is slightly more expensive. Has no known contraindications. Has fewer false-positive results. Is more sensitive in detecting fetal compromise.

Has no known contraindications.

The new parents express concern that their 4-year-old son is jealous of the new baby. They are planning on going home tomorrow and are not sure how the preschooler will react when they bring the baby home. Which of the following suggestions by the nurse will be most helpful?

Have the mother go into the house alone and spend time with the child before the father brings the baby in. The child needs to have the mother's love reaffirmed. By giving the child some private time with the mother he will get the extra attention and reassurance he needs at this point.

In assessing a woman for pain and discomfort management during labor, a nurse most likely would:

Have the woman use a visual analog scale (VAS) to determine her level of pain.

In the current practice of childbirth preparation, emphasis is placed on

Having expectant parents attend childbirth preparation in any or no specific method.

To assist the woman after delivery of the infant, the nurse knows that the blood patch is used after spinal anesthesia to relieve:

Headache.

Provides an update on goals for maternal and infant health?

Healthy people 2020

Because the risk for childbirth complications may be revealed, nurses should know that the point of maximal intensity (PMI) of the fetal heart tone (FHT) is:

Heard lower and closer to the midline of the mother's abdomen as the fetus descends and rotates internally.

During a client's physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: Chadwick's sign Hegar's sign Goodell's sign McDonald's sign

Hegar's sign

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

Hydralazine.

4. Does the evidence objectively support your conclusion?

If bilirubin levels are measured, there may be evidence to support the conclusion that the baby is experiencing physiologic jaundice. If this is the case, the baby will appear more jaundiced over the next 2 or 3 days.

What has had the greatest impact on reducing infant mortality in the United States? Improvements in perinatal care Decreased incidence of congenital abnormalities Better maternal nutrition Improved funding for health care

Improvements in perinatal care The improvements in perinatal care, particularly care of the mother-baby dyad before birth, have had the greatest impact. There has been a decrease in some congenital anomalies, such as spina bifida, but this has not had the greatest impact. This has had a positive influence but not the greatest overall impact. Changes in funding have not had the greatest impact.

The nurse should expect to assess which clinical manifestations in an adolescent with Cushing's syndrome Cushingoid features Susceptibility to infections Hyperglycemia

In Cushing's syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, and hypokalemia.

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping: On her back with a pillow under her knees. On her abdomen. In a side-lying position. With the head of the bed elevated.

In a side-lying position.

c (This category is correctly referred to as sociodemographic risk. These 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.)

In the past, factors to determine whether a woman was likely to develop 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. These categories include all of these except: A. Biophysical B. Psychosocial C. Geographic D. Environmental

Name 3 vulnerable populations?

Incarcerated women Migrant women Rural versus urban community settings Homeless women and homeless families Refugees and immigrants Implications for nursing Women Racial and ethnic minorities Adolescent girls Older women Low literacy

What do you think the challenges would be to provide FCC in a pediatric unit?

Language, culture, family issues and involvement

pelvic relaxation

Lengthening and weakening of the fascial supports of pelvic structures

During which phase of maternal adjustment will the mother relinquish the baby of her fantasies and accept the real baby?

Letting go

Which statement correctly describes the effects of various pain factors?

Levels of pain-mitigating Beta-endorphins are higher during a spontaneous, natural childbirth.

Signs that precede labor include

Lightening.Bloody show. Rupture of membranes.

In the first trimester, ultrasonography can be used to gain information on: Cervical length. Placental location and maturity. Location of Gestational sacs Amniotic fluid volume.

Location of Gestational sacs

The multi-marker or triple screen test is recommended with the MSAFP. What three levels does this test measure & what do high or low levels indicate?

MSAFP, hCG, unconjugated estriol High or low levels indicate chromosomal abnormalities

Less pain and anxiety during the first stage of labor

Massage

When the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called:Mutuality

Mutuality extends the concept of attachment to include this shared set of behaviors.

For vaginal birth to be successful, the fetus must adapt to the birth canal during the descent. The turns and other adjustments necessary in the human birth process are termed the "mechanism of labor." Please list the seven cardinal movements in the mechanism of labor in the correct order. One Two Three Four Five Six Seven

One- Engagement Two- Descent Three- Flexion Four- Internal rotation Five- Extension Six- External rotation Seven- Expulsion

The postpartum woman has a blood pressure of 150/90, pulse of 72 beats per minute, and respirations of 14 breaths per minute. She continues to bleed heavily. The order states she may have either methylergonovine (Methergine) 0.2 mg IM or oxytocin (Pitocin) 10 units IM for heavy bleeding. The nurse should administer which medication?

Oxytocin. Methylergonovine is contraindicated if the woman has an elevated blood pressure.

engorgement

Painful swelling of breast tissue as a result of rapid increase in milk production and venous congestion causing interstitial tissue edema; impaired milk flow results in accumulation of milk in breasts; most often occurs between the third and fifth postpartum days

What are the leading health indicators for Healthy People 2020?

Physical activity Overweight and Obesity Tobacco Substance Abuse Responsible Sexual behavior

supply-meets-demand system

Physiologic basis for milk production; milk volume is produced in response to amount removed from the breast

Which basic type of pelvis includes the correct description and percentage of occurrence in women?

Platypelloid: flattened, wide, shallow; 3%

Step 2

Position the woman to prevent supine hypotension.

Which factor is known to increase the risk of gestational diabetes mellitus? Maternal age younger than 25 years Previous birth of large infant Underweight before pregnancy Previous diagnosis of type 2 diabetes mellitus

Previous birth of large infant

Name the levels of preventative care, and list some examples?

Primary prevention: immunizations, car seats, etc. Secondary prevention: screenings, testing, early treatments Tertiary prevention: treatment and rehabilitation to prevent complications and further deterioration

Recommended Dietary Allowances (RDAs)

Recommended nutrient intakes estimated to meet the needs of almost all (97%-98%) of the healthy people in the population

List some ethical issues in Perinatal Nursing

Reproductive technology Scarce resources Older age pregnancies Third-party payers Induced ovulation and in vitro fertilization Multifetal pregnancy reduction Intrauterine fetal surgery, Fetoscopy Therapeutic insemination Genetic engineering, Stem cell research Surgery for infertility, "Test tube" babies Treatment of very low-birth-weight (VLBW) infants

The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is:

Respiratory depression.

When pressure is applied to the fetal chin through the perineum at the same time pressure is applied to the occiput of the fetal head, it is termed the _______________.

Ritgen maneuver

The midwife has just examined a labor client and states she is 10 cm dilated. The nurse is aware that this client is in which stage of labor?

Second - The second stage begins with complete dilation (10 cm) and ends with the birth of the baby.

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that: Hemorrhage is the major concern.

Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture in order to prevent hemorrhaging. If the tube must be

milia

Small, white sebaceous glands, appearing as tiny, white, pinpoint papules on the forehead, nose, cheeks, and chin of the neonate

The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate a need for further teaching?I have to stay on strict bed rest for 3 days."

Surgical closure of the ductus arteriosus would:Prevent the return of oxygenated blood to the lungs.

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care.

The 4-year-old brother is punching his mother on the back. The nurse should: Realize that this is a normal family adjusting to family change.

The nurse knows that the second stage of labor, the descent phase, has begun when:

The woman experiences a strong urge to bear down.

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours.

The woman is crying and wants an epidural. What is the likely status of this woman's labor? She is exhibiting hypertonic uterine dysfunction.

What are Erickson's developmental groups?

Trust vs Mistrust (birth to 1 yr) Autonomy vs Shame and Doubt (1-3y) Initiative vs Guilt (3 - 6y) Industry vs Inferiority (6 - 12y) Identity vs Role confusion (12- 18y)

pica

Unusual oral craving during pregnancy (e.g., for laundry starch, dirt, red clay)

The nurse is preparing to admit a newborn with myelomeningocele to the neonatal intensive care nursery. Which describes this newborn's defect?

Visible defect with an external saclike protrusion containing meninges, spinal fluid, and nerves

Significantly decreased use of analgesia, shorter labor

Water immersion

A 38 weeks pregnant woman expresses concern about the striae on her abdomen and breasts and asks when they will disappear. The nurse's best response would be, "The striae: Question options: a) "will disappear in approximately 6 weeks." b) "are a result of pregnancy and will not disappear." c) "will eventually fade to silver or white." d) "will disappear with the use of vitamin E oil."

c) "will eventually fade to silver or white."

woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely

correlated with these orders? The woman has an episiotomy.

The placental site heals by a process of _______________.

exfoliation

LM Ch1: What are the 3 leading causes of maternal death in the US?

gestational hypertension, PE, and hemorrhage

The majority of infant abductions in a hospital setting occur in the _____________.

mother's room

A woman in active labor receives an analgesic opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but

should be used cautiously in women with cardiac disease? Meperidine Demerol

Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is management of the environment. While providing routine mother-baby care,

the nurse should ensure that: An environment that fosters as much privacy as possible should be created.

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming

the soup so that his wife can eat it. The nurse's most appropriate response is to ask the woman: "I'll warm the soup in the microwave for you."

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that

this condition can best be treated by: Applying ice to the breasts for comfort.

The nurse is caring for a 4-year-old child immobilized by a fractured hip. Which complications should the nurse monitor?Decreased metabolic rate

with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. The purpose of this is to prevent:Central nervous system disease.

young boy will receive a bone marrow transplant . This is possible because one of his older siblings is a histocompatible donor. This type of BMT is termed Allogeneic transplants from another individual

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? A) A dipstick value of 3+ for protein in her urine B) Pitting pedal edema at the end of the day C) Blood pressure (BP) increase to 138/86 mm Hg D) Weight gain of 0.5 kg during the past 2 weeks

A) A dipstick value of 3+ for protein in her urine

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? Select all that apply. A) Decreased urinary output and irritability B) Transient headache and +1 proteinuria C) Ankle clonus and epigastric pain D) Platelet count of less than 100,000/mm3 and visual problems E) Seizure activity and hypotension

A) Decreased urinary output and irritability C) Ankle clonus and epigastric pain D) Platelet count of less than 100,000/mm3 and visual problems RATIONAL: A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia.

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _____ has increased. A) Intrauterine infection B) Hemorrhage C) Precipitous labor D) Supine hypotension

A) Intrauterine infection

Which of the following is true about labor dystocia. A) Labor dystocia would be defined if it took longer than an hour to dilate 1 cm during active labor in a first time laboring woman. B) In a nulliparous women with an arrest of labor, the use of pitocin will only help about 25% of women achieve a vaginal birth. C) second stage is abnormally long if it takes longer than 1 hour in a first time mother. D) When a woman has weak and infrequent contractions it is an indication that the baby is too large and she needs to have a Cesarean soon.

A) Labor dystocia would be defined if it took longer than an hour to dilate 1 cm during active labor in a first time laboring woman.

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory? A) Massaging the woman's back B) Changing the woman's position C) Giving the prescribed medication D) Encouraging the woman to rest between contractions

A) Massaging the woman's back

A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease? A) Meperidine (Demerol) B) Promethazine (Phenergan) C) Butorphanol tartrate (Stadol) D) Nalbuphine (Nubain)

A) Meperidine (Demerol)

A primiparous woman is in the triage room being evaluated for labor. She has been having contractions for 2 days, has slept little and is feeling exhausted. On cervical exam she is 1.5 cm dilated, 50% effaced, -1 station - which is not changed from a day ago. Contractions are irregular, 30-40 secs long. Which of the following is the best option for her? A) Offer morphine IM, and a sedative to help her sleep. B) Admit her and give her an epidural. C) Tell her to go home, relax D) Give her a couple of seconal to help her sleep.

A) Offer morphine IM, and a sedative to help her sleep.

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? A) Serum magnesium level of 10 mg/dl B) Respiratory rate of 16 breaths/min C) Deep tendon reflexes 2+ and no clonus D) Urine output of 160 ml in 4 hours

A) Serum magnesium level of 10 mg/dl

A woman arrive in the admission area of L&D. She is complaining of severe abdominal pain which she thinks are contractions and vaginal bleeding. You notice the sheet on the bed is about 1/3 covered with port wine fluid. You would do all of the following EXCEPT: A) Take a complete medical history and measure her vital signs. B) Position on her side and give her oxygen if the fetal heart rate was category II. C) NOtify the charge nurse and patient's provider. D) Start an IV E) Put her on the monitor

A) Take a complete medical history and measure her vital signs.

What is not a trend in the delivery of health care in the United States? A. Greater emphasis has been placed on curing disease and disability than on preventing them. B. Hospital stays for many conditions have been shortened. C. Acute care increasingly is provided through home-based services. D. Hospital-based nurses are increasingly involved in follow-up care after discharge.

A. Greater emphasis has been placed on curing disease and disability than on preventing them.

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: A. Hegar sign B. McDonald sign C. Chadwick sign D. Goodell sign

A. Hegar sign

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? ___________________

3-1-0-1-0

Under the Newborns' and Mothers' Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of

48 hours after a normal vaginal birth and for 96 hours after a cesarean birth.The attending provider and the mother together can decide on an earlier discharge.

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: After taking antibiotics for 24 hours

A child is diagnosed with influenza, probably type A disease. Management includes: Amantadine hydrochloride to reduce symptoms

Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia.

A child with hypoparathyroidism is receiving vitamin D therapy. The parents should be advised to watch for which sign of vitamin D toxicity?Weakness and lassitude

The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve: IV therapy to correct fluid and electrolyte imbalances.

A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has

c (Sperm analysis is the basic test for male infertility.)

A couple presents for their first appointment at an infertility center. A noninvasive test done during initial diagnostic testing is: A. Hysterosalpingogram B. Endometrial biopsy C. Sperm analysis D. Laparoscopy

Which problem is most often associated with myelomeningocele? Hydrocephalus

A current recommendation to prevent neural tube defects is the supplementation of: Folic acid for all women of childbearing age.

Therapeutic management of nephrosis includes: Corticosteroids. Response is usually seen within 7 to 21 days. Antihypertensive agents and long-term diuretic therapy are usually not necessary.

A diet that has fluid and salt restrictions may be indicated.

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? Pitting pedal edema at the end of the day A dipstick value of 3+ for protein in her urine Weight gain of 0.5 kg during the past 2 weeks Blood pressure (BP) increase to 138/86 mm Hg

A dipstick value of 3+ for protein in her urine

With regard to spinal and epidural (block) anesthesia, nurses should know that: Epidural blocks allow the woman to move freely. A high incidence of after-birth headache is seen with spinal blocks. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. Spinal and epidural blocks are never used together.

A high incidence of after-birth headache is seen with spinal blocks.

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that: The hCG level increases gradually and uniformly throughout pregnancy. Much lower than normal increases in the level of hCG may indicate a postdate pregnancy. hCG can be detected 2.5 weeks after conception. A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

A 4-month-old infant has gastroesophageal reflux disease but is thriving without other complications. What should the nurse suggest to minimize reflux? Thicken formula with rice cereal.

A histamine receptor antagonist such as cimetidine Tagamet or ranitidine Zantac is ordered for an infant with gastroesophageal reflux. The purpose of this is to: Reduce gastric acid production.

a (If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.)

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

Syngeneic marrow is from an identical twin Autologous refers to the individual's own marrow.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. most appropriate nursing action to prevent or minimize these reactions with subsequent treatments

Which of the following women can the nurse anticipate having difficulty dealing with labor pain?

A woman having her second baby; the first child was in a posterior position and the labor lasted 18 hours. - Previous experiences with pain can alter a woman's perception of labor pain. The woman with a prolonged labor and posterior position with the last birth will come to this labor anxious about the outcome and amount of pain.

therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: Stimulate fetal surfactant production.

b (Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle.)

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? A. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." C. "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." D. "Herbs have no bearing on fertility."

c (This is the correct calculation of this woman's gravidity and parity.)

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity a9nd parity using the GTPAL system? A. 2-0-0-1-1 B. 2-1-0-1-0 C. 3-1-0-1-0 D. 3-0-1-1-0

b (Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice.)

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? A. "Many women imagine what their baby is like." B. "A baby in utero does respond to the mother's voice." C. "You'll need to ask the doctor if the baby can hear yet." D. "Thinking that your baby hears will help you bond with the baby."

Which assessment is least likely to be associated with a breech presentation? Post-term gestation Breech presentations often occur in preterm births.

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0.

comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? An African-American client who is 19 years old and pregnant with twins

A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care

a (A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none.)

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: A. Primipara B. Primigravida C. Multipara D. Nulligravida

d (A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.)

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her: A. "Because you're in your second trimester, there's no problem with having one drink with dinner." B. "One drink every night is too much. One drink three times a week should be fine." C. "Because you're in your second trimester, you can drink as much as you like." D. "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

b (An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy.)

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: A. Constipation B. Alteration in the pattern of fetal movement C. Heart palpitations D. Edema in the ankles and feet at the end of the day

d (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.)

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

nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc:Would be considered evidence of good diabetes control with a result of 5% to 6%.

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days.

c (The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week.)

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? A. "We don't really know when such defects occur." B. "It depends on what caused the defect." C. "They occur between the third and fifth weeks of development." D. "They usually occur in the first 2 weeks of development."

Spastic cerebral palsy, the most common type of cerebral palsy, will manifest with hypertonicity and increased deep tendon reflexes. The child's muscles are very tight and any stimuli may cause a sudden jerking movement.

A young boy has just been diagnosed with pseudohypertrophic Duchenne's muscular dystrophy. The management plan should include: Recommending genetic counseling.

Bone demineralization leads to a negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi.

A young girl has just injured her ankle at school. In addition to calling the child's parents, the most appropriate immediate action by the school nurse is to: Apply ice.

Select ALL that are true about post dates pregnancy. A) After the due date, women should have assessments of fetal well beings which could include fetal movement counting, biophysical profile and non stress test. B) All women should be induced within a few days part their due date. C) Risks associated with going past 42 weeks gestation include a large baby, low amniotic fluid, meconium aspiration syndrome, and fetal distress in labor. D) An amniotic fluid index of less than 8 has been associated with a higher incidence of Apgar scores less than 7 at 5 minutes.

A) After the due date, women should have assessments of fetal well beings which could include fetal movement counting, biophysical profile and non stress test. C) Risks associated with going past 42 weeks gestation include a large baby, low amniotic fluid, meconium aspiration syndrome, and fetal distress in labor.

The nurse providing care for a woman with preterm labor on terbutaline would include which intervention to identify side effects of the drug? A) Assessing for dyspnea and crackles B) Assessing for bradycardia C) Assessing deep tendon reflexes (DTRs) D) Assessing for hypoglycemia

A) Assessing for dyspnea and crackles

With regard to fetal positioning during labor, nurses should be aware that: A) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine. B) Engagement is the term used to describe the beginning of labor. C) The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. D) Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal.

A) Birth is imminent when the presenting part is at +4 to +5 cm, below the spine. p. 378 • Primary Powers (involuntary uterine contractions) = term used to describe the beginning of labor. • The largest transverse diameter of the presenting part is the biparietal or occipitomental diameter. • Station = measure of the degree of descent of the presenting part of the fetus through the birth canal.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? A) Call for help and Notify the care provider immediately B) Start pitocin C) Have her empty her bladder D) Insert a Foley catheter

A) Call for help and Notify the care provider immediately

Which presentation is described accurately in terms of both presenting part and frequency of occurrence? A) Cephalic: occiput; at least 95% B) Cephalic: cranial; 80% to 85% C) Shoulder: scapula; 10% to 15% D) Breech: sacrum; 10% to 15%

A) Cephalic: occiput; at least 95% p. 377

In evaluating the effectiveness of oxytocin induction, the nurse would expect: A) Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. B) Labor to progress at least 2 cm/hr dilation. C) At least 30 mU/min of oxytocin will be needed to achieve cervical dilation D) The intensity of contractions to be at least 110 to 130 mm Hg.

A) Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: A) Counterpressure against the sacrum B) Pant-blow (breaths and puffs) breathing techniques C) Effleurage. D) Conscious relaxation or guided imagery.

A) Counterpressure against the sacrum

What is the correct order of the cardinal movements? A.Extension B.Internal Rotation C.Expulsion D.Engagement, Flexion Descent E.External Rotation A) D, B, A, E, C B) D, A, B, E, C C) B, D, A, C, E D) D, B, A, C. E

A) D, B, A, E, C p. 388-389

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse: A) Discontinues the magnesium sulfate infusion. B) Administers oxygen. C) Calls for a stat magnesium sulfate level. D) Prepares to administer hydralazine.

A) Discontinues the magnesium sulfate infusion.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: A) Encouraging the woman to try various upright positions, including squatting and standing. Giving positive feedback about her efforts. B) Telling the woman to start pushing as soon as her cervix is fully dilated. C) Stopping the epidural anesthetic so the woman can feel the urge to push and thereby push more effectively D) Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

A) Encouraging the woman to try various upright positions, including squatting and standing. Giving positive feedback about her efforts.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 175/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: A) Hydralazine. B) Magnesium sulfate bolus. C) Diazepam. D) Calcium gluconate.

A) Hydralazine.

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

A) Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

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

A) One fetal movement noted in 1 hour of assessment by the mother

The father of a hospitalized child tells the nurse, "He can't have meat. We are Buddhist and vegetarians." The nurse's best intervention is to: A) Order the child a meatless tray. B) ask a Buddhist priest to visit. C) explain that hospital patients are exempt from dietary rules. D) help the parent understand that meat provides protein needed for healing.

A) Order the child a meatless tray.

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 of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: A) Placental abruption. B) Rupture of the uterus. C) Placenta previa. D) Eclamptic seizure.

A) Placental abruption.

Which basic type of pelvis includes the correct description and percentage of occurrence in women? A) Platypelloid: flattened, wide, shallow; 3% B) Anthropoid: resembling the ape; narrower; 10% C) Android: resembling the male; wider oval; 15% D) Gynecoid: classic female; heart shaped; 75%

A) Platypelloid: flattened, wide, shallow; 3% p. 383

Which of the following nursing interventions is most descriptive of atraumatic care of children? A) Preparing child before any unfamiliar treatment or procedure B) Preparing child for separation from parents during hospitalization C) Helping child accept pain that is associated with a treatment or procedure D) Helping child accept the loss of control associated with hospitalization

A) Preparing child before any unfamiliar treatment or procedure

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance A) Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. B) In the United States early in this century, preterm birth accounted for 18% to 20% of all births. C) Low birth weight is anything below 3.7 pounds. D) The terms preterm birth and low birth weight can be used interchangeably.

A) Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. B) Perform a vaginal examination, reposition the mother, and provide oxygen via face mask. C) Administer oxygen to the mother, increase IV fluid, and notify the care provider. D) Call the provider, reposition the mother, and perform a vaginal examination

A) Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.

The nurse providing care for the laboring woman should understand that variable fetal heart rate (FHR) decelerations are caused by: A) Umbilical cord compression. B) Altered fetal cerebral blood flow C) Fetal hypoxemia. D) Uteroplacental insufficiency

A) Umbilical cord compression. p. 432

Which is correct concerning the performance of a Papanicolaou (Pap) test? A. The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. B. It should be performed once a year beginning with the onset of puberty. C. A lubricant such as Vaseline should be used to ease speculum insertion. D. The specimen for the Pap test should be obtained after specimens are collected for cervical infection.

A. The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test.

8. Although all other joints return to their normal prepregnancy state, those in the parous woman's feet do not. The new mother may notice a permanent increase in her shoe size. A. True B. False

A. True This is an accurate statement.

5. The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: A. Wear a snug, supportive bra. B. Allow warm water to soothe the breasts during a shower. C. Express milk from breasts occasionally to relieve discomfort. D. Place absorbent pads with plastic liners into her bra to absorb leakage.

A. Wear a snug, supportive bra. A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.

5. The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: A. Wear a snug, supportive bra. B. Allow warm water to soothe the breasts during a shower. C. Express milk from breasts occasionally to relieve discomfort. D. Place absorbent pads with plastic liners into her bra to absorb leakage.

A. Wear a snug, supportive bra. A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.

5. Which measure would be least effective in preventing postpartum hemorrhage? A. Administer Methergine, 0.2 mg every 6 hours for four doses, as ordered. B. Encourage the woman to void every 2 hours. C. Massage the fundus every hour for the first 24 hours following birth. D. Teach the woman the importance of rest and nutrition to enhance healing.

C. Massage the fundus every hour for the first 24 hours following birth. Administration of Methergine can help prevent postpartum hemorrhage. Voiding frequently can help the uterus contract, thus preventing postpartum hemorrhage. The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Rest and nutrition are helpful for enhancing healing and preventing hemorrhage.

25. During a phone follow-up conversation with a woman who is 4 days' postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!" The nurse would recognize that the woman is experiencing: A. Taking-in. B. Postpartum depression (PPD). C. Postpartum (PP) blues. D. Attachment difficulty.

C. Postpartum (PP) blues. The taking-in phase is the period after birth when the mother focuses on her own psychologic needs. Typically this period lasts 24 hours. PPD is an intense, pervasive sadness marked by severe, labile mood swings; it is more serious and persistent than the PP blues. During the PP blues, women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day. Crying is not a maladaptive attachment response; it indicates PP blues.

To reassure and educate their pregnant clients about changes in their blood pressure, maternity nurses should be aware that: The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit.

Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

What is an advantage of external electronic fetal monitoring? A) Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions. B) The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring. D) The external EFM can accurately record FHR all the time.

C) The external EFM does not require rupture of membranes or introduction of scalp electrode or IUPC which may introduce risk of infection or fetal scarring. p. 426

Which of the following is NOT a reason to come to labor and birth. A) The patient is 39 weeks with second baby. She has been having contractions for 2 hours. Contractions are getting longer and stronger and closer together. B) The patients says she has noticed greenish fluid leaking from her vagina. She is 41.5 weeks pregnant and not having contractions. C) The patient is 40 weeks and has contractions that are 8-10 minutes apart, 30 seconds long and been that way for 8 hours. D) The patient has not felt the baby move for 8 hours, despite drinking cold fluids, and nudging the baby with her hand.

C) The patient is 40 weeks and has contractions that are 8-10 minutes apart, 30 seconds long and been that way for 8 hours.

The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are caused by: A) Altered cerebral blood flow B) Spontaneous rupture of membranes C) Uteroplacental insufficiency D) Umbilical cord compression

C) Uteroplacental insufficiency p. 432; see box 17-4

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat: A) Fetal tachycardia. B) Fetal bradycardia. C) Variable decelerations D) Late decelerations.

C) Variable decelerations p. 432 & 436; see box 17-5

8. While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a click sound when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has: A. Polydactyly. B. Clubfoot. C. Hip dysplasia. D. Webbing

C. Hip dysplasia. Polydactyly is the presence of extra digits. Clubfoot (talipes equinovarus) is a deformity in which the foot turns inward and is fixed in a plantar-flexion position. The Ortolani maneuver is used to detect the presence of hip dysplasia. Webbing, or syndactyly, is a fusing of the fingers or toes.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates: A. The fetus is at risk for Down syndrome B. The woman is at high risk for developing preterm labor C. Lung maturity D. Meconium is present in the amniotic fluid

C. Lung maturity

14. Which measure would be least effective in preventing postpartum hemorrhage? A. Administer Methergine, 0.2 mg every 6 hours for four doses, as ordered. B. Encourage the woman to void every 2 hours. C. Massage the fundus every hour for the first 24 hours following birth. D. Teach the woman the importance of rest and nutrition to enhance healing.

C. Massage the fundus every hour for the first 24 hours following birth. Administration of Methergine can help prevent postpartum hemorrhage. Voiding frequently can help the uterus contract, thus preventing postpartum hemorrhage. The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Rest and nutrition are helpful for enhancing healing and preventing hemorrhage.

A nurse is checking the fundus of a mother who delivered 30 minutes ago. She assesses the fundus to be boggy. The nurse's next action should be to:

massage the fundus until firm and then gently express any clots. The fundus should be massaged until firm before trying to express any clots. Pushing on an uncontracted uterus could invert the uterus and cause massive hemorrhage and rapid shock.

Your client has been on magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client? A) Absence of uterine bleeding in the postpartum period B) A fundus firm below the level of the umbilicus C) Scant lochia flow D) A boggy uterus with heavy lochia flow

D) A boggy uterus with heavy lochia flow

Which of the following is true with respect to chorioamninitis? (See power point Labor Complications part 4) A) If a woman has chorioamnionitis she will be treated with penicilin and cefotetan. B) Most often chorioamnionitis is caused by pathogens such as GBBS, pneumococci, and CMV. C) Once a woman who has had chorioamnionitis has delivered the antibiotics will be stopped. D) An epidural can cause maternal fever and fetal tachycardia.

D) An epidural can cause maternal fever and fetal tachycardia.

9. When counseling a patient about getting enough iron in her diet, the maternity nurse should tell her that: A. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. Iron absorption is inhibited by a diet rich in vitamin C. C. Iron supplements are permissible for children in small doses. D. Constipation is common with iron supplements.

D. Constipation is common with iron supplements. The beverages listed inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem when iron intake is increased.

The nurse who provides preconception care understands that it: A. Is designed for women who have never been pregnant B. Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions C. Avoids teaching about safe sex to avoid political controversy D. Could include interventions to reduce substance use and abuse

D. Could include interventions to reduce substance use and abuse

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA)

D. Enzyme-linked immunosorbent assay (ELISA)

2. Which finding would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum? A. Postural hypotension B. Temperature of 100.4° F C. Bradycardia—pulse rate of 55 beats/min D. Pain in left calf with dorsiflexion of left foot

D. Pain in left calf with dorsiflexion of left foot Postural hypotension is an expected finding related to circulatory changes after birth. A temperature of 100.4° F in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake. A heart rate of 55 beats/min is an expected finding in the initial postpartum period. Findings of pain in the left calf with dorsiflexion of the left foot indicate a positive Homan's sign and are suggestive of thrombophlebitis and should be investigated.

5. When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should: A. Place the thermistor probe on left side of the chest. B. Cover probe with a nonreflective material. C. Recheck temperature by periodically taking a rectal temperature. D. Prewarm the radiant heat warmer and place the undressed newborn under it.

D. Prewarm the radiant heat warmer and place the undressed newborn under it. The thermistor probe should be placed on the upper abdomen away from the ribs. The probe should be covered with reflective material. Rectal temperatures should be avoided because rectal thermometers can perforate the intestine, and the temperature may remain normal until cold stress is advanced. The radiant warmer should be prewarmed so the infant does not experience more cold stress.

6. Nurses should be able to tell breastfeeding mothers that all of the following are signs that the infant has latched on correctly to her breast except: A. She feels a firm tugging sensation on her nipples but not pinching or pain. B. The baby sucks with cheeks rounded, not dimpled. C. The baby's jaw glides smoothly with sucking. D. She hears a clicking or smacking sound when the infant feeds.

D. She hears a clicking or smacking sound when the infant feeds. The tugging sensation without pinching is a good sign. The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. Rounded cheeks are a good sign. The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. A smoothly gliding jaw is a good sign. The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing.

7. Postbirth uterine/vaginal discharge, called lochia: A. Is similar to a light menstrual period for the first 6 to 12 hours. B. Is usually greater after cesarean births. C. Will usually decrease with ambulation and breastfeeding. D. Should smell like normal menstrual flow unless an infection is present.

D. Should smell like normal menstrual flow unless an infection is present. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.

7. Postbirth uterine/vaginal discharge, called lochia: A. Is similar to a light menstrual period for the first 6 to 12 hours. B. Is usually greater after cesarean births. C. Will usually decrease with ambulation and breastfeeding. D. Should smell like normal menstrual flow unless an infection is present.

D. Should smell like normal menstrual flow unless an infection is present. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.

Parents must learn specific, important guidelines for administration of digoxin.

Diuretics that work on the proximal and distal renal tubules contribute to increased losses of potassium.

What are the overarching goals of Healthy People 2020

Increase quality/years of life and eliminate health disparities

A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would explain that "true" labor contractions:

Increase with activity such as ambulation.

The nurse would expect which maternal cardiovascular finding during labor?

Increased cardiac output

To reassure and educate pregnant clients about changes in the cervix, vagina, and position of the fetus, nurses should be aware that: Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester. The deepening color of the vaginal mucosa and cervix (Chadwick's sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate. Quickening is a technique of palpating the fetus to engage it in passive movement.

Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

In planning care for women with preeclampsia, nurses should be aware that: Vaginal birth is still an option, even in severe cases. A special diet low in protein and salt should be initiated. If at home, the woman should be confined to her bed, even with mild preeclampsia. Induction of labor is likely, as near term as possible.

Induction of labor is likely, as near term as possible.

A student nurse is asked to administer vitamin K to a newborn. The student is aware that vitamin K must be administered within 1 hour of birth but is not sure about which route is appropriate. Vitamin K should be given by which route to this newborn?

Intramuscular. Oral vitamin K has been used for newborn prophylaxis. It is not recommended at this time because it has not been shown to be as effective as parenteral vitamin K. The appropriate route is intramuscular.

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

Is performed primarily for the benefit of the fetus.

8. The __________ test is used to detect the amount of fetal blood in the maternal circulation.

Kleihauer-Betke If more than 15 ml of fetal blood is present in maternal circulation, the dose of Rh immune globulin must be increased.

In regards to vaccines, which ones should be avoided during pregnancy?

LIVE VACCINES SUCH AS MMR OR VARICELLA

afterpains (afterbirth pains)

Painful uterine cramps that occur intermittently for approximately 2 or 3 days after birth and that result from contractile efforts of the uterus to return to its normal involuted condition

Avoidance of intramuscular (IM) injections Acetaminophen (Tylenol) for mild pain control Soft toothbrush for dental hygiene

Parents of a school-age child with hemophilia ask the nurse, "Which sports are recommended for children with hemophilia?" Which sports should the nurse recommend

Name the stages of Language Development

Newborn - cooing, crying 9 - 12months - "mama, dada", "no" 18 - 24 months - 10-20 words, body parts 24 mos - 2-word phrases, 50% unintelligent 3 y - 3-4 word phrases, 75% intelligent, name 4 y - sentences, past tense, story, stutter 5 y- >5 word, future tense

Which method is correct for assessing the fontanels of a newborn?

Newborn slightly elevated and at rest. When the anterior fontanel is palpated, the infant's head should be elevated for accurate assessment. The fontanel should be palpated when the newborn is quiet, because vigorous crying may cause it to protrude.

The nurse must evaluate a male patient's knowledge regarding the use of a condom. The nurse would recognize the need for further instruction if the patient states that he: lubricates the condom with a spermicide containing nonoxynol-9. leaves an empty space at the tip of the condom. leaves a small amount of air in the tip. removes his still-erect penis from the vagina while holding onto the base of the condom.

Nonoxynol-9 is no longer recommended. Recent data suggest that frequent use of nonoxynol-9 may increase human immunodeficiency virus transmission and can cause genital lesions. An empty space at the tip of the condom is the correct instruction. Leaving a small amount of air at the tip of the condom is the correct instruction. Removing the condom while holding the base is the correct instruction.

d (This is correct. MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP.)

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

The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is:Hypertension.Preeclampsia and eclampsia are two noted deadly forms of hypertension

Nurses should be aware that HELLP syndrome Is characterized by hemolysis, elevated liver enzymes, and low platelets.

a (Women tend to be more stressed about infertility tests and to place more importance on having children.)

Nurses should be aware that infertility: A. Is perceived differently by women and men B. Has a relatively stable prevalence among the overall population and throughout a women's potential reproductive years C. Is more likely the result of a physical flaw in the woman than in her male partner D. Is the same thing as sterility

nurse is caring for a client whose labor is being augmented with oxytocin.she recognizes that the oxytocin should be discontinued immediately if there is evidence of: A fetal heart rate of 180 with absence of variability.

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance:Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks

List common childhood health problems

Obesity and Type 2 Diabetes Childhood Injuries Violence Substance Abuse Mental Health Problems

When assessing the preterm infant the nurse understands that compared with the term infant, the preterm infant has: Greater surface area in proportion to weight.

On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask whether they can hold their infant during his next gavage feeding.

- s/s lactose intolerance: GI distress

One problem that can interfere with milk consumption is lactose intolerance, the inability to digest milk sugar (lactose) caused by the absence of the lactase enzyme in the small intestine. Lactose intolerance is relatively common in adults, particularly African-Americans, Asians, Native Americans, and Inuits. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. Yogurt, sweet acidophilus milk, buttermilk, cheese, chocolate milk, and cocoa may be tolerated even when fresh fluid milk is not. Commercial lactase supplements (e.g., Lactaid) are widely available to consume with milk. Many supermarkets stock lactase-treated milk. The lactase in these products hydrolyzes, or digests, the lactose in milk, thus enabling lactose-intolerant people to drink milk. Women with lactose intolerance and those who do not include milk in their diet for any reason are at risk for vitamin D deficiency.

The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by: Interaction of maternal and fetal pH levels within the endometrial vessels. Contact between maternal blood and fetal capillaries within the chorionic villi. A mixture of maternal and fetal blood within the intervillous spaces. Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.

Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries. Fetal capillaries within the chorionic villi are bathed with oxygen-rich and nutrient-rich maternal blood within the intervillous spaces. The endometrial vessels are part of the uterus. There is no interaction with the fetal blood at this point. Maternal and fetal blood do not normally mix. Maternal carbon dioxide does not enter into the fetal circulation.

kernicterus

Pathologic process characterized by deposition of bilirubin in the brain

What are the cognitive development stages of Piaget?

Sensorimotor (birth to 2 years) Preoperational (2 to 7 years) Concrete Operations (7 to 11 years) Formal Operations (11 to 15 years)

Nurses should be aware of the differences experience can make in labor pain such as:

Sensory pain for nulliparous women often is greater than for multiparous women during early labor.

a (Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position.)

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: A. Change in position B. Oxytocin administration C. Regional anesthesia D. Intravenous analgesic

a (Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously it was believed that the left lateral position promoted maternal cardiac output, thereby enhancing blood flow to the fetus. However, it is now known that either side-lying position enhances uteroplacental blood flow.)

The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping: A. In a side-lying position B. On her back with a pillow under her knees C. With the head of the bed elevated D. On her abdomen

The nurse is caring for an infant with suspected pyloric stenosis. Which clinical manifestation would indicate pyloric stenosis? Visible peristalsis and weight loss The upper abdomen is distended

The nurse is caring for a boy with probable intussusception. He had diarrhea before admission but, while waiting for administration of air pressure to reduce the intussusception, he passes a normal brown stool.

A nurse is planning care for a school-age child with type 1 diabetes. Which insulin preparations are rapid and short acting NovoLog 15 minutes Novolin R 30 minutes

The nurse is caring for a school-age child with hyperthyroidism . Which clinical manifestations should the nurse monitor that may indicate a thyroid storm Hyperthermia Tachycardia Vomiting

José is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be: Adapted to his level of development so that he can understand.

The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with blood.

The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate? Creatinine clearance

The nurse is conducting an assessment on a school-age child with urosepsis. Which assessment finding should the nurse expect? Fever with a positive blood culture

is to: Administer an antiemetic before chemotherapy begins.

The nurse is preparing a child for possible alopecia from chemotherapy. Which suggestion should be included in the teaching?Explaining to the child that, when hair regrows, it may have a slightly different color or texture.

Document the findings because they reflect the expected contraction pattern for the active phase of labor.

The nurse is responsible for monitoring the uterine contractions to ascertain whether they are powerful and frequent enough to accomplish the work of expelling the fetus and the placenta.

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow? Tetralogy of Fallot results in decreased blood flow to the lungs.

The nurse is talking to a parent of an infant with heart failure about feeding the infant. Which statement about feeding the child is correct? You may need to increase the caloric density of your infant's formula."

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. The nurse's best response should be that the: Urinary output will increase.

The nurse is teaching the parent about the diet of a child experiencing severe edema associated with acute glomerulonephritis. Which information should the nurse include in the teaching?

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when:

The nurse is unable to feel the cervix during a vaginal examination.The only certain objective sign that the second stage has begun is the inability to feel the cervix because it is fully dilated and effaced.

3. What implications and priorities for nursing care can be drawn at this time?

The nurse needs to reinforce the importance of placing the infant on his or her back to sleep and discuss with the parents the acceptability of placing the infant on the side or abdomen while the infant is awake. The nurse can also advocate for continuing education programs for the nurses to update their clinical knowledge. Signs could be posted in the nursery to remind nurses of the correct positioning.

Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated.

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: A gravida 4 who has had all cesarean births.

a (Episodic accelerations in the fetal heart rate, FHR, occur during fetal movement and are indications of fetal well-being.)

The nurse providing care for the laboring woman understands that accelerations with fetal movement: A. Are reassuring B. Are caused by umbilical cord compression C. Warrant close observation D. Are caused by uteroplacental insufficiency

a (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 pregnancies because of intrauterine growth restriction, IUGR, diabetes mellitus, multiple fetuses, or preterm labor.)

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? A. Doppler blood flow analysis B. Contraction stress test (CST) C. Amniocentesis D. Daily fetal movement counts

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to:Massage the woman's fundus.

The nurse should assess the uterus for atony. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action.

During a phone follow-up conversation with a woman who is 4 days' postpartum, the woman tells the nurse, "I don't know what's wrong. I love my son, but I feel so let down. I seem to cry for no reason!"

The nurse would recognize that the woman is experiencing:During the PP blues women are emotionally labile, often crying easily and for no apparent reason. This lability seems to peak around the fifth PP day.

b (Safety is the most significant part of the intervention.)

The nurse's best measure when evaluating the care of a woman in an abusive situation is based on the: A. Woman's decision to leave her partner B. Woman's declaration of a safety plan C. Couple's follow-through on a referral for counseling D. Woman's gratitude to the nurse for the helpful information

3. What implications and priorities for nursing care can be drawn at this time?

The nurse's priority at this time is to do everything possible to keep Jamie comfortable during labor and assist her in achieving a satisfying birth experience, even though she will not be able to use her desired method of pain relief. Jamie can be informed that there are many methods for relieving pain in labor other than epidural anesthesia, and that we will keep trying until we find the methods that work best for her. Jamie's satisfaction with her labor and birth experience will be determined in large part by the quality of support and interaction she receives from her caregivers. Therefore, it is critical that the nurse, along with any support persons present, remains at the bedside to provide assistance in coping with each contraction. The nurse may need to try a variety of nonpharmacologic methods of pain relief in order to identify those that are most effective for Jamie.

New parents express concern that, because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth.

The nurse's response should convey to the parents that:Attachment, or bonding, is a process that occurs over time and does not require early contact.

An appropriate nursing intervention when caring for a child with pneumonia is to: Encourage rest.Lying on the affected side may promote comfort by splinting the chest and reducing pleural rubbing.

The parent of a toddler calls the nurse, asking about croup. What is a distinguishing manifestation of spasmodic croup? It is marked by a harsh, metallic, barky cough; sore throat; inspiratory stridor; and hoarseness.

When caring for an infant with an upper respiratory tract infection and elevated temperature, an appropriate nursing intervention is to: Give small amounts of favorite fluids frequently to prevent dehydration.

The parent of an infant with nasopharyngitis should be instructed to notify the health care professional if the infant: Shows signs of an earache.

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. Which one is a facilitating behavior?

The parents hover around the infant, directing attention to and pointing at the infant.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be:Dilation of the cervix.

The vaginal examination reveals whether the woman is in true labor

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged?

The woman leaves the infant on her bed while she takes a shower.

The mother of a 1-month-old infant tells the nurse that she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on knowing that:

Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

The nurse providing care for the laboring woman realizes that variable fetal heart rate decelerations are caused by:Umbilical cord compression.

Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord.

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat: Fetal tachycardia. Late decelerations. Variable decelerations. Fetal bradycardia.

Variable decelerations.

sleep-wake states

Variation in states of newborn consciousness from deep sleep to extreme irritability

Congenital syphilis The lesions may extend over the trunk and extremities.

What bacterial infection is definitely decreasing because of effective drug treatment? Group B streptococcal infection

When the patient experiences a partial placenta previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os.

What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae? Hard, boardlike abdomen

Which order should the nurse expect for a patient admitted with a threatened abortion? Bed rest

What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole? Fundal height measurement of 18 cm

Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin: Varies depending on the stage of gestation.

What form of heart disease in women of childbearing years usually has a benign effect on pregnancy? Mitral valve prolapse

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink, but the hands and feet are blue.

What is the correct Apgar score for this infant? The Apgar score is 9 because 1 point is deducted from the total score of 10 for the infant's blue hands and feet.

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline.

What is the likely position of the fetus? RSA

What is the most important information to be included in the discharge planning for an infant with gastroesophageal reflux? Teach the parents how to do infant cardiopulmonary resuscitation (CPR).

What is the major focus of the therapeutic management for a child with lactose intolerance? Teaching dietary modifications

When assessing a child for possible congenital heart defects (CHDs), where should the nurse measure blood pressure All four extremities

What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?Assess the parents' anxiety level and readiness to learn.

nurse, "Why is it taking so long?" The most appropriate response by the nurse would be:"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia? Risk for injury to the fetus related to uteroplacental insufficiency

The nurse is discussing various sites used for insulin injections with a child and her family. Which site usually has the fastest rate of absorption? Abdomen

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness? Substitute simple carbohydrates or calorie-containing liquids for solid foods.

b (A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty.)

What type of cultural concern is the most likely deterrent to many women seeking prenatal care? A. Religion B. Modesty C. Ignorance D. Belief that physicians are evil

c (Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important.)

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

b (Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period, LMP, until the day of birth.)

Which time span delineates the appropriate length for a normal pregnancy? A. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days B. 10 lunar months, 9 calendar months, 40 weeks, 280 days C. 9 calendar months, 10 lunar months, 42 weeks, 294 days D. 9 calendar months, 38 weeks, 266 days

Nurses must be alert for increased fluid requirements when a child has: fever

Which type of dehydration results from water loss in excess of electrolyte loss? Hypertonic dehydration

The nurse is caring for a neonate with a suspected tracheoesophageal fistula. Nursing care should include: Elevating the head but giving nothing by mouth.

Which type of hernia has an impaired blood supply to the herniated organ? Strangulated hernia

The nurse's best response is:"The seizure may or may not mean that your child has epilepsy."

Which type of seizure involves both hemispheres of the brain? Generalized Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres

Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? Arrest of active phase

With an arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, thus indicating an arrest of labor

with Marfan syndrome during labor, which intervention should the nurse complete first?Antibiotic prophylaxis

With one exception, the safest pregnancy is one in which the woman is drug and alcohol free. For women addicted to opioids, Methadone maintenance treatment is the current standard of care during pregnancy

a (This is especially true for new medications and combinations of drugs.)

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: A. Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus B. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester C. Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible D. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus

b (A lactating woman needs to avoid consuming too much caffeine.)

With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. The mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy B. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful C. Critical iron and folic acid levels must be maintained D. Lactating women can go back to their prepregnant calorie intake

a (Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron.)

With regard to protein in the diet of pregnant women, nurses should be aware that: A. Many protein-rich foods are also good sources of calcium, iron, and B vitamins B. Many women need to increase their protein intake during pregnancy C. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet D. High-protein supplements can be used without risk by women on macrobiotic diets

a (A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role.)

With regard to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: A. The father goes through three phases of acceptance of his own B. The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth C. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home D. Typically men remain ambivalent about fatherhood right up to the birth of their child

A boggy uterus with heavy lochia flow Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus increased amounts of bleeding and a heavy lochia flow in the postpartum period.

Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the

A woman is admitted in early labor. The prenatal record states that the fetus is in a transverse lie with a shoulder presentation. The nurse can anticipate:

a cesarean birth. - A transverse lie with a shoulder presentation almost always ends with a cesarean birth.

When assessing the lochia of a new mother for the last time before discharge the nurse notes a foul smell from the vaginal discharge. The mother states she noticed it for the first time a couple of hours ago. The nurse should assess for:

a fever.With endometritis the mother will have signs and symptoms of a fever, chills, malaise, lethargy, anorexia, abdominal pain, abdominal cramping, uterine tenderness, and a purulent, foul-smelling lochia. Other signs include tachycardia and subinvolution.

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse would tell him to: ejaculate into a sterile container. obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. transport specimen with container packed in ice. ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

abstinence from ejaculation of 2 to 5 days. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. An ejaculated sample should be obtained after a period of abstinence to get the best results. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

The term used to describe a situation in which a cultural group loses its identity and becomes part of the dominant culture is called: assimilation. cultural relativism. acculturation. ethnocentrism.

assimilation Assimilation is the process by which groups "melt" into the mainstream. Cultural relativism refers to learning about and applying the standards of another person's culture to activities within that culture. Acculturation refers to changes that occur within one group or among several groups when people from different cultures come in contact with one another. Ethnocentrism is a belief in the rightness of one's culture's way of doing things.

A multipara in the fourteenth week of pregnancy seems discouraged after her second clinic visit. She tells the nurse, "I guess I am pleased to be pregnant, but these visits are so routine. It's hard for me to take time from work to sit in the waiting room for just a urine check and weigh-in." What teaching by the nurse would be emphasized with this client? Question options: a) "Although pregnancy is normal, one must be prepared for any problems." b) "These routine visits are essential to the fetus and to your health." c) "Perhaps you might weigh yourself at home each week and call us." d) "Have you considered resigning from your job at this time?"

b) "These routine visits are essential to the fetus and to your health."

During the first trimester of pregnancy, a woman can expect which one of the following changes in her sexual desire? Question options: a) Increase because of enlarging breasts b) Decrease because of nausea and fatigue c) No change in the first trimester d) Increase due to lack of need for birth control

b) Decrease because of nausea and fatigue

A couple is preparing to interview obstetric primary care providers in order to determine who they wll go to for care during their pregnancy and delivery. In order to make the best choice, which of the following actions should the couple perform first? Question options: a) Take a tour of hospital delivery areas. b) Develop a preliminary birth plan. c) Make appointments with three or four obstetric care providers. d) Search the internet for the malpractice histories of the providers.

b) Develop a preliminary birth plan.

A pregnant woman who is Rh negative is to receive RhoGAM prophylactically at 28 weeks' gestation. Before receiving the medication, she asks the nurse how the drug works. Which of the following best describes how RhoGAM acts in the expectant mother's body? Question options: a) RhoGAM attaches to maternal and paternal Rh antibodies and directly destroys them. b) RhoGAM suppresses the production of maternal antibodies. c) RhoGAM destroys fetal Rh positive red blood cells in the maternal circulation before sensitization can occur d) RhoGAM prevents fetal-maternal bleeding episodes from occurring at the former placenta site.

b) RhoGAM suppresses the production of maternal antibodies.

The nurse instructs an expectant couple about the symptoms of pregnancy. The symptoms a woman may experience during the first trimester are which of the following? Question options: a) amenorrhea, urinary frequency, and quickening. b) urinary frequency, morning sickness, and amenorrhea. c) weight gain and Braxton Hicks contractions. d) amenorrhea, ankle edema, and urinary frequency.

b) urinary frequency, morning sickness, and amenorrhea.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96

beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: Hydralazine.

In order to obtain an accurate blood pressure of a woman in labor, the nurse should assess the blood pressure:

between contractions with the woman lying on her side. - During uterine contractions, blood flow to the placenta gradually decreases, causing a relative increase in the woman's blood volume. This temporary change increases her blood pressure slightly. If the woman lies on her back, the weight of the fetus, placenta, and fluid may decrease blood flow, causing supine hypotension. Therefore her blood pressure is more accurate when taken between contractions with her lying on her side.

The nurse should assess all newborns for jaundice daily. This is done by:

blanching the newborn's skin. - Assess for jaundice by blanching the infant's skin on the nose or sternum. Blood work is ordered if changes in color occur.

The development of a strong emotional tie of a parent to a newborn is called _____________.

bonding

What is most descriptive of the pathophysiology of leukemia Unrestricted proliferation of immature white blood cells WBCs occurs.

boy with leukemia screams whenever he needs to be turned or moved. probable cause of this pain is invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures

When providing health education to the client, the nurse understands that an example of the secondary level of prevention is: approved infant car seats. breast self-examination (BSE). immunizations. support groups for parents of children with Down syndrome.

breast self-examination (BSE) Infant car seats are an example of primary prevention. BSE is an example of secondary prevention, which includes health screening measures for early detection of health problems. Immunizations are an example of primary prevention. Support groups are an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., Down syndrome).

A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 years old at 28 weeks gestation; delivered a daughter, now 5 years old, at 39 weeks gestation; had a miscarriage 3 years ago; and had a first trimester abortion 2 years ago. She is currently pregnant. Which of the following correctly protrays her GTPAL? Question options: a) G4P2121 b) G4P1212 c) G5P1122 d) G5P2211

c) G5P1122 Rationale: This client has been pregnant 5 times (G5). She birthed a son and a daughter, had 1 miscarriage, had 1 abortion and is currently pregnant. Her parity reflects her obstetrical history: 1 full term birth (daughter); 1 preterm birth (son); 2 abortions (miscarriages count as abortions and are referred to as such even though they aren't induced), and has two living children.

The phenomenon of physiologic anemia of pregnancy occurs because of which of the following? Question options: a) Hemolysis of red blood cells is accelerated during pregnancy. b) Iron stores are depleted due to nausea and vomiting in early pregnancy. c) Plasma volume is greater than the red blood cell mass. d) Red blood cell production decreases during pregnancy.

c) Plasma volume is greater than the red blood cell mass.

The client is admitted in early labor. Her support person tells the nurse that the contractions have the following pattern: started 1232, ended 1233; started 1235, ended 1236; started 1239, ended 1240; started 1243, ended 1244. From this information the nurse determines that the frequency of the contractions is:

every 3 to 4 minutes. - The frequency of a contraction is measured from the beginning of one contraction until the beginning of the next contraction. The contractions started at 1232, 1235, 1239, and 1243. This would put the contractions every 3 to 4 minutes. The duration of the contractions is from the beginning of a contraction until the end of the same contractions. The duration for this pattern would be 1 minute.

Self-care instructions for a woman following a modified radical mastectomy would include that she: wears clothing with snug sleeves to support her affected arm. use depilatory creams instead of shaving the axilla of her affected arm. expect a decrease in sensation or tingling in her affected arm as her body heals. empty surgical drains once a day or every other day.

expect a decrease in sensation or tingling in her affected arm as her body heals Loose clothing should be worn since tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Drains should be emptied at least twice a day and more often if necessary.

A mother's household consists of her husband, his mother, and another child. She is living in a/an: extended family. single-parent family. married-blended family. trinuclear family.

extended family. An extended family includes blood relatives living with the nuclear family. Both parents and a grandparent are living in this extended family. Married-blended refers to families reconstructed after divorce. Both parents and a grandparent make up an extended family.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the

fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for Macrosomia.

The obstetric nurse is preparing the patient for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware and prepared for the

greatest risk of administering general anesthesia to the patient. This risk is: Aspiration of stomach contents.

The nurse notices on the admission record that the fetus is in a cephalic military presentation. The nurse realizes that the fetus:

has the head in the birth canal first, but the head is not flexed. - Cephalic presentation shows that the head is coming into the birth canal first. The military presentation means that the head is in a neutral position, neither flexed nor extended.

One reason preterm infants are at higher risk for cold stress is the fact that they:

have a decreased amount of brown fat. The primary method of heat production in infants is the metabolism of brown fat to produce heat. Preterm infants may be born before stores of brown fat have accumulated.

During the active stage of labor the woman is using a rapid "pant-blow" breathing pattern. She starts to complain of feeling dizzy and has some numbness in her fingers. The nurse's next action should be to:

have the woman breathe into a paper bag. - Hyperventilation is common when breathing techniques are used. It results from rapid deep breathing that causes excessive loss of carbon dioxide and therefore respiratory alkalosis. Blowing into a paper bag or her own cupped hands will increase the carbon dioxide levels by having the woman rebreathe her exhaled air.

During active labor the woman complains about tingling in her hands. The nurse's next action should be to:

help the woman slow down her breathing and breathe into her cupped hands. - Hyperventilation may occur during active labor as the woman breathes rapidly. She may feel tingling in her hands and feet, and dizziness. By having the woman slow her breathing and breathe into her cupped hands, the carbon dioxide levels will return to normal and relieve the symptoms.

When obesity is present either before conception or during, there is an increased likelihood of what complications in the fetus?

macrosomia, fetopelvic disproportion, operative vaginal birth, emergency cesarean birth, postpartum hemorrhage, wound, genital tract or urinary tract infections, birth trauma, & late fetal death

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's intravenous fluid for a preprocedural bolus. She reviews

her laboratory values and notes that the woman's hemoglobin is 12 g/dL, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman She has thrombocytopenia

The two most frequently reported maternal medical risk factors are: hypertension associated with pregnancy and diabetes. drug use and alcohol abuse. homelessness and lack of insurance. behaviors and lifestyles.

hypertension associated with pregnancy and diabetes These are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of increased health care services and longer hospital stays. Both drug and alcohol use continue to increase in the maternal population. These are associated with low-birth-weight infants, mental retardation, and birth defects. The number of these clients are increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching?

"If my child develops a sore throat and fever, I should contact the physician immediately."

Techniques the nurse can use to prevent heat loss in a newborn include:

- turning the radiant warmer on before the infant's birth. - drying the wet infant quickly. - changing the linens if they become wet with warm dry linens.

- if mom doesn't want to breastfeed: avoid breast stimulation, tight bra, ice packs. leave them alone

...

• The infant's individual growth pattern helps determine the right time to start solid foods.

...

During the first trimester, the average expected weight gain is what?

1-2 kg, because growth occurs mainly in maternal tissue

Quickening usually occurs b/w which wks of gestation?

16-20 wks

A new mother asks the nurse when the "soft spot" on her son's head will go away. The nurse's answer is based on the knowledge that the anterior fontanel closes after birth by _____ months. 8 12 2 18

18

Achieving and maintaining euglycemia comprise the primary goals of medical therapy for the pregnant woman with diabetes. These goals are achieved through a combination of diet, insulin, exercise, and blood glucose monitoring. The target blood glucose levels 1 hour after a meal should be: _________________

180mg/dL

What are some methods for nutritional assessments?

24 hour recall Food diary Food frequency

Neonatal mortality rate is described as the # of deaths of infants younger than ____ per 1000 live births.

28 days

What is the recommended daily fiber intake during pregnancy?

28 g

The US ranks _____ & Canada ranks ____ among industrialized nations in infant mortality rates.

29th 25th

The normal respiratory rate of a newborn is _____ to ________ breaths per minute.

30; 60

Recommended daily fluid intake for pregnant women is?

8-10 glasses or 2-3 L of fluid

Which foods provide a good source of potassium for pregnant women?

8-10 servings of unprocessed fruits & vegs daily, with moderate amounts of low fat meats & dairy products

Because of the premature infant's decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant? Risk for infection

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate before birth is 180 beats/min with limited

The most common cause of decreased variability in the fetal heart rate FHR that lasts 30 minutes or less is:Fetal sleep cycles

A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. The nurse concludes that: A) The placenta has separated. B) A cervical tear occurred during the birth C) The woman is beginning to hemorrhage. D) Clots have formed in the upper uterine segment.

A) The placenta has separated.

With regard to a woman's intake and output during labor, nurses should be aware that: A) The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia and studies are not showing harm from drinking fluids in labor. B) Intravenous (IV) fluids usually are necessary to ensure that the laboring woman stays hydrated. C) Routine use of an enema empties the rectum and is very helpful for producing a clean, clear delivery. D) When a nulliparous woman experiences the urge to defecate, it often means birth will follow quickly

A) The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia and studies are not showing harm from drinking fluids in labor.

The two most frequently reported maternal medical risk factors are: A. Hypertension associated with pregnancy and diabetes B. Drug use and alcohol abuse C. Homelessness and lack of insurance D. Behaviors and lifestyles

A. Hypertension associated with pregnancy and diabetes

The nurse is caring for an adolescent who has just started dialysis. The child seems always angry, hostile, or depressed. The nurse should recognize that this is most likely related to:

Adolescents often resenting the control and enforced dependence imposed by dialysis.

child with hypopituitarism is being started on growth hormone therapy. Nurses should be based Replacement therapy requires daily sub Q injections.therapy is not needed after attaining final height.

An adolescent is being seen in the clinic for evaluation of acromegaly. nurse understands that which occurs with acromegaly? There is excess GH after closure of the epiphyseal plates.

Nurses caring for antepartum women with cardiac conditions should be aware that:Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.

As related to the care of the patient with anemia, the nurse should be aware that:It is the most common medical disorder of pregnancy.

Currently, the fastest-growing segment of the homeless population in the United States consists of which of the following? A) Families B) "Runaway" adolescents C) Migrant farm workers D) Individuals with mental disorders

B) "Runaway" adolescents

Perinatal nurses are legally responsible for: A) Applying the external fetal monitor and notifying the care provider. B) Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. C) Greeting the client on arrival, assessing her, and starting an intravenous line. D) Making sure that the woman is comfortable.

B) Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes. p. 434

Which of the following terms best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior? A) Race B) Culture C) Ethnicity D) Social group

B) Culture

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop: Slowed growth.

B-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? Dilate the bronchioles

9. Changes in the maternal immune system during the postpartum period account for the profuse diaphoresis that new mothers experience. A. True B. False

B. False No significant changes in the maternal immune system occur during the postpartum period.

Family after divorce in which the child is a member of both the maternal and the paternal nuclear households

BINUCLEAR FAMILY

______ care is provided by obstetricians, family physicians, CNMs, and other advanced practice clinicians approved by local governance.

Basic

The risk of uterine rupture increases for the patient who has had multiple prior births with no vaginal births. As the number of prior uterine incisions increases, so does the risk for uterine rupture

Before the physician performs an external version, the nurse should expect an order for a: Tocolytic drug. A tocolytic drug will relax the uterus before and during version, thus making manipulation easier.

A 41-week pregnant multigravida presents in the labor and delivery unit after a nonstress test indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool would yield more detailed information about the fetus? Percutaneous umbilical blood sampling (PUBS) Biophysical profile (BPP) Ultrasound for fetal anomalies Maternal serum alpha-fetoprotein (MSAFP) screening

Biophysical profile (BPP)

What are trends in physical development related to weight?

Birth weight doubles by 4-6mos Triples by 1 year 4-6" per year until adolescence

anthropometric measurements

Body measurements, such as height and weight

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

C) A fetal heart rate (FHR) of 180 with absence of variability.

A woman in labor has just received an epidural block. The most important nursing intervention is to: A) Limit parenteral fluids. B) Monitor the fetus for possible tachycardia C) Monitor the maternal blood pressure for possible hypotension. D) Monitor the maternal pulse for possible bradycardia

C) Monitor the maternal blood pressure for possible hypotension.

What assessment is least likely to be associated with a breech presentation? A) Fetal heart tones heard at or above the maternal umbilicus B) Meconium-stained amniotic fluid C) Postterm gestation D) Preterm labor and birth

C) Postterm gestation

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:Degree of glycemic control during pregnancy.

Concerning the use and abuse of legal drugs or substances, nurses should be aware that:Caucasian women are more likely to experience alcohol-related problems.

Which of the following is NOT a reassuring component of the fetal heart rate A) FHR of 114 B) Accelerations of the FHR C) Moderate Variability D) Absent FHR Variability

D) Absent FHR Variability p. 428

What do morbidity rates measure? A) Life span statistics B) Acute illness, chronic disease, or disability C) Cost-effective treatment for general population D) Prevalence of a specific illness in a population

D) Prevalence of a specific illness in a population

The hormone responsible for maturation of mammary gland tissue is: A. Estrogen B. Testosterone C. Prolactin D. Progesterone

D. Progesterone

Which of the following characteristics is associated with false labor contractions?

Decrease in intensity with ambulation - Whereas false labor contractions decrease with activity, true labor contractions are enhanced or stimulated with activity such as ambulation.

hyperbilirubinemia

Elevation of unconjugated serum bilirubin concentrations

What are some of the benefits that result from moderate exercise during pregnancy?

Improved muscle tone, potentially shortened course of labor, promoted sense of well-being

Nurses should be aware that chronic hypertension:Can occur independently of or simultaneously with gestational hypertension.

In planning care for women with preeclampsia, nurses should be aware that:Induction of labor is likely, as near term as possible.

late preterm infant

Infants born at 34-0/7 to 36-6/7 weeks of gestation

- know when to take iron: at bedtime with orange juice to increase absorption. avoid taking it with dairy. sip through straw if liquid suspension to avoid staining teeth.

Iron Iron is needed both to allow transfer of adequate iron to the fetus and to permit expansion of the maternal red blood cell (RBC) mass. The RDA of iron during pregnancy is 27 mg per day (National Institutes of Health, 2007). Pregnant women should receive a supplement of 30 mg of ferrous iron daily, starting by 12 weeks of gestation. (Iron supplements may be poorly tolerated during the nausea that is prevalent in the first trimester.) Iron supplementation of women with iron deficiency can improve maternal hematologic indices and appears to reduce LBW births. If maternal iron-deficiency anemia is present (preferably diagnosed by measurement of serum ferritin, a storage form of iron), increased doses (60-120 mg daily) are recommended. Certain foods taken with an iron supplement can promote or inhibit absorption of iron from the supplement. See the Patient Instructions for Self-Management box regarding iron supplementation. Even when a woman is taking an iron supplement, she should include good food sources of iron in her daily diet (see Table 8-1). PATIENT INSTRUCTIONS FOR SELF-MANAGEMENT Iron Supplementation • Iron absorption is promoted by a diet rich in vitamin C (e.g., citrus fruits, melons) or "heme iron" (found in red meats, fish, and poultry). • Iron supplements are best absorbed on an empty stomach; to this end, they can be taken between meals with beverages other than milk, tea, or coffee. • Bran, milk, egg yolks, coffee, tea, or oxalate-containing vegetables such as spinach and Swiss chard will inhibit iron absorption if consumed at the same time as iron. • Some women have gastrointestinal discomfort when they take the supplement on an empty stomach; therefore a good time for them to take the supplement is just before bedtime. • Constipation is common with iron supplementation. • Iron supplements should be kept away from any children in the household because ingestion of these supplements could result in acute iron poisoning and even death. • Iron may cause black, tarry stools. Zinc is a constituent of numerous enzymes involved in major metabolic pathways. Zinc deficiency is associated with malformations of the central nervous system in infants. When large amounts of iron and folic acid are consumed the absorption of zinc is inhibited, and serum zinc levels are reduced as a result. Because iron and folic acid supplements are commonly prescribed during pregnancy, pregnant women should be encouraged to consume good sources of zinc daily (see Table 8-1). Women with anemia who receive high-dose iron supplements also need supplements of zinc and copper. Vitamin C, or ascorbic acid, plays an important role in tissue formation and enhances the absorption of iron. The vitamin C needs of most women are readily met by a diet that includes at least one daily serving of citrus fruit or juice or another good source of the vitamin (see Table 8-1), but women who smoke need more. For women at nutritional risk, a supplement of 50 mg/day is recommended. However, if the mother takes excessive doses of this vitamin during pregnancy, a vitamin C deficiency may develop in the infant after birth.

The most common neurologic disorder accompanying pregnancy is: Eclampsia.

Marfan syndrome is an autosomal dominant genetic disorder that displays as weakness of the connective tissue, joint deformities, ocular dislocation, and weakness to the aortic wall and root. While providing care to a client

A laboring woman received an opioid agonist (meperidine) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? Promethazine (Phenergan) Nalbuphine (Nubain) Naloxone (Narcan) Fentanyl (Sublimaze)

Naloxone (Narcan)

inverted nipples

Nipples invert rather than evert when stimulated; may interfere with effective latch

Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?

PPD can easily go undetected.

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? Preparing the woman for a cesarean birth Placing the woman in the knee-chest position Starting oxygen by face mask Covering the cord in sterile gauze soaked in saline

Placing the woman in the knee-chest position

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present? Poor wound healing

Poor wound healing is often an early sign of type 1 diabetes mellitus. Dry skin, weight loss, and dehydration are clinical manifestations of type 1 diabetes mellitus.

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? Thrombocytopenia Bleeding time of 10 minutes Presence of fibrin split products Hyperfibrinogenemia

Presence of fibrin split products

What is Morbidity?

Prevalence of disease

vernix caseosa

Protective gray-white fatty substance of cheesy consistency covering the fetal skin

Maternal mortality the first 42 days after termination of pregnancy?

Puerperium

uterine atony

Relaxation of uterine muscle possibly leading to excessive postpartum bleeding and postpartum hemorrhage

Commonly 45 seconds or more in the second stage of labor

Relaxation time

Amphetamine. Heroin. Nicotine. PCP.

Risk factors associated with necrotizing enterocolitis (NEC) include Polycythemia. Anemia. Congenital heart disease.

nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment?

Seldom makes eye contact with her son

b (An ejaculated sample should be obtained after a period of abstinence to get the best results.)

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to: A. Ejaculate into a sterile container B. Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days C. Transport specimen with container packed in ice D. Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? Slightly above the symphysis pubis Not palpable above the symphysis at this time Slightly above the umbilicus At the level of the umbillicus

Slightly above the symphysis pubis

A school-age child with chronic renal failure is admitted to the hospital with a serum potassium level of 5.2 mEq/L. Which prescribed medication should the nurse plan to administer?

Sodium polystyrene sulfonate Kayexalate

Peaking at 40 to 70 mm Hg in the first stage of labor

Strength

caput succedaneum

Swelling of the tissue over the presenting part of the fetal head caused by pressure during labor

A means of controlling the birth of the fetal head with a vertex presentation is:

The Ritgen maneuver.The Ritgen maneuver extends the head during the actual birth and protects the perineum. Gentle, steady pressure against the fundus of the uterus facilitates vaginal birth.

17. The _________________________ test is used to detect the amount of fetal blood in the maternal circulation.

The correct response is "Kleihauer-Betke"

Providing care for the neonate born to mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach.

The first step in the provision of this care is: Neonatal abstinence syndrome scoring.

d (A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes.)

The most common cause of decreased variability in the FHR that lasts 30 minutes or less is: A. Altered cerebral blood flow B. Fetal hypoxemia C. Umbilical cord compression D. Fetal sleep cycles

The metabolic rate of infants with heart failure is greater because of poor cardiac function and increased heart and respiratory rates

The nurse is admitting a child with rheumatic fever. Which therapeutic management should the nurse expect to implement? Administering penicillin

The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is: Vomiting.

The parents of a young child with congestive heart failure tell the nurse that they are "nervous" about giving digoxin. The nurse's response should be based on knowing that:

It is paramount for the obstetric nurse to understand the regulatory procedures and criteria for admitting a woman to the hospital labor unit. Which guideline is an important legal requirement of maternity care?

The patient's weight gain is calculated to determine whether she is at greater risk for cephalopelvic disproportion (CPD) and cesarean birth.

When assessing a multiparous woman who has just given birth to an 8 lb boy, nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. nurse concludes that:

The placenta has separated.

Fetal well-being during labor is assessed by: The response of the fetal heart rate (FHR) to uterine contractions (UCs). Accelerations in the FHR. An FHR above 110 beats/min. Maternal pain control.

The response of the fetal heart rate (FHR) to uterine contractions (UCs).

autolysis

The self-destruction of excess hypertrophied tissue

In what part of culture would you find reproductive beliefs and practices?

They are found in economic, religious, kinship, and political structures

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure?

Ultrasound for placental location

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure? Ultrasound for placental location Internal fetal monitoring Contraction stress test (CST) Amniocentesis for fetal lung maturity

Ultrasound for placental location

What are positive indicators?

Undeniable signs of pregnancy such as evaluation of the fetus on ultrasound

lochia

Vaginal discharge during the puerperium consisting of blood, tissue, and mucus

Cultural prescriptions tell women?

What to do

c (Goodell sign might be the result of pelvic congestion, not polyps.)

Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? A. Amenorrhea-stress, endocrine problems B. Quickening-gas, peristalsis C. Goodell sign-cervical polyps D. Chadwick sign-pelvic congestion

jaundice

Yellow color of skin due to increased level of bilirubin in body tissues

4. Does the evidence objectively support your conclusion?

Yes. Many studies done over the years have shown that there are many nonpharmacologic methods available to effectively relieve labor pain.

While providing preconception counseling to a couple, the nurse explains that during development the fetus is most vulnerable to damaging agents during the: Question options: a) second trimester. b) embryonic period. c) third trimester. d) period immediately after conception.

b) embryonic period.

A positive early diagnosis of pregnancy is based on the presence of which of the following? Question options: a) Quickening b) Chadwick's sign c) A fetal heart rate d) Positive pregnancy test

c) A fetal heart rate

One nursing measure that can help prevent postpartum hemorrhage and urinary tract infections is:

encouraging voiding every 2 to 3 hours. Urinary retention and overdistention of the bladder may cause both urinary tract infection and postpartum hemorrhage. Encouraging the mother to empty her bladder frequently will help prevent retention and overdistention.

Women who have participated in childbirth education classes often bring a "birth bag" or "Lamaze bag" with them to the hospital. These items often assist in reducing stress and providing comfort measures. The nurse caring

for women in labor should be aware of common items that a client may bring, including Rolling pin.Tennis balls.Pillow.Stuffed animal or photo.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia would be:

hypotension. - Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure.

A woman who is about 37 weeks of gestation tells the nurse that for some reason this morning she can breathe easier. The nurse can best explain this as being a:

normal change due to the fetus's dropping down into the pelvis region, relieving the pressure on her diaphragm. - Lightening occurs toward the end of the pregnancy as the fetus descends toward the pelvic inlet. When this occurs the woman notices that she breathes more easily because upward pressure on her diaphragm is reduced.

The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor."

normal uterine activity pattern in labor is characterized by:Contractions every 2 to 5 minutes.Contractions normally occur every 2 to 5 minutes and last less than 90 seconds with about 30 seconds in between

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. The nurse, recognizing women's needs during this stage should:

provide time for the mother to reflect on the events of the childbirth. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition. Once they are met, she is more able to take an active role, not only in her own care but also the care of the newborn. Women express a need to review their childbirth experience and evaluate their performance.

An objective of care for the child with nephrosis is to: Reduce excretion of urinary protein.

reduction of fluid retention, prevention of infection, and minimizing of complications associated with therapy. Blood pressure is usually not elevated in nephrosis

A newborn was admitted to the neonatal intensive care unit after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until premature

rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be:

soft, nontender; colostrum is present. Breasts are essentially unchanged for the first 2 or 3 days after birth. Colostrum is present and may leak from the nipples. On day 3 or 4 lactation begins and engorgement can occur.

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? "I feel irritable and moody a week before my period is supposed to start." "I have lower abdominal pain beginning the third day of my menstrual period." "I have nausea and headaches after my period starts, and they last 2 to 3 days." "I have abdominal bloating and breast pain after a couple days of my period."

"I feel irritable and moody a week before my period is supposed to start." PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

Chapter 17: Assessment and Care of the Newborn and Family

...

Chapter 18: Newborn Nutrition and Feeding

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• The mother should void spontaneously within 6 to 8 hours after giving birth.

...

When reading the postpartum chart the nurse notices that the client's fundus is recorded as "u+1". The nurse understands that this means the fundus is:

1 cm above the umbilicus. Descent of the fundus is documented in relation to the umbilicus and is measured in centimeters. Numbers with the "+" sign means the fundus is above the umbilicus, numbers with the "-" sign means the fundus is below the umbilicus.

While working with the pregnant woman in her first trimester, the nurse is aware that chorionic villus sampling (CVS) can be performed during pregnancy at: 4 weeks 10 weeks 14 weeks 8 weeks

10 weeks

For women with single fetuses, the current recommendation for weight gain during pregnancy in women with normal range BMI is?

11.5-16 kg or 25-35 lbs during pregnancy

Maternal serum alpha-fetoprotein (MSAFP) screening is recommended b/w what wks?

15-22 wks

A new mother asks the nurse when the "soft spot" on her son's head will go away. The nurse's answer is based on the knowledge that the anterior fontanel closes after birth by _____ months

18

Match the degree of tear or episiotomy to its description A. Laceration that goes through the anal sphincter and the rectal wall B. a tear through part or all of the perineal muscles C. small nick in the perineum, not involving muscle D. Laceration through part or all of anal sphincter muscle 1st degree 2nd degree 3rd degree 4th degree

1st degree = C. small nick in the perineum, not involving muscle 2nd degree = B. a tear through part or all of the perineal muscles 3rd degree = D. Laceration through part or all of anal sphincter muscle 4th degree = A. Laceration that goes through the anal sphincter and the rectal wall

9. The nurse is performing a blood glucose test every 4 hours on an infant born to a diabetic mother. This is to assess the infant's risk of hypoglycemia. The nurse becomes concerned if the infant's blood glucose concentration falls below _________ mg/dl.

36 mg/dL If the newborn has a blood glucose level below 36 mg/dl, intervention such as breatfeeding or bottle-feeding should be instituted. If levels remain low after this intervention, an intravenous infusion with dextrose may be warranted.

In gross development at what time will there be no more head lag?

6 months

After delivery the nurse assesses the newborn. The heart rate is 90 beats per minute, the body is flexed and there is vigorous movement, the newborn is actively crying when stimulated, and has bluish coloration in the feet and hands. The proper Apgar score for this newborn should be:

8 - The heart rate less than 100 gets a score of 1; a lusty cry will give a score of 2 for both respiratory effort and reflex response; the flexed posture and vigorous movements gives a score of 2; and the bluish coloration of the hands and feet will give a score of 1.

d (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 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? A. Biophysical profile B. Amniocentesis C. Maternal serum alpha-fetoprotein (MSAFP) D. Transvaginal ultrasound

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:

A normal baseline heart rate.

Pupils are dilated and fixed. What type of head injury should the nurse suspect? Brainstem

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother

To adequately care for a laboring woman, the nurse knows that which stage of labor varies the most in length? A) First B) Fourth C) Third D) Second

A) First p. 387-388

The uterus is a muscular pear-shaped organ that is responsible for: A. Cyclic menstruation B. Sex hormone production C. Fertilization D. Sexual arousal

A. Cyclic menstruation

The nurse caring for a pregnant woman knows that her health teaching regarding fetal circulation has been effective when the woman reports that she has been sleeping: A. In a side-lying position B. On her back with a pillow under her knees C. With the head of the bed elevated D. On her abdomen

A. In a side-lying position

analgesia

Absence of pain without loss of consciousness

Step 4

After obtaining permission, gently insert the index and middle fingers into the vagina.

Orient the patient and family to the labor and birth unit.

Anxiety related to labor and the birthing process

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should:

Ask the woman to describe why she believes she is in labor.

2. Assumptions—What assumptions can be made about the following methods for relieving pain during labor that would likely be available to Jamie? a. Breathing and relaxation techniques b. Application of heat and cold c. Intradermal water block d. Systemic analgesia

Assumptions. a. Breathing techniques provide distraction, thereby reducing the perception of pain and helping Jamie maintain control throughout contractions. In the first stage of labor, such breathing techniques can promote relaxation of the abdominal muscles and thereby increase the size of the abdominal cavity. This lessens discomfort generated by friction between the uterus and abdominal wall during contractions. Because the muscles of the genital area also become more relaxed, they do not interfere with fetal descent. Although Jamie has had no prior preparation, she can be given instruction in simple breathing and relaxation techniques early in labor and will likely find these techniques to be helpful. b. Warmed blankets, warm compresses, heated rice bags, a warm bath or shower, or a moist heating pad can enhance relaxation and reduce pain during labor. Heat relieves muscle ischemia and increases blood flow to the area of discomfort. Cold application such as cool cloths or ice packs applied to the back, the chest, and/or the face during labor may be effective in increasing comfort when the woman feels warm. They may also be applied to areas of pain. Cooling relieves pain by reducing the muscle temperature and relieving muscle spasms. Heat and cold may be used alternately for a greater effect. c. An intradermal water block involves the injection of small amounts of sterile water into four locations on the lower back to relieve back pain. It is simple to perform and is effective in early labor and in an effort to delay the initiation of pharmacologic pain relief measures. Relief of back pain for up to 2 hours has been reported. Effectiveness of this method is probably related to the mechanism of counterirritation. d. Systemic analgesics cross the maternal blood-brain barrier to provide central analgesic effects. They also cross the placenta and are transferred to the fetus. Effects on the fetus and newborn can be profound (e.g., respiratory depression, decreased alertness, delayed sucking), depending on the characteristics of the specific systemic analgesic used, the dosage given, and the route and timing of administration. Intravenous (IV) administration is preferred to intramuscular (IM) administration because the medication's onset of action is faster and more predictable; as a result, a higher level of pain relief usually occurs with smaller doses. Ideally, birth should occur less than 1 hour or more than 4 hours after administration of systemic analgesia so that neonatal CNS depression is minimized.

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal:

Attitude is the relation of the fetal body parts to one another

The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: A) Fetal hypoxemia B) Fetal sleep cycles C) Altered cerebral blood flow. D) Umbilical cord compression.

B) Fetal sleep cycles p. 428

Which characteristic is associated with false labor contractions? A. Painless B. Decrease in intensity with ambulation C. Regular pattern of frequency established D. Progressive in terms of intensity and duration

B. Decrease in intensity with ambulation RATIONAL: Although false labor contractions decrease with activity, true labor contractions are enhanced or stimulated with activity such as ambulation.

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. A positive pregnancy test B. Fetal movement palpated by the nurse-midwife C. Braxton Hicks contractions D. Quickening

B. Fetal movement palpated by the nurse-midwife

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR):

Before and after ambulation and rupture of membranes.

The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the: Perineum Bony Pelvis Vaginal Vestibule Fourchette

Bony Pelvis

Fetal bradycardia is most common during:Prolonged umbilical cord compression.Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death

Bradycardia can result from placental transfer of drugs, prolonged compression of the umbilical cord, maternal hypothermia, and maternal hypotension.

The nurse understands the importance of a walking survey because this tool: A. Determines how much exercise expectant mothers have been getting, to help inform client care decisions B. Usually takes place on the maternity ward but can be expanded to other areas of the hospital C. Is a method of observing the resources and health-related environment of the community D. Is performed by government census takers as part of their canvas

C

When caring for pregnant women, the RN should keep in mind that violence during pregnancy: A. Affects more than 25% of pregnant women in the United States B. Increases a pregnant woman's risk for gestational hypertension C. May be assoc with substance abuse by both the pregnant woman & her partner D. Has decreased in incidence as a result of better assessment techniques & record keeping

C

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? A. "We don't really know when such defects occur." B. "It depends on what caused the defect." C. "They occur between the third and fifth weeks of development." D. "They usually occur in the first 2 weeks of development."

C. "They occur between the third and fifth weeks of development."

Following rupture of membranes, a prolapse of the cord was noted on vaginal examination. A recommended action to prevent cord compression would be to: A. Place woman in a supine position and elevate legs from the hips. B. Insert a Foley catheter to keep the bladder empty. C. Keep the protruding cord moist with warm sterile normal saline compresses. D. Attempt to reinsert the cord.

C. Keep the protruding cord moist with warm sterile normal saline compresses.

Zinc deficiency is associate with what types of malformations in the fetus?

CNS malformations

RNs with education in the two disciplines of nursing and mid-wifery?

Certified nurse-midwives (CNMs)

- high C2+ foods: small fish (sardines, anchovies), green leafy vegetables avoid high mercury fish,

Calcium The DRI shows no increase of calcium during pregnancy and lactation, in comparison with the recommendation for the nonpregnant woman (see Table 8-1). The DRI appears to provide sufficient calcium for fetal bone and tooth development to proceed while maintaining maternal bone mass. Milk and yogurt are especially rich sources of calcium, providing approximately 300 mg per cup (240 ml). Nevertheless, many women do not consume these foods or do not consume adequate amounts to provide the recommended intakes of calcium. One problem that can interfere with milk consumption is lactose intolerance, the inability to digest milk sugar (lactose) caused by the absence of the lactase enzyme in the small intestine. Lactose intolerance is relatively common in adults, particularly African-Americans, Asians, Native Americans, and Inuits. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. Yogurt, sweet acidophilus milk, buttermilk, cheese, chocolate milk, and cocoa may be tolerated even when fresh fluid milk is not. Commercial lactase supplements (e.g., Lactaid) are widely available to consume with milk. Many supermarkets stock lactase-treated milk. The lactase in these products hydrolyzes, or digests, the lactose in milk, thus enabling lactose-intolerant people to drink milk. BOX 8-4 Calcium Sources for Women Who Do Not Drink Milk Each of the following food items provides approximately the same amount of calcium as 1 cup of milk. FISH • 3-oz can of sardines • 4.5-oz can of salmon (if bones are eaten) BEANS AND LEGUMES • 3 cups cooked dried beans • 2.5 cups refried beans • 2 cups baked beans with molasses • 1 cup tofu (calcium is added in processing) GREENS • 1 cup collards • 1.5 cups kale or turnip greens BAKED PRODUCTS • 3 pieces cornbread • 3 English muffins • 4 slices French toast • 2 waffles (7 inches in diameter) FRUITS • 11 dried figs • 1.125 cups orange juice with calcium added SAUCES • 3 oz pesto sauce • 5 oz cheese sauce In some cultures, adults rarely drink milk. For example, Puerto Ricans and other Hispanic people may use milk only as an additive in coffee. Pregnant women from these cultures may need to consume nondairy sources of calcium. Vegetarian diets may also be deficient in calcium (Box 8-4). If calcium intake appears low and the woman does not change her dietary habits despite counseling, a daily supplement containing 600 mg of elemental calcium may be needed. Calcium supplements may also be recommended when a pregnant woman experiences leg cramps caused by an imbalance in the calcium/phosphorus ratio. Bone meal supplements are not recommended in pregnancy.

Step 3

Cleanse the perineum and vulva if necessary.

A normal uterine activity pattern in labor is characterized by: Contractions every 2 to 5 minutes. Contractions about 1 minute apart. A contraction intensity of about 1000 mm Hg with relaxation at 50 mm Hg. Contractions lasting about 2 minutes.

Contractions every 2 to 5 minutes.

While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include

Culture. Anxiety and fear. Previous experiences with pain. Support systems.

The earliest recognizable clinical manifestation of cystic fibrosis (CF) is: Meconium ileus.

Cystic fibrosis is suspected in a toddler. Which test is essential in establishing this diagnosis? A sweat chloride test result greater than 60 mEq/L is diagnostic of CF

The term used to describe legal & professional responsibility for practice for maternity RNs is: A. Collegiality B. Ethics C. Evaluation D. Accountability

D

When a RN is unsure about how to perform a pt care procedure, the best action would be to: A. Ask another RN B. Discuss the procedure with the pt's physician C. Look up the procedure in a nursing textbook D. Consult the agency procedure manual & follow the guidelines for the procedure

D

The nurse providing care for the laboring woman should understand that accelerations with fetal movement: A) Are caused by umbilical cord compression B) Are caused by uteroplacental insufficiency C) Warrant close observation D) Are reassuring.

D) Are reassuring. p. 427

The factors that affect the process of labor and birth, known commonly as the five Ps, include all EXCEPT: A) Passageway. B) Powers. C) Passenger. D) Pressure.

D) Pressure. :: The 5 P's are: 1. Powers (contractions) 2. Passengers (fetus & placenta) 3. Passageway (birth canal) 4. Position (of the mother) 5. Psychological Response

The nurse has received a report about a woman in labor. The woman's last vaginal examination was recorded as 4, 80%, and -2. The nurse's interpretation of this assessment is that: A) The cervix is dilated 4 cm, it is effaced 80%, and the presenting part is 2 cm below the ischial spines B) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm below the ischial spines. C) The cervix is effaced 4 cm, it is dilated 80%, and the presenting part is 2 cm above the ischial spines D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines

D) The cervix is 4 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines

The term used to describe legal and professional responsibility for practice for maternity nurses is: A. Collegiality B. Ethics C. Evaluation D. Accountability

D. Accountability

Pelvic pain Abdominal pain Vaginal spotting or light bleeding Missed period

Decreased placental perfusion in supine position Increased heart rate

Good food sources of Vitamin A are?

Deep yellow & deep green vegs, fruits, leafy greens, broccoli, carrots, cantaloupe, & apricots

Which description of the phases of the second stage of labor is accurate?

Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varied

Congenital anomalies can occur with the use of antiepileptic drugs (AEDs), including Cleft lip. Congenital heart disease. Neural tube defects.

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular

The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products:

Diminishes as the spiral arteries are compressed.

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse: Calls for a stat magnesium sulfate level. Administers oxygen. Prepares to administer hydralazine. Discontinues the magnesium sulfate infusion.

Discontinues the magnesium sulfate infusion.

The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: Tell the couple they need to have an abortion within 2 to 3 weeks. Explain that the fetus has a 50% chance of having the disorder. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. Refer the couple to a psychologist for emotional support.

Discuss options with the couple, including amniocentesis to determine whether the fetus is affected.

The nurse who performs vaginal examinations to assess a woman's progress in labor should:

Discuss the findings with the woman and her partner.

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 other tool would be useful in confirming the diagnosis? Amniocentesis Contraction stress test (CST) Doppler blood flow analysis Daily fetal movement counts

Doppler blood flow analysis

At birth the nurse should do which activity in order to prevent heat loss in the newborn?

Dry the infant. Evaporation occurs when wet surfaces are exposed to air. As the surfaces dry, heat is lost. At birth the infant loses heat when amniotic fluid on the skin evaporates. Drying the infant helps prevent excessive heat loss.

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should understand that:

During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

Practice based on knowledge that has been gained through research and clinical trials

EVIDENCE BASED PRACTICE

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? Early decelerations

Early decelerations and accelerations generally do not need any nursing intervention.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:

Encouraging the woman to try various upright positions, including squatting and standing.

In which culture is the father more likely to be expected to participate in the labor and delivery? Asian-American African-American European-American Hispanic

European-American Asian-American fathers do not actively participate in labor or birth. African-American men view pregnancy as a sign of virility; however, they may be less likely to participate actively in labor or birth.

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?

Evaluate the intensity by pressing the fingertips into the uterine fundus.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by: Expanding maternal blood volume. Maintaining normal maternal temperature. Preventing normal maternal hypoglycemia. Increasing the oxygen-carrying capacity of the maternal blood.

Expanding maternal blood volume.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by:

Expanding maternal blood volume.Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension

With regard to parents' early and extended contact with their infant and the relationships built, nurses should be aware that:

Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies.

A woman who is gravida 3 para 2 enters the intrapartum unit. The most important nursing assessments are:

Fetal heart rate, maternal vital signs, and the woman's nearness to birth.

The nurse caring for the laboring woman should know that meconium is produced by: The placenta. Fetal kidneys. Fetal intestines. Amniotic fluid.

Fetal intestines.

List some barriers to seeking health care (women)

Financial issues Cultural issues Gender issues

The best position for a woman who has postpartum endometritis is:

Fowler's. Fowler's position aids in the drainage of the uterine cavity.

vitamin D toxicity includes weakness, fatigue, lassitude, headache, nausea, vomiting, and diarrhea. Renal impairment is manifested through polyuria, polydipsia, and nocturia.

Glucocorticoids, mineralocorticoids, and sex steroids are secreted by the: Adrenal cortex.

Which factor is known to increase the risk of gestational diabetes mellitus? Previous birth of large infant

Glucose metabolism is profoundly affected during pregnancy because: Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

Which breastfeeding patient is most likely to have severe afterbirth pains and request a narcotic analgesic?

Gravida 5, para 5

If an opioid antagonist is administered to a laboring woman, she should be told that:

Her pain will return.

18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, "My contractions are so strong that

I don't know what to do with myself." The nurse should Recognize that pain is personalized for each individual

d (Uterine contractions are described in terms of frequency, intensity, duration, and resting tone. Appearance is not a term used to describe contractions. Duration is another characteristic of uterine contractions.)

In documenting labor experiences, nurses should know that a uterine contraction is described according to all of these characteristics except: A. Frequency (how often contractions occur) B. Intensity (the strength of the contraction at its peak) C. Resting tone (the tension in the uterine muscle) D. Appearance (shape and height)

beta 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? Serum magnesium level of 10 mg/dL

In evaluating the effectiveness of oxytocin induction, the nurse would expect: Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information would the nurse include?

When caring for a newborn the nurse must be alert for signs of cold stress, which would include which of the following?

Increased respiratory rate. Additional signs of cold stress include increased activity level, crying, BMR, and heat production. Hypoglycemia occurs as glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production; they increase their activity level instead.

Increased risk of acidosis Increased oxygen consumption

Increased risk of aspiration Decreased gastric motility

What are trends in physical development related to length?

Increases 50% by 1 year Doubles by age 4y 1-3" through adolescence

Which concerns about parenthood are often expressed by visually impaired mothers

Infant safety Transportation Missing out visually Needing extra time for parenting activities to

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say:

Infants can learn to distinguish their mother's voice from others soon after birth.

An infant with pyloric stenosis experiences excessive vomiting that can result in: Metabolic alkalosis.

Infants with excessive vomiting are prone to metabolic alkalosis from the loss of hydrogen ions. Chloride ions and sodium are lost with vomiting.

ophthalmia neonatorum

Infection in the neonate's eyes usually resulting from gonorrheal, chlamydial, or other infection contracted when the fetus passes through the birth canal (vagina)

A child with growth hormone (GH) deficiency is receiving GH therapy. The best time for the GH to be administered is: bedtime

Injections are best given at bedtime to more closely approximate the physiologic release of GH.

four

Internal rotation

You are a maternal-newborn nurse caring for a mother who just delivered a baby born with Down syndrome. What nursing diagnosis would be the most essential in caring for the mother of this infant? Interrupted family processes Anxiety Disturbed body image Risk for injury

Interrupted family processes

If a mother has stable or decreased fundal height, the presence of what is indicated?

Intrauterine growth restriction, IUGR

A maternity nurse should be aware of which fact about the amniotic fluid? The volume remains about the same throughout the term of a healthy pregnancy. A volume of more than 2 L is associated with fetal renal abnormalities. It serves as a source of oral fluid and a repository for waste from the fetus. A volume of less than 300 mL is associated with gastrointestinal malformations.

It serves as a source of oral fluid and a repository for waste from the fetus.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is:

It's normal to be anxious about labor. Let's discuss what makes you afraid."

5. Do alternative perspectives to your conclusion exist?

Jaundice could also be caused by blood incompatibilities or liver anomalies; however, this type of jaundice is considered pathologic and usually appears within the first 24 hours of life.

The most critical nursing action in caring for the newborn immediately after birth is:

Keeping the newborn's airway clear.The care given immediately after the birth focuses on assessing and stabilizing the newborn.

What are key factors influencing family health?

Key factors include: family socioeconomics, response to stress, and culture

kcal

Kilocalorie; unit of heat content or energy equal to 1000 small calories

When doing a vaginal exam, the nurse notes a triangular-shaped depression toward the mother's left side and pointing up toward her abdomen. The nurse can record the fetal position as:

LOA - The triangular shape is the posterior fontanel, which makes the positing part the occiput. The posterior fontanel is toward the mother's left side and anterior. This makes the position left occiput anterior.

What correctly matches the type of deceleration with its likely cause?

Late deceleration—uteroplacental inefficiency

HIV may be perinatally transmitted: Through the ingestion of breast milk from an infected mother.

Many common drugs of abuse cause significant physiologic and behavioral problems in infants who are breastfed by mothers currently using

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory?

Massaging the woman's back

body mass index (BMI)

Method of calculating appropriateness of weight for height (BMI = weight/height2)

What other fluids are considered good sources of fluid other than water?

Milk & decaf tea

What foods can provide the needed protein amounts during pregnancy?

Milk, meat, eggs, cheese, legumes, whole grains, & nuts

A woman in labor has just received an epidural block. The most important nursing intervention is to:

Monitor the maternal blood pressure for possible hypotension

A 14-year-old girl is in the intensive care unit after a spinal cord injury 2 days ago. Which nursing care interventions are needed for this child

Monitoring and maintaining systemic blood pressure. Administering corticosteroids. Monitoring for respiratory complications.

A nurse is reviewing the laboratory results on a school-age child with hypoparathyroidism. Which results are consistent with this condition? decreased serum calcium and increased serum phosphorus

Nursing care of a child diagnosed with syndrome of inappropriate antidiuretic hormone should include Weigh daily Restrict fluids.

couplet care

One nurse, educated in both maternal and newborn care, functions as the primary nurse for both mother and neonate (also known as mother-baby care or single-room maternity care)

The primary method of treating osteomyelitis is: Intravenous antibiotic therapy. Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus

Osteosarcoma is the most common bone cancer in children. Where are most of the primary tumor sites? Femur

Measures effectiveness of care against benchmarks or standards?

Outcomes-oriented care

Infants born before 37 weeks of gestation

PRETERM INFANT

gate-control theory of pain

Pain theory used to explain the neurophysiologic mechanism underlying the perception of pain: the capacity of nerve pathways to transmit pain is reduced or completely blocked by using distraction techniques

latch

Placement of the infant's mouth over the nipple, areola, and breast, making a seal between the mouth and breast to create adequate suction for milk removal

lactogenesis

Process of breast milk production

physiologic anemia

Relative excess of plasma leading to a decrease in hemoglobin concentration and hematocrit; normal adaptation during pregnancy

Name the progression of gross motor skills?

Roll over Tripod Sit by self Crawl Pull self up Walk

variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history, the cause of this newborn's distress is most likely to be:

Sepsis.The prolonged rupture of membranes and the tachypnea before and after birth both suggest sepsis.

lochia serosa

Serous, pinkish brown, watery vaginal discharge that follows lochia rubra until approximately the tenth day after birth

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? Deep tendon reflexes 2+ and no clonus Respiratory rate of 16 breaths/min Serum magnesium level of 10 mg/dL Urine output of 160 mL in 4 hours

Serum magnesium level of 10 mg/dL

With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that:

Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: Suppress uterine contractions. Stimulate fetal surfactant production. Reduce maternal and fetal tachycardia associated with ritodrine administration. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

Stimulate fetal surfactant production.

- breastfeeding storage: look in powerpoint we haven't covered in class

Storage of breast milk The preferred containers for long-term storage of breast milk are hard sided, such as hard plastic or glass, with an airtight seal. For short-term storage (<72 hours), plastic bags designed for human milk storage can be safely used. For full-term, healthy infants, freshly expressed breast milk can be safely stored at room temperature for up to 8 hours, and it can be refrigerated safely for up to 5 days. Milk can be frozen for up to 6 months in the freezer section of a refrigerator with a separate door and for up to 12 months in a deep freeze. Storage guidelines for hospitalized infants are somewhat stricter. When breast milk is stored, the container should be dated, and the oldest milk should be used first (Jones & Tully, 2006). Frozen milk is thawed by placing the container in the refrigerator for gradual thawing or in warm water for faster thawing. It cannot be refrozen and should be used within 24 hours. After thawing the container needs to be shaken so as to mix the layers that have separated (Academy of Breastfeeding Medicine [ABM], 2004; Jones & Tully, 2006) (see Patient Instructions for Self-Management Box). PATIENT INSTRUCTIONS FOR SELF-MANAGEMENT Breast Milk Storage Guidelines for Home Use • Before expressing or pumping breast milk, wash your hands. • Containers for storing milk should be washed in hot, soapy water and rinsed thoroughly; they can also be washed in a dishwasher. If the water supply may not be clean, boil the containers after washing. Plastic bags designed specifically for breast milk storage can be used for short term storage (<72 hr). • Write the date of expression on the container before storing the milk. A waterproof label is best. • Store milk in serving sizes of 2 to 4 ounces to prevent waste. • Storing breast milk in the refrigerator or freezer with other food items is acceptable. • When storing milk in a refrigerator or freezer, place the containers in the middle or back of the freezer, not on the door. • When filling a storage container that will be frozen, fill only full, allowing space at the top of the container for expansion. • To thaw frozen breast milk, place the container in the refrigerator for gradual thawing, or place the container under warm, running water for quicker thawing. Never boil or microwave. • Milk thawed in the refrigerator can be stored for 24 hours. • Thawed breast milk should never be refrozen. • Shake the milk container before feeding baby, and test the temperature of the milk on the inner aspect of your wrist. • Any unused milk left in the bottle after feeding is discarded. STORAGE GUIDELINES FOR HUMAN MILK Method | Healthy Infant | Hospitalized Infant Room temperature (77° F or 25° C): <6 hours: <4 hours Refrigerator (39° F or 4° C): <8 days: <8 days Freezer compartment of a one door refrigerator: 2 weeks: Not recommended Freezer compartment of a two door refrigerator (23° F or −5° C) (not in door): <6 months: <3 months Deep freezer(−4° F or −20° C): <12 months: <6 months NURSING ALERT Breast milk is never thawed or heated in a microwave oven. Microwaving does not heat evenly and can cause encapsulated boiling bubbles to form in the center of the liquid, which may not be detected when drops of milk are checked for temperature. Babies have sustained severe burns to the mouth, throat, and upper GI tract as a result of microwaved milk. In addition, microwaving (72°-98° C) significantly destroys the antiinfective factors and vitamin C content. The safety of low-temperature microwaving is questionable (Lawrence & Lawrence, 2005).

Cultural proscriptions establish?

Taboos

Human immunodeficiency virus (HIV) may be perinatally transmitted: Through the ingestion of breast milk from an infected mother.

The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States? Alcohol

Which postoperative intervention should be questioned for a child after a cardiac catheterization? Keep the affected leg flexed and elevated.

The child should be positioned with the affected leg straight for 4 to 6 hours after the procedure.

What food choice by the parent of a 2-year-old child with celiac disease indicates a need for further teaching? Oatmeal

The child with celiac disease is unable to fully digest gluten, the protein found in wheat, barley, rye, and oats. Corn is digestible because it does not contain gluten.

Oral calcium carbonate preparations combine with phosphorus to decrease gastrointestinal absorption and the serum levels of phosphate

The diet of a child with chronic renal failure is usually characterized as: Low in phosphorus. . Protein should be limited in chronic renal failure to decrease intake of phosphorus.

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as:First stage, active phase.

The first stage, active phase of maternal progress indicates that the woman is in the active phase of the first stage of labor.

Extracorporeal membrane oxygenation The infant is likely to have been first connected to a ventilator.

The goal of treatment of the infant with phenylketonuria is to:Prevent central nervous system damage, which leads to mental retardation.CNS damage can occur as a result of toxic levels of phenylalanine

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?A dipstick value of 3+ for protein in her urine

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated

An important nursing consideration when chest tubes will be removed from a child is to: Administer analgesics before the procedure.

The most common causative agent of bacterial endocarditis is: Streptococcus viridans. Janeway lesions are painless hemorrhagic areas on palms and soles in bacterial endocarditis.

While completing a newborn assessment, the nurse should be aware that the most common birth injury is: Fracture of the clavicle.

The most common cause of pathologic hyperbilirubinemia is: Hemolytic disorders in the newborn.

In practical terms regarding genetic health care, nurses should be aware that: The most important of all nursing functions is providing emotional support to the family during counseling. Genetic disorders affect people of all socioeconomic backgrounds, races, and ethnic groups equally. Taking genetic histories is the province of large universities and medical centers. Genetic health care is more concerned with populations than individuals.

The most important of all nursing functions is providing emotional support to the family during counseling.

turn head to side, and nipple feed.

The nurse is talking to a parent with a child who has a latex allergy. Which statement by the parent would indicate a correct understanding of the teaching? "My child should not eat bananas or kiwis."

The mother-baby nurse is able to recognize reciprocal attachment behavior. This refers to:

The positive feedback an infant exhibits toward parents during the attachment process.Reciprocal attachment applies to feedback behavior and is not unidirectional.

To help clients manage discomfort and pain during labor, nurses should be aware that:

The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.

A maternal indication for the use of vacuum extraction is: Maternal exhaustion.

The priority nursing intervention after an amniotomy should be to: Assess the fetal heart rate.

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

The vulva bulges and encircles the fetal head.

lochia alba

Thin, yellowish to white, vaginal discharge that follows lochia serosa on approximately the tenth day after birth and that may last from 2 to 6 weeks postpartum

Step 1

Use sterile gloves and soluble gel for lubrication.

The nurse caring for a woman in labor understands that prolonged decelerations:

Usually are isolated events that end spontaneously.

The nurse caring for a woman in labor understands that prolonged decelerations: Usually are isolated events that end spontaneously. Are a continuing pattern of benign decelerations that do not require intervention. Require the usual fetal monitoring by the nurse. Constitute a baseline change when they last longer than 5 minutes.

Usually are isolated events that end spontaneously.

Why is continuous electronic fetal monitoring usually used when oxytocin is administered?

Uteroplacental exchange may be compromised.The uterus may contract more firmly, and the resting tone may be increased with oxytocin use

The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are the result of: Altered cerebral blood flow. Meconium fluid. Uteroplacental insufficiency. Umbilical cord compression.

Uteroplacental insufficiency.

The nurse is teaching parents of a child with chronic renal failure (CRF) about the use of recombinant human erythropoietin (rHuEPO) subcutaneous injections.

Which statement indicates the parents have understood the teaching?"The red blood cell count should begin to improve with these injections."

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: Labor sometimes can be induced with balloon catheters or laminaria tents.

With regard to the process of augmentation of labor, the nurse should be aware that it: Is part of the active management of labor that is instituted when the labor process is unsatisfactory.

physiologic jaundice

Yellow tinge to skin and mucous membranes in response to increased serum levels of unconjugated bilirubin; not usually apparent until after 24 hours; also called neonatal jaundice, physiologic hyperbilirubinemia

The nurse recognizes which of the following maternal behaviors during the first trimester of pregnancy as a sign of normal maternal adaptation? Question options: a) Accepting the reality of the pregnancy b) Selecting a name for the newborn c) Taking prepared childbirth classes d) Buying newborn clothes

a) Accepting the reality of the pregnancy

The following four changes occur during pregnancy. Which of them will most likely increase the father's interest and involvement in the pregnancy? Question options: a) Learning the results of the pregnancy test. b) Attending childbirth education classes. c) Hearing the fetal heartbeat. d) Meeting the obstetrician or midwife.

c) Hearing the fetal heartbeat. Rationale: Father's have a hard time seeing the pregnancy as real, and many times the physical complaints of the woman (morning sickness, fatigue, breast tenderness, and urinary frequency) put them off the whole idea. But when they first hear the heart beat..the pregnancy becomes real and they become very excited.

What is the priority nursing goal for a 14-year-old with Graves' disease? Verbalizing the importance of adherence to the medication regimen

children need to understand that the medication must be taken two or three times per day

A 39-week primigravida calls the birthing center and tells the nurse she has contractions that are 10 to 15 minutes apart and had a small gush of fluid about 1 hour ago. The nurse should tell her to:

come to the birthing center now. - A gush or trickle of fluid from the vagina should be evaluated as soon as possible. Waiting until the contractions are 5 minutes apart is appropriate for a primigravida if the membranes have not ruptured.

A woman at 36 weeks gestation complains of leg cramps. The nurse knows that this symptom is most likely due to which of the following? Question options: a) high levels of circulating hormones. b) decreased number of red blood cells. c) lack of daily exercise. d) electrolyte imbalance.

d) electrolyte imbalance.

A nurse is asked to do a home visit on a woman who delivered 2 weeks ago. When assessing the woman the nurse was not able to locate the fundus. The next action would be:

document this normal finding. The uterus descends at the rate of about 1 cm per day. By 10 to 14 days it is no longer palpable above the symphysis pubis. This is a normal finding.

For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately, she may become a passive player and

emotionally absent herself from the process The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can

One important and simple measure that can be used to prevent infection in newborns is _____________

handwashing

Which is considered a normal physiologic change during pregnancy? a. ECG T-wave changes b. Increased cardiac output c. Increased bleeding time d. Decreased renal perfusion

increased cardiac output

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:Place the child in the knee-chest position.

nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. nurse recognizes that a risk of cerebrovascular accidents strokes exists. An important objective to decrease this risk is to:Prevent dehydration.

The new mother comments that the newborn "has his father's eyes." The nurse recognizes this as:

part of the bonding process called claiming. Claiming or binding-in begins when the mother begins to identify specific features of the newborn. She then begins to relate features to family members.

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should:

prewarm the radiant heat warmer and place the undressed newborn under it. - The probe should be placed on the upper abdomen. It should be covered with reflective material. Rectal temperatures should be avoided because rectal thermometers can perforate the intestine.

A woman was admitted to the ED with her newborn baby. The baby was born 4 days ago at home. The woman had no prenatal care. The nurse is assessing the lab work and sees that the mother has O-negative blood type and the baby is O positive and the Coombs test shows the mother is not sensitized to the positive blood. The nurse's next action should be:

record the findings of the lab work and not plan on any further action at this time. The mother is a candidate for Rh(D) immune globulin; however, it should be given with 72 hours after childbirth to prevent the development of maternal antibodies. Because she gave birth 4 days ago, that time period as passed and she is not sensitized to the positive blood.

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.

related to CNS injuries that could occur to the infant during labor and birth, nurses is aware that In many infants signs of hemorrhage in a full-term infant are absent and are diagnosed only through laboratory tests.

nurse teaches a pregnant woman about the characteristics of true labor contractions. nurse evaluates the woman's understanding of the instructions when she states, "True labor contractions will Continue and get stronger even if I

relax and take a shower."They may become intense during walking and continue despite comfort measures. Typically true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen

The first time a woman ambulates after the birth of the newborn, she has a nursing diagnosis of Risk for Injury. The is due to the:

risk for developing orthostatic hypotension. After birth a rapid decrease in intraabdominal pressure results in dilation of blood vessels supplying the viscera. The resulting engorgement of abdominal blood vessels contributes to a rapid fall in blood pressure when the woman moves from a recumbent to a sitting position. The mother feels dizzy or lightheaded and may faint when she stands.

The nurse should refer the patient for further testing if she noted this on inspection of the breasts of a 55-year-old woman: left breast slightly smaller than right breast. eversion (elevation) of both nipples. bilateral symmetry of venous network, which is faintly visible. small dimple located in the upper outer quadrant of the right breast.

small dimple located in the upper outer quadrant of the right breast. In many women, one breast is smaller than the other. Eversion of both nipples is a normal finding. Faintly visible venous network is a normal finding. A small dimple is an abnormal finding and should be further evaluated.

The nurse is graphing the weight, length, and head circumference of a newborn in relationship to the gestational age. The newborn falls within the 6th percentile for the weight, 5th percentile for the length, and 9th percentile for the head circumference. This newborn would be classified as:

small-for-gestational age. Infants that fall above the 90th percentile are considered large-for-gestational age. Infants that are between 10th and 90th percentiles are considered appropriate-for-gestational age. Infants that fall below the 10th percentile are considered small-for-gestational age.

A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens, and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to

subside. When the inhalation stops, the valve closes. This procedure is:An application of nitrous oxide.

Necrotizing enterocolitis is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is

supportive; however, known interventions may decrease the risk of NEC. To develop an optimal plan of care for this infant,

Providing treatment and rehabilitation for people who have developed disease is part of: primary preventive care. secondary preventive care. tertiary preventive care. primordial preventive care.

tertiary preventive care Primary preventive care involves promoting healthy lifestyles. Secondary preventive care involves targeting populations at risk. Tertiary preventive care is the treatment or rehabilitation of those who already have a specific disease. Primordial preventive care refers to prevention of the risk factors themselves at either the social or environmental level.

When doing the initial measurements of a newborn, the nurse records the head diameter as 34 cm, and the chest diameter as 32 cm. The nurse is aware that:

these measurements are within normal limits. The head diameter should be 33 to 35.5 cm; the chest diameter should be 30.5 to 33 cm. The chest is usually 2 to 3 cm smaller than the head.

A 26-year-old woman is considering Depo-Provera as the form of contraception that is best for her since she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse would tell her that Depo-Provera: is a combination of progesterone and estrogen. is a small adhesive hormonal birth control patch that is applied weekly. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. has an effectiveness rate in preventing pregnancy of 99% when used correctly.

thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. An ejaculated sample should be obtained after a period of abstinence to get the best results. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman's

umbilicus and recognizes this assessment finding as:Cullen's sign associated with a ruptured ectopic pregnancy.

A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and

understand the significance of each category. These categories include Category I. Category II. Nonreassuring.

A new mother asks the nurse about the red stains in her baby boy's wet diapers. The nurse explains this as being:

urate crystals. Urate crystals may be in a newborn's urine for the first few days of life. They will cause a reddish or pink stain on the diaper. This is known as "brick dust staining."

The nurse is admitting a school-age child with suspected Guillain-Barré syndrome . Which nursing intervention is a priority in the care for this child? Assessing respiratory efforts Treatment modalities include aggressive

ventilatory support in the event of respiratory compromise, administration of IV immunoglobulin , and sometimes steroids; plasmapheresis and immunosuppressive drugs may also be used.

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help clients. Nurses should know that _____ women may be stoic until late in labor,

when they may become vocal and request pain relief. Hispanic

The home-care nurse is visiting a new mother who delivered 1 week ago. The mother complains about not being able to sleep and that she is tired and cries easily. The best response by the nurse would be:

"It is normal for this to happen and it should go away in 2 weeks. It must be very difficult for you to feel this way with a new baby." Postpartum blues begins in the first week and usually last no longer than 2 weeks. The mother needs to be supported during this time and given accurate information about the process.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: "Karyotyping will reveal if your baby will develop normally." "Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes." "Karyotyping will reveal if the baby's lungs are mature." "Karyotyping will detect any physical deformities the baby has."

"Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes."

A new mother expresses concern that her 18-hour-old son has only voided one time since birth. The nurse's best response is:

"Newborns don't void frequently for the first 2 days, but by the fourth day it will be about 6 times a day." It is appropriate to teach the mother about newborn characteristics. Newborns may not void at all for the first 24 hours; however, most will void once in the first 12 hours. Only one or two voidings may occur during the first 2 days of life. The infant voids at least six times a day by the fourth day.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: "The lubricant prevents vaginal irritation." "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." "The additional lubrication improves sex." "Nonoxynol-9 improves penile sensitivity."

"Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Nonoxynol-9 may cause vaginal irritation. This is a true statement. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.

A woman who is 16 weeks pregnant asks the nurse, "Is it possible to tell by ultrasound if the baby is a boy or girl yet?" The best answer is: "It might be possible to determine your baby's sex, but the external organs look very similar right now." "A baby's sex is determined as soon as conception occurs." "Boys and girls look alike until about 20 weeks after conception, and then they begin to look different." "The baby has developed enough that we can determine the sex by examining the genitals through ultrasound."

"The baby has developed enough that we can determine the sex by examining the genitals through ultrasound." Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, "Why is it taking so long?" The most appropriate response by the nurse would be: "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." "The length of labor varies for different women." "Your baby is just being stubborn." "I don't know why it is taking so long."

"The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

Sally comes in for her first prenatal examination. This is her first child. She asks you (the nurse), "How does my baby get air inside my uterus?" The correct response is: "The placenta delivers oxygen-rich blood through the umbilical artery to the baby's abdomen." "The baby absorbs oxygen from your blood system." "The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream." "The baby's lungs work in utero to exchange oxygen and carbon dioxide."

"The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream."

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? "We don't really know when such defects occur." "It depends on what caused the defect." "They usually occur in the first 2 weeks of development." "They occur between the third and fifth weeks of development."

"They occur between the third and fifth weeks of development."

A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby won't be affected. What response by the nurse is most accurate? "I think you'd better check with your doctor first." "Good planning; you need to take advantage of the odds in your favor." "The ultrasound indicates a boy, and boys are not affected by PKU." "You are both carriers, so each baby has a 25% chance of being affected."

"You are both carriers, so each baby has a 25% chance of being affected."

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: "This probably means you're pregnant." "Don't worry; it's probably nothing." "Have you been sick this month?" "You probably didn't ovulate during this cycle."

"You probably didn't ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the BBT method). A comment such as this discredits the client's concerns. Illness would most likely cause an increase in BBT. The absence of a temperature decrease most likely is the result of lack of ovulation.

A woman asks the nurse, "What protects my baby's umbilical cord from being squashed while the baby's inside of me?" The nurse's best response is: "The umbilical cord is a group of blood vessels that are very well protected by the placenta." "Your baby's umbilical floats around in blood anyway." "Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby." "You don't need to worry about things like that."

"Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby."

Nursing measures to promote bonding and attachment include which of the following?

- Assist the parents in unwrapping the baby to inspect. - Position the infant in a face-to-face position with the mother.

Which of the following are important points when teaching a client the proper method for pushing during the second stage of labor?

- Begin and end by taking a deep breath and exhaling. - Push for 4 to 6 seconds at a time.

Select all of the following occurrences that assist the newborn to initiate respirations.

- Decrease in oxygen - Release of pressure on the chest at birth

To promote bonding during the first hour after birth the nurse can do which of the following?

- Delay procedures if appropriate - Allow father to hold newborn - Allow as much contact with the newborn as possible

Constipation is a common problem during the postpartum period. Select all of the reasons for constipation during this period.

- Diminished bowel tone -. Episiotomy that causes the fear of pain with elimination - Iron supplementation - Some pain medications

When giving an initial bath to a newborn, which of the following techniques are appropriate?

- Do not bathe until newborn's temperature is stable. - Gloves should be worn. - The bath should be performed quickly and the infant dried.

Clinical signs and symptoms of pulmonary embolism may include:

- Dyspnea - Sudden sharp chest pain - Syncope - Tachypnea - Hemoptysis

When assessing the perineum, episiotomy site, or surgical site, the nurse should assess for specific signs. Select all of the signs that are appropriate when assessing a surgical site.

- Heat - Edema - Decrease in pedal pulses - Homans sign

Select all the ways that childbirth pain differs from other types of pain.

- It is a normal process. - Preparation time exists. - It is self-limiting. - It is intermittent.

Select all of the following factors that lead to the production of excessive amounts of bilirubin during the first week of life.

- Liver immaturity - A sterile intestines - Trauma during birth

Which of the following newborns are at risk for hypoglycemia?

- Prematurity - Postmaturity - Cold stress - Maternal diabetes - Maternal intake of terbutaline

Select all of the newborns listed that are at high risk for hypoglycemia. a

- Preterm - Small-for-gestational age - Postterm - Large-for-gestational age - Infants with infections - Infants with cold stress

LM Ch1: What do maternity nurse teach about pregnancy?

- Process of labor, birth and recovery - Provide continuity of care through the childbirth cycle

A mother is at high risk for thromboembolic disease in the postpartum period. Select all of the reasons that may put this mother at high risk for clot formation.

- Prolonged period of time in the stirrups for delivery and repair - The elevated levels of coagulation factors during pregnancy - Cesarean delivery - Smoking

Relaxation of the mother during labor is important for several reasons. Listed are the reasons that promoting relaxation is important.

- Promotes uterine blood flow - Improves fetal oxygenation - Promotes efficient uterine contractions - Reduces tension that increases pain

What are the key components of cultural competence?

- Recognize difference between own culture and client's - Understanding pt's cultural background - Recognize the importance of: communication styles, problem-solving techniques, concepts of space and time, desires to be involved with care decisions - Anticipate language ability and literacy

Name some of the Healthy People 2020 perinatal proposed objectives?

- Reduce maternal deaths, illness, and complications r/t pregnancy - Early and adequate prenatal care - Reduce LBW and VLBW, and pre term births - To decrease occurrence of SIDS have babies sleep on back - Abstain from alcohol, cigarettes, and illicit drugs among pregnant women - Reduce the occurrence of FAS - Increase BF - Quit smoking before, during and after pregnancy - Increase preconception care services - Increase work site lactation programs - Increase 1 yr survival rate for babies with Down Syndrome - Reduce the proportion of persons ages 18-44 who have impaired fecundity.

Why the big push for EBP?

- Reimbursement costs have decreased - Patient population not willing to accept errors - Professional organizations review/set standards

Parent teaching is an important aspect of care of the newborn and family. Which of the following are appropriate teaching techniques during the first two days after birth?

- Setting priorities - Giving written material to the family to reinforce learning - Using audiovisual materials to reinforce learning - Modeling behavior for the new family - Including the father - Being sensitive to cultural differences

Throughout the assessment, the nurse must be alert for signs of respiratory distress. Select all of the following that are signs of respiratory distress.

- Substernal retractions - Grunting - Seesaw respirations

Which of the following are appropriate goals for a newborn for the first 2 to 3 days of life?

- The infant will maintain a patent airway as evidenced by a respiratory rate within the range of 30 to 60 breaths a minute. - The infant will show no signs of respiratory distress. - The infant will maintain an axillary temperature between 36.5º and 37.5º C. - The infant will show no signs of hypoglycemia.

Which factors contribute to pain during labor and delivery?

- Tissue ischemia - Cervical dilation - Distention of the vagina and perineum

Select all the reasons why an intravenous access is started in most labor clients.

- To have quick access if drugs are needed - To provide fluids to prevent dehydration - In case an epidural block is administered

There are many causes of early postpartum hemorrhage. Pick the two major causes.

- Uterine atony - Inversion of the uterus

Pick all of the following that are considered theories of the onset of labor.

-Changes in the relative effects of estrogen and progesterone - An increase in prostaglandins - Stretching and irritation of the uterus and cervix

Nursing care during labor should include which of the following?

-Offer ice chips in small amounts to relieve a dry mouth. -Monitor for a full bladder because the woman may have a decreased sensation of the urge to void. -Keep the woman in a side-lying position to prevent supine hypotension. -Monitor the fetal heart rate for changes from normal.

Chapter 8: Maternal and Fetal Nutrition

...

• Breast milk provides immunologic protection against infections and diseases.

...

• Breastfeeding beliefs and practices vary across cultures.

...

• By 12 weeks of gestation, the pregnant woman should start taking 30 mg of ferrous iron daily. Depending on nutritional risk factors, a woman may need other supplements.

...

• Common causes of discomfort include pain from uterine contractions (afterpains), perineal lacerations, episiotomy, hemorrhoids, sore nipples, and breast engorgement.

...

• Postpartum care is family-centered.

...

Maternal adaptation to pregnancy usually occurs in what order & during what time frame?

1st trimester- I am pregnant, acceptance of pregnancy 2nd- I am having a baby, acceptance of baby 3rd- I am going to be a mom, prep for parenthood

A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? 4-2-1-0-3 3-1-1-1-3 3-0-3-0-3 4-1-2-0-4

4-1-2-0-4

What is the highest childhood morbidity?

50% are acute respiratory infections Infections 11% Injuries 15% Chronic Illness Asthma Allergies Behavior

Postpartum hemorrhage is defined as blood loss that exceeds ___________ ml after a vaginal childbirth.

500

A newborn weighed 7 lb 8 oz at birth. What is the lowest this newborn can weigh and still be within the guidelines of weight loss the first 7 to 10 days of life?

6 lb 12 oz. A newborn can lose up to 10% of its birth weight during the first 7 to 10 days of life. The 7 lb 8 oz newborn can lose 12 oz and still be within the guidelines. The lowest weight would be 6 lb and 12 oz.

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to

70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should:

List the progression of depth in vision?

8-12in 9 mos 20/30 by 3 years 20/20 by 5 years

The process by which people retain some of their own culture while adopting the practices of the dominant society is known as: A. Acculturation B. Assimilation C. Ethnocentrism D. Cultural relativism

A

What is not a trend in the delivery of health care in the US? A. Greater emphasis has been placed on curing disease & disability than on preventing them. B. Hospital stays for many conditions have been shortened. C. Acute care increasingly is provided through home-based services. D. Hospital-based RNs are increasingly involved in follow-up care after discharge.

A

d (This is an accurate statement. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.)

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:Peripheral edema.

A beneficial effect of administering digoxin is that it:Decreases edema.

Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client? Absence of uterine bleeding in the postpartum period A fundus firm below the level of the umbilicus A boggy uterus with heavy lochia flow Scant lochia flow

A boggy uterus with heavy lochia flow

Asthma in infants is usually triggered by: A viral infection Viral illnesses cause inflammation that causes increased airway reactivity in asthma.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests: Asthma.

Which statement best describes why children have fewer respiratory tract infections as they grow older? Repeated exposure to organisms causes increased immunity.

A child has had cold symptoms for more than 2 weeks, a headache, nasal congestion with purulent nasal drainage, facial tenderness, and a cough that increases during sleep.

The diet of a child with nephrosis usually includes: salt restrictions

A child is admitted with acute glomerulonephritis. The nurse would expect the urinalysis during this acute phase to show: Hematuria and proteinuria.

Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin as soon as possible.

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy.

Which clinical changes occur as a result of septic shock? Increased cardiac output

A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what med should the nurse prepare for administration?Epinephrine

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

A fetal heart rate (FHR) of 180 with absence of variability.

warm line

A help line, or consultation service, for families to access, most often for support of newborn care and postpartum care after hospital discharge

With regard to spinal and epidural (block) anesthesia, nurses should know that:

A high incidence of after-birth headache is seen with spinal blocks.

Chronic adrenocortical insufficiency is also referred to as: Addison's disease. Graves' and Hashimoto's diseases involve the thyroid gland.

A neonate born with ambiguous genitalia is diagnosed with congenital adrenogenital hyperplasia. Therapeutic management includes administration of: Cortisone.

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. What should be included? Return to the clinic every 1 to 2 weeks.

A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that: Frequent, serial casting is tried first.

Which one should the nurse tell her indicates a need for adjustment (insulin or sugar)?60 mg/dL just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding? Phenylketonuria (PKU)

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have: Tachycardia. Bradycardia. A normal baseline heart rate. Hypoxia.

A normal baseline heart rate.

When working with parents who have some form of sensory impairment, nurses should understand that Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact. is an inaccurate statement.

A number of electronic devices can turn sound into light flashes to help pick up a child's cry

The airway in infants and young children is narrower, not wider, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways.

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? Dyspnea

Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and 2 or 3 times a week for the remaining 4 months

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? There is heightened airway reactivity.

child has a total cholesterol level of 180 mg/dL. What dietary recommendations should the nurse make to child's parents Replace whole milk with 2% or 1% milkIncrease servings of fish Avoid excessive intake of fruit juices

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician if what conditions occur

c (No late decelerations indicate a positive CST.)

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

Given that this newborn is physiologically stable, what response would the nurse give? You may hold your baby during the feeding."

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents?

"You will need to avoid adding salt to your child's food."

A preschool child is being admitted to the hospital with dehydration and a urinary tract infection .Which urinalysis result should the nurse expect with these conditions? WBC >2; specific gravity 1.030

Which action by the school nurse is important in the prevention of rheumatic fever? Refer children with sore throats for throat cultures.

A preschool child is scheduled for an echocardiogram. Parents ask the nurse whether they can hold the child during the procedure. The nurse should answer with which response?

On which infant would the nurse notice the greater amounts of lanugo?

A preterm dark-skinned infant. Lanugo is fine hair that covers the fetus during intrauterine life. As the fetus nears term, the lanugo becomes thinner. Dark-skinned infants often have more lanugo than infants with lighter coloring.

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits: Absent ankle clonus. A sleepy, sedated affect. Deep tendon reflexes of 2. A respiratory rate of 10 breaths/min.

A respiratory rate of 10 breaths/min.

Which children admitted to the pediatric unit would the nurse monitor closely for development of syndrome of inappropriate antidiuretic hormone

A school-age child returning from surgery for removal of a brain tumor An infant with suspected meningitis A school-age child with head trauma

Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity.

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? The cervix is effacing and dilated to 2 cm.

c (The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation.)

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates: A. The fetus is at risk for Down syndrome B. The woman is at high risk for developing preterm labor C. Lung maturity D. Meconium is present in the amniotic fluid

In caring for a pregnant woman with sickle cell anemia, the nurse is aware that signs and symptoms of sickle cell crisis include: Fever and pain

A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action? Offer the vaccine.

What position would be least effective when gravity is desired to assist in fetal descent? A) Lithotomy B) Walking C) Kneeling D) Sitting

A) Lithotomy

Which of the following is most suggestive that a nurse has a nontherapeutic relationship with a patient or family? A) Staff is concerned about the nurse's actions with patient or family. B) Staff assignments allow nurse to care for same patient or family over an extended time. C) The nurse uses teaching skills to instruct the patient or family rather than doing everything for them. D) The nurse is able to withdraw emotionally when emotional overload occurs but still remain committed.

A) Staff is concerned about the nurse's actions with patient or family.

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: A) Stay with the client and call for help. B) Insert an oral airway. C) Administer oxygen by mask. D) Suction the mouth to prevent aspiration.

A) Stay with the client and call for help.

Which of the following statements is true concerning folk remedies? A) They may be used to reinforce the treatment plan. B) They are incompatible with modern medical regimens. C) They are a leading cause of death in some cultural groups. D) They are not a part of the culture in large, developed countries.

A) They may be used to reinforce the treatment plan

Which of the following is descriptive of nursing diagnoses? A) They provide the basis for the selection of nursing interventions. B) They should describe everything for which nursing is responsible. C) The cause of the problem must be identified before a nursing diagnosis can be made. D) The cause of the problem implies a cause-and-effect relationship in the nursing diagnosis

A) They provide the basis for the selection of nursing interventions.

10. After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? A. "Protein will help my baby grow." B. "Eating protein will prevent me from becoming anemic." C. "Eating protein will make my baby have strong teeth after he is born." D. "Eating protein will prevent me from being diabetic."

A. "Protein will help my baby grow." Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

1. What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? A. Apical heart rate of 90 beats/min, slightly irregular, when awake and active B. Acrocyanosis C. Harlequin color sign D. Weight loss representing 5% of the newborn's birth weight

A. Apical heart rate of 90 beats/min, slightly irregular, when awake and active The heart rate of a newborn should range from 120 to 140 beats/min, especially when active. The rate should be regular with sharp, strong sounds. Acrocyanosis is a normal finding in a newborn at 24 hours of age. A harlequin sign is a normal finding related to the immature neurologic system of a newborn. A 5% weight loss is acceptable in the newborn.

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse would be to: A. Assess the fetal heart rate (FHR) pattern. B. Perform a vaginal examination. C. Inspect the characteristics of the fluid. D. Assess maternal temperature.

A. Assess the fetal heart rate (FHR) pattern. RATIONAL: The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy).

16. Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins: A. At the time of admission to the nurse's unit. B. When the infant is presented to the mother at birth. C. During the first visit with the physician in the unit. D. When the take-home information packet is given to the couple.

A. At the time of admission to the nurse's unit. Discharge planning, the teaching of maternal and newborn care, begins on the woman's admission to the unit, continues throughout her stay, and actually never ends as long as she has contact with medical personnel.

3. A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: A. Counterpressure against the sacrum. B. Pant-blow (breaths and puffs) breathing techniques. C. Effleurage. D. Conscious relaxation or guided imagery.

A. Counterpressure against the sacrum. Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Breathing techniques are usually helpful during contractions because they provide distraction; they are not necessarily targeted at back pain. Effleurage is usually helpful for relieving pain from contractions per the gate-control theory. Conscious relaxation or guided imagery techniques are usually helpful during contractions because they provide the opportunity to focus on a more pleasant situation; they are not targeted specifically toward back pain.

On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: A. Describe the finding in the nurse's notes. B. Reposition the woman onto her side. C. Call the physician for instructions. D. Administer oxygen at 8 to 10 L/min with a tight face mask.

A. Describe the finding in the nurse's notes. RATIONAL: An early deceleration pattern from head compression is described. No action other than documentation of the finding is required since this is an expected reaction to compression of the fetal head as it passes through the cervix.

The following conditions have contributed to the increase in maternity-related health care costs except: A. Early postpartum discharges B. Maternal medical risk factors, such as diabetes C. The use of high-tech equipment D. The cost of care for low-birth-weight (LBW) infants

A. Early postpartum discharges

15. While admitting the pregnant woman, the nurse should be aware that postpartum hospital stays that are becoming shorter are primarily the result of the influence of: A. Health maintenance organizations (HMOs) and private insurers. B. Consumer demand. C. Hospitals. D. The federal government.

A. Health maintenance organizations (HMOs) and private insurers. The trend for shortened hospital stays is based largely on efforts to reduce health care costs. Secondarily consumers have demanded less medical intervention and more family-centered experiences. Hospitals are obligated to follow standards of care and federal statutes regarding discharge policies. The Newborns' and Mothers' Health Protection Act provided minimum federal standards for health plan coverage for mothers and their newborns. Under this act, couples were allowed to stay in the hospital for longer periods.

2. A woman in active labor receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease? A. Meperidine (Demerol) B. Promethazine (Phenergan) C. Butorphanol tartrate (Stadol) D. Nalbuphine (Nubain)

A. Meperidine (Demerol) Meperidine used to be the most commonly used opioid agonist analgesic for women in labor throughout the world. It overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, meperidine is used cautiously in women with cardiac disease. Other medication options with fewer side effects are now available for use during labor. Promethazine is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of the undesirable effects of those drugs. Butorphanol tartrate is an opioid agonist-antagonist analgesic. Nalbuphine is an opioid agonist-antagonist analgesic.

22. When the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called: A. Mutuality. B. Bonding. C. Claiming. D. Acquaintance.

A. Mutuality. Mutuality extends the concept of attachment to include this shared set of behaviors. Bonding is the process over time of parents forming an emotional attachment to their infant. Mutuality refers to a shared set of behaviors that is a part of the bonding process. Claiming is the process by which parents identify their new baby in terms of likeness to other family members and their differences and uniqueness. Mutuality refers to a shared set of behaviors that is part of the bonding process. Like mutuality, acquaintance is part of attachment. It describes how parents get to know their baby during the immediate postpartum period through eye contact, touching, and talking.

4. Nurses should be aware of the differences experience can make in how labor pain is perceived, such as: A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor. B. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. C. Women with a history of substance abuse experience more pain during labor. D. Multiparous women have more fatigue from labor and therefore experience more pain.

A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous women during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

5. A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes: A. Several glasses of fluid. B. Extra protein sources such as peanut butter. C. Salty foods to replace lost sodium. D. Easily digested sources of carbohydrate.

A. Several glasses of fluid. If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. The woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. Extra protein would not be needed. The woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. It would not be necessary to replace lost sodium. The woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. Adding easily digested carbohydrate sources would not be necessary.

On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data? A. The fetal presenting part is 1 cm above the ischial spines. B. Effacement is 4 cm from completion. C. Dilation is 50% completed. D. The fetus has achieved passage through the ischial spines.

A. The fetal presenting part is 1 cm above the ischial spines.

8. Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (choose all that apply): A. Unwrapping the infant. B. Changing the diaper. C. Talking to the infant. D. Slapping the infant's hands and feet. E. Applying a cold towel to the infant's abdomen.

A. Unwrapping the infant. B. Changing the diaper. C. Talking to the infant. Unwrapping the infant is an appropriate technique to use when trying to wake a sleepy infant. Changing the diaper is an appropriate technique to use when trying to wake a sleepy infant. Talking to the infant is an appropriate technique to use when trying to wake a sleepy infant. Slapping an infant's hands and feet is not appropriate. The parent can gently rub the infant's hands or feet to wake the infant. Applying a cold towel to the infant's abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant's face to wake the infant.

3. 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: A. Wash the top of the can and the can opener with soap and water before opening the can. B. Adjust the amount of water added according to weight gain pattern of the newborn. C. Add some honey to sweeten the formula and make it more appealing to a fussy newborn. D. Warm formula in a microwave oven for a couple of minutes prior to feeding.

A. Wash the top of the can and the can opener with soap and water before opening the can. Washing the top of the can and the can opener with soap and water before opening the can of formula is a good habit for parents to get into to prevent contamination of the formula. 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 or heat it unevenly.

Article: What is AWHONN's position in regards to reproductive health care services or research activity?

AWHONN supports the protection of an individual RN's right to choose to participate. RN's have the right under federal law to refuse to assist in keeping with their personal moral, ethical, or religious beliefs.

- normal weight loss for newborn?: 3% is normal.

Acceptable weight loss: 10% or less infirst 3-5 days Weight loss over 10% to 15% (growth failure, dehydration); assess breastfeeding sucess. The newborn is usually weighed shortly after birth. This assessment may be performed in the labor and birthing area, the mother's room, or on admission to the nursery. Care must be taken to ensure that the scales are balanced. The totally unclothed neonate is placed in the center of the scale, which is usually covered with a disposable pad or cloth to prevent heat loss via conduction to prevent cross-infection. The nurse should place one hand over (but not touching) the neonate to prevent the infant from falling off the scales (p. 460). Weighing the infant at the same time every day is common during the hospital stay. Birth weight of a term infant typically ranges from 2500 to 4000 g. The presence of decreased caloric intake (less milk), weight loss of more than 5% to 7% in the first 5 days of life, increasing serum bilirubin (unconjugated) levels, decreased stooling, and increased jaundice is also sometimes called starvation jaundice or nonbreastfeeding jaundice. To prevent this pattern the following measures are suggested: initiation of breastfeeding within the first few hours of life, continuous rooming-in with the mother, breastfeeding 10 to 12 times per day, no supplements, and recognition of and response to hunger cues.

The role of the nurse with regard to informed consent is to:

Act as a client advocate and help clarify the procedure and the options

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor?

Active phase

The nurse is caring for an intubated infant with botulism in the pediatric intensive care unit. Which health care provider prescriptions should the nurse clarify with the health care provider before implementing?

Administer gentamicin sulfate Garamycin 10 mg per intravenous piggyback every 12 hours.

The nurse is preparing to care for an infant returning from pyloromyotomy surgery. Which prescribed orders should the nurse anticipate implementing

Administration of analgesics for pain Intravenous (IV) fluids continued until tolerating fluids by mouth Clear liquids as the first feeding

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

Administration of blood

Of the many factors that influence parental responses, nurses should be conscious of negative stereotypes that apply to specific patient populations. Which response could be an inappropriate stereotype of adolescent mothers?

Adolescent mothers have a higher documented incidence of child abuse.

In caring for the mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that:

Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria learning disabilities, speech and language problems are often not detected until the child goes to school.

A 25-year-old gravida 1 para 1 who had an emergency cesarean birth 3 days ago is scheduled for discharge. As you prepare her for discharge, she begins to cry. Your initial action should be to

Allow her time to express her feelings.

The nurse caring for the laboring woman should understand that early decelerations are caused by:

Altered fetal cerebral blood flow.Early decelerations are the fetus's response to fetal head compression

Increased risk of thrombus formation Increase in clotting factors

Altered pain referral Displacement of abdominal viscera

At 35 weeks of pregnancy a woman experiences preterm labor. Tocolytics are administered and she is placed on bed rest, but she continues to experience regular uterine contractions, and her cervix is beginning to dilate and efface. What would be an important test for fetal well-being at this time? Nonstress test (NST) Percutaneous umbilical blood sampling (PUBS) Ultrasound for fetal size Amniocentesis for fetal lung maturity

Amniocentesis for fetal lung maturity

Spontaneous termination of a pregnancy is considered to be an abortion if:The pregnancy is less than 20 weeks.

An abortion in which the fetus dies but is retained within the uterus is called a(n):Missed abortion

The nurse should recommend medical attention if a child with a slight head injury experiences: Confusion or abnormal behavior.

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure.

d (Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.)

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: A. Intercourse should be avoided if any spotting from the vagina occurs afterward B. Intercourse is safe until the third trimester C. Safer-sex practices should be used once the membranes rupture D. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present

Slow, small, warm bolus feedings over 30 minutes Feedings by gravity are done slowly over 20- to 30-minute periods to prevent adverse reactions.

An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter

Documentation of a gavage feeding should include 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.

An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?

Decreased urinary output Sweating inappropriate Fatigue

An infant with an unrepaired tetralogy of Fallot defect is becoming extremely cyanotic during a routine blood draw. Which interventions should the nurse implement

With regard to hemolytic diseases of the newborn, nurses should be aware that:The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

An infant with severe meconium aspiration syndrome is not responding to conventional treatment. Which highly technical method of treatment may be necessary for an infant who does not respond to conventional treatment?

Which statement is characteristic of acute otitis media (AOM)? It is treated with a broad range of antibiotics.

An infant's parents ask the nurse about preventing otitis media (OM). What should the nurse recommend? Avoid tobacco smoke.

c (Urofollitropin is given by IM injection; the dosage may vary.)

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of a/an: A. Intranasal spray B. Vaginal suppository C. Intramuscular injection D. Tablet

No difference when compared with placebo

Aromatherapy

The nurse is planning care for a patient with a different cultural background. What would be an appropriate goal? Strive to keep the patient's cultural background from influencing health needs. Encourage the continuation of cultural practices in the hospital setting. In a nonjudgmental way attempt to change the patient's cultural beliefs. As necessary adapt the patient's cultural practices to her health needs.

As necessary adapt the patient's cultural practices to her health needs. The cultural background is part of the individual. It would be very difficult to eliminate the influence of the patient's background. The cultural practices need to be evaluated within the context of the health care setting to determine if they are conflicting. It is not appropriate to attempt to change someone's cultural practices. Whenever possible, the nurse should facilitate the integration of cultural practices into health needs.

3. What implications and priorities for nursing care can be drawn at this time?

As part of her prenatal care, Tanisha (and all pregnant women) should receive nutrition counseling. Tanisha is currently overweight. Although reduction diets may be contraindicated in pregnancy, Tamara can be assisted to plan menus that allow a slow but adequate weight gain to support growth of the pregnancy and the fetus and avoid excess weight gain.

With regard to small for gestational age infants and intrauterine growth restrictions nurses should be aware that Infants with asymmetric IUGR have the potential for normal growth and development.

As related to the eventual discharge of the high risk newborn or transfer to a different facility, nurses and families should be aware that: Parents of high risk infants need special support and detailed contact information.

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to: Perform a venipuncture for hemoglobin and hematocrit levels Monitor uterine contractions Place clean disposable pads to collect any drainage Assess fetal heart rate (FHR) and maternal vital signs

Assess fetal heart rate (FHR) and maternal vital signs

If the nurse notices one artery and one vein on the initial assessment of a newborn, which of the following actions should be carried out?

Assess for other anomalies. A two-vessel cord is associated with chromosomal, renal, and gastrointestinal defects. Therefore the newborn should be assessed for other anomalies.

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to:

Assess the fetal heart rate and pattern.

The best way for the nurse to promote and support the maternal-infant bonding process is to:

Assist the family with rooming-in.

and macrovascular circulations. These complications include:Atherosclerosis. Retinopathy.Nephropathy. Neuropathy. Autonomcs neuropathy.

Autoimmune disorders often occur during pregnancy because a large percentage of women with an autoimmune disorder are of childbearing age. Identify all disorders that fall into the category of collagen vascular disease.

A married woman has made the decision to use a diaphragm as her primary method of birth control. The clinic nurse should provide which instructions regarding care of, insertion, and removal of the diaphragm? (Select all that apply.) Remove the diaphragm by catching the rim from below the dome. Avoid using mineral oil body products. On insertion, direct the diaphragm down toward the space below cervix. Wash diaphragm monthly with mild soap and water. A dusting of cornstarch is appropriate after drying the diaphragm.

Avoid using mineral oil body products. On insertion, direct the diaphragm down toward the space below cervix. Wash diaphragm monthly with mild soap and water. A dusting of cornstarch is appropriate after drying the diaphragm. The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber.

A newborn is 2 days old and scheduled for discharge. The hospital stay has been uneventful. The nurse is preparing to assess the newborn's temperature. Which method would be the best choice?

Axillary. Axillary temperature is the most common method of taking a newborn's temperature because it is safer than rectal temperatures. Rectal temperatures have the risk of irritating or damaging the rectum. Tympanic thermometers are less accurate in newborns.

What would a breastfeeding mother who is concerned that her baby is not getting enough to eat find most helpful and most cost-effective on the day after discharge? A. Visiting a pediatric screening clinic at the hospital B. Placing a call to the hospital nursery "warm line" C. Calling the pediatrician for a lactation consult referral D. Requesting a home visit

B

When providing health education to the client, the nurse understands that an example of the secondary level of prevention is: A. Approved infant car seats B. Breast self-examination (BSE) C. Immunizations D. Support groups for parents of children with Down syndrome

B

The role of the nurse with regard to informed consent is to: A) Inform the client about the procedure and have her sign the consent form. B) Act as a client advocate and help clarify the procedure and the options. C) Call the physician to see the client D) Witness the signing of the consent form.

B) Act as a client advocate and help clarify the procedure and the options.

A client is admitted to the labor and delivery unit with contractions that are 3-5 minutes apart, lasting 60-70 seconds. She reports that she is leaking fluid. A vaginal exam reveals that her cervix is 80 percent effaced and 4 cm dilated and a -1 station. The nurse knows that the client is in which phase and stage of labor? A) Latent phase, First Stage B) Active Phase of First Stage C) Latent phase of Second Stage D) Transition

B) Active Phase of First Stage Second stage = full dilation until birth

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? A) Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B) Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours C) Lull: No contractions; dilation stable; duration of 20 to 60 minutes D) Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 3-4 hours

B) Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours

Concerning the third stage of labor, nurses should be aware that: A) The placenta eventually detaches itself from a flaccid uterus B) An active approach to managing this stage of labor reduces the risk of excessive bleeding C) It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. D) The major risk for women during the third stage is a rapid heart rate.

B) An active approach to managing this stage of labor reduces the risk of excessive bleeding

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate in a slow curve at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: A) Insert an internal monitor B) Document the finding in the client's record. C) Discontinue the oxytocin infusion D) Change the woman's position

B) Document the finding in the client's record. p. 430

With regard to systemic analgesics administered during labor, nurses should be aware that: A) Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B) Effects on the fetus and newborn can include decreased alertness and delayed sucking. C) Intramuscular administration (IM) is preferred over intravenous (IV) administration. D) IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B) Effects on the fetus and newborn can include decreased alertness and delayed sucking.

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as: A) First stage, latent phase B) First stage, active phase C) First stage, transition phase D) Second stage, latent phase

B) First stage, active phase

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that apply. A) Place the woman in a supine position. B) Place the woman in a lateral position. C) Increase intravenous (IV) fluids. D) Continuous Fetal Monitor E) Administer ephedrine per MD order

B) Place the woman in a lateral position. C) Increase intravenous (IV) fluids. E) Administer ephedrine per MD order

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? A) Sitting B) Squatting C) Side-lying D) Semirecumbent

B) Squatting p. 385

The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to: A) Relieve pain. B) Stimulate uterine contraction C) Prevent infection D) Facilitate rest and relaxation.

B) Stimulate uterine contraction

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: A) The resting tone between contractions is described as either placid or turbulent B) The examiner's hand should be placed over the fundus before, during, and after contractions. C) The frequency and duration of contractions is measured in seconds for consistency D) Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together.

B) The examiner's hand should be placed over the fundus before, during, and after contractions. p. 424

With regard to spinal and epidural (block) anesthesia, nurses should know that: A) This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births B) The incidence of after-birth headache is higher with spinal blocks than epidurals. C) Epidural blocks allow the woman to move freely D) Spinal and epidural blocks are never used together.

B) The incidence of after-birth headache is higher with spinal blocks than epidurals.

20. Many first-time parents do not plan on their parents' help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents? A. "You should tell your parents to leave you alone." B. "Grandparents can help you with parenting skills and also help preserve family traditions." C. "Grandparent involvement can be very disruptive to the family." D. "They are getting old. You should let them be involved while they can."

B. "Grandparents can help you with parenting skills and also help preserve family traditions." Intergenerational help may be perceived as interference, but a statement of this sort is not therapeutic to the adaptation of the family. Stating that grandparents can help with parenting skills and also help preserve family traditions is the most appropriate response. Stating that grandparent involvement can be disruptive is invalid; it also is not an appropriate nursing response. Regardless of age, grandparents can help with parenting skills and can preserve family traditions. Stating that the grandparents are old is not the most appropriate statement, and it does not demonstrate sensitivity on the part of the nurse.

The nurse-midwife is teaching a group of women who are pregnant, including instruction on Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction? A. "I will only see results if I perform 100 Kegel exercises each day." B. "I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." C. "I should only perform Kegel exercises in the sitting position." D. "I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results."

B. "I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises."

3. Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? A. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." B. "My first menstrual cycle will be heavier than normal, and my period will return to my prepregnant volume within three or four cycles." C. "I will not have a menstrual cycle for 6 months after childbirth." D. "My first menstrual cycle will be heavier than normal and then will be light for several months after."

B. "My first menstrual cycle will be heavier than normal, and my period will return to my prepregnant volume within three or four cycles." She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles. Saying the first menstrual cycle will be heavier than normal and the subsequent three or four cycles will return to prepregnant volume is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.

3. Which statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? A. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." B. "My first menstrual cycle will be heavier than normal, and my period will return to my prepregnant volume within three or four cycles." C. "I will not have a menstrual cycle for 6 months after childbirth." D. "My first menstrual cycle will be heavier than normal and then will be light for several months after."

B. "My first menstrual cycle will be heavier than normal, and my period will return to my prepregnant volume within three or four cycles." She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles. Saying the first menstrual cycle will be heavier than normal and the subsequent three or four cycles will return to prepregnant volume is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.

8. With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. The mother's intake of vitamin C, zinc, and protein can be lower than during pregnancy. B. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. Critical iron and folic acid levels, higher than during pregnancy, must be maintained to ensure the health of the infant. D. Lactating women can go back to their prepregnant calorie intake.

B. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

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

B. Cleanse eyes from inner to outer canthus before administration. Instillation of the ointment can be delayed for up to 1 hour to facilitate eye-to-eye contact between the newborn and parents, an activity that fosters bonding and attachment, especially for fathers. The newborn's eyes should be cleansed from the inner to the outer canthus before the administration of erythromycin ointment. Erythromycin should be applied into the conjunctival sac to avoid accidental injury to the eye. The eyes should not be flushed after instillation of the erythromycin.

4. Following circumcision of a newborn, the nurse provides instructions to his parents regarding postcircumcision care. The nurse should tell the parents to: A. Apply topical anesthetics with each diaper change. B. Expect a yellowish exudate to cover the glans after the first 24 hours. C. Change the diaper every 2 hours and cleanse the site with soap and water or baby wipes. D. Apply constant pressure to the site if bleeding occurs and call the physician.

B. Expect a yellowish exudate to cover the glans after the first 24 hours. Topical anesthetics are applied before the circumcision. Infant-comforting techniques are generally sufficient following the procedure. Parents should be taught that a yellow exudate will develop over the glans and should not be removed. The diaper is changed frequently, but the site is cleansed with warm water only because soap and baby wipes can cause pain/burning and irritation at the site. Intermittent pressure is applied if bleeding occurs.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: A. Encourage the woman to breathe more slowly. B. Help the woman breathe into a paper bag. C. Turn the woman on her side. D. Administer a sedative.

B. Help the woman breathe into a paper bag. RATIONAL: The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level.

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production

B. Increased pulse rate

12. The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: A. Place her on a bedpan to empty her bladder. B. Massage her fundus. C. Call the physician. D. Administer Methergine, 0.2 mg IM, which has been ordered prn.

B. Massage her fundus. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.

3. The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: A. Place her on a bedpan to empty her bladder. B. Massage her fundus. C. Call the physician. D. Administer Methergine, 0.2 mg IM, which has been ordered prn.

B. Massage her fundus. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.

6. The nurse notes that, when the newborn is placed on the scale, he immediately abducts and extends his arms and his fingers fan out with the thumb and forefinger forming a "C." This response is known as a: A. Tonic neck reflex. B. Moro reflex. C. Cremasteric reflex. D. Babinski reflex.

B. Moro reflex. Tonic neck reflex refers to the "fencing posture" a newborn assumes when he is supine and turns his head to the side. These actions show the Moro reflex. The cremasteric reflex refers to retraction of testes when chilled. The Babinski reflex refers to the flaring of the toes when the sole is stroked.

21. The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to: A. Tell the mother she must pay attention to her infant. B. Show the mother how the infant initiates interaction and pays attention to her. C. Demonstrate for the mother different positions for holding her infant while feeding. D. Arrange for the mother to watch a video on parent-infant interaction.

B. Show the mother how the infant initiates interaction and pays attention to her. Telling the mother she has to pay attention to the baby may be perceived as derogatory and is not appropriate. Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment. Educating the young mother in infant care is important, but pointing out the responsiveness of her baby is a better tool for facilitating mother-infant attachment. Videos are an educational tool that can demonstrate parent-infant attachment, but encouraging the mother to recognize the infant's responsiveness is more appropriate.

4. Which description of postpartum restoration or healing times is accurate? A. The cervix shortens, becomes firm, and returns to form within a month postpartum. B. The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth. C. Most episiotomies heal within a week. D. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

B. The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth. The cervix regains its form within days; the cervical os may take longer to return to form. The vagina returns to prepregnancy size by 6 to 10 weeks; however, lubrication may take longer to return to prepregnancy level. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

4. Which description of postpartum restoration or healing times is accurate? A. The cervix shortens, becomes firm, and returns to form within a month postpartum. B. The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth. C. Most episiotomies heal within a week. D. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

B. The vagina gradually returns to prepregnancy size by 6 to 10 weeks after childbirth. The cervix regains its form within days; the cervical os may take longer to return to form. The vagina returns to prepregnancy size by 6 to 10 weeks; however, lubrication may take longer to return to prepregnancy level. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

Explain some key indicators of physiologic development in children

BMR decreases as do caloric needs Decrease in HR, RR (Adult values by adolescence) Decrease in sleep needs Neonatal reflexes extinguish by 6 months

11. Obstetricians today are seeing more morbidly obese pregnant women (those that weigh 400 pounds or greater). A new medical subspecialty referred to as __________ obstetrics has subsequently arisen.

Bariatric To manage the conditions of morbidly obese pregnant women and to meet their logistical needs, the subspecialty of bariatric obstetrics has been developed. Extra wide BP cuffs, surgical tables and scales that can hold these patients are necessary to deliver safe patient care. Special techniques for ultrasound and longer surgical instruments are also required.

The nurse is assessing a child post-cardiac catheterization. Which complication might the nurse anticipate? Cardiac arrhythmia

Because a catheter is introduced into the heart, a risk exists of catheter-induced arrhythmias occurring during the procedure.

Women with hyperemesis gravidarum:Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance.

Because pregnant women may need surgery during pregnancy, nurses should be aware that The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy.

A 40-year-old woman is 10 weeks pregnant. Which diagnostic tool would be appropriate to suggest to her at this time? Amniocentesis Biophysical profile (BPP) Transvaginal ultrasound Maternal serum alpha-fetoprotein (MSAFP) screening

Biophysical profile (BPP) Ultrasound would be performed at this gestational age for biophysical assessment of the infant. BPP would be a method of biophysical assessment of fetal well-being in the third trimester. Amniocentesis is performed after the fourteenth week of pregnancy. MSAFP screening is performed from week 15 to week 22 of gestation (weeks 16 to 18 are ideal).

After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as:

Biorhythmicity.

As relates to fetal positioning during labor, nurses should be aware that:

Birth is imminent when the presenting part is at +4 to +5 cm below the spine

What is used to treat moderate-to-severe inflammatory bowel disease? Corticosteroids

Bismuth subsalicylate, clarithromycin, and metronidazole are prescribed for a child with a peptic ulcer to:Eradicate Helicobacter pylori.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? Before chest physiotherapy (CPT)

Bronchodilators should be given before CPT to open bronchi and make expectoration easier

A newborn's mother has tested positive for hepatitis B. When should the newborn receive the hepatitis B vaccine?

By 2 months - For infants of hepatitis B-positive mothers the vaccine is given within 12 hours of birth and at 1 to 2 months and 6 months. Hepatitis B immune globulin is also given within 12 hours of birth. * NOTE - I am not sure this is the correct answer to this questions. One of the options was within 12 hours of birth but when I answered this question with 12 hours of birth, it marked it wrong. The rationale seems to follow 12 hours too. Double check.

- breastfeed every 2 hours to avoid engorgment

Breastfeeding Mothers During the first 24 hours after birth, little, if any, change occurs in the breast tissue. Colostrum, a clear yellow fluid, may be expressed from the breasts. The breasts gradually become fuller and heavier as the colostrum transitions to milk by approximately 72 to 96 hours after birth; this breast change is often referred to as the "milk coming in." The breasts may feel warm, firm, and somewhat tender. Bluish-white milk with a skim-milk appearance (true milk) can be expressed from the nipples. As milk glands and milk ducts fill with milk, breast tissue may feel somewhat nodular or lumpy. Unlike the lumps associated with fibrocystic breast disease or cancer, which may be consistently palpated in the same location, the nodularity associated with milk production tends to shift in position. Some women experience engorgement, but with frequent breastfeeding and proper care, this condition is temporary and typically lasts only 24 to 48 hours (see Chapter 18). Non-Breastfeeding Mothers The breasts generally feel nodular in contrast to the granular feel of breasts in nonpregnant women. The nodularity is bilateral and diffuse. Prolactin levels drop rapidly. Colostrum is present for the first few days after childbirth. Palpation of the breasts on the second or third day, as milk production begins, may reveal tissue tenderness in some women. On the third or fourth postpartum day, engorgement may occur. The breasts are distended (swollen), firm, tender, and warm to the touch (because of vasocongestion). Breast distention is caused primarily by the temporary congestion of veins and lymphatics rather than by an accumulation of milk. Milk is present but should not be expressed. Axillary breast tissue (the tail of Spence) and any accessory breast or nipple tissue along the milk line may be involved. Engorgement resolves spontaneously, and discomfort decreases usually within 24 to 36 hours. A breast binder or well-fitted, supportive bra, ice packs, fresh cabbage leaves, and mild analgesics may be used to relieve discomfort. Nipple stimulation is avoided. If suckling is never begun (or is discontinued), lactation ceases within a few days to a week.

In which culture is the father more likely to be expected to participate in the labor and delivery? A. Asian-American B. African-American C. European-American D. Hispanic

C

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions? A) "I will not experience mood swings since I was only at 10 weeks of gestation." B) "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." C) "I should eat foods that are high in iron and protein to help my body heal." D) "I should expect the bleeding to be heavy and bright red for at lease 1 week."

C) "I should eat foods that are high in iron and protein to help my body heal."

Maria is a Spanish-speaking 5-year-old who has started kindergarten in an English-speaking school. Crying most of the time, she appears helpless and unable to function in this new situation. The best explanation for this is which of the following? A) Lacks adequate maturity for attending school B) Lacks the maturity needed in school C) Is experiencing cultural shock D) Is experiencing minority group discrimination

C) Is experiencing cultural shock

With regard to the process of augmentation of labor, the nurse should be aware that it: A) Augmentation is the use of medications to start labor that has not begun yet. B) Relies on more invasive methods when oxytocin and amniotomy have failed. C) Is part of the active management of labor that is instituted when the labor process is unsatisfactory. D) Is a modern management term to cover up the negative connotations of forceps-assisted birth

C) Is part of the active management of labor that is instituted when the labor process is unsatisfactory.

A laboring woman received meperidine (Demerol) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? A) Fentanyl (Sublimaze) B) Promethazine (Phenergan) C) Naloxone (Narcan) D) Nalbuphine (Nubain)

C) Naloxone (Narcan)

The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of "time-outs," which of the following instructions should the nurse include? A) Send child to his or her room, if child has one. B) If child cries, refuses, or is more disruptive, try another approach. C) Select an area that is safe and unstimulating, such as a hallway. D) General rule for length of time is 1 hour per year of age.

C) Select an area that is safe and unstimulating, such as a hallway.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? A. 2-0-0-1-1 B. 2-1-0-1-0 C. 3-1-0-1-0 D. 3-0-1-1-0

C. 3-1-0-1-0

Which hematocrit (HCT) and hemoglobin (HGB) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? A. 38% HCT; 14 g/dl HGB B. 35% HCT; 13 g/dl HGB C. 33% HCT; 11 g/dl HGB D. 32% HCT; 10.5 g/dl HGB

C. 33% HCT; 11 g/dl HGB

1. At 1 minute following birth, a newborn exhibited the following: heart rate of 155; loud, vigorous crying with active movement of all extremities; sneezing when nose was stimulated with a catheter; hands and feet bluish and cool to the touch. The Apgar score of this newborn should be recorded as: A. 5. B. 7. C. 9. D. 10.

C. 9. The newborn receives 2 points each for a heart rate over 100 beats/min, a vigorous cry, active movement, and sneezing as a response to nasal stimulation. The newborn receives 1 point for color because he exhibits acrocyanosis. The point total is 9.

10. When palpating the fundus of a woman 18 hours after birth, the nurse notes that it is firm, 2 fingerbreadths above the umbilicus, and deviated to the left of midline. The nurse should: A. Massage the fundus. B. Administer Methergine, 0.2 mg PO, that has been ordered prn. C. Assist the woman to empty her bladder D. Recognize this as an expected finding during the first 24 hours following birth

C. Assist the woman to empty her bladder A firm fundus should not be massaged because massage could overstimulate the fundus and cause it to relax. Methergine is not indicated in this case because it is an oxytocic and the fundus is already firm. The findings indicate a full bladder, which pushes the uterus up and to the right or left of midline. The recommended action would be to empty the bladder. If the bladder remains distended, uterine atony could occur, resulting in a profuse flow. A Firm fundus that is 2 fingerbreadths above the umbilicus and deviated to the left of midline is not a normal finding, and an action is required.

1. When palpating the fundus of a woman 18 hours after birth, the nurse notes that it is firm, 2 fingerbreadths above the umbilicus, and deviated to the left of midline. The nurse should: A. Massage the fundus. B. Administer Methergine, 0.2 mg PO, that has been ordered prn. C. Assist the woman to empty her bladder D. Recognize this as an expected finding during the first 24 hours following birth

C. Assist the woman to empty her bladder A firm fundus should not be massaged because massage could overstimulate the fundus and cause it to relax. Methergine is not indicated in this case because it is an oxytocic and the fundus is already firm. The findings indicate a full bladder, which pushes the uterus up and to the right or left of midline. The recommended action would be to empty the bladder. If the bladder remains distended, uterine atony could occur, resulting in a profuse flow. A Firm fundus that is 2 fingerbreadths above the umbilicus and deviated to the left of midline is not a normal finding, and an action is required.

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

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

Which presumptive sign (felt by woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? A. Amenorrhea-stress, endocrine problems B. Quickening-gas, peristalsis C. Goodell sign-cervical polyps D. Chadwick sign-pelvic congestion

C. Goodell sign-cervical polyps

8. With regard to laboratory tests and diagnostic tests performed in the hospital after birth, nurses should be aware that: A. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. B. Federal law prohibits newborn genetic testing without parental consent. C. If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks. D. Hearing screening is now mandated by federal law.

C. If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks. All states test for PKU and hypothyroidism, but other genetic defects are not universally covered. Federal law mandates newborn genetic screening, but not screening for hearing problems (although more than half the states do mandate hearing screening). If done very early, genetic screening should be repeated. Federal law mandates newborn genetic screening, but not screening for hearing problems (although more than half the states do mandate hearing screening).

7. Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C. Iron and folate Fat-soluble vitamins should be supplemented as a medical prescription, because vitamin D might be needed for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented during pregnancy, and folic acid supplements often are needed because folate is so important to the growing fetus. Zinc is sometimes supplemented during pregnancy. Most women get enough calcium.

When caring for pregnant women, the nurse should keep in mind that violence during pregnancy: A. Affects more than 25% of pregnant women in the United States B. Increases a pregnant woman's risk for gestational hypertension C. May be associated with substance abuse by both the pregnant woman and her partner D. Has decreased in incidence as a result of better assessment techniques and record keeping

C. May be associated with substance abuse by both the pregnant woman and her partner

6. With regard to afterbirth pains, nurses should be aware that these pains are: A. Caused by mild, continuous contractions for the duration of the postpartum period. B. More common in first-time mothers. C. More noticeable in births in which the uterus was overdistended. D. Alleviated somewhat when the mother breastfeeds.

C. More noticeable in births in which the uterus was overdistended. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations, which persist throughout the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus and this accounts for afterbirth pains. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

6. With regard to afterbirth pains, nurses should be aware that these pains are: A. Caused by mild, continuous contractions for the duration of the postpartum period. B. More common in first-time mothers. C. More noticeable in births in which the uterus was overdistended. D. Alleviated somewhat when the mother breastfeeds.

C. More noticeable in births in which the uterus was overdistended. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations, which persist throughout the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus and this accounts for afterbirth pains. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Which statement about female sexual response is not accurate? A. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. B. Vasocongestion is the congestion of blood vessels. C. The orgasmic phase is the final state of the sexual response cycle. D. Facial grimaces and spasms of hands and feet are often part of arousal.

C. The orgasmic phase is the final state of the sexual response cycle.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? A. Encourage her to empty her bladder. B. Decrease her intravenous (IV) rate to a keep vein-open rate. C. Turn the woman to the left lateral position or place a pillow under her hip. D. No action is necessary since a decrease in the woman's blood pressure is expected.

C. Turn the woman to the left lateral position or place a pillow under her hip. RATIONAL: Turing the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction.

3. Newborns are at high risk for injury if appropriate safety precautions are not implemented. Parents should be taught to: A. Place newborn on abdomen (prone) after feeding and for sleep. B. Avoid use of pacifiers. C. Use a rear-facing car seat until the infant weighs at least 20 lb. D. Use a crib with side-rail slats that are no more than 3 inches apart.

C. Use a rear-facing car seat until the infant weighs at least 20 lb. The prone position is no longer recommended because it may interfere with chest expansion and lead to sudden infant death syndrome. Approved pacifiers are safe to use and fulfill a newborn's need to suck. If the newborn is breastfed, the use of pacifiers should be delayed until breastfeeding is well established to avoid the development of nipple confusion. The APA recommends using a rear-facing car seat until a baby weighs 20 lb. Slats in a crib should be no more than 2 inches apart.

18. When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: A. Express a strong need to review events and her behavior during the process of labor and birth. B. Exhibit a reduced attention span, limiting readiness to learn. C. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. D. Have reestablished her role as a spouse/partner.

C. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. Expressing a strong need to review events is characteristic of the taking-in stage, which lasts for the first few days after birth. Exhibiting a reduced attention span is characteristic of the taking-in stage, which lasts for the first few days after birth. One week after birth, the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth. Reestablishing her role as spouse/partner reflects the letting-go stage, which indicates that psychosocial recovery is complete.

Database of up-to-date systematic reviews and dissemination of reviews of randomized controlled trials of health care

COCHRANE PREGNANCY AND CHILDBIRTH DATABASE

Range of clinical services provided for an individual or group that reflects care given during a single hospitalization or care for multiple conditions over a lifetime

CONTINUUM OF CARE

Awareness, acceptance, and knowledge of cultural differences and adaptation of services to acknowledge and support the culture of the patient

CULTURAL COMPETENCE

Setting in which one considers the individual's and the family's beliefs and practices (culture)

CULTURAL CONTEXT

Knowledge that includes beliefs and values about each facet of life and is passed from one generation to the next

CULTURAL KNOWLEDGE

Learning about and applying the standards of another person's culture to activities within a particular culture

CULTURAL RELATIVISM

One of the clinical manifestations of chronic renal failure is uremic frost. What best describes this term? Deposits of urea crystals on skin

Calcium carbonate is given with meals to a child with chronic renal disease. The purpose of this is to Bind phosphorus.

A multigravida at 37 weeks of gestation is admitted to the labor room. She has contractions every 3 to 4 minutes lasting 40 to 50 seconds and no history of clear fluid leakage from the vagina, but complains of bright red bleeding for the past hour. The fetal heart rate is 145. What should be the nurse's next intervention?

Call the physician. - Bright red bleeding is a sign of complications, and the physician or primary health care provider should be notified immediately.

Nurses should be aware that chronic hypertension: Can occur independently of or simultaneously with gestational hypertension. Is general hypertension plus proteinuria. Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy. Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg.

Can occur independently of or simultaneously with gestational hypertension.

Since the gene for cystic fibrosis was identified in 1989, data can be collected for the purposes of genetic counseling for couples regarding carrier status. According to statistics, how often does cystic fibrosis occur in

Caucasian live births? 1 in 3000

To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor?

Cervical dilation and effacement

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:

Change in position.

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: Change the woman's position. Assist with amnioinfusion. Insert a scalp electrode. Notify the care provider.

Change the woman's position.

A common clinical manifestation of juvenile hypothyroidism is:Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism.

Children with hypothyroidism are usually sleepy. Decelerated growth is common in juvenile hypothyroidism.

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe: Discolored teeth.

Children with osteogenesis imperfecta have incomplete development of bones, teeth, ligaments, and sclerae. Teeth are discolored because of abnormal enamel

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? Immunologic factors Infections Endocrine imbalance Chromosomal abnormalities

Chromosomal abnormalities

Amantadine hydrochloride may reduce symptoms related to influenza type A if administered within 24 to 48 hours of onset

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by: A feeling of fullness in the ear.

The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad's chin. This woman's statement reflects:Claiming.

Claiming refers to the process by which the child is identified in terms of likeness to other family members

treatment of brain tumors in children consists of which therapies Surgery Chemotherapy Radiation Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination

Clinical manifestations of increased intracranial pressure (ICP) in infants are Diplopia and blurred vision. Irritability.Distended scalp veins.

- clotting factors increase during pregnancy. increased risk for DVT.

Coagulation factors Clotting factors and fibrinogen are normally increased during pregnancy and remain elevated in the immediate puerperium. When combined with vessel damage and immobility, this hypercoagulable state causes an increased risk of thromboembolism, especially after a cesarean birth. Fibrinolytic activity also increases during the first 1 to 4 days after childbirth (Katz, 2007). Circulation and coagulation times The circulation time decreases slightly by week 32. It returns to near normal by near term. The blood tends to coagulate (clot) during pregnancy because of increases in various clotting factors (factors VII, VIII, IX, X, and fibrinogen). This change, combined with the fact that fibrinolytic activity (the splitting up or the dissolving of a clot) is depressed during pregnancy and the postpartum period, provides a protective function to decrease the chance of bleeding, but it also makes the woman more vulnerable to thrombosis, especially after cesarean birth.

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the woman's understanding of the instructions when she states, "True labor contractions will: Remain irregular but become stronger Subside when I walk around Cause discomfort over the top of my uterus Continue and get stronger even if I relax and take a shower

Continue and get stronger even if I relax and take a shower

Perinatal nurses are legally responsible for: Applying the external fetal monitor and notifying the care provider. Greeting the client on arrival, assessing her, and starting an intravenous line. Making sure that the woman is comfortable. Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.

Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use:

Counterpressure against the sacrum.

The nurse is caring for an infant with myelomeningocele scheduled for surgical closure in the morning. Which interventions should the nurse plan for the care of the myelomeningocele sac?

Covered with a sterile, moist, nonadherent dressing

Dehydration during pregnancy can increase the risk of what complications?

Cramping, contractions, & preterm labor

A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman's umbilicus and recognizes this assessment finding as: Normal integumentary changes associated with pregnancy. Cullen's sign associated with a ruptured ectopic pregnancy. Chadwick's sign associated with early pregnancy. Turner's sign associated with appendicitis.

Cullen's sign associated with a ruptured ectopic pregnancy.

When assessing the fetus using Leopold maneuvers, the nurse feels a round, hard, movable fetal part just above the symphysis and a long, smooth surface in the mother's left side close to midline. In the fundus, there is a prominence- when pushed the whole body seems to follow. What is the likely position of the fetus? A) RSA B) ROA C) LSP D) LOA

D) LOA p. 422

Which of the following is true about placenta previa. A) The bleeding from placenta previa usually occurs late in pregnancy at term. B) In evaluating the bleeding, a vaginal exam would be done to determine the cause of the bleeding. C) Symptoms of placenta previa are painful frequent contractions and bright red vaginal bleeding D) Once placenta previa is diagnosed by a 20 week ultrasound, it is very likely the placenta previa will resolve in the third trimester.

D) Once placenta previa is diagnosed by a 20 week ultrasound, it is very likely the placenta previa will resolve in the third trimester.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. What intervention would be the top priority? A) Starting oxygen by face mask B) Preparing the woman for a cesarean birth C) Covering the cord in sterile gauze soaked in saline D) Placing the woman in the knee-chest position

D) Placing the woman in the knee-chest position

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? (Note: see power point on complications of Labor for homework part 1 on preterm labor) A) Estriol is not found in maternal saliva. B) Irregular, mild uterine contractions are occurring every 12 to 15 minutes C) Fetal fibronectin is present in vaginal secretions. D) The cervix is effacing and dilated to 2 cm.

D) The cervix is effacing and dilated to 2 cm.

Which of the following is descriptive of family systems theory? A) The family is viewed as the sum of individual members. B) Change in one family member cannot create a change in other members. C) Individual family members are readily identified as the source of a problem. D) When the family system is disrupted, change can occur at any point in the system.

D) When the family system is disrupted, change can occur at any point in the system.

24. Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the management of the environment. While providing routine mother-baby care, the nurse should ensure that: A. The baby is able to return to the nursery at night so that the new mother can sleep. B. Routine times for care are established to reassure the parents. C. The father should be encouraged to go home at night to prepare for mother-baby discharge. D. An environment that fosters as much privacy as possible should be created.

D. An environment that fosters as much privacy as possible should be created. Once the baby has demonstrated adjustment to extrauterine life (either in the mother's room or the transitional nursery), all care should be provided in one location. This important principle of family-centered maternity care fosters attachment by giving parents the opportunity to learn about their infant 24 hours a day. One nurse should provide care to both mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to return to the nursery at night. In fact, the mother will sleep better with the infant close by. Care should be individualized to meet the parents' needs, not the routines of the staff. Teaching goals should be developed in collaboration with the parents. The father or other significant other should be permitted to sleep in the room with the mother. The maternity unit should develop policies that allow for the presence of significant others as much as the new mother desires. Care providers need to knock before gaining entry. Nursing care activities should be grouped.

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: A. Weight gain of 1 to 3 pounds. B. Quickening. C. Fatigue and lethargy. D. Bloody show.

D. Bloody show. RATIONAL: Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.

When a nurse is unsure about how to perform a client care procedure, the best action would be to: A. Ask another nurse B. Discuss the procedure with the client's physician C. Look up the procedure in a nursing textbook D. Consult the agency procedure manual and follow the guidelines for the procedure

D. Consult the agency procedure manual and follow the guidelines for the procedure

A 23-y/o African-American woman is pregnant with her 1st child. Based on the statistics for infant mortality, which plan is most important for the RN to implement? A. Perform a nutrition assessment. B. Refer the woman to a social worker. C. Advise the woman to see an obstetrician, not a midwife. D. Explain to the woman the importance of keeping her prenatal care appointments.

D. Explain to the woman the importance of keeping her prenatal care appointments. RATIONALE: Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? A. Perform a nutrition assessment. B. Refer the woman to a social worker. C. Advise the woman to see an obstetrician, not a midwife. D. Explain to the woman the importance of keeping her prenatal care appointments.

D. Explain to the woman the importance of keeping her prenatal care appointments.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia is: A. Severe postpartum headache. B. Limited perception of bladder fullness. C. Increase in respiratory rate. D. Hypotension.

D. Hypotension. RATIONAL: Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure.

10. All of these statements describe the first phase of the transition period except: A. It lasts no longer than 30 minutes. B. It is marked by spontaneous tremors, crying, and head movements. C. It includes the passage of meconium. D. It may involve the infant suddenly sleeping briefly.

D. It may involve the infant suddenly sleeping The first phase is the shortest, lasting less than 30 minutes. Spontaneous tremors, crying, head movements, and also spontaneous startle reactions are expected exploratory behaviors in the first phase. In the first phase, in addition to passing meconium, the newborn also produces saliva. The first phase is an active phase in which the baby is alert. Decreased activity and sleep mark the second phase.

11. Which finding would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum? A. Postural hypotension B. Temperature of 100.4° F C. Bradycardia—pulse rate of 55 beats/min D. Pain in left calf with dorsiflexion of left foot

D. Pain in left calf with dorsiflexion of left foot Postural hypotension is an expected finding related to circulatory changes after birth. A temperature of 100.4° F in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake. A heart rate of 55 beats/min is an expected finding in the initial postpartum period. Findings of pain in the left calf with dorsiflexion of the left foot indicate a positive Homan's sign and are suggestive of thrombophlebitis and should be investigated.

4. Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: A. Uses soap and warm water to wash the vulva and perineum. B. Washes from symphysis pubis back to episiotomy. C. Changes her perineal pad every 2 to 3 hours. D. Uses the peribottle to rinse upward into her vagina.

D. Uses the peribottle to rinse upward into her vagina. Washing the vulva and perineum with soap and water is an appropriate measure. Washing from symphysis pubis back toward episiotomy is an appropriate measure. Changing the perineal pad every 2 to 3 hours in an appropriate measure. The peribottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina because debris would be forced upward into the uterus through the still-open cervix.

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

D. Weigh the newborn at the same time each day for accuracy. 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. Weighing a newborn at the same time each day allows for accurate weights.

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: Disseminated intravascular coagulation (DIC) Hemorrhage Amniotic fluid embolism (AFE) HELLP syndrome

Disseminated intravascular coagulation (DIC)

In their role of implementing a plan of care for infertile couples, nurses should: Be comfortable with their sexuality and nonjudgmental about others to counsel their clients effectively. Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid. Know about such nonmedical remedies as diet, exercise, and stress management. Do all of the above plus be knowledgeable about potential drug and surgical remedies.

Do all of the above plus be knowledgeable about potential drug and surgical remedies.

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should: Discontinue the oxytocin infusion. Change the woman's position. Document the finding in the client's record. Insert an internal monitor.

Document the finding in the client's record.

Remaining fairly stable throughout the first and second stages

Duration

a (At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign.)

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: A. Hegar sign B. McDonald sign C. Chadwick sign D. Goodell sign

What is physiologic anemia? Is this condition a cause of concern or is it expected during pregnancy?

During pregnancy, plasma volume increases more than RBC mass. The excess of plasma causes a modest decrease in Hgb concentration & Hct ESSENTIALLY, THE EXCESS PLASMA "DILUTES" OR WATERS DOWN THE HGB & HCT

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? Early decelerations Late decelerations It is always a good idea to change the woman's position. Variable decelerations

Early decelerations

colostrum

Early milk, produced from approximately 16 weeks of pregnancy into the first postpartum days; rich in antibodies, higher in protein, and lower in fat than mature milk, with laxative effect to clear meconium and promote excretion of bilirubin

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by: Eating six small equal meals per day. Eating her meals and snacks on a fixed schedule. Reducing carbohydrates in her diet. Increasing her consumption of protein.

Eating her meals and snacks on a fixed schedule.

With regard to systemic analgesics administered during labor, nurses should be aware that:

Effects on the fetus and newborn can include decreased alertness and delayed sucking.

Maternity nurses often have to answer questions about the many, sometimes unusual ways people have tried to make the birthing experience more comfortable. For instance, nurses should be aware that:

Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

What is atraumatic care?

Eliminate or minimize distress Prevent or minimize separation from the family Promote sense of control Prevent or minimize bodily injury and pain Examples: - Foster the parent-child relationship - Prepare child before any treatment or procedure - Control pain - Provide play activities for expression of fear and aggression

What is the difference between enabling and empowerment?

Enabling: Strengthens current abilities and competencies it also aids in acquiring new abilities and competencies as needed Empowerment: Interaction that allows the family to maintain or acquire a sense of control. Behaviors that foster family's strengths, abilities, and actions

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? Perform a nutrition assessment. Refer the woman to a social worker. Advise the woman to see an obstetrician, not a midwife. Explain to the woman the importance of keeping her prenatal care appointments.

Explain to the woman the importance of keeping her prenatal care appointments Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but this is not the most important aspect the nurse should address at this time. If the woman has identifiable high risk problems, her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high risk issues. Additionally, this is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive. Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality.

The hospital risk management nurse is providing annual in-service training at the obstetrical unit staff meeting. The risk management nurse should discuss which conditions included on the National Quality Forum list that pertain to maternity nursing? (Select all that apply) Falls and trauma Decreased incidence of urinary tract infections with catheter use Air embolism Foreign objects retained after surgery Blood incompatibility

Falls and trauma,Air embolism, Foreign objects retained after surgery,Blood incompatibility Catheter use should be minimized to decreased urinary tract infections. Five of the conditions are also on the National Quality Forum list. Conditions that might pertain to maternity nursing include a foreign object retained after surgery, air embolism, blood incompatibility, falls and trauma, and catheter-associated urinary tract infections. Almost 1300 U.S. hospitals waive (do not bill for) costs associated with serious reportable events (O'Reilly, 2008).

A woman is giving birth to her third child in a setting that allows her husband and other two children to be actively involved in the process. The nurse caring for the woman must also consider the husband and family as patients and work to meet their needs. This type of setting is termed: family-centered care. emergency care. hospice care. individual care.

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

Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm -1. Which of the following is a correct interpretation of the data?

Fetal presenting part is 1 cm above the ischial spines - station of -1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. A station of zero would indicate that the presenting part has passed through the inlet and is at the level of the ischial spines or is engaged. Passage through the ischial spines with internal rotation would be indicated by a plus station, such as +1. Progress of effacement is referred to by percentages, with 100% indicating full effacement, and dilation by centimeters (cm), with 10 cm indicating full dilation.

a (Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement.)

Fetal well-being during labor is assessed by: A. The response of the fetal heart rate (FHR) to uterine contractions (UCs) B. Maternal pain control C. Accelerations in the FHR D. An FHR greater than 110 beats/min

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? Freezing embryos for later use Financial ability to cover the cost of treatment Whether or how to disclose the facts of conception to offspring Risks of multiple gestation

Financial ability to cover the cost of treatment

Which description of the four stages of labor is correct for both definition and duration?

First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours

The intake of which nutrient is vital during the periconception period to prevent neural tube defects?

Folate, Folic Acid The neural tube begins to close during the first mo of fetal development

A school-age child is admitted to the hospital with acute glomerulonephritis and oliguria. Which dietary menu items should be allowed for this child Apples Carrot sticks Strawberries

Foods with substantial amounts of potassium and sodium are generally restricted during the period of oliguria.

"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse? One fetal movement noted in 1 hour of assessment by the mother

nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. This intervention:Helps infants to interact directly with their parents and enhances their temperature regulation.

For clinical purposes, preterm and post-term infants are defined as: Preterm before 37 weeks, and post-term beyond 42 weeks, no matter the size for gestational age at birth.

Generally ranging from two to five contractions per 10 minutes of labor

Frequency

Many first-time parents do not plan on their parents' help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents?

Grandparents can help you with parenting skills and also help preserve family traditions."

What are some food sources of magnesium?

Green leafy vegs, nuts, whole grains, dairy products

meconium

Greenish black, viscous first stool formed during fetal life from the amniotic fluid and its constituents, intestinal secretions (including bilirubin), and cells (shed from the mucosa)

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of: Eclampsia. HELLP syndrome. Idiopathic thrombocytopenia. Disseminated intravascular coagulation (DIC).

HELLP syndrome.

On observing a woman on her first postpartum day sitting in bed while her newborn lies awake in the bassinet, the nurse should:

Hand the baby to the woman.

What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae? Decrease in abdominal pain Bradycardia Decrease in fundal height Hard, boardlike abdomen

Hard, boardlike abdomen

If a woman is at risk for thrombus and is not ready to ambulate, nurses may intervene by performing a number of interventions. Which intervention should the nurse avoid?

Having the patient sit in a chair.

The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. What should be included in the teaching plan for daily injections?

He is old enough to give most of his own injections.

lactation consultant

Health care professional who has specialized training and experience working with breastfeeding mothers and infants

What is the lower limit for Hgb during pregnancy in the first & third trimesters? In the second? What about Hct in first & third? second?

Hgb- 1&3= 11 d/dL, 2= 10.5 Hct- 1&3= 33 %, 2= 32%

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: Hypoxemia. Maternal drug use. Hypotension. Cord compression.

Hypoxemia.

The nurse-midwife is teaching a group of women who are pregnant, including instruction on Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction? I will only see results if I perform 100 Kegel exercises each day. I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises. I should only perform Kegel exercises in the sitting position. I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results.

I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises Guidelines suggest that women perform between 30 and 80 Kegel exercises. The correct technique for Kegel exercises is to hold the contraction for at least 10 seconds and rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. Kegel exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase

IV fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take?Notify the physcian

The diagnosis of pregnancy is based on which positive signs of pregnancy (Select all that apply)? Positive hCG test Identification of fetal heartbeat Verification of fetal movement Palpation of fetal outline Visualization of the fetus

Identification of fetal heartbeat Verification of fetal movement Visualization of the fetus

Which infant would be more likely to have Rh incompatibility? Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor

If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, all the children will be Rh positive.

The priority nursing care associated with an oxytocin (Pitocin) infusion is: Monitoring uterine response.

Immediately after the forceps-assisted birth of an infant, the nurse should: Assess the infant for signs of trauma.

From the nurse's perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further? Implementing programs to ensure women's early participation in ongoing prenatal care Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days Expanding the number of neonatal intensive care units (NICUs) Mandating that all pregnant women receive care from an obstetrician

Implementing programs to ensure women's early participation in ongoing prenatal care Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs would offer better access for high risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to:

Improve the accuracy of blood loss estimation, which usually is a subjective assessment.

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: Disseminated intravascular coagulation (DIC)

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? Administration of blood

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with:The nurse.

In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care.

d (This compression also leads to varicose veins in the legs and vulva.)

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: A. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is B. Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit C. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant D. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy

Children born to women with untreated PKU are more likely to be born with mental retardation, microcephaly, congenital heart disease, and low birth weight

In terms of the incidence and classification of diabetes, maternity nurses should know that: Type 2 diabetes often goes undiagnosed.

b (Reorganization is not a phase of RTS.)

In the 1970s rape-trauma syndrome (RTS) was identified as a cluster of characteristics, symptoms, and related behaviors seen in the weeks and months after a rape. Which pattern of responses would not apply to a victim of rape? A. Acute phase: disorganization B. Acute phase: rearranging C. Outward adjustment phase D. Long-term process: reorganization phase

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? Retinopathy of prematurity is thought to occur as a result of high levels of oxygen in the blood

In the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. The nurse should suspect:Hypovolemia and/or shock.

During the taking-hold phase the mother assumes responsibility for her own care and shifts her attention to the infant

In the taking-in phase the mother is primarily focused on her own needs.

b (Mood swings are natural and are likely to affect every woman to some degree.)

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that: A. Nonacceptance of the pregnancy very often equates to rejection of the child B. Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes C. Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers D. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure (Select all that apply)? Place the woman in a supine position. Increase intravenous (IV) fluids. Perform a vaginal examination. Place the woman in a lateral position. Administer oxygen.

Increase intravenous (IV) fluids. Place the woman in a lateral position. Administer oxygen.

Complications and risks associated with cesarean births include Wound dehiscence. Hemorrhage. Urinary tract infections. Fetal injuries.

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and

Nurses should be aware that the induction of labor: Is rated for viability by a Bishop score.

Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans.

erythema toxicum

Innocuous pink papular neonatal rash of unknown cause, with superimposed vesicles appearing within 24 to 48 hours after birth and resolving spontaneously within a few days

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse could try is:

Inserting a sterile catheter.

Late decelerations are almost always caused by uteroplacental insufficiency.

Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption.

Combines modern technology with ancient healing practices and encompasses the whole of body, mind, and spirit?

Integrative medicine

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

Intense abdominal pain.

What is included in a women's health assessment?

Interview* Women with special needs History* Physical examination* Pelvic examination during pregnancy Pelvic examination after hysterectomy Laboratory and diagnostic procedures

A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply): Expectation of heavy bleeding for at least 2 weeks. Iron supplementation. Emphasizing the need for rest. Resumption of intercourse at 6 weeks following the procedure. Referral to a support group if necessary.

Iron supplementation. Emphasizing the need for rest. Referral to a support group if necessary.

Nurses should be aware that HELLP syndrome: Is associated with preterm labor but not perinatal mortality. Is characterized by hemolysis, elevated liver enzymes, and low platelets. 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.

In many hospitals new mothers are routinely presented with gift bags containing samples of infant formula. This practice:

Is inconsistent with the Baby Friendly Hospital Initiative.Infant formula should not be given to mothers who are breastfeeding.

LM Ch1: List some serious problems in the US related to healthcare of mothers and infants?

Lack of access to pregnancy Pregnancy related care for all women Lack of reproductive health services for adolescents

To reassure and educate pregnant clients about changes in their breasts, nurses should be aware that: The mammary glands do not develop until 2 weeks before labor. Lactation is inhibited until the estrogen level declines after birth. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding. The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomery's tubercles and possibly infection of the tubercles.

Lactation is inhibited until the estrogen level declines after birth.

As the nurse is admitting a woman in labor she notices that the woman is happy and excited that she is in labor. The contractions are 5 minutes apart, lasting 30 to 35 seconds. The nurse can anticipate that the client is in which phase of labor?

Latent - During the latent phase of the first stage of labor the woman is usually sociable, excited, and cooperative. The contractions are about 5 minutes apart.

What are two nutritional teaching points a nurse should be sure & give to a mother who is exercising throughout her pregnancy?

Liberal amounts of fluid should be consumed before, during, & after exercise & the calorie intake should be sufficient enough to meet the increased needs of pregnancy & demands of exercise

LM Ch 1: What are some factors associated with higher infant mortality rates?

Limited maternal education Young maternal age Unmarried status Poverty Lack of prenatal care Smoking Poor nutrition Alcohol use Maternal conditions: poor health, hypertension

implement a number of care measures to help the client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care?

Limiting the number of procedures that invade her body

Which assessment findings should the nurse note in a school-age child with Duchenne's muscular dystrophy (DMD)

Lordosis Gower's sign Waddling gait

Typically, affected boys have a waddling gait and lordosis, fall frequently, and develop a characteristic manner of rising from a squatting or sitting position on the floor Gower's sign

Lordosis occurs as a result of weakened pelvic muscles, and the waddling gait is a result of weakness in the gluteus medius and maximus muscles.

The postpartum woman who continually repeats the story of her labor, delivery, and recovery experience is:

Making the birth experience "real." Reliving the birth experience makes the event real and helps the mother realize that the pregnancy is over and that the infant is born and is now a separate individual.

A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by:Complex carbohydrate and protein.

Manifestations of hypoglycemia include: Shaky feeling and dizziness.

a (If the parents-to-be are older and have taken fertility drugs, they would be very interested in this information.)

Many parents-to-be have questions about multiple births. Maternity nurses should be able to tell them that: A. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing B. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins C. Identical twins are more common in Caucasian families D. Fraternal twins are same gender, usually male

5. Do alternative perspectives to your conclusion exist?

Mary could have a history of breast surgery, in which case the milk ducts may have been severed, and there is no outlet for the milk to be emptied from the breasts. The baby may be the source of the latch problem because of some physical characteristic such as a tight frenulum ("tongue-tied"). The baby needs to be assessed to determine whether there are factors that may inhibit successful latch-on. In addition, Mary may be lacking in her commitment to breastfeed and may be looking for an excuse to stop. In her mind, the difficulties she is experiencing may provide her with enough reason to switch to formula.

What nursing diagnosis is most appropriate for the woman at this time?Imbalanced nutrition: less than body requirements

Maternal PKU is an important health concern during pregnancy because:The fetus may develop neurologic problems.

Problems of the US health care system that can affect maternity & women's health?

Med errors (leading cause of death) High cost Limited access to care Ethnic & minority groups

opioid (narcotic) agonist-antagonist analgesics

Medications that combine agonist activity (activates or stimulates a receptor to perform a function) and antagonist activity (blocks a receptor or medication designed to activate a receptor) to relieve pain without causing significant maternal or fetal or newborn respiratory depression

Is a stimulant with vasoconstrictive characteristics.

Methamphetamines are stimulants with vasoconstrictive characteristics similar to cocaine and are used similarly. As is the case with cocaine users, methamphetamine users are urged to immediately stop all use during pregnancy

Methotrexate is recommended as part of the treatment plan for which obstetric complication? Unruptured ectopic pregnancy

Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter.

Alcohol use in pregnancy has been associated with?

Miscarriages Mental retardation >BW Alcohol related birth defects

The nurse should include questions regarding sexuality when gathering data for a reproductive health history of a female patient. Which principle should guide the nurse when interviewing the patient? An in-depth exploration of specific sexual practices should be included for every patient. Sexual histories are optional if the patient is not currently sexually active. Misconceptions and inaccurate information expressed by the patient should be corrected promptly. Questions regarding the patient's sexual relationship are unnecessary if she is monogamous.

Misconceptions and inaccurate information expressed by the patient should be corrected promptly. More in-depth assessments are required if the patient is sexually active or if problems or concerns are raised during general questions. Sexuality should be included on every reproductive health history whether or not the patient is sexually active. To obtain the most accurate reproductive health history, the nurse needs to correct misconceptions and inaccurate information. The relationship and sexual partner should be discussed even if the patient is monogamous.

- mongolian spots.

Mongolian spots Mongolian spots, bluish-black areas of pigmentation, may appear over any part of the exterior surface of the body, including the extremities. They are more commonly noted on the back and buttocks (Fig. 16-5). These pigmented areas are most frequently noted in newborns whose ethnic origins are in the Mediterranean area, Latin America, Asia, or Africa. They are more common in dark-skinned individuals but may occur in 5% to 13% of Caucasians as well (Blackburn, 2007). They fade gradually over months or years.

Article: As an RN what we qualified to do during epidurals for women?

Monitor the pt's vital signs, mobility, level of consciousness, and perception if pain. Monitor the status of the fetus Replace empty infusion syringes or infusion bags with new, pre-prepared solutions containing the same medication and concentration, according to standing orders provided by the anesthesia care provider Stop the continuous infusion if there is a safety concern or the woman has given birth Remove the catheter, if educational criteria have been met and institutional policy and law allow. Remo

The priority nursing care associated with an oxytocin (Pitocin) infusion is: Monitoring uterine response. Increasing infusion rate every 30 minutes. Measuring urinary output. Evaluating cervical dilation.

Monitoring uterine response.

The infant should first be placed in the knee-chest position to reduce blood returning to the heart. Next, 100% oxygen is given to alleviate the hypoxemia.

Morphine is next administered to reduce infundibular spasms. Last, the nurse should remain calm.

A mother expresses concern to the nurse that her new baby has blue eyes. She states, "Everyone in my family and my husband's family has brown eyes." The nurse should base her answer on which of the following?

Most babies have gray-blue eyes at birth. Most light-skinned newborns will have slate gray-blue eyes for about 3 to 12 months. At that point they will turn to their true color.

nurse can create an environment for the infant that prevents temperature instability. evaluating the plan that has been implemented, the nurse knows that the infant is experiencing cold stress when he or she exhibits:

Mottled skin with acrocyanosis. The infant has minimal to no fat stores. During times of cold stress the skin will become mottled, and acrocyanosis will develop, progressing to cyanosis.

To care adequately for infants at risk for neonatal bacterial infection, nurses should be aware that: Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot.

Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of:

A woman is undergoing a nipple-stimulated contraction stress test (CST). She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline of approximately 120 beats/min without any decelerations. The interpretation of this test is said to be: Positive. Unsatisfactory. Negative. Satisfactory.

Negative.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." "Herbs have no bearing on fertility."

Nettle leaf, dong quai, and vitamin E promote fertility. Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Vitamin E, calcium, and magnesium may promote fertility and conception. Although most herbal remedies have not been proven clinically to promote fertility, women should avoid the following herbs while trying to conceive: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle.

5. Do alternative perspectives to your conclusion exist?

Not all women belonging to a particular cultural group will desire to use the traditional health practices that represent that group. Many young women who are first- or second-generation Americans follow their cultural traditions only when older family members are present or not at all. Adherents to the "melting pot" theory of acculturation in the United States would assert that women, regardless of their cultural heritage, should "act like Americans" if they live in America.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take? Scream for help. Notify the care provider immediately. Start Pitocin. Insert a Foley catheter.

Notify the care provider immediately.

5. Do alternative perspectives to your conclusion exist?

Nursery nurses may have had experience with babies choking on mucus and used the prone or side-lying position to promote drainage of mucus. Based on that experience, they may fear that the back-lying position will promote aspiration. They may rely on experience rather than research evidence in their care of infants. Continuing education programs should address research findings. Nurse managers can implement programs of reward for those nurses who base their practice on evidence.

The nurse is caring for an infant with congestive heart disease (CHD). The nurse should plan which intervention to decrease cardiac demands?Organize nursing activities to allow for uninterrupted sleep.

Nursing interventions for the child after a cardiac catheterization include which of the following Assess the affected extremity for temperature and color Maintain a patent peripheral intravenous catheter until discharge.

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to:

Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood.

As a nurse what are Anticipatory Guidance for Health Promotion and Illness Prevention?

Nutrition Exercise Stress management Substance use cessation Safer sexual practices Health screening schedule Health risk prevention Health protection

What are some influential factors of childhood development?

Nutrition most important influence Other: - Genetics - Race - Environment - Affection - Disease - Stress

Dietary Reference Intakes (DRIs)

Nutritional recommendations for the United States, consisting of the recommended dietary allowances, adequate intakes, and tolerable upper intake levels; the upper limit of intake associated with low risk in almost all members of a population

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: Over the uterine fundus. On the fetal scalp. Inside the uterus. Over the mother's lower abdomen.

Over the uterine fundus.

d (OTC pregnancy tests use ELISA for its one-step, accurate results.)

Over-the-counter (OTC) pregnancy tests usually rely on which technology to test for human chorionic gonadotropin (hCG)? A. Radioimmunoassay B. Radioreceptor assay C. Latex agglutination test D. Enzyme-linked immunosorbent assay (ELISA)

systemic analgesia

Pain relief induced when an analgesic is administered parenterally (e.g., subcutaneous [SC], intramuscular [IM], or intravenous [IV] route) and crosses the blood-brain barrier to provide central analgesic effects

A child with cystic fibrosis is receiving recombinant human deoxyribonuclease (rhDNase). This drug: May cause voice alterations.

Pancreatic enzymes are administered to the child with cystic fibrosis. Nursing should include:Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that:

Participation in preparation classes helps both siblings and grandparents.Preparing older siblings and grandparents helps everyone to adapt.

The nurse is assessing a woman's breast self-examination (BSE) technique. Which action indicates that a woman needs further instruction regarding BSE? Performs every month on the first day of her menstrual period Uses the pads of her fingers when palpating each breast Inspects her breasts while standing before a mirror and changing arm positions Places a folded towel under right shoulder and right hand under head when palpating right breast

Performs every month on the first day of her menstrual period BSE should be performed once a month after the menstrual period has ended. These are correct actions for performing a BSE.

acrocyanosis

Peripheral cyanosis; blue color of hands and feet in most infants at birth that may persist for 7 to 10 days

surfactant

Phosphoprotein necessary for normal respiratory function that prevents alveolar collapse (atelectasis)

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure

Place the woman in a lateral position. Increase intravenous (IV) fluids. Administer oxygen.

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? Transcervical catheter

Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction.

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 of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: Placental abruption. Placenta previa. Eclamptic seizure. Rupture of the uterus.

Placental abruption.

What are reasons for a woman to enter the healthcare system?

Preconception counseling (Ideal) and care Pregnancy Well-woman care (Ideal) Fertility control and infertility Menstrual problems (younger women especially) Perimenopause

Insulin needs are reduced in the 1st trimester of increased insulin production by the pancreas and increased peripheral sensitivity to insulin. "Insulin dosage will likely need to be increased during the 2nd and 3rd trimesters

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:Congenital anomalies in the fetus.

Therapeutic management of child with Hirschsprung's disease is primarily: Surgical removal of affected section of bowel to clear obstruction, and restore normal bowel motility and function of the internal anal sphincter.

Preoperative management may include enemas and low-fiber, high-calorie, high-protein diet until the child is physically ready for surgery colostomy that is created in Hirschsprung's disease is usually temporary.

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? Placing the woman in the knee-chest position

Prepidil prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: Ripen the cervix in preparation for labor induction.

counterpressure

Pressure applied to the sacral area of the back during uterine contractions

The factors that affect the process of labor and birth, known commonly as the five Ps, include all except

Pressure.

Magnesium sulfate is given to women with preeclampsia and eclampsia to: Prevent a boggy uterus and lessen lochial flow. Improve patellar reflexes and increase respiratory efficiency. Prevent and treat convulsions. Shorten the duration of labor.

Prevent and treat convulsions.

The laboring woman in the latent phase called the birthing center and asked the nurse if it was appropriate to take a whirlpool bath before she comes to the center. The nurse should base her answer on the following information.

Preventing infections is a major concern with whirlpool baths during labor.- A whirlpool bath is relaxing and provides thermal stimulation for the labor client. The major concern about immersion therapy has been maternal infections caused by microorganisms in the water.

local perineal infiltration anesthesia

Process by which a local anesthetic medication is deposited within the tissue to anesthetize a limited region of the body

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is: Progesterone. Oxytocin. Estrogen. Human chorionic gonadotropin (hCG).

Progesterone.

The nurse is admitting a child with Werdnig-Hoffmann disease (spinal muscular atrophy type 1). Which signs and symptoms are associated with this disease?

Progressive weakness and wasting of skeletal muscle

In planning for home care of a woman with preterm labor, which concern must the nurse address? Prolonged bed rest may cause negative physiologic effects.

Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery

For what reason might a newborn infant with a cardiac defect, such as coarctation of the aorta, that results in a right-to-left shunt receive prostaglandin E1?To improve oxygenation

Prostaglandin E1 is given to infants with a right-to-left shunt to keep the ductus arteriosus patent. This will improve oxygenation and increase pulmonary blood flow.

What is healthy people 2020 & what are its goals?

Provides science-based 10-year national objectives set to improve health & prevent disease in the U.S. There are 467 objectives with 28 focus areas, one being in maternal infant, & child health

habituation

Psychologic and physiologic phenomenon whereby the response to a constant or repetitive stimulus is decreased

In order to care for obstetric patients adequately, the nurse understands that labor contractions facilitate cervical dilation by:

Pulling the cervix over the fetus and amniotic sac.

During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criteria? Development of the operculum Leukorrhea Quickening Lightening Ballottement

Quickening Lightening Ballottement

A man calls the nurse's station and states that his wife, who delivered 2 days ago, is happy one minute and crying the next. The man says, "She was never like this before the baby was born." The nurse's initial response could be to:

Reassure him that this behavior is normal.

Adequate Intakes (AIs)

Recommended nutrient intakes estimated to meet the needs of almost all healthy people in the population; provided for nutrients or age-group categories for which the available information is not sufficient to warrant establishing recommended dietary allowances

A man's wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: Occurrence risk. Recurrence risk. Predictive testing. Predisposition testing.

Recurrence risk.

lochia rubra

Red, distinctly blood-tinged vaginal flow that follows birth and lasts 2 to 4 days

spinal anesthesia (block)

Regional anesthesia induced by injection of a local anesthetic agent into the subarachnoid space at the level of the third, fourth, or fifth lumbar interspace

milk ejection reflex (MER)

Release of milk caused by the contraction of the myoepithelial cells surrounding the milk glands in response to oxytocin; also called the let-down reflex

Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. These complications include: Retinopathy. IUFD. Atherosclerosis. Neuropathy.Autonomcs neuropathy. Nephropathy.

Retinopathy. Atherosclerosis. Neuropathy.Autonomcs neuropathy. Nephropathy.

As full term nears, the cervix softens because of the effects of the hormone relaxin and increased water content. This cervical change is termed ____________________.

Ripening

Continue to provide comfort measures and minimize distractions.

Risk for impaired individual coping

Encourage frequent voiding and catheterize if necessary.

Risk for impaired urinary elimination

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data?

Rubella vaccine should be given

During the preconception phase, the nurse should teach about which infectious diseases as risk factors for maternal complications? (Select all that apply.) Diabetes Rubella Hepatitis B Anemia HIV/AIDS

Rubella, Hepatitis B, HIV/AIDS Rubella, Hepatitis B, and HIV/AIDS are all infectious diseases. Diabetes and anemia are chronic diseases.

therefore must be cognizant of the specific conditions appropriate for labor induction. These include

Rupture of membranes at or near term. Chorioamnionitis inflammation of the amniotic sac Post-term pregnancy. Fetal death.

3. Using the situation-background-assessment-recommendation (SBAR) technique, how would you report to Margarita's health care provider about her current status?

S: Margarita H., in Room 312, has excessive vaginal bleeding. Her underpad and perineal pad are both completely soaked, and she is lying in a puddle of blood. B: Margarita is a G9 P9. She gave birth vaginally 1 hour ago to twins with a combined birthweight of 14 pounds. Margarita did not have an episiotomy and sustained no lacerations requiring repair. A: Margarita's uterus was initially boggy to palpation, but firmed after fundal massage. Her bleeding has now decreased. Her most recent vital signs are BP 110/50, pulse 100, rate 22, temp 36.8° C. Her skin feels cool and dry. She is alert and oriented. An intravenous infusion of 500 ml D5LR with 30 units of oxytocin added is currently running at 50 ml per hour. I have just changed her underpad and perineal pad. R: Please come ASAP to evaluate this patient for other sources of bleeding. In the meantime, do you want her to receive any other medications? Do you want to order a stat hematocrit or hemoglobin?

Which personal safety precaution should guide the nurse working in home care? Do not carry personal items, such as extra car keys or a cellular phone. Avoid making a visit with another nurse. Schedule visits during daylight hours. Never wear a name tag.

Schedule visits during daylight hours. The nurse should carry keys and a cell phone in the event the keys must be used for self-defense or the cell phone is needed to call for help. Making a visit in pairs is a good personal strategy for nurses visiting families with a history of violence or substance abuse. For the nurse's personal safety, all home visits should be conducted during daylight hours. Dress should be casual but professional and should include a name tag.

If a nurse desires to promote infant-parent attachment, then the best time to have the parents spend time with the infant is when the infant is going through which stage?

Second period of reactivity. During the second period of reactivity the infant is alert and interested in feeding. It is a good time for the parents to get to know the infant. During the period of sleep, the quiet sleep state, and active sleep state the infant is asleep and will not interact with the parents.

Which laboratory finding confirms that a child with type 1 diabetes is experiencing diabetic ketoacidosis? Low arterial pH

Severe insulin deficiency produces metabolic acidosis low serum carbon dioxide low serum phosphorus Urinary ketones, often in large amounts

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dL, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman? She has thrombocytopenia. She is too far dilated. She is anemic. She is septic.

She has thrombocytopenia.

A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result? She has a fibroid tumor. She took the pregnancy test too early. She has been under considerable stress and has a hormone imbalance. She takes anticonvulsants.

She takes anticonvulsants

A nurse counseling a client with endometriosis understands which statements regarding the management of endometriosis is accurate? (Select all that apply) Bone loss from hypoestrogenism is not reversible. Side effects from the steroid danazol include masculinizing traits. Surgical intervention often is needed for severe or acute symptoms. Women without pain and who do not want to become pregnant need no treatment. Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs).

Side effects from the steroid danazol include masculinizing traits, Surgical intervention often is needed for severe or acute symptoms,Women without pain and who do not want to become pregnant need no treatment .Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of NSAIDs during menstruation.

The multiple marker screen to test for chromosomal abnormalities include what?

Sonographic exam such as NUCHAL TRANSLUCENCY, pregnancy associated placental protein PPAP, & free beta-human chorionic gonadotropin b-HCG

brown fat

Source of heat unique to neonates that is capable of greater thermogenic activity than ordinary fat; deposits are found around the adrenals, kidneys, and neck; between the scapulae; and behind the sternum for several weeks after birth

_____ care include obstetricians who must provide fetal diagnostic testing and mgmt of ob and medical complications in addition to basic care.

Specialty

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: Stay with the client and call for help. Administer oxygen by mask. Insert an oral airway. Suction the mouth to prevent aspiration.

Stay with the client and call for help.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to:

Stimulate the uterus to contract Stimulation of the nipples through breastfeeding or manual stimulation causes the release of oxytocin and prevents maternal hemorrhage.

Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth? Chloasma Epulis Striae gravidarum Telangiectasia

Striae gravidarum

Which factors influence cervical dilation

Strong uterine contractions The force of the presenting fetal part against the cervix The pressure applied by the amniotic sac Scarring of the cervix

_______ care is provided by maternal-fetal medicine specialists and includes the aforementioned in addition to genetic testing, advanced fetal therapies, and mgmt of severe maternal and fetal complications.

Subspecialty

- at birth: suction mouth first, then nose.

Suction the mouth and nasopharynx with a bulb syringe as needed; clean the nares of crusted secretions to clear the airway and prevent aspiration and airway obstruction.

engorgement

Swelling of the breast tissue brought about by an increase in blood and lymph supplied to the breast, occurring as early milk (colostrum) transitions to mature milk, at approximately 72 to 96 hours after birth

5. Do alternative perspectives to your conclusion exist?

Tanisha could have metabolic problems, including diabetes mellitus, that contribute to her weight. Ethnic and cultural patterns of eating and fast food choices could also be factors. Enlisting the support of her family would likely be helpful in planning appropriate meals.

________ is an umbrella term for the use of communication technologies and electronic info to provide or support health care when the participants are separated by distance?

Telehealth

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug?Assessing for chest discomfort and palpitations

Terbutaline is a Beta 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations

Which time-based description of a stage of development in pregnancy is accurate? Viability—22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight >500 g) Term—pregnancy from the beginning of week 38 of gestation to the end of week 42 Postdate—pregnancy that extends beyond 38 weeks Preterm—pregnancy from 20 to 28 weeks

Term—pregnancy from the beginning of week 38 of gestation to the end of week 42

- how to avoid cold stress: warmer, blankets, hats, avoid drafts

The care given immediately after the birth focuses on assessing and stabilizing the newborn. The nurse's main responsibility at this time is the infant because the primary health care provider is involved with the delivery of the placenta and the care of the mother. The nurse must watch the infant for any signs of distress and initiate appropriate interventions should any appear. Perform a brief assessment of the newborn immediately, even while the mother is holding the infant. This assessment includes assigning Apgar scores at 1 and 5 minutes after birth (see Table 17-1). Maintaining a patent airway, supporting respiratory effort, and preventing cold stress by drying the newborn and covering the newborn with a warmed blanket or placing him or her under a radiant warmer are the major priorities in terms of the newborn's immediate care. You can postpone further examination, identification procedures, and care until later in the third stage of labor or early in the fourth stage.

The nurse has received report regarding her patient in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and ?2-2. The nurse's interpretation of this assessment is that:

The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.

What is characterized by a chronic inflammatory process that may involve any part of the gastrointestinal (GI) tract from mouth to anus? Crohn's disease

The chronic inflammatory process of Crohn's disease involves any part of the GI tract from the mouth to the anus but most often affects the terminal ileum

Childbirth practices have changed to become more focused on....

The family & allow alternatives to care

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that: Alcohol or cigarette smoke can irritate the fetus into greater activity. "Kick counts" should be taken every half hour and averaged every 6 hours, with every other 6-hour stretch off. Obese mothers familiar with their bodies can assess fetal movement as well as average-size women. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.

The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.

To care for a laboring woman adequately, the nurse understands that the __________ stage of labor varies the most in length

The first stage of labor is considered to last from the onset of regular uterine contractions to full dilation of the cervix. The first stage is much longer than the second and third stages combined

- acrocyanosis: normal., blue hands and feet at birth

The hands and feet appear slightly cyanotic (acrocyanosis) [at birth], which is caused by vasomotor instability and capillary stasis. Acrocyanosis is normal and appears intermittently over the first 7 to 10 days, especially with exposure to cold. Acrocyanosis is a normal finding in the neonate, but central cyanosis indicates poor oxygenation.

What should the nurse include in a teaching plan for the parents of a child with vesicoureteral reflux? The importance of taking prophylactic antibiotics

The most common cause of acute renal failure in children is: Severe dehydration.

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot."

The most likely cause of postpartum hemorrhage in this woman is: Uterine atony.

There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole Any contraceptive method except an intrauterine device is acceptable.

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

The nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if

The mother and family's priorities and preferences are incorporated into the plan.

Skin testing for tuberculosis (the Mantoux test) is recommended: Periodically for children who reside in high-prevalence regions.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on: Inability to speak.

With regard to factors that affect how the fetus moves through the birth canal, nurses should be aware that:

The normal attitude of the fetus is called general flexion.

Which statement made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? The nurse encourages the mother and father to make choices whenever possible. The nurse updates the family about what is going to happen but instructs the client's sister that she cannot be present in the room during the birth. The nurse believes that he or she is acting in the best interest of the client and commands her what to do throughout labor. The father is discouraged from accompanying his wife during a cesarean birth.

The nurse encourages the mother and father to make choices whenever possible With family-centered maternity care it is important to allow for choices for the couple and to include the partner in the care process. Unless there is an institutional policy prohibiting the number of attendees at a birth, the client should be allowed to have whomever she desires with her (unless of course the birth is emergent and guests may be requested to leave). FCMC involves collaboration between the health care team and the client. In a family-centered care model, the partner, or even a grandparent may be present for a cesarean birth.

Which statement made by the nurse would indicate that she or he is practicing appropriate family-centered care techniques? (Select all that apply.) The nurse allows the mother and father to make choices when possible. The nurse informs the family about what is going to happen. The nurse instructs the patients sister, who is a nurse, that she cannot be in the room during the birth. The nurse commands the mother what to do. The nurse provides time for the partner to ask questions.

The nurse provides time for the partner to ask questions, The nurse allows the mother and father to make choices when possible It is important to allow for choices for the couple and to include the partner in the care process. Unless there is an institutional policy prohibiting the number of attendees at a birth, the patient should be allowed to have whomever she desires with her (unless the birth is emergent and the guests are requested to leave). Family-centered care involves collaboration between the health care team and the patient.

A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. nurse should base the explanation on knowing that:Children are better able to manage the diabetes.

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that:Extra snacks are needed before exercise.

provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? Threatened

The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months.

Diabetes insipidus is a disorder of the: Posterior pituitary.

The principal disorder of posterior pituitary hypofunction is diabetes insipidus.

Which neurologic diagnostic test gives a visualized horizontal and vertical cross section of the brain at any axis? Computed tomography (CT) scan

The priority nursing intervention when a child is unconscious after a fall is to: Establish an adequate airway.

The patient will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height will increase.

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to:Assess fetal heart rate (FHR) and maternal vital signs

Women's health nursing focuses on... The special physical, psychologic, & social needs of women throughout their life spans

The special physical, psychologic, & social needs of women throughout their life spans

Which patient status is an acceptable indication for serial oxytocin induction of labor? Past 42 weeks' gestation

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: Second twin from a transverse lie to a breech presentation during vaginal birth.

Which statement is most descriptive of Meckel's diverticulum? Intestinal bleeding may be mild or profuse.Blood stools are often a presenting sign of Meckel's diverticulum

The standard therapy is surgical removal of the diverticulum.

Systemic lupus erythematosus Antiphospholipid syndrome Rheumatoid arthritis Myasthenia gravis

The target blood glucose levels 1 hour after a meal should be: 130-140

What is an advantage of external electronic fetal monitoring?

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located: Over the uterine fundus

The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur.

adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching includes Iron supplementation. Referral to a support group if necessary. Emphasizing the need for rest.

The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation also is necessary

To reassure and educate pregnant clients about changes in the uterus, nurses should be aware that: The woman's increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. Lightening occurs near the end of the second trimester as the uterus rises into a different position. The uterine souffle is the movement of the fetus.

The woman's increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening.

4. Does the evidence objectively support your conclusion?

There is a significant amount of information available concerning diet and exercise for the postpartum woman who is breastfeeding. Data regarding self-esteem in new mothers also exist.

The three tiered system of FHR tracings include Category I, II, and III. Category I is a normal tracing requiring no action. Category II FHR tracings are indeterminate.

This category includes tracings that do not meet Category I or III criteria. Category III tracings are abnormal and require immediate intervention.

A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours.

This is most suggestive of:Bronchitis.

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends

This young woman appears more concerned about how her pregnancy will affect her social life than about her recent diagnosis of diabetes

growth spurts

Times of increased neonatal growth that usually occur at approximately 6 to 10 days, 6 weeks, 3 months, and 6 months; increased caloric needs of the infant prompt more frequent feedings

Why is important to understand causes of mortality in the pediatric population?

To address what the causes are, so that you can reduce that prevalence of pediatric mortality. So we know what kind of patients and issues we are dealing with.

A nurse may be called on to stimulate the fetal scalp: As part of fetal scalp blood sampling. In preparation for fetal oxygen saturation monitoring. In response to tocolysis. To elicit an acceleration in the fetal heart rate (FHR).

To elicit an acceleration in the fetal heart rate (FHR).

A nurse may be called on to stimulate the fetal scalp:

To elicit an acceleration in the fetal heart rate (FHR).The scalp can be stimulated using digital pressure during a vaginal examination

The primary difference between the labor of a nullipara and that of a multipara is the:

Total duration of labor.

Which maternal condition always necessitates delivery by cesarean section? Partial abruptio placentae Total placenta previa Ectopic pregnancy Eclampsia

Total placenta previa

List some complementary and alternative healing modalities?

Touch and energetic healing Massage Energy healing Acupressure Therapeutic touch (TT) Reiki Mind-body healing Guided imagery Meditation, prayer, reflection, and relaxation Biofeedback Alternative pharmacologic modalities Homeopathy Traditional Chinese Medicine (TCM) Acupuncture Nutrition and exercise Applications in women's health care Pregnancy and maternity care Gynecology

A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day, but she tells you that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique could be used with this pregnant woman at this time? Ultrasound examination Maternal serum alpha-fetoprotein (MSAFP) screening Nonstress test (NST) Amniocentesis

Ultrasound examination

Maternal serum alpha-fetoprotein (MSAFP) screening indicates an elevated level. MSAFP screening is repeated and again is reported as higher than normal. What would be the next step in the assessment sequence to determine the well-being of the fetus? Biophysical profile (BPP) for fetal well-being Ultrasound for fetal anomalies Percutaneous umbilical blood sampling (PUBS) Amniocentesis for genetic anomalies

Ultrasound for fetal anomalies

The nurse caring for the laboring woman should understand that early decelerations are caused by: Altered fetal cerebral blood flow. Spontaneous rupture of membranes. Uteroplacental insufficiency. Umbilical cord compression

Umbilical cord compression

The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by: Altered fetal cerebral blood flow. Umbilical cord compression. Fetal hypoxemia. Uteroplacental insufficiency.

Umbilical cord compression.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? Complete hydatidiform mole Missed abortion Unruptured ectopic pregnancy Abruptio placentae

Unruptured ectopic pregnancy

Which maternal condition is considered a contraindication for the application of internal monitoring devices?

Unruptured membranes In order to apply internal monitoring devices, the membranes must be ruptured.

Excessive blood loss after childbirth can have several causes; the most common is:Failure of the uterine muscle to contract firmly.

Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention

5. Do alternative perspectives to your conclusion exist?

Uterine atony is the most likely cause of Margarita's excessive bleeding. However, other possible causes of postpartum hemorrhage such as retained placental fragments or membranes or unrepaired genital tract lacerations need to be ruled out.

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation

Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency

The nurse caring for the woman in labor should understand that maternal hypotension can result in: Spontaneous rupture of membranes. Early decelerations. Uteroplacental insufficiency. Fetal dysrhythmias.

Uteroplacental insufficiency.

The nurse caring for the woman in labor should understand that maternal hypotension can result in:

Uteroplacental insufficiency.Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia.

The nurse providing care for the laboring woman should understand that late fetal heart rate decelerations are the result of:

Uteroplacental insufficiency.Uteroplacental insufficiency would result in late decelerations in the FHR

- positioning of fundus post partum: 2 fingerwidths above umbilicus, goes down every 24hrs

Uterus Involution process The return of the uterus to a nonpregnant state after birth is known as involution. This process begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle. At the end of the third stage of labor the uterus is in the midline, approximately 2 cm below the level of the umbilicus, with the fundus resting on the sacral promontory. At this time the uterus weighs approximately 1000 g. Within 12 hours the fundus rises to the level of the umbilicus, or slightly above or below (Fig. 13-1). Thereafter the fundus descends approximately 1 cm every day. By 1 week after birth the fundus is located 4 to 5 fingerbreadths below the umbilicus. The uterus should not be palpable abdominally after 2 weeks and should have returned to its nonpregnant location by 6 weeks after birth (Blackburn, 2007). The uterus, which at full term weighs approximately 11 times its prepregnancy weight, involutes to approximately 500 g by 1 week after birth and to 350 g by 2 weeks after birth. At 6 weeks, it weighs 60 to 80 g (see Fig. 13-1). Increased estrogen and progesterone levels are responsible for stimulating the massive growth of the uterus during pregnancy. Prenatal uterine growth results from both hyperplasia, an increase in the number of muscle cells, and from hypertrophy, an enlargement of the existing cells. Postpartally, the decrease in these hormones causes autolysis, the self-destruction of excess hypertrophied tissue. The additional cells laid down during pregnancy remain, however, and account for the slight increase in uterine size after each pregnancy. Subinvolution is the failure of the uterus to return to a nonpregnant state. The most common causes of subinvolution are retained placental fragments and infection (see Chapter 23).

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of: Vasa previa. Severe abruptio placentae. Placenta previa. Disseminated intravascular coagulation (DIC).

Vasa previa.

What are some good food sources of Vitamin E?

Veg oil & nuts

Technique of using one's senses while traveling through a community to obtain information about sociocultural characteristics and the environment, housing, transportation, and local community agencies

WALKING SURVEY

In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except:

Washing both the infant's face and the mother's face.

- how to calculate BMIs. what are the ranges

Weight gain The optimal weight gain during pregnancy is not known precisely. However, the amount of weight gained by the mother during pregnancy has an important bearing on the course and outcome of pregnancy. Adequate weight gain does not necessarily indicate that the diet is nutritionally adequate, but it is associated with a reduced risk of giving birth to a small-for-gestational-age (SGA) or preterm infant. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. Maternal and fetal risks in pregnancy are increased when the mother is either significantly underweight or overweight before pregnancy and when weight gain during pregnancy is either too low or too high. Severely underweight women are more likely to have preterm labor and to give birth to LBW infants. Women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction (IUGR). Greater-than-expected weight gain during pregnancy may occur for many reasons, including multiple gestation, edema, preeclampsia, and overeating. Obesity (either preexisting or developed during pregnancy) increases the likelihood of macrosomia and fetopelvic disproportion; operative birth; emergency cesarean birth; postpartum hemorrhage; wound, genital tract, or urinary tract infection; birth trauma; and late fetal death. Obese women are more likely than normal-weight women to have gestational hypertension and gestational diabetes; their risk of giving birth to a child with a major congenital defect is double that of normal-weight women. A commonly used method of evaluating the appropriateness of weight for height is the body mass index (BMI), which is calculated by the following formula: BMI = weight/height^2 where the weight is in kilograms and height is in meters. Therefore for a woman who weighed 51 kg before pregnancy and is 1.57 m tall: BMI = 51/(1.57)^2, or 20.7. Prepregnant BMI can be classified into the following categories: less than 18.5, underweight or low; 18.5 to 24.9, normal; 25 to 29.9, overweight or high; and greater than 30, obese (www.nhlbisupport.com/bmi/). For women with single fetuses, current recommendations are that women with a normal BMI should gain 11.3-15.9 kg during pregnancy, underweight women should gain 12.7-18.1 kg, overweight women should gain 6.8-11.3 kg, and obese women should gain 5.0-9.1 kg (Institute of Medicine, 2009). Adolescents are encouraged to strive for weight gains at the upper end of the recommended range for their BMI because the fetus and the still-growing mother apparently compete for nutrients. The risk of mechanical complications at birth is reduced if the weight gain of short adult women (shorter than 157 cm) is near the lower end of their recommended range. Pattern of weight gain Weight gain should take place throughout pregnancy. The risk of giving birth to an SGA infant is greater when the weight gain early in pregnancy has been poor. The likelihood of preterm birth increases when the gains during the last half of pregnancy have been inadequate. These risks exist even when the total gain for the pregnancy is in the recommended range. The optimal rate of weight gain depends on the stage of pregnancy. During the first and second trimesters, growth takes place primarily in maternal tissue; during the third trimester, growth occurs primarily in fetal tissues. During the first trimester the average total weight gain is only 1 to 2.5 kg. Thereafter the recommended weight gain increases to approximately 0.4 kg per week for a woman of normal weight. The recommended weekly weight gain for overweight women during the second and third trimesters is 0.3 kg and for underweight women is 0.5 kg. In twin gestations the recommended weight gain for women in the normal BMI category is 16.8 to 24.5 kg, for women who are overweight, 14.1 to 22.7 kg, and for obese women 11.3 to 19.1 kg (Institute of Medicine, 2009). The ideal weight gain for higher multiples is likely to be greater, but no specific recommendations have been issued (Malone & D'Alton, 2009). The recommended caloric intake corresponds to this pattern of gain. For the first trimester, no increment is necessary; during the second and third trimesters an additional 340 kcal per day and 462 kcal per day, respectively, over the prepregnant intake is recommended. The amount of food that provides the needed increase is not great. The 340 additional kcal needed during the second trimester can be provided by one additional serving from any one of the following groups: milk, yogurt, or cheese (all skim milk products); fruits; vegetables; and bread, cereal, rice, or pasta. The reasons for an inadequate weight gain (less than 1 kg per month for normal-weight women or less than 0.5 kg/month for obese women during the last two trimesters) or excessive weight gain (more than 3 kg per month) should be evaluated thoroughly. Possible reasons for deviations from the expected rate of weight gain, besides inadequate or excessive dietary intake, include measurement or recording errors, differences in weight of clothing, time of day, and accumulation of fluids. An exceptionally high gain is likely to be caused by an accumulation of fluids, and a gain of more than 3 kg in a month, especially after the twentieth week of gestation, often indicates the development of gestational hypertension. Hazards of restricting adequate weight gain Figure-conscious women can have difficulty making the transition from guarding against weight gain before pregnancy to valuing weight gain during pregnancy. In counseling these women the nurse can emphasize the positive effects of good nutrition, as well as the adverse effects of maternal malnutrition (demonstrated by poor weight gain) on infant growth and development. This counseling includes information on the components of weight gain during pregnancy (Table 8-2) and the amount of this weight that will be lost at birth. Because lactation can help to reduce maternal energy stores gradually, this discussion provides an opportunity to promote breastfeeding. In the United States, 20% of women who give birth are obese (Paul, 2008). However, pregnancy is not a time for weight-reduction. Even overweight or obese pregnant women need to gain at least enough weight to equal the weight of the products of conception (fetus, placenta, and amniotic fluid). If overweight women limit their caloric intake to prevent weight gain, they may also excessively limit their intake of important nutrients. Moreover, dietary restriction results in catabolism of fat stores, which, in turn, augments the production of ketones. The long-term effects of mild ketonemia during pregnancy are not known, but ketonuria has been found to be correlated with the occurrence of preterm labor. The idea that the quality of the weight gain is important should be stressed to obese women (and to all pregnant women), with emphasis placed on the consumption of nutrient-dense foods and the avoidance of empty-calorie foods. Adolescent pregnancy needs Many adolescent girls have diets that provide less than the recommended intakes of key nutrients, including energy, calcium, and iron. Pregnant adolescents and their infants are at increased risk of complications during pregnancy and parturition. Growth of the pelvis is delayed in comparison with growth in stature, which helps to explain why cephalopelvic disproportion and other mechanical problems associated with labor are common among young adolescents. Competition for nutrients between the growing adolescent and the fetus may also contribute to some of the poor outcomes apparent in teen pregnancies. Pregnant adolescents are encouraged to choose a weight gain goal at the upper end of the range for their BMI. Dietary management during diabetic pregnancy must be based on blood (not urine) glucose levels. The diet is individualized to allow for increased fetal and metabolic requirements, with consideration of such factors as prepregnancy weight and dietary habits, overall health, ethnic background, lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy. The dietary goals are to provide weight gain consistent with a normal pregnancy, to prevent ketoacidosis, and to minimize wide fluctuation of blood glucose levels. For nonobese women, dietary counseling based on preconceptional body mass index (BMI) is 30 kcal/kg/day (Cunningham et al., 2005). In contrast, for obese women with a BMI greater than 30, experts recommend that the caloric intake total 25 kcal/kg/day (Moore & Catalano, 2009). The average diet includes 2200 calories (first trimester) to 2500 calories (second and third trimesters). Total calories may be distributed among three meals and one evening snack or, more commonly, three meals and two or three snacks. Meals should be eaten on time and never skipped. Going more than 4 hours without food intake increases the risk for episodes of hypoglycemia. Snacks must be carefully planned in accordance with insulin therapy to prevent fluctuations in blood glucose levels. A large bedtime snack of at least 25 g of carbohydrate with some protein or fat is recommended to help prevent hypoglycemia and starvation ketosis during the night (Moore & Catalano).

b (Maternal diabetes mellitus and postmaturity are two indications for performing a contraction stress test.)

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

The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.

What is most descriptive of the therapeutic management of osteosarcoma? Treatment usually consists of surgery and chemotherapy.

What is characteristic of the immune-mediated type 1 diabetes mellitus? Age at onset is usually younger than 18 years. Peak incidence is between the ages of 10 and 15 years

What is the most appropriate intervention for the parents of a 6-year-old girl with precocious puberty? Explain the importance of having the child foster relationships with same-age peers.

Therapeutic management of a child with tetanus includes the administration of: Antibiotics to control bacterial proliferation at the site of injury.

What is the most appropriate nursing response to the father of a newborn infant with myelomeningocele who asks about the cause of this condition? "There may be no definitive cause identified."

Signs of hyperkalemia include electrocardiographic anomalies such as prolonged QRS complex, depressed ST segments, peaked T waves, bradycardia, or heart block

When a child has chronic renal failure, the progressive deterioration produces a variety of clinical and biochemical disturbances that eventually are manifested in the clinical syndrome known as: uremia

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination?

When accelerations of the fetal heart rate (FHR) are noted An accelerated FHR is a positive sign; however, variable decelerations merit a vaginal examination

Noncompliance related to lack of understanding of diabetes and pregnancy and requirements of the treatment plan.

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of cardiac decompensation, which include:Dyspnea; crackles; and an irregular, weak pulse.

d (Constipation can be a problem.)

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron B. Iron absorption is inhibited by a diet rich in vitamin C C. Iron supplements are permissible for children in small doses D. Constipation is common with iron supplements

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for Intrauterine infection has increased

When the membranes rupture, microorganisms from the vagina can ascend into the amniotic sac and cause chorioamnionitis and placentitis.

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by: Eating her meals and snacks on a fixed schedule.

When the pregnant diabetic woman experiences hypoglycemia while hospitalized, the nurse should intervene by having the patient: Eat six saltine crackers.

During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant.

When the woman asks why, the nurse's best response would be:"Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child."

a (The goal of prenatal care is to foster a safe birth for the infant and mother. Keeping all prenatal appointments is a good indication that the woman is indeed seeking "safe passage.")

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? A. She keeps all prenatal appointments. B. She "eats for two." C. She drives her car slowly. D. She wears only low-heeled shoes.

nurse is admitting a toddler with the diagnosis of juvenile hypothyroidism. Which is a common clinical manifestation of this disorder? Dry skin, mental decline, and myxedematous skin changes

Which clinical manifestation may occur in the child who is receiving too much methimazole Tapazole for the treatment of hyperthyroidism (Graves' disease)?Lethargy and somnolence

Chronic renal failure leads to water and sodium retention, which contributes to edema and vascular congestion

Which clinical manifestation would be seen in a child with chronic renal failure? Unpleasant "uremic" breath odor

Which diagnostic test allows visualization of the renal parenchyma and renal pelvis without exposure to external beam radiation or radioactive isotopes? Renal ultrasound

Which diagnostic finding is present when a child has primary nephrotic syndrome? Proteinuria

Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema. Heart size is decreased by digoxin.

Which drug is an angiotensin-converting enzyme ACE inhibitor? Captopril Capoten Lasix is a loop diuretic. Aldactone blocks the action of aldosterone. Diuril works on the distal tubules.

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home.

Which response by the nurse is most accurate? "When we can stabilize your preterm labor and arrange home health visits."

The nurse is conducting discharge teaching with parents of a preschool child with myelomeningocele, repaired at birth, who is being discharged from the hospital after a urinary tract infection (UTI).

Which should the nurse include in the discharge instructions related to management of the child's genitourinary function

Golf Bowling Swimming

Which should the nurse teach about prevention of sickle cell crises to parents of a preschool child with sickle cell disease

b (Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term.)

Which statement about multifetal pregnancy is not accurate? A. The expectant mother often develops anemia because the fetuses have a greater demand for iron. B. Twin pregnancies come to term with the same frequency as single pregnancies. C. The mother should be counseled to increase her nutritional intake and gain more weight. D. Backache and varicose veins are often more pronounced.

An advantage of peritoneal dialysis is that: Parents and older children can perform treatments.

Which statement is descriptive of renal transplantation in children? It is preferred means of renal replacement therapy in children.

A condition in which the normal adult hemoglobin is partly or completely replaced by abnormal hemoglobin is:Aplastic anemia.

Which statement most accurately describes the pathologic changes of sickle cell anemia?

It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour and on cribs and other nonporous surfaces for up to 6 hours.

Which vitamin supplements are necessary for children with cystic fibrosis? Vitamins A, D, E, and K Fat-soluble vitamins are poorly absorbed because of deficient

Prophylaxis for intrapartum endocarditis and pulmonary infection may be provided for women who have mitral valve stenosis

While providing care in an obstetric setting, the nurse should understand that postpartum care of the woman with cardiac disease:Includes rest, stool softeners, and monitoring of the effect of activity.

A nurse is conducting dietary teaching on high-fiber foods for parents of a child with constipation. Which foods should the nurse include as being high in fiber

Whole grain breads Bran pancakes Raw carrots Raw fruits, especially those with skins or seeds, other than ripe banana or avocados are high in fiber

pancreatic enzymes in children with cystic fibrosis; therefore, supplements are necessary

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? Mucus and edema obstruct small airways.

b (Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction.)

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. Spina bifida B. Intrauterine growth restriction C. Diabetes mellitus D. Down syndrome

d (Bipolar disorder is a specific illness (also known as manic depressive disorder, not related to abuse.)

Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships. However, many women develop mental health problems as a result of long-term abuse. The psychologic consequences of continued abuse do not A. Substance abuse B. Posttraumatic stress disorder (PTSD) C. Eating disorders D. Bipolar disorder

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of: Worsening disease and impending convulsion. Effects of magnesium sulfate. Gastrointestinal upset. Anxiety due to hospitalization.

Worsening disease and impending convulsion.

1. Evidence—Is evidence sufficient to support the anesthesia care provider's decision to avoid epidural anesthesia for Jamie?

Yes. Jamie's platelet count of 28,000 is considered very low. Because of her thrombocytopenia Jamie is at risk for excessive bleeding if a blood vessel were to be damaged during insertion of the epidural catheter. Bleeding in the epidural space could cause the formation of a hematoma that might compress the cauda equina or the spinal cord and lead to serious CNS complications.

A Native American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: delayed attachment. embarrassment. disappointment that the baby is a girl. a belief that babies should not be fed colostrum.

a belief that babies should not be fed colostrum. Delayed attachment is a cultural belief, not a delay in attachment. Embarrassment is a cultural belief, not an expression of embarrassment. This cultural belief does not indicate that there is disappointment regarding the sex of the baby. Native Americans often use cradle boards and avoid handling their newborn often; they believe that the infant should not be fed colostrum.

During contractions the fetus has mechanisms in place to protect it from the decrease in blood flow. Those mechanisms include:

a high cardiac output level. - To prepare for labor, the fetus develops hemoglobin levels that readily take on oxygen and release carbon dioxide. The fetal hemoglobin and hematocrit levels are higher to have more oxygen-carrying capacity. The fetus does have a higher cardiac output level. The fetus does not breathe yet, so there is no respiratory count.

In her fourth lunar month of pregnancy, a woman is advised to adjust her daily routine as a typist. Office activities and the requirements of her work are discussed. Which of the following tasks needs to be modified for her to promote a healthy pregnancy? Question options: a) Sitting in one position for 6 hours without a break. b) Delivering messages to several adjacent departments each day. c) Answering the phone as relief for the receptionist 1 hour each day. d) Filing vouchers fro sales personnel for 2 hours daily.

a) Sitting in one position for 6 hours without a break. Rationale. To promote comfort and enhance venous circulation, she must change positions more frequently than once every 6 hours. The other activities discussed are not problematic. To promote comfort and enhance venous circulation, she must change positions more frequently than once every 6 hours. The other activities discussed are not problematic.

A new expectant father asks about leisure activities he can enjoy with his wife during their pregnancy. Which response by the nurse best indicatesa an understanding of the needs of the couple during pregnancy? Question options: a) "Although she may tire easily, you can continue most activities you have enjoyed in the past." b) "You may wish to continue with your hobbies, and allow you wife to enjoy leisure activites with her friends." c) "You should explore more sedentary recreation now, since active exercise needs to be limited." d) "This is a time to prepare yourselves for the role of new parents, rather than thinking of yourselves."

a) "Although she may tire easily, you can continue most activities you have enjoyed in the past."

The nurse determines that a woman is in her tenth week of gestation. Which of the following signs of pregnancy would the nurse expect to observe? Question options: a) Breast tenderness b) Quickening c) Dyspnea d) Dependent edema

a) Breast tenderness

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring

after the peak of the contraction. The nurse's first priority is to: Change the woman's position.Late decelerations may be caused by maternal supine hypotension syndrome.

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions

and returns to baseline before each contraction ends. The nurse should Document the finding in the client's record The FHR indicates early decelerations, which are not an ominous sign and do not require any intervention

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded

and states that her fingers are tingling. The nurse should:Help her breathe into a paper bag

When checking the fundus on a mother who delivered 1 hour ago, the nurse notices that it is 3 cm above the umbilicus displaced to the right, and slightly boggy. The nurse should massage the fundus until firm, then:

assist the mother to empty her bladder. If the fundus is above the level of the umbilicus and displaced, a full bladder may be the cause of excessive bleeding and a boggy uterus.

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically:

attempt to meet the needs of the infant and is eager to learn about infant care. One week after birth the woman should exhibit behaviors characteristic of the taking-hold phase. This stage lasts for as long as 4 to 5 weeks after birth.

A woman is 8 months pregnant. She told the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which one of the following responses by the nurse is most appropriate? Question options: a) "Many women imagine what their baby is like." b) "Babies in utero respond to sounds including their mother's voice." c) "You'll need to ask the physician if the baby can hear yet." d) "Thinking that your baby hears will help you bond to the baby."

b) "Babies in utero respond to sounds including their mother's voice."

An expectant father tells the nurse that he has been experiencing nausea and vomiting during his wife's pregnancy. This is an example of which of the following? Question options: a) Developmental crisis. b) Couvade. c) Maladaptive processes. d) Situational crisis.

b) Couvade.

Several noted health risks are associated with menopause. These risks include all except: osteoporosis. coronary heart disease. breast cancer. obesity.

breast cancer Osteoporosis is a major health problem in the United States. It is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk of developing and dying of cardiovascular disease increases significantly after menopause. Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, which may require an adjustment in lifestyle and eating patterns.

A client makes the following statement after finding out that her pregnancy test is positive, "This is not a good time. I am in college and the baby will be due during final exams!" Which of the following responses by the nurse would be most appropriate at this time? Question options: a) "I'm absolutely positive that everything will turn out all right." b) "I suggest that you email your professors to set up an alternative plan." c) "It sounds like you're feeling a little overwhelmed right now." d) "You and the baby's father will find a way to get through the pregnancy."

c) "It sounds like you're feeling a little overwhelmed right now."

A pregnant woman at 10 weeks of gestation jogs about the effect of exercise on the fetus. The nurse would inform her that: Question options: a) "You do not need to modify your exercising anytime during your pregnancy." b) "Stop exercising because it will harm the fetus." c) "You may find that you will need to switch to walking during the third trimester." d) "Jogging is too hard on your body; switch to walking now."

c) "You may find that you will need to switch to walking during the third trimester." No rationale provided but review page 238-239 if help is needed

A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no

change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of: Vasa previa.

The midwife records that the client's cervix is "100%, 5 cm." The nurse understands that the client's cervix is:

completely effaced and half dilated. - Effacement is measured in percentages. The fully thinned cervix is 100% effaced. The dilation is measured in centimeters; dilation goes from closed to 10 cm. This client is completely effaced and halfway dilated.

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures? Congestive heart failure

congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body

A pregnant woman must have a glucose challenge test (GCT). Which of the following should be included in the preprocedure teaching? Question options: a) Fast for 12 hours before the test. b) Bring a urine specimen to the laboratory on the day of the test. c) Be prepared to have 4 blood specimens taken on the day of the test. d) The test should take one hour to complete.

d) The test should take one hour to complete. Rationale The GCT is done at approx 24 weeks gestation to assess the client's ability to metabolixe glucose. it is a one hour. nonfasting screening test. One hour after the client consumes 50 grams of concentrated glucose, as glucose serum is drawn. If the level is 130 mg/dL or higher, the client is referred for a 3 hour glucose tolerance test to determine if she has gestational diabetes.

The most appropriate nursing diagnosis for the child with acute glomerulonephritis is: Excess Fluid Volume related to decreased plasma filtration.

decrease in plasma filtration results in an excessive accumulation of water and sodium that expands plasma and interstitial fluid volumes, leading to circulatory congestion and edema.

An effective relief measure for primary dysmenorrhea would be to: reduce physical activity level until menstruation ceases. begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. decrease intake of salt and refined sugar about 1 week before menstruation is about to occur.

decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. use barrier methods rather than the oral contraceptive pill (OCP) for birth control. Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.

An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory

distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant's mother asks the nurse whether her baby will meet developmental

The laboring woman may rub her abdomen during a contraction to counteract discomfort. This is called ______________________.

effleurage

A breastfeeding woman develops mastitis. She tells the nurse that she will just feed her baby formula instead of breastfeeding. The best nursing response is that:

emptying the breast is important to prevent an abscess. Continued emptying of the breast by breastfeeding or a breast pump constitutes the first line of treatment for mastitis. This assists in preventing a breast abscess.

When the father develops a bond with the new infant and has an intense interest in how the infant looks and responds, this is called ________________.

engrossment

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to: reassure the woman that the examination will not reveal any problems. explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. reassure the woman that "bumps" can be treated. reassure her that most women have "bumps" on their labia.

explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. This statement is inappropriate and may be untrue. During assessment and evaluation the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Because the nurse is unsure of the cause of this client's discomfort, this comment would be incorrect. This statement is not accurate and should not be used in this situation.

When obtaining a reproductive health history from a female patient, the nurse should: limit the time spent on exploration of intimate topics. avoid asking questions that may embarrass the patient. use only accepted medical terminology when referring to body parts and functions. explain the purpose for the questions asked and how the information will be used.

explain the purpose for the questions asked and how the information will be used. Sufficient time must be spent on gathering relevant data. All questions should be asked, even if it may be embarrassing for the patient or the nurse, or if it involves intimate topics. Always use terms the patient can understand. Explanation of the purpose for the questions asked while obtaining a reproductive health history will help to gather honest and relevant data.

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 dark green, almost black. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by:

explaining that the stool is called meconium and is expected for the first few bowel movements of all newborns. At this early age this type of stool is typical of both bottle- and breastfed newborns.

A newborn's blood glucose reading is 38 mg/dl. The nurse should:

feed the infant and reassess in 30 minutes. If the glucose reading is around 40 to 45 mg/dl, the infant is usually fed and then the glucose is reassessed in 30 minutes to 1 hour.

During the latent phase of labor the nurse suggests to the woman to play cards with her husband. The nurse is aware that this will help the woman deal with the pain of contractions. This technique is called:

gate control theory. - In the gate control theory of pain the use of cognitive processes can affect the perception of stimuli as painful. Diversional activities in early labor and focal points or breathing techniques later in labor are examples of the gate control theory of pain. Cutaneous stimulation is using touch to relax the muscles. Thermal stimulation is the use of warmth to relax the muscles. Hydrotherapy is the use of water for relaxation.

A primigravida is admitted in early labor. The nurse notices on the prenatal record that the position of the fetus is left occiput posterior. Because of this information the nurse can anticipate:

increased back pain with labor. - When the fetus is in the posterior position, the labor may be longer and more uncomfortable. Back discomfort increases with contractions and will continue between contractions. The fetus may not be able to deliver until it rotates into the anterior position.

Postpartal overdistention of the bladder and urinary retention can lead to which complications?Postpartum hemorrhage and urinary tract

infection Incomplete emptying and overdistention of the bladder can lead to urinary tract infection. Overdistention of the bladder displaces the uterus and prevents contraction of the uterine muscle, leading to postpartum hemorrhage

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of a/an: intranasal spray. vaginal suppository. intramuscular injection. tablet.

intramuscular injection. Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin is given by IM injection; the dosage may vary. Urofollitropin cannot be given by tablet; it is given only by IM injection.

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: it is most commonly caused by anovulation. it most often occurs in middle age. the diagnosis of DUB should be the first considered for abnormal menstrual bleeding. the most effective medical treatment involves steroids.

it is most commonly caused by anovulation. Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: it probably is the result of a hormone deficiency that can be treated with medication. it may be caused by stress or excessive exercise or both. it likely will require the client to eat less and exercise more. it often goes away on its own.

it may be caused by stress or excessive exercise or both. Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is usually caused by stress, body fat to lean ratio, and in rare occurrences a pituitary tumor. It cannot be treated by medication. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. In most cases a client will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.

The day after her delivery, the woman complains that she did not lose all the weight she had gained during the pregnancy. The nurse can best respond to the mother with the knowledge that:

it will take about 6 to 12 months for all of the weight gained with the pregnancy to disappear. Women are very concerned about regaining their normal figures. Nurses must emphasize that weight loss should be gradual and that about 6 to 12 months is usually required to lose most weight gained during pregnancy.

The hematocrit for a newborn is 72%. The nurse is aware that this newborn is at risk for:

jaundice. The hematocrit level in the normal infant is 48% to 69%. A level greater than 65% indicates polycythemia. Polycythemia increases the risk of jaundice and damage to the brain.

Immediately after delivery the nurse can anticipate the fundus to be located:

midway between the symphysis pubis and umbilicus. Immediately after delivery the uterus is about the size of a large grapefruit and the fundus can be palpated midway between the symphysis pubis and umbilicus. Within 12 hours the fundus rises to the level of the umbilicus. By the second day the fundus starts to descend approximately 1 cm per day.

Baclofen given intrathecally is best suited for children with severe spasticity that interferes with activities of daily living and ambulation

most common problem of children born with a myelomeningocele is: Neurogenic bladder. Myelomeningocele is one of the most common causes of neuropathic bladder dysfunction among children.

On the first day postpartum a client's white blood cell count is 25,000/mm3. The nurse's next action should be to:

note the results in the chart. Marked leukocytosis occurs during the postpartum period. The WBC count increases to as high as 30,000/mm3. The WBC count should fall to normal values by day 7. Neutrophils, which increase in response to inflammation, pain, and stress to protect against invading organisms, account for the major increase in WBCs. Because this is a normal reading, noting the results in the chart is the appropriate action.

When assessing a woman that gave birth 2 hours ago, the nurse notices a constant trickle of lochia. The uterus is well contracted. The next nursing action should be to:

notify the physician. Excessive lochia in the presence of a contracted uterus suggests lacerations of the birth canal. The health care provider must be notified so that lacerations can be located and repaired. The uterus is well contracted, so further massage is not necessary.

Which type of croup is always considered a medical emergency? Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment

nurse encourages mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible.rationale for this action is primarily mother's presence reduce anxiety ease the child's respiratory efforts.

Which immunization should not be given to a child receiving chemotherapy for cancer? The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection

nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? STOP IT

A 3-year-old with Hirschsprung's disease is hospitalized for surgery. A temporary colostomy will be necessary. nurse should recognize that preparing this child psychologically is: Necessary it will be an adjustment.

nurse is explaining to a parent how to care for a child with vomiting associated with a viral illness. nurse should include: Brushing teeth or rinsing mouth after vomiting.it dilutes hydrochloric acid from teeth

A 2-day-old newborn develops jaundice in the face area only. The nurse can correctly identify this type of jaundice as:

physiologic.

A newborn is rooming-in with his teenage mother, who is watching TV. The nurse notes that the baby is awake and quiet. The best nursing action is to:

pick the baby up and point out his alert behaviors to the mother. Modeling behavior by the nurse is an excellent way to teach infant care. The inexperience teenage mother can observe the proper skills and then the nurse can encourage her to try those skills.

After delivery the woman complains of chills. The first intervention by the nurse should be to:

place a warm blanket on the woman. - Many women are chilled after birth. The cause of this reaction is unknown but probably relates to the sudden decrease in effort, loss of the heat produced by the fetus, decrease in intraabdominal pressure, and fetal blood cells entering the maternal circulation. The chill lasts for about 20 minutes and subsides spontaneously. A warm blanket may help shorten the chill.

When the fingers or toes of a newborn have more than five digits, it is called ____________________.

polydactyly

During the early post-cesarean section phase it is important for the woman to turn, cough, and deep breathe. The rationale for this is to prevent:

pooling of secretions in the airway. The post-cesarean section woman is usually on bed rest for the first 8 to 12 hours. She is at risk for pooling of secretions in the airway. By assisting her to turn, cough, and expand the lungs by breathing deeply at least every 2 hours, the pooling of secretions will be decreased.

Healthy People 2020 goals include (select all that apply): promoting quality of life. promoting healthy behaviors in middle adulthood. attaining high-quality, longer lives. eliminating health disparities. creating social and physical environments that promote health.

promoting quality of life,attaining high-quality, longer lives, eliminating health disparities.,creating social and physical environments that promote health. Healthy People 2020 promotes healthy behaviors across all life stages. Healthy People provides science-based 10-year national objectives for improving the health of all Americans. It has four overarching goals: (1) attaining high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieving health equity, eliminating disparities, and improving the health of all groups; (3) creating social and physical environments that promote good health for all; and (4) promoting quality of life, healthy development, and healthy behaviors across all life stages. The goals of Healthy People 2020 are based on assessments of major risks to health and wellness, changes in public health priorities, and issues related to the health preparedness and prevention of our nation.

Evidence-based practice is best described as: gathering evidence of mortality and morbidity in children. meeting physical and psychosocial needs of the family in all areas of practice. using a professional code of ethics as a means for professional self-regulation. providing care based on evidence gained through research and clinical trials.

providing care based on evidence gained through research and clinical trials This will assist the nurse in determining areas of concern and potential involvement. It is not possible to meet all needs of the patient and family in all areas of practice. The nurse is an advocate for the family. This is part of professional role and licensure. Evidence-based practice is providing care based on evidence gained through research and clinical trials. Practitioners must use the best available information on which to base their interventions.

A postpartum woman had excessive vaginal bleeding after delivery. The bleeding has decreased to a normal rate and the fundus has remained firm for the past 3 hours. She has requested to walk to the bathroom. The nurse should:

slowly sit her up and allow her to dangle her legs before standing. Due to the loss of blood, she is at high risk for orthostatic hypotension. The nurse should assist her in getting out of bed after dangling her legs and assessing for dizziness and low blood pressure.

The class of drugs known as opioid analgesics butorphanol, nalbuphine is not suitable for administration to women with known opioid dependence. The antagonistic activity could precipitate withdrawal

symptoms abstinence syndrome in both mothers and newborns. Signs of opioid/narcotic withdrawal in the mother would include Yawning, runny nose.Chills and hot flashes.Irritability, restlessness

One of the earliest signs of hypovolemic shock is ______________.

tachycardia

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should:

take the baby back to the nursery, reassuring the woman that her rest is a priority at this time. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby.

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less

than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care.

A 42-year-old woman asks the nurse about mammograms, now that she is "getting older." The nurse should tell her that: the American Cancer Society recommends mammograms every 1 to 2 years for women ages 40 to 49. the best time to perform a mammogram is just before a menstrual period. regular mammograms reduce the need to perform breast self-examination (BSE). mammograms can confirm the diagnosis for breast cancer.

the American Cancer Society recommends mammograms every 1 to 2 years for women ages 40 to 49. The current guidelines indicate that a mammogram should be performed every 1 to 2 years on women between the ages of 40 and 49. Mammograms are best performed beginning at about 1 week after menstruation when the breasts are the least tender. Mammograms are not a substitute for BSE, which should still be performed every month. A biopsy of cells from suspicious lesions is required to confirm a diagnosis of cancer.

nurse is interpreting the results of a tuberculin skin test on an adolescent who is HIV positive. Which induration size indicates a positive result for this child 48 to 72 hours after the test? 5 mm

who travel to high-prevalence TB regions of the world are positive when the induration is 10 mm Children 4 years of age or older without any risk factors are positive when the induration is 20 mm.

In relation to primary and secondary powers, the maternity nurse comprehends that:

Primary powers are responsible for effacement and dilation of the cervix.

In order to evaluate the condition of the patient accurately during labor, the nurse should be aware that:

The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

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

. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.

Critical Thinking/Clinical Decision Making Laboring Without an Epidural Jamie is a 16-year-old G1 P0 who has been admitted with severe preeclampsia (HELLP syndrome) at 34 weeks of gestation. Jamie's physician plans to induce labor and anticipates a vaginal birth. Jamie has not attended any childbirth preparation classes and has been planning to have an epidural for labor and birth. Unfortunately, because her platelet count is very low (28,000), the anesthesia care provider refuses to place an epidural block. Jamie bursts into tears and says, "I can't make it through labor without an epidural! It's going to hurt too much! Help me!!

...

Critical Thinking/Clinical Decision Making Nutrition and the Overweight Pregnant Woman Tamara, of African-American and Asian heritage, is 3 months pregnant and comes to her initial appointment for diagnosis and care. She appears to be overweight for her height. To provide optimal care for her, you plan to calculate her prepregnancy body mass index. When her pregnancy is confirmed, you are asked to plan a diet with Tamara that meets the minimum daily requirements and allows for growth of the pregnancy. You know the importance of including consideration of personal preferences and cultural factors in your plan. With Tamara, identify barriers to implementing the plan.

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Critical Thinking/Clinical Decision Making Assessment of Postpartum Bleeding You are the nurse assigned to care for Margarita, a G9 P9 who gave birth vaginally 1 hour ago to twins. Twin A weighed 7 pounds, 4 ounces, and Twin B weighed 6 pounds, 12 ounces. Margarita did not have an episiotomy and sustained no lacerations requiring repair. You are at the nurse's station when Margarita calls and asks for her nurse to "come quick!" When you arrive in her room, you find Margarita lying in a puddle of blood. The disposable pad underneath her, as well as Margarita's perineal pad, are completely soaked with blood.

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Critical Thinking/Clinical Decision Making Breastfeeding: Engorgement and Nipple Soreness Mary was discharged from the birthing center at 48 hours postpartum with her newborn son, Matthew. He is now 4 days of age, and she has brought him to the clinic for a follow-up visit. Mary states that her milk came in yesterday, and her breasts have been hard and painful ever since. Latching the baby on has been difficult. She reports that breastfeeding is very painful and that her nipples are cracked and so sore that she "can hardly stand to feed the baby." Matthew has had only one wet diaper and no bowel movements in the last 24 hours. He is crying most of the time and never seems to settle down to sleep for very long. Mary states, "I am ready to give up on this breastfeeding thing and just switch to formula."

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Critical Thinking/Clinical Decision Making Cultural Influences during the Postpartum Period Mingyu is a 29 year old from China who gave birth to her first child last evening. Her husband is completing postdoctoral study at the local university. Both Mingyu and her husband speak some English, although he is more fluent than she is. Her mother and father have come from China to be with her for 3 months. When the nurse enters the room, she notices immediately that the room temperature is rather warm and Mingyu is lying in bed with several layers of covers pulled up to her neck. She also has a blanket around her head. She has eaten nothing from the breakfast tray. The nursing assistant had reported that Mingyu refused to shower this morning. Although Mingyu's chart indicates that she intends to breastfeed, she requests formula for her baby.

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Critical Thinking/Clinical Decision Making Near Term Infant with Physiologic Jaundice Veronica gave birth vaginally with the assistance of vacuum extraction to a 7-lb baby boy 36 hours ago. The baby was estimated to be at 35 to 36 weeks of gestation. As a result of the vacuum extraction the baby's occiput is bruised and slightly edematous (his condition appeared much worse yesterday). For the first 24 hours, he was very sleepy and difficult to arouse for feedings, but for the last 12 hours, he has breastfed every 2 to 3 hours for approximately 15 minutes. He has voided twice and passed only one small meconium stool since birth. Randy was holding his baby this morning and stated, "Look at his handsome skin tones! Why, he looks like he has been on vacation and started to get his suntan."

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In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the nurse would: Instruct the woman to eat a low-fat diet and avoid fried foods.

Which maternal condition always necessitates delivery by cesarean section?Total placenta previa

What are the goals for Healthy People 2020 (pediatrics)?

Framework for identifying essential components for child health promotion programs Designed to prevent future health problems in children Overarching goal: Increase quality and length of healthy life and eliminate health disparities.

Which of the following findings during the fourth stage would require immediate interventions by the nurse?

Fundus firm, deviated to the right, with slight distention over the symphysis pubis. - Even though the fundus is firm, it is not midline and the bladder is filling. A full bladder will interfere with contraction of the uterus and lead to increased bleeding.

infant's physical findings, this woman should be questioned about her use of which substance during pregnancy? Alcohol

A plan of care for an infant experiencing symptoms of drug withdrawal should include: Swaddling the infant snugly and holding the baby tightly.

Aplastic anemia refers to a bone marrow-failure condition in which the formed elements of the blood are simultaneously depressed

A possible cause of acquired aplastic anemia in children is: Drugs.Drugs such as chemotherapeutic agents and several antibiotics such as chloramphenicol can cause aplastic anemia.

c (Typically, running should be replaced with walking around the seventh month of pregnancy.)

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: A. any time during your pregnancy." B. "Stop exercising, because it will harm the fetus." C. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." D. "Jogging is too hard on your joints; switch to walking now."

c (Extending the leg and dorsiflexing the foot is the appropriate relief measure for a leg cramp.)

A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: A. Wiggles and points her toes during the cramp B. Applies cold compresses to the affected leg C. Extends her leg and dorsiflexes her foot during the cramp D. Avoids weight bearing on the affected leg during the cramp

b (This is a correct suggestion for a woman experiencing nausea and vomiting.)

A pregnant woman experiencing nausea and vomiting should: A. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning B. Eat small, frequent meals (every 2 to 3 hours) C. Increase her intake of high-fat foods to keep the stomach full and coated D. Limit fluid intake throughout the day

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: Stay with the client and call for help.

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88

The most important nursing action in preventing neonatal infection is: Good handwashing.

A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her

A common, serious complication of rheumatic fever is Cardiac valve damage.

A major clinical manifestation of rheumatic fever is: Polyarthritis. is swollen, hot, red, and painful joints. The affected joints will change every 1 to 2 days. Primarily the large joints are affected

Uremia is the retention of nitrogenous products, producing toxic symptoms.

A major complication in a child with chronic renal failure is: Water and sodium retention.

a (Amniotic fluid also cushions the fetus and helps maintain a constant body temperature.)

A maternity nurse should be aware of which fact about the amniotic fluid? A. It serves as a source of oral fluid and as a repository for waste from the fetus. B. The volume remains about the same throughout the term of a healthy pregnancy. C. A volume of less than 300 ml is associated with gastrointestinal malformations. D. A volume of more than 2 L is associated with fetal renal abnormalities.

c (The use of illicit drugs such as cocaine or methamphetamines might cause increased variability.)

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: A. Narcotics B. Barbiturates C. Methamphetamines D. Tranquilizers

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Observe closely for signs of infection. Maintain an accurate record of intake and output. Monitor for abdominal distention.

A nurse should expect which cerebrospinal fluid laboratory results on a child diagnosed with bacterial meningitis Decreased glucose Cloudy or milky in color Elevated white blood cell count elevated protein

b (Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement.)

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. A positive pregnancy test B. Fetal movement palpated by the nurse-midwife C. Braxton Hicks contractions D. Quickening

epidural blood patch

A patch formed by a few milliliters of the mother's blood occluding a tear in the dura mater around the spinal cord that occurs during induction of spinal or epidural block; its purpose is to relieve headache associated with leakage of spinal fluid

A placenta previa in which the placental edge just reaches the internal os is more commonly known as: Marginal

A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os.

9. A patient feels too warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on "high." The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse's best response is: A. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." B. "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." C. "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." D. "Your baby will get cold stressed easily and needs to be bundled up at all times."

A. "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him." Saying the baby will lose heat by convection is an accurate statement. Conduction is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn. Evaporation is loss of heat that occurs when a liquid is converted into a vapor. In the newborn, heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Cold stress may occur from excessive heat loss, but this does not imply that the infant will become stressed if not bundled at all times. Furthermore, excessive bundling may result in a rise in the infant's temperature.

7. Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins: A. At the time of admission to the nurse's unit. B. When the infant is presented to the mother at birth. C. During the first visit with the physician in the unit. D. When the take-home information packet is given to the couple.

A. At the time of admission to the nurse's unit. Discharge planning, the teaching of maternal and newborn care, begins on the woman's admission to the unit, continues throughout her stay, and actually never ends as long as she has contact with medical personnel.

5. With regard to breathing techniques used by a woman during labor, maternity nurses should be aware that: A. Breathing techniques used in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. B. By the time labor has begun, it is too late for instruction in breathing and relaxation. C. Controlled breathing techniques are most difficult to adhere to near the end of the second stage of labor. D. The patterned-paced breathing technique can help prevent hyperventilation.

A. Breathing techniques used in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. First-stage breathing techniques promote relaxation of abdominal muscles, thereby increasing the size of the abdominal cavity. Providing instruction in simple breathing and relaxation techniques early in labor is possible and effective. Controlled breathing techniques are most difficult to adhere to in the transition phase at the end of the first stage of labor when the cervix is dilated 8 to 10 cm. Patterned-paced breathing sometimes can lead to hyperventilation.

When performing vaginal examinations on laboring women, the nurse should be guided by what principle? A. Cleanse the vulva and perineum before and after the examination as needed B. Wear a clean glove lubricated with tap water to reduce discomfort C. Perform the examination every hour during the active phase of the first stage of labor D. Perform immediately if active bleeding is present

A. Cleanse the vulva and perineum before and after the examination as needed RATIONAL: Cleansing will reduce the possibility of secretions and microorganisms ascending into the vagina to the cervix. Maternal comfort will also be enhanced. Examinations are never done by the nurse if vaginal bleeding is present since the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.

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

A. Encourage the mother to continue breastfeeding because it is effective in meeting the newborn's nutrient and fluid needs. Weight loss of 8 ounces 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 ounces. Breastfeeding is effective at this time. Breastfeeding is effective, and bottle-feeding does not need to be initiated at this time. The infant is not undernourished, and the physician does not need to be notified. The weight loss is within normal limits; breastfeeding is effective.

5. With regard to the special qualities of human breast milk, nurses should be aware that: A. Frequent feedings during predictable growth spurts stimulate increased milk production. B. The milk of preterm mothers is the same as the milk of mothers who gave birth at term. C. The milk at the beginning of the feeding is the same as the milk at the end of the feeding. D. Colostrum is an early, less concentrated, less rich version of mature milk.

A. Frequent feedings during predictable growth spurts stimulate increased milk production. Growth spurts (at 10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding and milk production returns to previous production level. The milk of mothers of preterm infants is different from that of mothers of full-term infants, which is necessary to meet the needs of these newborns. The composition of milk changes during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

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

A. The stump can easily become infected. The cord stump is an excellent medium for bacterial growth. 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.

19. Parents can facilitate the adjustment of their other children to a new baby by: A. Having the children choose or make a gift to give to the new baby on its arrival home. B. Emphasizing activities that keep the new baby and other children together. C. Having the mother carry the new baby into the home so she can show him or her to the other children. D. Reducing stress on other children by limiting their involvement in the care of the new baby.

A. Having the children choose or make a gift to give to the new baby on its arrival home. Having the sibling make or choose a gift for the new baby helps to make the child feel a part of the process. Special time should be set aside just for the other children, time without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability but without overwhelming them.

6. While admitting the pregnant woman, the nurse should be aware that postpartum hospital stays that are becoming shorter are primarily the result of the influence of: A. Health maintenance organizations (HMOs) and private insurers. B. Consumer demand. C. Hospitals. D. The federal government.

A. Health maintenance organizations (HMOs) and private insurers. The trend for shortened hospital stays is based largely on efforts to reduce health care costs. Secondarily consumers have demanded less medical intervention and more family-centered experiences. Hospitals are obligated to follow standards of care and federal statutes regarding discharge policies. The Newborns' and Mothers' Health Protection Act provided minimum federal standards for health plan coverage for mothers and their newborns. Under this act, couples were allowed to stay in the hospital for longer periods.

From the nurse's perspective, what measure should be the focus of the health care system in order to reduce the rate of infant mortality further? A. Implementing programs to ensure women's early participation in ongoing prenatal care B. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days C. Expanding the number of neonatal intensive care units (NICUs) D. Mandating that all pregnant women receive care from an obstetrician

A. Implementing programs to ensure women's early participation in ongoing prenatal care

26. What concerns about parenthood are often expressed by visually impaired mothers? Choose all that apply. A. Infant safety B. Transportation C. The ability to care for the infant D. Missing out visually E. Needing extra time for parenting activities to accommodate the visual limitations

A. Infant safety B. Transportation D. Missing out visually E. Needing extra time for parenting activities to accommodate the visual limitations

A maternity nurse should be aware of which fact about the amniotic fluid? A. It serves as a source of oral fluid and as a repository for waste from the fetus. B. The volume remains about the same throughout the term of a healthy pregnancy. C. A volume of less than 300 ml is associated with gastrointestinal malformations. D. A volume of more than 2 L is associated with fetal renal abnormalities.

A. It serves as a source of oral fluid and as a repository for waste from the fetus.

1. As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be: A. Presence of soft, nontender colostrum. B. Leakage of milk at let-down C. Swollen, warm, and tender on palpation. D. A few blisters and a bruise on each areola.

A. Presence of soft, nontender colostrum. Breasts are essentially unchanged for the first 2 to 3 days after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs around day 2 or 3. Engorgement occurs at day 2 or 3 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

1. As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1 day postpartum. An expected finding would be: A. Presence of soft, nontender colostrum. B. Leakage of milk at let-down C. Swollen, warm, and tender on palpation. D. A few blisters and a bruise on each areola.

A. Presence of soft, nontender colostrum. Breasts are essentially unchanged for the first 2 to 3 days after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs around day 2 or 3. Engorgement occurs at day 2 or 3 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: A. Primipara B. Primigravida C. Multipara D. Nulligravida

A. Primipara

The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: A. Progressive uterine contractions. B. Lightening. C. Rupture of membranes. D. Passage of the mucous plug (operculum).

A. Progressive uterine contractions.

1. When planning a diet with a pregnant woman, the nurse's first action would be to: A. Review the woman's current dietary intake. B. Teach the woman about the food pyramid. C. Caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. Instruct the woman to limit the intake of fatty foods.

A. Review the woman's current dietary intake. Reviewing the woman's dietary intake as the first step will help to establish whether she has a balanced diet or whether changes in the diet are required. Teaching about the food pyramid is a correct action on the part of the nurse, but the first action should be to assess the woman's current dietary pattern and practices because instruction should be geared to what she already knows and does. Cautioning the woman to avoid large doses of vitamins is a correct action on the part of the nurse, but the first action should be to assess the woman's current dietary pattern and practices because instruction should be geared to what she already knows and does. Instructing the woman to limit intake of fatty foods is a correct action on the part of the nurse, but the first action should be to assess the woman's current dietary pattern and practices because instruction should be geared to what she already knows and does.

Which statement made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? A. The nurse encourages the mother and father to make choices whenever possible. B. The nurse updates the family about what is going to happen but instructs the clients sister that she cannot be present in the room during the birth. C. The nurse believes that he or she is acting in the best interest of the client and commands her what to do throughout labor. D. The father is discouraged from accompanying his wife during a cesarean birth.

A. The nurse encourages the mother and father to make choices whenever possible.

A complication of the frequent blood transfusions in thalassemia is iron overload. Chelation therapy with deferoxamine an iron-chelating agent is given with oral supplements of vitamin C to increase iron excretion

In which condition are all the formed elements of the blood simultaneously depressed? Aplastic anemia

A laboring woman received an opioid agonist meperidine intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate?

Naloxone Narcan

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? Assessing for hypoglycemia Assessing deep tendon reflexes (DTRs) Assessing for chest discomfort and palpitations Assessing for bradycardia

Assessing for chest discomfort and palpitations

To promote bonding and attachment immediately after delivery, the most important nursing intervention is to:

Assist the mother in assuming an en face position with her newborn

- multipara mom is going to have greater pain than primipara

Afterpains In first-time mothers, uterine tone is good, the fundus generally remains firm, and the mother usually perceives only mild uterine cramping. Periodic relaxation and vigorous contraction are more common in subsequent pregnancies and may cause uncomfortable cramping called afterpains (afterbirth pains) that persist throughout the early puerperium. Afterpains are more noticeable after births in which the uterus was overdistended (e.g., large baby, multifetal gestation, polyhydramnios). Breastfeeding and exogenous oxytocic medication usually intensify these afterpains because both stimulate uterine contractions.

d (Although the method of payment is important, obtaining this information is not the nurse's responsibility. It is also of note that 14 states have mandated some form of insurance to assist couples with coverage for infertility.)

Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with a number of legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple before treatment? A. Risk of multiple gestation B. Whether or how to disclose the facts of conception to offspring C. Freezing embryos for later use D. Financial ability to cover the cost of treatment

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat:Variable decelerations

Amnioinfusion is used during labor either to dilute meconium-stained amniotic fluid or to supplement the amount of amniotic fluid to reduce the severity of variable decelerations caused by cord compression

Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents made from desiccated seaweed , or Lamicel contains magnesium sulfate

Amniotomy is a surgical method of augmentation and induction.Intravenous Pitocin and insertion of prostaglandins are medical methods of induction.

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

Assist the patient in emptying her bladder.

An infant with short bowel syndrome will be discharged home on total parenteral nutrition and gastrostomy feedings. Nursing care should include: Teaching the family signs of central venous catheter infection.

For what clinical manifestation should a nurse be alert when suspecting a diagnosis of esophageal atresia? A nasogastric tube fails to pass at birth. . Bronchoscopy and endoscopy can be used to identify this defect.

Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? A 25-year-old Asian-American whose pregnancy is the result of donor insemination An African-American client who is 19 years old and pregnant with twins A 41-year-old Caucasian primigravida A 30-year-old obese Caucasian with her third pregnancy

An African-American client who is 19 years old and pregnant with twins A 30-year-old obese Caucasian with her third pregnancy Three risk factors are present for this woman. She is of African-American ethnicity, is at the young end of the age distribution, and has a multiple pregnancy. In planning care for this client the nurse must monitor blood pressure frequently and teach the woman regarding early warning signs. The 30-year-old client only has one known risk factor, obesity. Age distribution appears to be U-shaped, with women less than 20 years and more than 40 years being at greatest risk. Preeclampsia continues to be seen more frequently in primigravidas; this client is a multigravida woman. Two risk factors are present for the 41-year-old client. Her age and status as a primigravida put her at increased risk for preeclampsia. Caucasian women are at a lower risk than African-American women. The Asian-American client exhibits only one risk factor. Pregnancies that result from donor insemination, oocyte donation, and embryo donation are at an increased risk of developing preeclampsia.

c (This is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop.)

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response is: A. "This is normal behavior and should begin to subside by the second trimester." B. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." C. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." D. "You seem impatient with her. Perhaps this is precipitating her behavior."

Concerning the third stage of labor, nurses should be aware that:

An expectant or active approach to managing this stage of labor reduces the risk of complications.

The most appropriate nursing action is to: Notify the practitioner.

An important nursing consideration in the care of a child with celiac disease is to: Refer to a nutritionist for detailed dietary instructions and education.

removed, the woman's fertility will decrease; however, she will not be infertile. D&C is performed on the inside of the uterine cavity. The ectopic pregnancy is located within the tubes

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? Chromosomal abnormalities

the nurse must understand which intervention has the greatest effect on lowering the risk of NEC: Breastfeeding

As a result of large body surface in relation to weight, the preterm infant is at high risk for heat loss and cold stress. By understanding the four mechanisms of heat transfer convection, conduction, radiation, and evaporation, the

A parent who has a hearing impairment is presented with a number of challenges in parenting. Which nursing approaches are appropriate for working with hearing-impaired new parents

Ascertain whether the patient can read lips before teaching. Written messages aid in communication. Use devices that transform sound into light.

Immediately after the forceps-assisted birth of an infant, the nurse should: Apply a cold pack to the infant's scalp. Measure the circumference of the infant's head. Give the infant prophylactic antibiotics. Assess the infant for signs of trauma.

Assess the infant for signs of trauma.

2. Assumptions—What assumptions can be made about the following factors related to infant positioning? a. Role modeling by nurses b. Sleep position in the nursery versus sleep position at home c. Sleep position for preterm versus term infants d. Nurses' knowledge and use of research evidence

Assumptions. a. Role modeling by the nurses is a powerful teacher. Stastny and colleagues (2004) found that only 30% of nursery staff placed babies on their backs to sleep and cited fear of aspiration as the reason. Continued staff education is necessary to promote the use of the supine position for sleep. b. In the newborn nursery, nurses may place an infant on his or her side to promote drainage of secretions, although there is no evidence that this is effective. In the neonatal intensive care unit (NICU), infants in respiratory distress may breathe more easily in the prone position. As the distress lessens and the infant matures, the infant should be placed on his or her back for sleep. Parents should be counseled to place infants on their backs for sleep. During waking hours, while the parent is supervising, the infant can be placed on his or her side or abdomen. c. Discuss sleep position for preterm versus term infants. Preterm infants may be placed in prone position to facilitate respiration; however, they should be on a cardiorespiratory monitor. d. Not all nurses read research reports and use research evidence in their practices. Therefore they do not place infants on their backs to sleep and do not instruct parents in sleep positioning. Continuing education programs for nurses working in nurseries should address the latest findings related to the prevention of SIDS by use of positioning infants on their backs to sleep.

2. Assumptions—What assumptions can be made about the following issues? a. Appropriate diet for the postpartum mother who wants to improve her appearance b. The relationship between breastfeeding and postpartum weight loss c. Exercises for the postpartum woman who wants to improve her appearance d. The relationship between perceived body image and self-esteem in postpartum women

Assumptions. a. The postpartum woman will lose weight gradually if she consumes a balanced diet that provides slightly fewer calories than her daily energy expenditure. Most women rapidly lose several pounds during the month after birth. Because fat is the most concentrated source of calories in the diet, the first step in weight reduction is to identify sources of fat in the diet and explore ways to reduce them. b. In general, the breastfeeding mother should eat a healthy, well-balanced diet that includes an extra 200 to 500 calories per day over nonpregnant requirements. According to the Institute of Medicine (IOM) (2005), the estimated energy requirement (EER) for a lactating woman during the first 6 months is 2700 kcal/day; during the next 6 months, the EER is 2768 kcal/day. Even with the increased caloric intake, women who are breastfeeding tend to lose weight more quickly than those who are formula feeding (Becker & Scott, 2008). Rapid weight reduction while breastfeeding may result in decreased milk supply; it is best to lose weight gradually while consuming a nutritious, well-balanced diet. c. Women can begin exercising soon after birth, although they are encouraged to begin with simple exercises and gradually progress to more strenuous ones. Because Wendy has had a cesarean birth, she should not be doing any strenuous exercise for at least 4 to 6 weeks and has been cleared by her health care provider. The nurse might recommend walking as a beneficial form of exercise for Wendy during the next few weeks. d. A woman's self-esteem is often related to her perceived body image. How a new mother feels about herself and her body may affect her behavior and adaptation to parenting.

2. Assumptions—What assumptions can be made about the following issues? a. Mary's milk supply b. Mary's sore nipples c. Matthew's urinary output and bowel elimination pattern d. Mary's commitment to breastfeeding

Assumptions. a. This mother has experienced the onset of mature milk production at the expected time, approximately 3 days after birth. Her breasts are engorged, the tissues surrounding the milk glands and milk ducts are edematous, and the milk is not flowing well from the breasts because of the compression of the milk ducts. She is producing mature milk, but has a problem with milk transfer to the baby. b. The sore nipples are likely to be the result of a problem with latching the baby onto the breast. This most likely began during the first 2 days after birth and has grown more severe with the increased pressure in the breasts because of fullness, which tends to flatten the nipple and make it more difficult for the baby to latch on. She is experiencing pain with latch-on, which can inhibit her milk ejection or let-down reflex. c. The urinary output and number of stools are signs that the baby has not received sufficient feeding. After the milk has come in, from about the fourth day of life, the baby should have at least six to eight wet diapers and at least three or four bowel movements every 24 hours. His fussiness and lack of sleep are evidence that he is not being satisfied when he nurses; he is hungry and needs more milk to feel satiated. d. Mary's frustration, fatigue, and mental exhaustion are causing her to question her desire to breastfeed. She is tired and her breasts are painful. The discomfort intensifies when the baby tries to breastfeed on the very sore nipples. She may be wondering whether breastfeeding is worth all this.

2. Assumptions—Describe the underlying assumptions about each of the following issues: a. Dietary reference intakes for pregnancy and lactation b. Indicators of nutritional risk in pregnancy c. Daily food guide for pregnancy and lactation d. Sources of calcium for women who do not drink milk

Assumptions. a. A list of dietary reference intakes (RDIs) for pregnancy and lactation can be shared with Tanisha. Through discussion, you can determine whether Tanisha is ingesting adequate amounts of these important elements and whether supplementation of vitamins and minerals is necessary. b. While reviewing indicators of nutritional risk in pregnancy with Tanisha, problem areas can be identified, and recommendations for change provided as needed. c. The daily food guide for pregnancy and lactation can be shared with Tanisha. It can provide a basis for planning appropriate menus to provide the necessary nutrients and avoid consuming more energy (calories) than is desired. d. As someone of African-American and Asian heritage, Tanisha may be lactose intolerant and may need sources of calcium other than milk. Through careful questioning, her lactose status can be determined and counseling can be provided about nonmilk sources of calcium.

2. Assumptions—What assumptions can be made about the following? a. The baby's skin color b. Baby's intake and output since birth c. The parents' understanding of physiologic jaundice

Assumptions. a. At 36 hours of age, the newborn is likely exhibiting physiologic jaundice. He is at risk for development of physiologic jaundice because of the bruising of his head and because he is preterm. b. The baby has not been feeding well thus far and has had only one stool. Because bilirubin is excreted primarily through the stool, it is important that his bowel movements increase. Because he is preterm, he may be more difficult to awaken for feedings than a full-term infant. The more he feeds, the greater his output will be. c. Randy noted the appearance of his son's skin color as evidenced by his comment. The nurse can explain why the baby appears somewhat "yellow" and describe physiologic jaundice in terms that the parents can understand.

2. What assumptions can be made about the following issues: a. Normal amount of lochia expected at this time (1 hour after birth) b. Margarita's risk factors for uterine atony c. Immediate nursing interventions for Margarita d. Other possible causes for Margarita's excessive bleeding

Assumptions: a. For the first 2 hours after birth, the amount of lochial flow should be approximately that of a heavy menstrual period. If Maria is lying in a puddle of blood and both the disposable pad underneath her and her perineal pad are completely soaked, she is obviously bleeding excessively. b. Margarita has at least two risk factors for uterine atony. She is a grand multipara (G9 P9). She has also given birth to twins whose combined birthweight is 14 pounds. c. Once uterine atony is confirmed, the nurse should continue to massage Margarita's fundus until it feels firm, like a hard ball. If an IV is already in place, the rate should be increased to provide additional volume. The intravenous fluid should contain oxytocin to further encourage uterine contraction. Next, vital signs should be obtained, especially blood pressure and heart rate. While obtaining vital signs, the nurse will also assess Margarita's skin temperature and mental status. d. Other possible causes for Margarita's excessive bleeding include retained placental fragments or membranes or undiscovered, and thus unrepaired, genital tract lacerations.

The nurse should include which information when teaching a 15-year-old about genital tract infection prevention? (Select all that apply.) Wear nylon undergarments. Avoid tight-fitting jeans. Use floral scented bath salts. Decrease sugar intake. Do not douche. Limit time spent wearing a wet bathing suit.

Avoid tight-fitting jeans. Decrease sugar intake. Do not douche. Limit time spent wearing a wet bathing suit. Correct Feedback: Patient teaching for the prevention of genital tract infections in women includes the following guidelines: • Practice genital hygiene. • Choose underwear or hosiery with a cotton crotch. • Avoid tight-fitting clothing (especially tight jeans). • Select cloth car seat covers instead of vinyl. • Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). • Limit exposure to bath salts or bubble bath. • Avoid colored or scented toilet tissue. • If sensitive, discontinue use of feminine hygiene deodorant sprays. • Use condoms. • Void before and after intercourse. • Decrease dietary sugar. • Drink yeast-active milk and eat yogurt (with lactobacilli). • Do not douche. Incorrect Feedback: Patient teaching for the prevention of genital tract infections in women includes the following guidelines: • Practice genital hygiene. • Choose underwear or hosiery with a cotton crotch. • Avoid tight-fitting clothing (especially tight jeans). • Select cloth car seat covers instead of vinyl. • Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights). • Limit exposure to bath salts or bubble bath. • Avoid colored or scented toilet tissue. • If sensitive, discontinue use of feminine hygiene deodorant sprays. • Use condoms. • Void before and after intercourse. • Decrease dietary sugar. • Drink yeast-active milk and eat yogurt (with lactobacilli). • Do not douche.

Choose ALL that are true about post dates pregnancy. A) All women should be induced within a few days past their due date. B) Additional tests of fetal well being are ordered after the due date and include a nonstress test, fetal movement counting, and biophysical profile or Amniotic fluid Index. C) A low amniotic fluid index of less than 8 is associated with a higher incidence of low Apgar scores of 7 or lower. D) Post dates pregnancy is associated with larger babies, prolonged labor, fetal distressi in labor, meconium aspiration syndrome and more cesarean births.

B) Additional tests of fetal well being are ordered after the due date and include a nonstress test, fetal movement counting, and biophysical profile or Amniotic fluid Index. D) Post dates pregnancy is associated with larger babies, prolonged labor, fetal distressi in labor, meconium aspiration syndrome and more cesarean births.

During labor, the patient at 4 cm suddenly becomes dyspneic, cyanotic, and hypotensive. The nurse must prepare immediately for: (Select all that apply.) A) Immediate vaginal delivery B) Cesarean delivery C) CPR D) McRobert's maneuver

B) Cesarean delivery C) CPR

Dunst, Trivette, and Deal have identified the qualities of strong families that help them function effectively. These include which of the following? A) Lack of congruence among family members B) Clear set of family values, rules, and beliefs C) Adoption of one coping strategy that always promotes positive functioning in dealing with life events D) Sense of commitment toward growth of individual family members as opposed to that of the family unit

B) Clear set of family values, rules, and beliefs

A parent of a school-age child tells the school nurse that the parents are going through a divorce. The child has not been doing well in school and sometimes has trouble sleeping. The nurse should recognize this as which of the following? A) Indicative of maladjustment B) Common reaction to divorce C) Suggestive of lack of adequate parenting D) Unusual response that indicates need for referral

B) Common reaction to divorce

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation? Choose all that apply. A) Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency B) Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency C) Uterine resting tone >20 mm Hg D) Uterine resting tone <20 mm Hg E) Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) pattern

B) Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency C) Uterine resting tone >20 mm Hg E) Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) pattern

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: A) Suppress uterine contractions. B) Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. C) Stimulate fetal surfactant production. D) Reduce maternal and fetal tachycardia associated with ritodrine administration

C) Stimulate fetal surfactant production.

2. A pregnant woman with a body mass index (BMI) of 22 asks the nurse how much weight she should be gaining during pregnancy. The nurse's best response would be to tell the woman that her pattern of weight gain should be approximately: A. A pound a week throughout pregnancy. B. 2 to 5 pounds during the first trimester, then a pound each week until the end of pregnancy. C. A pound a week during the first two trimesters, then 2 pounds per week during the third trimester. D. A total of 25 to 35 pounds.

B. 2 to 5 pounds during the first trimester, then a pound each week until the end of pregnancy. A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 pounds or about 2 to 5 pounds in the first trimester and about 1 pound per week during the second and third trimesters. A pound per week the first two trimesters and 2 pounds per week the third trimester are not accurate guidelines for weight gain during pregnancy. The total weight gain of 25 to 35 pounds is correct, but the pattern of weight gain needs to be explained.

7. With regard to spinal and epidural (block) anesthesia, nurses should know that: A. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. B. A high incidence of after-birth headache is seen with spinal blocks. C. Epidural blocks allow the woman to move freely. D. Spinal and epidural blocks are never used together.

B. A high incidence of after-birth headache is seen with spinal blocks. Spinal blocks may be used for vaginal births, but the woman must be assisted while she is in labor. A high incidence of after-birth headache can occur; headaches may be prevented or mitigated to some degree by a number of methods. Epidural blocks limit the woman's ability to move freely. Combined use of spinal and epidural blocks is becoming increasingly popular.

3. A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. Drink warm fluids with each of her meals. B. Eat a high-protein snack before going to bed. C. Keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. Schedule three meals and one mid-afternoon snack a day.

B. Eat a high-protein snack before going to bed. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Adding peanut butter would not be helpful. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

6. With regard to systemic analgesics administered during labor, nurses should be aware that: A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. C. Intramuscular administration (IM) is preferred over intravenous (IV) administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCA results in decreased use of an analgesic.

2. A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: A. Urinary tract infection. B. Excessive uterine bleeding. C. A ruptured bladder. D. Bladder wall atony.

B. Excessive uterine bleeding. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

2. A woman gave birth to a 7-pound, 3-ounce infant boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: A. Urinary tract infection. B. Excessive uterine bleeding. C. A ruptured bladder. D. Bladder wall atony.

B. Excessive uterine bleeding. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to: A. Reassure the woman that the examination will not reveal any problems B. Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination C. Reassure the woman that "bumps" can be treated D. Reassure her that most women have "bumps" on their labia

B. Explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination

3. 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 in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: A. Telling the mother not to worry because all breastfed babies have this type of stool. B. Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. C. Asking the mother what she ate at her last meal. D. Suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

B. Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. This thick dark stool, known as meconium, is typical of the first stool of all newborns, not just breastfed babies. At this early age, this type of stool (meconium) is typical of both bottle-fed and breastfed newborns. The mother's nutritional intake is not responsible for the appearance of 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.

1. A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: A. Encourage the woman to breathe more slowly. B. Help the woman breathe into a paper bag. C. Turn the woman on her side. D. Administer a sedative.

B. Help the woman breathe into a paper bag. Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her exhaled air would increase the carbon dioxide level. Turning her on her side would not solve this problem. The side-lying position would be appropriate for supine hypotension. Administration of a sedative could lead to neonatal respiratory depression because this woman, being in the transition phase, is nearing the birth process.

2. When caring for a newborn, the nurse must be alert for signs of cold stress, including: A. Decreased activity level. B. Increased respiratory rate. C. Hyperglycemia. D. Shivering.

B. Increased respiratory rate. Infants experiencing cold stress would have an increased activity level. An increased respiratory rate is a sign of cold stress in the newborn. Hypoglycemia would occur with cold stress. Newborns are unable to shiver as a means of increasing heat production; they increase their activity level instead.

When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to: A. Maternal hyperthyroidism. B. Initiation of epidural anesthesia that resulted in maternal hypotension. C. Maternal infection accompanied by fever. D. Alteration in maternal position from semirecumbent to lateral.

B. Initiation of epidural anesthesia that resulted in maternal hypotension. RATIONAL: Fetal bradycardia is the pattern described and results from the hypoxia that would occur when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure. Assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern.

6. Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. Spina bifida. B. Intrauterine growth restriction. C. Diabetes mellitus. D. Down syndrome.

B. Intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not associated with inadequate maternal weight gain. Down syndrome is not associated with inadequate maternal weight gain.

4. Benefits to the mother associated with breastfeeding include all except it: A. Decreases risk of breast cancer. B. Is an effective method of birth control. C. Increases bone density. D. May enhance postpartum weight loss.

B. Is an effective method of birth control. Women who breastfeed have a decreased risk of breast cancer. Breastfeeding delays the return of fertility, but it is NOT an effective birth control method. Women who breastfeed display an increase in bone density. Women who breastfeed report a quicker weight loss postpartum.

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

B. Leans forward to bring breast toward the baby Holding the breast with four fingers along the bottom and the thumb at top is a correct technique. 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. Stimulating the rooting reflex is correct technique. Placing the finger in the mouth to remove the baby from the breast is correct technique.

A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family doctor has retired, and she is going to see the women's health nurse practitioner for her visit. To facilitate a positive health care experience, the nurse should: A. Remind the woman that she is long overdue for her examination and that she should come in annually B. Listen carefully and allow extra time for this woman's health history interview C. Reassure the woman that a nurse practitioner is just as good as her old doctor D. Encourage the woman to talk about the death of her husband and her fears about her own death

B. Listen carefully and allow extra time for this woman's health history interview

8. Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the patient's blood pressure if hypotension occurs? Choose all that apply. A. Place the woman in a supine position. B. Place the woman in a lateral position. C. Increase intravenous (IV) fluids. D. Administer oxygen. E. Perform a vaginal examination.

B. Place the woman in a lateral position. C. Increase intravenous (IV) fluids. D. Administer oxygen. Placing the woman in a supine position would cause venous compression, thereby limiting blood flow to and oxygenation of the placenta and fetus. Nursing interventions for maternal hypotension arising from analgesia or anesthesia include turning the woman to a lateral position, increasing IV fluids, administering oxygen via face mask, elevating the woman's legs, notifying the physician, administering an IV vasopressor, and monitoring the maternal and fetal status at least every 5 minutes until these are stable. A sterile vaginal examination has no bearing on maternal blood pressure.

23. A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: A. Foster an active role in the baby's care. B. Provide time for the mother to reflect on the events of and her behavior during childbirth. C. Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. D. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

B. Provide time for the mother to reflect on the events of and her behavior during childbirth. Once the mother's needs are met, she would be more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's immediate action would be to: A. Change the woman's position. B. Stop the Pitocin. C. Elevate the woman's legs. D. Administer oxygen via a tight mask at 8 to 10 L/min.

B. Stop the Pitocin. RATIONAL: Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic that stimulates the uterus to contract. Elevation of her legs would be appropriate if hypotension were present.

A woman is evaluated to be using an effective bearing-down effort if she: A. Begins pushing as soon as she is told that her cervix is fully dilated and effaced. B. Takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. C. Uses the Valsalva maneuver by holding her breath and pushing vigorously for a count of 12. D. Continues to push for short periods between uterine contractions throughout the second stage of labor.

B. Takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. RATIONAL: Cleansing breaths at the onset of a contraction allow it to build to a peak before pushing begins. They also enhance gas exchange in the alveoli and help the woman relax after the uterine contraction subsides. Women should avoid closed-glottis pushing (Valsalva maneuver) since uteroplacental perfusion is usually reduced. Open-glottis pushing is recommended. The woman should push with contractions to combine the force of both powers of labor: uterine and abdominal.

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

B. Testes descended into scrotum. The newborn's good muscle tone will result in a more flexed posture when at rest. A full-term male infant will have both testes in his scrotum and rugae on his scrotum. The newborn will exhibit only a moderate amount of lanugo, usually on his shoulders and back. The newborn would not have the ability to move his elbow past midline.

7. During the complete physical examination 24 hours after birth: A. The parents are excused from the room to reduce their normal anxiety. B. The nurse can gauge the neonate's maturity level by assessing its general appearance. C. Once often neglected, blood pressure is now routinely checked. D. When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second.

B. The nurse can gauge the neonate's maturity level by assessing its general appearance. Having the parents present during the examination actively involves them in child care and gives the nurse a chance to observe interactions. The nurse is able to gauge maturity level by assessing appearance. The nurse will be looking at skin color, alertness, cry, head size, and other features. Blood pressure is not usually taken unless cardiac problems are suspected. The second heart sound is higher and sharper than the first.

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? Presence of fibrin split products

Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.

Which occurrence is associated with cervical dilation and effacement?

Bloody show

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe which of the following?

Bloody show - Premonitory signs of labor (prodromal labor) include weight loss of 1 to 3 pounds, a burst of energy or the nesting instinct, and passage of the mucus plug (also termed pink/bloody show) as the cervix ripens.

mongolian spots

Bluish gray or dark nonelevated pigmented areas usually found over the lower back and buttocks that are present at birth in some infants, primarily nonwhite, usually fading by school age

Your client is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, "Why is it taking so long?" The most appropriate response by the nurse would be: A) "Your baby is just being stubborn." B) "The length of labor varies for different women." C) "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." D) "I don't know why it is taking so long."

C) "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should: A) Notify the woman's primary health care provider immediately B) Prepare to administer an oxytocic to stimulate uterine activity C) Document the findings because they reflect the expected contraction pattern for the active phase of labor. D) Prepare the woman for the onset of the second stage of labor.

C) Document the findings because they reflect the expected contraction pattern for the active phase of labor.

A number of methods to assist in the assessment of fetal well-being have been developed for use in conjunction with electronic fetal monitoring. These various technologies assist in supporting interventions for a nonreassuring fetal heart rate pattern when necessary. The labor and delivery nurse should be aware that one of these modalities, fetal oxygen saturation monitoring, includes the use of: A) Fetal blood sampling B) Umbilical cord acid-base determination C) Fetal pulse oximetry. D) A fetal acoustic stimulator.

C) Fetal pulse oximetry. p. 436 (book says this has been withdrawn from the market)

All of the following women in labor are requesting pain medication. Which one should the nurse administer an opioid analgesic to first? A) Primigravida, 2 cm dilated, 50% effaced, grimacing slightly with each contraction B) Gravida 4, 9 cm dilated, 100% effaced, wants to push with each contraction C) Gravida 2, 6 cm dilated, 100% effaced, rocks back and forth in bed with each contraction D) Primigravida, 1 cm dilated, moans loudly with each contraction, has present history of heroin use

C) Gravida 2, 6 cm dilated, 100% effaced, rocks back and forth in bed with each contraction. - The gravida 2 is well established into the labor and the medication will not slow the contractions. The primigravida that is 2 cm dilated is too early into the labor; the medication may slow or stop her contractions. The gravida 4 is too near delivery and the medication may affect the newborn's respiratory effort. The primigravida that is 1 cm dilated has a history of heroin use; further opioid medication is not recommended.

Which of the following clients would be at higher risk for postpartum hemorrhage? A) Primigravida that delivered a 6 lb 3 oz girl B) Gravida 2 that delivered a 8 lb 6 oz boy C) Gravida 3 that delivered twins, 5 lb 3 oz and 4 lb 2 oz. D) Gravida 3 that delivered a 4 lb 3 oz boy

C) Gravida 3 that delivered twins, 5 lb 3 oz and 4 lb 2 oz. Overdistention of the uterus from any cause—multiple gestations, large infant, hydramnios—makes it more difficult for the uterus to contract with enough firmness to prevent excessive bleeding. Multiparity results in muscle fibers that have been stretched repeatedly, and these flaccid muscle fibers may not remain contracted after birth. The gravida iii has both the problems of multiparity and overdistended uterus with the twins.

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman? A) She is too far dilated B) She is anemic. C) She has thrombocytopenia D) She is septic

C) She has thrombocytopenia

7. With regard to basic care of the breastfeeding mother, nurses should be able to advise her that she: A. Will need an extra 1000 calories a day to maintain energy and produce milk. B. Can go back to prepregnancy consumption patterns of any drinks as long as she gets enough calcium. C. Should avoid trying to lose large amounts of weight. D. Must avoid exercising because it is too fatiguing.

C. Should avoid trying to lose large amounts of weight. A breastfeeding mother need add only 200 to 500 extra calories to her diet to provide extra nutrients for the infant. This is true only if she doesn't drink alcohol, limits coffee to no more than two cups (caffeine is also found in chocolate, tea, and some sodas), and reads the herbal tea ingredients carefully. Large weight loss would release fat-stored contaminants into her breast milk. It would also likely involve eating too little and/or exercising too much. She needs her rest, but moderate exercise is healthy.

4. A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman's intake of: A. Calcium. B. Protein C. Vitamin B12. D. Folic acid.

C. Vitamin B12. This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both:

Can be used during the antepartum and intrapartum periods.

- caput succedaneum

Caput succedaneum Caput succedaneum is a generalized, easily identifiable edematous area of the scalp, most commonly found on the occiput. The sustained pressure of the presenting vertex against the cervix results in compression of local vessels, thereby slowing venous return. The slower venous return causes an increase in tissue fluids within the skin of the scalp, and an edematous swelling develops. This edematous swelling, present at birth, extends across suture lines of the skull and disappears spontaneously within 3 to 4 days. Infants who are born with the assistance of vacuum extraction usually have a caput in the area where the cup was applied.

b (Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term.)

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production

What should the nurse stress in a teaching plan for the mother of an 11-year-old boy with ulcerative colitis? Coping with stress and avoiding triggers

Careful hand washing before and after contact can prevent the spread of which condition in day care and school settings? Hepatitis A

neonatal narcosis

Central nervous system depression in the newborn caused by an opioid (narcotic); may be signaled by respiratory depression, hypotonia, lethargy, and delay in temperature regulation

- what is a cephalhematoma: more at risk for jaundice than caput

Cephalhematoma Cephalhematoma is a collection of blood between a skull bone and its periosteum; therefore a cephalhematoma does not cross a cranial suture line. Caput succedaneum and cephalhematoma often occur simultaneously. Bleeding may occur with spontaneous birth from pressure against the maternal bony pelvis. Low forceps birth and difficult forceps rotation and extraction may also cause bleeding. This soft, fluctuating, irreducible fullness does not pulsate or bulge when the infant cries. It appears several hours or the day after birth and may not become apparent until a caput succedaneum is absorbed. A cephalhematoma is usually largest on the second or third day, by which time the bleeding stops. The fullness of a cephalhematoma spontaneously resolves in 3 to 6 weeks. It is not aspirated because infection may develop if the skin is punctured. As the hematoma resolves, hemolysis of RBCs occurs, and jaundice may result. Hyperbilirubinemia and jaundice may occur after the newborn is discharged home.

Which presentation is described accurately in terms of both presenting part and frequency of occurrence?

Cephalic: occiput; at least 95%

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? Diet should be high in carbohydrates and protein.

Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.

To assess uterine contractions the nurse would A) Asses duration from the beginning of the contraction to the peak of the same contraction, frequency by measuring the time between the beginning of one contraction to the beginning of the next contraction. B) Assess frequency as the time between the end of one contraction and the beginning of the next contraction, duration as the length of time from the beginning to the end of contractions, and palpate the uterus for strength C) Assess duration from beginning to end of each contraction. Assess the strength of the contraction by the external fetal monitor reading. Measure frequency by measuring the beginning of one contraction to another. D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength.

D) Assess duration from beginning to end of each contraction., frequency by measuring the time between the beginnings of contractions, and palpate the fundus of the uterus for strength. p. 453

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to: A) Prepare the woman for imminent birth B) Notify the woman's primary health care provider. C) Document the characteristics of the fluid. D) Assess the fetal heart rate and pattern.

D) Assess the fetal heart rate and pattern.

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal: A) Lie. B) Position. C) Presentation. D) Attitude.

D) Attitude. • Lie = relationship between the longitudinal axis of fetus and mother • Position = relationship of the presenting part to the 4 quadrants of the mother's pelvis, ie 3 letter abr: 1.) R or L 2.) O, S, M or Sc (Occiput, Sacrum, Mentum, SCapula) 3.) A, P, or T (Anterior, Posterior, Transverse) • Presentation = presenting part that overlies pelvic inlet

Public health interventions that have had the greatest impact on world health include: A) improved dental hygiene. B) advances in prenatal care. C) better methods of detection. D) Clean drinking water and childhood vaccination programs.

D) Clean drinking water and childhood vaccination programs.

Maternity nurses often have to answer questions about the many, sometimes unusual ways people have tried to make the birthing experience more comfortable. For instance, nurses should be aware that: A) Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine. B) Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time. C) Effleurage is permissible, but counterpressure is almost always counterproductive. D) Electrodes attached to either side of the spine to provide mild-intensity electrical impulses facilitate the release of endorphins.

D) Electrodes attached to either side of the spine to provide mild-intensity electrical impulses facilitate the release of endorphins.

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and decreased serum haptoglobin. The nurse notifies the physician because the laboratory results are indicative of: A) Eclampsia. B) Idiopathic thrombocytopenia. C) Disseminated intravascular coagulation (DIC). D) HELLP syndrome.

D) HELLP syndrome.

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: A) Notify the woman's physician. B) Tell the woman to "calm down" and slow the pace of her breathing. C) Administer oxygen via a mask or nasal cannula. D) Help her breathe into a paper bag

D) Help her breathe into a paper bag

Which of the following is correct about care for a pregnant woman who has experienced blunt trauma in a car accident? (See Labor Complications Part 4 power point) A) Rhogam is not necessary for rH negative pregnant women after a blunt force trauma. B) If the woman does not have more than 6 ctx an hour she may go home after 4 hours. C) The two most common risks are preterm labor and fetal death. D) In the ER she is evaluated and treated to hemodynamically stabilize her, then she is evaluated with an electronic fetal monitor for a minimum of 4 hours.

D) In the ER she is evaluated and treated to hemodynamically stabilize her, then she is evaluated with an electronic fetal monitor for a minimum of 4 hours.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? A. "My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK." B. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." C. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." D. "We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage."

D. "We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage." RATIONAL: Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally.

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: A. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high B. Shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit C. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant D. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy

D. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should understand that: Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own. Maternal insulin requirements steadily decline during pregnancy.

During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

- care of episiotomy: ice packs, sitz baths

Episiotomy An episiotomy is an incision made in the perineum to enlarge the vaginal outlet (Fig. 12-23). It is performed more commonly in the United States and Canada than in Europe. The side-lying position for birth, used routinely in Europe, reduces tension on the perineum, making possible a gradual stretching of the perineum with fewer indications for episiotomies. Different types of episiotomies are performed, depending on the site and direction of the incision (see Fig. 12-23). The type of episiotomy that provides the best outcome is unknown (Berghella et al., 2008). Midline (median) episiotomy is most commonly used in the United States. It is effective, easily repaired, and generally the least painful. However, midline episiotomies also are associated with an increased incidence of third- and fourth-degree lacerations. Sphincter tone is usually restored after primary healing and a good repair. Mediolateral episiotomy is used in operative births when the need for posterior extension is likely. Although a fourth-degree laceration can be prevented using this technique, a third-degree laceration may occur. The blood loss is also greater and the repair more difficult and painful than with midline episiotomies. It is also more painful in the postpartum period, and the pain lasts longer. Routine performance of episiotomies has declined in the United States since the 1990s. The practice in many settings now is to support the perineum manually during birth and allow the perineum to tear rather than perform an episiotomy. Tears are often smaller than an episiotomy, are repaired easily or not at all, and heal quickly. Routine use of episiotomy is associated with increased posterior perineal trauma, suturing and healing complications, and later pain with intercourse. Therefore episiotomy should be avoided if at all possible (Berghella et al., 2008). When the third stage of labor has been completed the primary health care provider examines the woman for any perineal, vaginal, or cervical lacerations requiring repair. If an episiotomy was performed, it will be sutured. Immediate repair promotes healing, limits residual damage, and decreases the possibility of infection.

The best response from the nurse would be:"The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy.

If you were to get pregnant, it would make the diagnosis of this cancer more difficult." . Human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is completely gone

The most basic information a maternity nurse should have concerning conception is that: Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. Implantation in the endometrium occurs 6 to 10 days after conception. Ova are considered fertile 48 to 72 hours after ovulation. Sperm remain viable in the woman's reproductive system for an average of 12 to 24 hours.

Implantation in the endometrium occurs 6 to 10 days after conception.

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on knowing that:

Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

A home care nurse is caring for an adolescent with a T1 spinal cord injury. The adolescent suddenly becomes flushed, hypertensive, and diaphoretic. Which intervention should the nurse perform first?

Implement a standing prescription to empty the bladder with a sterile in-and-out Foley catheter.

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by:Methamphetamines

Narcotics, barbiturates, and tranquilizers may be causes of decreased variability; methamphetamines may cause increased variability.

- know all the lochias (rubra, serosa, alba) and duration

Lochia Post-childbirth uterine discharge, commonly called lochia, is initially bright red (lochia rubra) and may contain small clots. For the first 2 hours after birth the amount of uterine discharge should be approximately that of a heavy menstrual period. After that time the lochial flow should steadily decrease. Lochia rubra consists mainly of blood and decidual and trophoblastic debris. The flow pales, becoming pink or brown (lochia serosa) after 3 to 4 days. Lochia serosa consists of old blood, serum, leukocytes, and tissue debris. The median duration for lochia serosa discharge is 22 to 27 days (Katz, 2007). In most women, approximately 10 days after childbirth the drainage becomes yellow to white (lochia alba). Lochia alba consists primarily of leukocytes and decidual cells but also contains epithelial cells, mucus, serum, and bacteria. Lochia alba may last until 6 weeks after birth (Blackburn, 2007). If the woman receives an oxytocic medication, the flow of lochia is often scant until the effects of the medication wear off. The amount of lochia is typically smaller after cesarean births. Flow of lochia usually increases with ambulation and breastfeeding. Lochia tends to pool in the vagina when the woman is lying in bed; on standing the woman may experience a gush of blood. This gush should not be confused with hemorrhage. Persistence of lochia rubra early in the postpartum period suggests continued bleeding as a result of retained fragments of the placenta or membranes. Recurrence of bleeding approximately 7 to 14 days after birth is from the healing placental site. Approximately 10% to 15% of women will still be experiencing normal lochia serosa discharge at the 6-week postpartum examination (Katz, 2007). In the majority of women, however, a continued flow of lochia serosa or lochia alba by 3 to 4 weeks after birth may indicate endometritis, particularly if fever, pain, or abdominal tenderness is associated with the discharge. Lochia should smell similar to normal menstrual flow; an offensive odor usually indicates infection. Not all postpartal vaginal bleeding is lochia; vaginal bleeding after birth may be a result of unrepaired vaginal or cervical lacerations. Table 13-1 distinguishes between lochial and nonlochial bleeding TABLE 13-1 Lochial and Nonlochial Bleeding LOCHIAL BLEEDING - Lochia usually trickles from the vaginal opening. The steady flow increases as the uterus contracts. - A gush of lochia may result as the uterus is massaged. If the lochia is dark in color, it has been pooled in the relaxed vagina, and the amount soon lessens to a trickle of bright red lochia (in the early puerperium). NONLOCHIAL BLEEDING - If the bloody discharge spurts from the vagina, damage to a blood vessel may have occurred during birth. If so, some of the bleeding is not just normal lochial flow. - If the amount of bleeding continues to be excessive and bright red, a vaginal or cervical tear may be the source.

1. Evidence—Does the nurse have sufficient evidence at this time to draw conclusions about the feeding difficulties experienced by this mother and infant?

Mary is experiencing a crisis that involves physical discomfort from engorged breasts and sore nipples, physical exhaustion from the demands of a fussy infant who is not sleeping well, frustration in being unable to successfully latch her baby on and provide milk to satisfy him, such that she is questioning her commitment to breastfeeding and considering formula for her infant.

Which statement is the best rationale for assessing maternal vital signs between contractions?

Maternal circulating blood volume increases temporarily during contractions.

Why is continuous electronic fetal monitoring usually used when oxytocin is administered? Fetal chemoreceptors are stimulated. Uteroplacental exchange may be compromised. Maternal fluid volume deficit may occur. The mother may become hypotensive.

Maternal fluid volume deficit may occur.

Transvaginal ultrasonography is often performed during the first trimester. While preparing your 6-week gestation patient for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for a number of situations (Select all that apply). Fetal abnormalities Obesity Multifetal gestation Ectopic pregnancy Amniotic fluid volume

Multifetal gestation Ectopic pregnancy Obesity Fetal abnormalities Transvaginal ultrasound is useful in obese women whose thick abdominal layers cannot be penetrated with traditional abdominal ultrasound. This procedure is also used for identifying mulifetal gestation, ectopic pregnancy, estimating gestational age, confirming fetal viability, and identifying fetal abnormalities. Amniotic fluid volume is assessed during the second and third trimester. Conventional ultrasound would be used.

- pica

Pica and food cravings Pica, the practice of consuming nonfood substances (e.g., clay, dirt, laundry starch) or excessive amounts of foodstuffs low in nutritional value (e.g., cornstarch, ice, baking powder, baking soda), is often influenced by the woman's cultural background (Fig. 8-2). In the United States, pica appears to be most common among African-American women, women from rural areas, and women with a family history of pica. Regular and heavy consumption of low-nutrient products may cause more nutritious foods to be displaced from the diet, and the items consumed may interfere with the absorption of nutrients, especially minerals. As an example, cornstarch ingestion is popular among African-American women. It is a source of "empty" calories; one half cup (64 g) provides 240 kcal (57 kJ) but almost no vitamins, minerals, or protein. Grotegut, Dandolu, Katari, Whiteman, Geifman-Holtzman, and Teitelman (2006) reported a case of a 31-week gestation multigravida ingesting a box of baking soda (454 g of sodium bicarbonate) each day, which resulted in severe hypokalemic metabolic alkalosis and rhabdomyolysis. More than one substance may be ingested (Ngozi, 2008). Women with pica have lower hemoglobin levels than those without pica. Moreover, a risk exists that nonfood items are contaminated with heavy metals or other toxic substances. Among Mexican-American women, consumption of "tierra" includes both soil and pulverized Mexican pottery (Klitzman, Sharma, Nicaj, Vitkevich, & Leighton, 2002; Shannon, 2003). Lead contamination of soils and soil-based products has caused high levels of lead in both pregnant women and their newborns. Regular household use of Mexican pottery in cooking or serving food or ingestion of ground pottery must be included in interviews or questionnaires regarding nutritional intake of pregnant women. The possibility of pica must be considered when pregnant women are found to be anemic, and the nurse should provide counseling about the health risks associated with pica (Corbett, Ryan, & Weinrich, 2003). One hypothesis proposes that pica and food cravings (e.g., the urge to consume ice cream, pickles, or pizza) during pregnancy are caused by an innate drive to consume nutrients missing from the diet. However, research has not supported this hypothesis.

What would a breastfeeding mother who is concerned that her baby is not getting enough to eat find most helpful and most cost-effective on the day after discharge? Visiting a pediatric screening clinic at the hospital Placing a call to the hospital nursery "warm line" Calling the pediatrician for a lactation consult referral Requesting a home visit

Placing a call to the hospital nursery "warm line" This action would not necessarily be cost-effective. The first course of action should be to call a warm line for advice from a nurse. Warm lines are telephone lines offered as a community service to provide new parents with support, encouragement, and basic parenting education. This action would not necessarily be cost-effective. The first course of action should be to call a warm line for advice from a nurse. This action would not necessarily be cost-effective. The first course of action should be to call a warm line for advice from a nurse.

The nurse can help a father in his transition to parenthood by:

Pointing out that the infant turned at the sound of his voice.

A child with pulmonary atresia exhibits cyanosis with feeding. On reviewing this child's laboratory values, the nurse is not surprised to notice which abnormality?Polycythemia

Polycythemia is a compensatory response to chronic hypoxiaThe body attempts to improve tissue oxygenation by producing additional red blood cells and thereby increases the oxygen-carrying capacity of the blood.

The nurse is caring for a child with suspected diabetes insipidus. Which clinical manifestation would she or he expect to observe?

Polyuria and polydipsia

- diaphoresis during labor normal: releasing accumulated blood volume. normal to lose up to 2kg during labor.

Postpartal Diuresis Within 12 hours of birth, women begin to lose excess tissue fluid accumulated during pregnancy. Profuse diaphoresis often occurs, especially at night, for the first 2 or 3 days after childbirth. Postpartal diuresis, caused by decreased estrogen levels, removal of increased venous pressure in the lower extremities, and loss of the remaining pregnancy-induced increase in blood volume, also aids the body in ridding itself of excess fluid. Fluid loss through perspiration and increased urinary output accounts for a weight loss of approximately 2.25 kg during the puerperium. Profuse diaphoresis that occurs in the immediate postpartum period is the most noticeable change in the integumentary system.

Other symptoms could include hypotension, prolonged capillary refill, and tachycardia followed by bradycardia. Intervention is necessary.

Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are:Breathing in a respiratory pattern common to premature infants.

3. What implications and priorities for nursing care can be drawn at this time?

Priority for nursing care at this time is to educate Wendy regarding a weight reduction diet for a breastfeeding woman and a sensible exercise plan for a postpartum cesarean mother. She should be encouraged to follow the same balanced diet recommended during pregnancy and urged to avoid overly strict dieting. In addition, Wendy can be encouraged to eliminate "empty" calories, such as sugar-sweetened drinks, desserts, and chips from her diet. She will likely be surprised and pleased to learn that she will burn about 500 calories per day through milk production. Wendy's individual dietary preferences should also be considered. It is important to inform Wendy that dieting can cause her milk supply to decrease; she should monitor the baby's intake and output to see whether the infant is receiving adequate nutrition. If her milk production is declining, she may need to add more calories to her diet. Wendy can be encouraged to begin simple nonstrenuous exercises after discharge, waiting to begin more strenuous exercises until she sees the health care provider at her 6-week follow-up visit. Taking the baby for a walk each day would provide both an opportunity for exercise and help in regaining a normal routine. In terms of body image and self-esteem, if Wendy voiced concerns about feeling unable to cope, having no support, or perceiving that things are now very different and will "never return to normal," a referral for more extensive evaluation and counseling would be warranted.

Signs of cardiac decompensation include dyspnea; crackles; an irregular, weak, rapid pulse; rapid respirations; a moist, frequent cough; generalized edema; increasing fatigue; and cyanosis of the lips and nail beds

Prophylaxis of subacute bacterial endocarditis is given before and after birth when a pregnant woman has:Valvular disease.

Which congenital malformations result from multifactorial inheritance (Select all that apply)? Pyloric stenosis Cri du chat syndrome Cleft lip Anencephaly Congentital heart disease All these congenital malformations are associated with multifactorial inheritance, except cri du chat which is related to chromosome deletion.

Pyloric stenosis Cleft lip Anencephaly Congentital heart disease

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus? LOA RSA LSP ROA

RSA

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken.

Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. Administer oxygen to the mother, increase IV fluid, and notify the care provider. Call the provider, reposition the mother, and perform a vaginal examination. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask.

What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia? Risk for deficient fluid volume related to increased sodium retention secondary to administration of MgSO4 Risk for injury to the fetus related to uteroplacental insufficiency Risk for increased cardiac output related to use of antihypertensive drugs Risk for eclampsia

Risk for injury to the fetus related to uteroplacental insufficiency

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: Fetus from a transverse lie to a longitudinal lie before cesarean birth. Second twin from an oblique lie to a transverse lie before labor begins. Second twin from a transverse lie to a breech presentation during vaginal birth. Fetus from a breech to a cephalic presentation before labor begins.

Second twin from a transverse lie to a breech presentation during vaginal birth.

1. Evidence—Is evidence sufficient to draw conclusions about the baby's skin color?

The nurse can assess the newborn for the presence of jaundice by blanching the skin over the baby's forehead, chest, abdomen, and legs. At this point, the baby is over 24 hours of age and would likely be experiencing physiologic jaundice.

With regard to the care management of preterm labor, nurses should be aware that The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that:

The effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head.

- vernix caseosa

The epidermis begins as a single layer of cells derived from the ectoderm at 4 weeks. By the seventh week, two layers of cells have formed. The cells of the superficial layer are sloughed and become mixed with the sebaceous gland secretions to form the white, cheesy vernix caseosa, the material that protects the skin of the fetus. The vernix is thick at 24 weeks but becomes scant by term. Vernix caseosa is a product of the sebaceous glands. Removal of the vernix is followed by desquamation of the epidermis in most infants. Vernix has been shown to be an epidermal barrier with positive benefits for neonatal skin such as decreasing the skin pH, decreased skin erythema, and improved skin hydration. Vernix caseosa may be present between the labia and should not be forcibly removed during bathing. Allowing vernix caseosa to remain on the infant's skin has not been associated with a decrease in axillary temperature in the first hour after birth. Vernix caseosa has benefits for the preterm infant's skin. Vernix acts as an epidermal barrier, decreases bacterial contamination of the skin through its antimicrobial peptides and proteins, and decreases transepidermal water loss.

3. What implications and priorities for nursing care can be drawn at this time?

The infant's level of jaundice should be assessed and the health care provider notified. The nurse may be able to determine a transcutaneous measurement of hyperbilirubinemia if equipment is available. The health care provider may order a serum bilirubin measurement to establish a baseline and reassess bilirubin levels periodically to determine whether hyperbilirubinemia is increasing. It is important to closely monitor the infant and to intervene to prevent the development of kernicterus. Feeding is important because it promotes excretion of excess bilirubin. The parents may need to be encouraged to awaken the baby for feedings, and breastfeeding should be observed to determine the mother's ability to feed and to assess for milk transfer. Assistance is given as needed. The baby's output is closely monitored; parents may be instructed to keep a log of feedings, urination, and stooling. The parents will likely need some explanation about physiologic jaundice. First, the nurse will assess their knowledge and proceed to provide needed information. They are encouraged to ask questions of the nurse and the health care provider.

3. What implications and priorities for nursing care can be identified at this time?

The major priority at this time is to feed the baby. He is at risk of becoming dehydrated because of inadequate intake. If the engorgement can be treated quickly, he may be able to breastfeed. Otherwise, he needs to be fed some infant formula via syringe or slow flow bottle until she can express milk or get him to nurse. Mary needs help with her engorgement; ice packs can be applied to the breasts for 20 minutes to help reduce the tissue swelling. She can also take an antiinflammatory medication such as ibuprofen. After the ice is applied, Mary can use a hospital-grade electric breast pump to try to express milk to begin softening the breasts. Even with the pumping of just a half ounce or so, the nipples may soften enough for the baby to latch on and continue softening the breasts. Ideally, the infant will latch on and the milk will flow sufficiently to provide him with enough milk to feel satisfied and to allow Mary's breasts to feel more comfortable. If the ice and pumping do not result in milk flow, cabbage leaves may be used on the breasts for 20 minutes, followed by pumping. The cracked, sore nipples need to be treated. Hydrogel pads can be applied after feeding or pumping. If the nipples are too uncomfortable for the baby to nurse, Mary may pump her breasts with an electric breast pump for 24 hours to allow the nipples some time to begin healing; the expressed breast milk can be syringe fed or fed with a slow flow nipple or bottle. As the nipples improve, the baby can be gradually reintroduced to the breast, with a nurse or lactation consultant assisting Mary with proper latch-on technique. Mary needs emotional support at this time. The nurse can provide her an opportunity to express her frustrations and concerns. It is important that Mary is aware that what she is experiencing is not uncommon; the breasts of many women become engorged. It is a temporary condition, usually lasting no more than 24 to 48 hours. She may be feeling as if she is failing as a mother. Empathetic concern from the nurse can help to boost Mary's self-esteem and increase her confidence as a mother.

1. What other immediate assessment is necessary to determine the cause and management of Margarita's excessive bleeding?

The most likely cause of Margarita's excessive bleeding is uterine atony. Therefore, the nurse's first assessment is to palpate Margarita's uterus. If the uterine fundus initially feels boggy rather than firm and well-contracted, uterine atony is confirmed as the probable cause of the excessive bleeding.

When suctioning a newborn, which technique is correct?

The mouth should be suctioned first and then the nose with the bulb syringe. - The mouth should be suctioned first because the infant may gasp when the nose is suctioned, causing aspiration of mucus or fluid in the mouth. Then gently suction the nose only if necessary. A bulb syringe should be used for infant suctioning unless deeper suctioning is necessary. The bulb syringe should be depressed first and then put inside the mouth.

With regard to factors that affect how the fetus moves through the birth canal, nurses should be aware that: Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother. The fetal attitude describes the angle at which the fetus exits the uterus. The transverse lie is preferred for vaginal birth. The normal attitude of the fetus is called general flexion.

The normal attitude of the fetus is called general flexion.

beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm."

The nurse Discontinues the magnesium sulfate infusion.

d (Midwives usually see low risk obstetric clients. Care is often noninterventional with active involvement from the woman and her family. Nurse-midwives must refer clients to physicians for complications.)

The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that: A. She will have to give birth at home B. She must see an obstetrician as well as the midwife during pregnancy C. She will not be able to have epidural analgesia for labor pain D. She must be having a low risk pregnancy

Which intervention should be included in the plan of care for an infant with the nursing diagnosis of Excess Fluid Volume related to congestive heart failure?Weigh the infant every day on the same scale at the same time.

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?Patent ductus arteriosus

3. What implications and priorities for nursing care can be drawn at this time?

The priority for nursing care at this time is to assist Mingyu in recovering from childbirth in a way that is congruent with her cultural beliefs. Every effort should be made to determine Mingyu's preferences with regard to diet, activity, and hygiene, and to honor them as much as possible. Although Mingyu's beliefs may seem unusual, they should be encouraged as long as she wants to conform to them and she and the baby suffer no ill effects. Culturally appropriate accommodations that can be made for Mingyu on the postpartum unit include providing a sponge bath if desired, offering only warm food and drink, and encouraging family members or friends to bring in especially desired foods if the hospital's dietary department is unable to provide them. If Mingyu desires, family members or friends can be encouraged to stay with her as much as possible to assist with her care and the baby's care. Breastfeeding will also need to be addressed with Mingyu. A good way to determine the information Mingyu needs is to discover why she prefers to feed her baby infant formula. Discussing the benefits of colostrum for newborns may cause Mingyu to change her mind about delaying breastfeeding. Asian women may decide to breastfeed and offer formula as a supplement after breastfeeding. It is helpful for the nurse or lactation consultant to observe a breastfeeding session to identify any potential issues.

b (By the age of 40 the total number of ovarian follicles is diminishing and the quality of the remaining eggs is poor.)

The rate of fertility declines dramatically after the age of 35. While explaining the cause of this rapid decline in fertility to the client, the nurse is aware that the primary reason for this is related to: A. Endometriosis B. Abnormalities of oocytes C. Infection D. Metabolic disease

Fetal well-being during labor is assessed by

The response of the fetal heart rate to uterine contractions

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: The risk factor remains the same no matter how many affected children are already in the family. An autosomal recessive disease carries a one in eight risk of the second child also having the disorder. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. With a dominant disorder, the likelihood of the second child also having the condition is 100%.

The risk factor remains the same no matter how many affected children are already in the family.

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? Relax any eating pressures.

The school nurse is informed that a child with human immunodeficiency virus (HIV) will be attending school soon. Which is an important nursing intervention? Carefully follow universal precautions.

With regard to amniocentesis, nurses should be aware that: The presence of meconium in the amniotic fluid is always cause for concern. Despite the use of ultrasound, complications still occur in the mother or infant in 5% to 10% of cases. The shake test, or bubble stability test, is a quick means of determining fetal maturity. Because of new imaging techniques, amniocentesis is now possible in the first trimester.

The shake test, or bubble stability test, is a quick means of determining fetal maturity.

What is an advantage of external electronic fetal monitoring? The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions (UCs). Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions. The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the fetal heart rate. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

With regard to a woman's intake and output during labor, nurses should be aware that:

The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia.

A woman with asthma is experiencing a postpartum hemorrhage. Which drug would not be used to treat her bleeding because it may exacerbate her asthma? Hemabate

The use of methamphetamine has been described as a significant drug problem in the United States. In order to provide adequate nursing care to this client population the nurse must be cognizant that methamphetamine:

Which is correct concerning the performance of a Papanicolaou (Pap) smear? The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. It should be performed once a year beginning with the onset of puberty. A lubricant such as Vaseline should be used to ease speculum insertion. The specimen for the Pap smear should be obtained after specimens are collected for cervical infection.

The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before the examination so as not to alter the cytology results. Pap smears are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap smears may be performed every 3 years in low risk women after three negative results on annual examination. Only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first.

4. Does the evidence objectively support your conclusion?

There is a significant amount of information available concerning culturally appropriate care during the postpartum period for Asian women. Women who receive culturally appropriate care during this time will likely be more satisfied with their care. They will also be better able to assume care for themselves and their babies in the future if their early needs for passive nurturing are met.

4. Does the evidence objectively support your conclusion?

There is ample evidence of the efficacy of sleeping on the back in prevention of SIDS. There is also documentation that many nurses do not follow these recommendations. Stastny and colleagues (2004) found that Latina and Pacific Islander mothers were less likely than Caucasian mothers to be instructed in positioning the infant on his or her back to sleep.

11. The shivering mechanism of heat production is rarely functioning in the newborn. Nonshivering __________ is accomplished primarily by metabolism of brown fat, which is unique to the newborn, and by increased metabolic activity in the brain, heart, and liver.

Thermogenesis Hypothermia from excessive heat loss is a common and dangerous problem in neonates. The newborn infant's ability to produce heat (thermogenesis) often approaches that of the adult; however, the tendency toward rapid heat loss in a cold environment is increased in the newborn and poses a hazard.

The nurse providing care to a woman in labor should understand that cesarean birth: Is performed primarily for the benefit of the fetus.

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? -2 station

The new mother is complaining of pain at the episiotomy site; however, because she is breastfeeding she does not want any medication. What other alternatives can the nurse offer this mother to help relieve the pain?

Topical anesthetics. Topical anesthetics can be applied directly to the site to numb the area. This will not cause systemic effects like pain medications.

phototherapy

Use of lights to reduce serum bilirubin levels by oxidation of bilirubin into water-soluble compounds that are processed in the liver and excreted in bile and urine

What is descriptive of the family systems theory? The family is viewed as the sum of individual members. When the family system is disrupted, change can occur at any point in the system. Change in one family member cannot create change in other members. Individual family members are readily identified as the source of a problem.

When the family system is disrupted, change can occur at any point in the system. Although the family is the sum of the individual members, the family systems theory focuses on the number of dyad interactions that can occur. The family systems theory describes an interactional model. Any change in one member will create change in others. Change in any family member will affect other members of the family. The interactions are considered to be the problem, not the individual family members.

a (The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed.)

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: A. The examiner's hand should be placed over the fundus before, during, and after contractions B. The frequency and duration of contractions are measured in seconds for consistency C. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together D. The resting tone between contractions is described as either placid or turbulent

What effect does immobilization have on the cardiovascular system? Venous stasis This can lead to pulmonary emboli or thrombi

Which condition can result from the bone demineralization associated with immobility? Osteoporosis

As related to the care of the patient with miscarriage, nurses should be aware that:If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.

Which condition would not be classified as a bleeding disorder in late pregnancy? Spontaneous abortion.

Which intervention should be included in the nurse's plan of care for a 7-year-old child with encopresis who has cleared the initial impaction? Give the child a choice of beverage to mix with a laxative.

Which description of a stool is characteristic of intussusception? "Currant jelly" stools With intussusception, passage of bloody mucus-coated stools occurs.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include: avoid latex

Which finding should cause the nurse to suspect a diagnosis of spastic cerebral palsy? Sudden jerking movement caused by stimuli

Encourage infant to drink 8 ounces of formula every 4 hours. Institute cluster care to encourage adequate rest. Place on noninvasive oxygen monitoring.

Which information should the nurse teach families about reducing exposure to pollens and dust Replace wall-to-wall carpeting with wood and tile floors. Use an air conditioner. Put dust-proof covers on pillows and mattresses.

Which intervention for treating croup at home should be taught to parents? Take the child outside.Taking the child into the cool, humid, night air may relieve mucosal swelling and improve symptoms

Which information should the nurse teach workers at a day care center about respiratory syncytial virus (RSV)? Frequent hand washing can decrease the spread of the virus.

tobacco use/abuse during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications

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

The women's health nurse knows which statements regarding sexual response are accurate? (Select all that apply.) Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. Vasocongestion is the congestion of blood vessels. The orgasmic phase is the final state of the sexual response cycle. Facial grimaces and spasms of hands and feet are often part of arousal. Sexual difficulties should be disregarded in the postpartum period.

Women and men are more alike than different in their physiologic response to sexual arousal and orgasm, Vasocongestion is the congestion of blood vessels, Facial grimaces and spasms of hands and feet are often part of arousal. Men and women are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the genitals. The final state of the sexual response cycle is the resolution phase after orgasm. Arousal is characterized by increased muscular tension (myotonia). Sexual difficulties should be addressed during the postpartum period.

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of:

Worsening disease and impending convulsion.Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent.

4. Does the evidence objectively support your conclusion?

Yes, according to the American Academy of Pediatrics (AAP) (2005) guidelines for breastfeeding, the infant is not receiving adequate feedings. Mary is experiencing primary engorgement, a common problem that is temporary and should resolve with appropriate interventions.

4. Does the evidence objectively support your conclusion?

Yes, there is ample evidence about DRIs in pregnancy and lactation. Nutrition counseling should be part of the plan of care for Tanisha.

1. Evidence—Is evidence sufficient to draw conclusions about an appropriate nutrition plan, taking into consideration personal preferences and cultural factors?

Yes. A dietary assessment using a food intake questionnaire should be conducted and a physical assessment of nutritional status performed. Based on these data, the desired pattern of weight gain during pregnancy, and a knowledge of characteristic food patterns of African-American and Asian people, planning can begin.

5. Do alternative perspectives to your conclusion exist?

Yes. Although there are many nonpharmacologic methods that effectively relieve labor pain, epidural anesthesia and analgesia is the most effective pharmacologic pain relief method for labor that is currently available. As a result, it is the most commonly used method for relieving pain during labor in the United States, and its use has been increasing. Currently, nearly two thirds of American women giving birth choose epidural analgesia.

4. Does the evidence objectively support your conclusion?

Yes. Margarita's excessive bleeding was likely the result of uterine atony, probably caused by the huge expansion of her uterus necessary for her to give birth to two normal-sized term babies. Also, because Margarita is a grand multipara, her uterus will most likely not contract postpartum as well as it would if she had only given birth once or twice before.

1. Evidence—Is evidence sufficient to draw conclusions about counseling women with regard to regaining their nonpregnant appearance?

Yes. Normal weight gain during pregnancy is approximately 25 pounds. Because Wendy gained almost twice that much weight during her pregnancy, she will need to make changes in her diet and exercise regularly in order to reach her prepregnant weight. There are multiple sources of information about diet and exercise during the postpartum period, including health care professionals, dietitians, web sites, television programs, and magazines available to Wendy. Although making changes in her diet and exercise regimen will not be easy, with determination and persistence Wendy can certainly succeed at regaining her prepregnant appearance.

1. Evidence—Is evidence sufficient to draw conclusions about the cultural beliefs of Asians as they relate to the postpartum period and breastfeeding?

Yes. Potential sources of information include journal articles, books, and interviews with women who are members of that cultural group. Information regarding how traditional Asian beliefs may be adapted by women who immigrate to other countries is also available from these sources.

1. Evidence—Is evidence sufficient to draw conclusions about the safety and efficacy of the supine position for sleep in reducing the incidence of sudden infant death syndrome (SIDS)?

Yes. There is ample evidence that the supine position for sleep reduces the incidence of sudden infant death syndrome (SIDS). The nurses should cite the evidence as well as explain that in preterm infants, use of the prone position can assist breathing in the early phases of recovery from respiratory distress. However, as the infant matures, he should be placed on his back to sleep.

d (To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately.)

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? A. Call for help. B. Insert a Foley catheter. D. Notify the primary health care provider immediately.

A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious.

You explain that opioid analgesics often are used with sedatives because:Sedatives help the opioid work better, and they also will assist you to relax and relieve your nausea."

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits: A respiratory rate of 10 breaths/min.

Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client?

A 36-week pregnant multigravida complains of dizziness and feels lightheaded when laying on her back. The symptom is caused by which of the following? Question options: a) pressure of the uterus on the vena cava and aorta. b) decreased red blood cell count in the third trimester. c) rapid breathing and subsequent hyperventilation. d) increased blood pressure due to expanded plasma volume.

a) pressure of the uterus on the vena cava and aorta.

A nurse is assessment a new mother on her first postpartum day. The nurse notes tenderness in both legs, slight redness in the calf of the left leg, and edema in both feet, with the left foot being larger (when measured, the right ankle was 29 cm, the left ankle was 32 cm in diameter). The nurse's next action should be to:

ask the mother to stay in bed until the physician can assess her. Deep venous thrombosis may have symptoms of leg swelling, with the affected leg more than 2 cm larger than the opposite leg, and erythema, heat, and tenderness. The tenderness in both legs may be strained muscles from the delivery. Edema in both feet is expected during the early postpartum period prior to diuresis. The treatment for DVT is bed rest and medication that would require a physician's assessment.

The nurse notices a 4-hour-old newborn developing jitteriness. The next action by the nurse should be to:

assess the blood glucose level. Jitteriness can be caused by maternal drug use, low calcium levels, and hypoglycemia. Of these three, hypoglycemia is the most common cause and should be assessed first.

A pregnant client walks into the birthing center complaining of contractions. After getting her to bed, the first thing the nurse should do is

assess the fetal heart rate. - Assessment priorities on admission of a labor client are to determine the condition of the mother and fetus and whether birth is imminent. Checking the fetal heart rate is one of the first assessments that should be carried out. Along with assessing the fetus, the nurse should also check the maternal blood pressure and temperature.

When a nurse is unsure about how to perform a client care procedure, the BEST action would be to: ask another nurse. discuss the procedure with the client's physician. look up the procedure in a nursing textbook. consult the agency procedure manual and follow the guidelines for the procedure.

consult the agency procedure manual and follow the guidelines for the procedure. ' Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies. It is always best to follow the agency's policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines.

A 65-year-old woman, G6 P6006, is complaining of increasing stress incontinence and pelvic pressure and fullness. Pelvic examination reveals a bulging in the anterior vaginal wall. This woman is most likely experiencing: uterine prolapse. rectocele. cystocele. vesicovaginal fistula.

cystocele Prolapse or downward displacement of the uterus could result in protrusion of the uterus through the vagina. Rectocele would result in herniation of the rectal wall through the posterior vagina. Clinical manifestations would relate to alterations in bowel elimination. This is the classic clinical manifestations of cystocele. A vesicovaginal fistula is an abnormal passage between the bladder and the vagina, resulting in urinary incontinence and excoriation of the vaginal mucosa.

The technique of delaying pushing until the reflex urge to push occurs may be called _____________________.

delayed pushing, laboring down, rest and descend, passive pushing

A mother that is 3 days postpartum calls the clinic and complains of "night sweats." She is afraid that she is going into early menopause. The nurse should base her answer on the fact that:

diaphoresis is normal during the postpartum period, and comfort measures can be suggested to the mother. Diaphoresis and diuresis rid the body of excess fluids that accumulated during the pregnancy. Diaphoresis is not clinically significant, but can be unsettling for the mother who is not prepared for it. Explanations of the cause and provision of comfort measures, such as showers and dry clothing, are generally sufficient.

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical

dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:Discharged home to await the onset of true labor

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical

dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:Discharged home to await the onset of true labor.

During a newborn's first assessment a few minutes after birth the nurse notes moisture in the left lower lung field. The newborn is having no respiratory difficulty. The nurse's next action should be to:

document the findings and continue to monitor. Hearing sounds of moisture in the lungs during the first hour or two after birth is not unusual because fetal lung fluid has not been completely absorbed. If the abnormal sounds continue, they should be reported.

While observing a 3-hour-old newborn, the nurse counted respirations of 45, irregular with one period of apnea lasting 15 seconds. The newborn had no cyanosis during this time, no retractions, and no grunting. The nurse's next action is to:

document the normal findings. The normal respiratory rate of a newborn is 30 to 60 breaths per minute. It is not unusual for a newborn to have periods of apnea lasting less than 20 seconds. Apnea lasting longer than 20 seconds accompanied by cyanosis, heart rate changes, or other signs of difficult breathing is abnormal.

When assessing the heart rate of a sleeping 1-day-old newborn, the nurse counts a rate of 105 beats per minute. The nurse's next action should be to:

document this normal finding. When newborns are in a deep sleep, the heart rate may drop to as low as 100 beats per minute.

The CDC-recommended medication for the treatment of chlamydia would be: doxycycline. podofilox. acyclovir. penicillin.

doxycycline. Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

In order to treat a woman with a urinary tract infection, the nurse should encourage her to:

drink fluids such as apricot, prune, or cranberry juice. To treat a UTI the mother should be encouraged to drink at least 2500 to 3000 ml of fluid each day to help dilute the bacterial count and flush the infection from the bladder. Acidification of the urine inhibits multiplication of bacteria, and drinks that acidify urine, such as apricot, plum, prune, or cranberry juices should be encouraged. Carbonated drinks should be avoided because they increase urine alkalinity.

The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed.

evaluating the woman's behavior with her infant, the nurse realizes that:What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits.

Late postpartum hemorrhage occurs usually at 7 to 14 days after delivery. The nurse should teach the new mother about to be discharged to notify the health care provider if the:

lochia rubra continues and increases. Mothers should be taught how to assess the fundus and the normal duration of lochia in order to assess for late postpartum hemorrhage. They should be instructed to notify their health care provider if bleeding persists or becomes unusually heavy.

If enough unconjugated bilirubin accumulates in the blood, it may cause staining of the tissues in the brain, resulting in __________________.

kernicterus

When assessing a newly delivered mother, the nurse notes that the fundus is firm, 1 cm below the umbilicus and midline. However, there is a continuous stream of blood coming from the vaginal area. The nurse is aware that these signs may indicate:

lacerations along the birth canal. If the fundus is firm but bleeding is excessive, the cause may be lacerations of the cervix or birth canal.

The maternal adaptation phase in which the mother relinquishes her previous role as a being childless and her old lifestyle is called _______________.

letting-go

The nurse is assessing the client's vaginal discharge. It is red and has about a 2-inch stain on the peripad. The nurse will record this finding as:

light amount of lochia rubra. Lochia rubra is red in color and occurs the first 3 or 4 days after birth. A light amount of discharge is classified as a 1- to 4-inch stain on the peripad.

Discharge instructions after tubal ligation should include: (Select all that apply.) being prepared for significant mood swings due to hormonal influences. expecting heavier menstrual periods. using two forms of birth control to prevent pregnancy. not expecting change in sexual functioning; may enjoy more. using condoms to prevent sexually transmitted infections.

not expecting change in sexual functioning; may enjoy more. using condoms to prevent sexually transmitted infections. Patient teaching regarding what to expect after tubal ligation includes: • You should expect no change in hormones and their influence. • Your menstrual period will be about the same as before the sterilization. • You may feel pain at ovulation. • The ovum disintegrates within the abdominal cavity. • It is highly unlikely that you will become pregnant. • You should not have a change in sexual functioning; you may enjoy sexual relations more because you will not be concerned about becoming pregnant. • Sterilization offers no protection against sexually transmitted infections. Therefore you may need to use condoms.

During an initial assessment of a newborn the nurse notices that the left arm does not move as freely as the right arm. When assessing the clavicle, crepitus is noted. The nurse's next action should be to:

notify the newborn's health care provider. Signs of a fractured clavicle are crepitus over the bone, swelling of the area, and decreased movement of the arm on the affected side. Treatment should start as soon as possible and the fracture should heal in a short time.

To help the adolescent deal with diabetes, the nurse must consider which characteristic of adolescence? Need to be perfect and similar to peers

nurse is implementing care for a school-age child admitted to the pediatric intensive care in diabetic ketoacidosis . Which prescribed intervention should the nurse implement first? Begin 0.9% saline solution IV

After giving birth to a healthy infant boy, a primiparous woman, 16 years old, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is Risk for impaired parenting related to deficient knowledge

of newborn care. In planning for the woman's discharge, what should the nurse be certain to include in the plan of care? Provide time for the patient to bathe her infant after she views an infant bath demonstration

After a planned cesarean section, the woman is being admitted back to the postpartum unit. The nurse notices that the client is rubbing her nose and eyes continually. Being aware that the woman had a dose of epidural opioids, the nurse's next action should be to:

offer the woman some medication to relieve the itching. - Pruritus of the face and neck is an annoying side effect that may occur with epidural opioids. Medications may be used to relieve the itching and make the woman more comfortable.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing

on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is:

Which of the following exercises should be taught to a pregnant woman who complains of backaches? Question options: a) Kegeling. b) Pelvic tilting. c) Leg lifting. d) Crunching.

pelvic tilting

When doing a newborn assessment on a 2-day-old infant, the nurse notices facial jaundice. The bilirubin level was assessed and found to be 6 mg/dl. The nurse understands that this jaundice will be classified as:

physiologic jaundice. With physiologic jaundice, the jaundice is not present during the first 24 hours of life. It appears on the second or third day and is considered a normal phenomenon. When jaundice is noted in the face only, the jaundice level can be estimated to be between 5 and 7 mg/dl.

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: point out that inappropriate sexual behavior caused the infection. position the woman in a semi-Fowler position. explain to the woman that infertility is a likely outcome of this type of infection. tell her that antibiotics need to be taken until pelvic pain is relieved.

position the woman in a semi-Fowler position Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and reduce discomfort. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. viral

preterm labor can be linked to cervical, urinary tract, periodontal, and other bacterial infections.

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis? Osler's nodes are red, painful, intradermal nodes found on pads of the phalanges in bacterial endocarditis.

primary nursing intervention necessary to prevent bacterial endocarditis is to: Counsel parents of high risk children about prophylactic antibiotics.prophylactic antibiotics for dental procedures and the necessity of maintaining excellent oral health

Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants,

they may receive care that is much like that of a full-term baby. The mother-baby or nursery nurse knows that these babies are at increased risk for Problems with thermoregulation Hyperbilirubinemia Sepsis

Upon admission to the labor suite, the woman begins to cry out loudly, "Lord help me, I am going to die." She repeats this phase loudly with each contraction. The nurse's best response would be to:

understand that this may be a cultural mannerism and accept her individual response to labor. - Women should be encouraged to express themselves in any way they find comforting. The cultural diversity of their expressions must be respected. Accepting a woman's individual response to labor and pain promotes a therapeutic relationship. Belittling her, praising her falsely, or trying to show her a "better way" of dealing with the pain will interfere with the therapeutic relationship and lower the woman's self-esteem.

An embryo or fetus that is removed or expelled from the uterus at 20 wks of gestation or less, weight 500 g or less, or measures 25 cm or less?

Abortus

The recommended weekly weight gain following the first trimester for an overweight women is what? For an obese women?

0.3 kg, 0.2 kg

The recommended weight gain per wk following the first trimester is what?

0.5 kg for underweight women & 0.4 kg for normal weight women

The infant mortality rate continues to be higher in?

AA's

A Native-American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for bottle feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: A. Delayed attachment B. Embarrassment C. Disappointment in the sex of the baby D. A belief that babies should not be fed colostrum

D

Number of maternal deaths from births and complications of pregnancy, childbirth, and puerperium (the first 42 days after termination of pregnancy) per 100,000 live births?

Maternal mortality rate

What affects women's health?

Race Age Violence ETC

What are presumptive indicators?

Subjective data usually obtained from the mom

Use of communication technologies and electronic information to provide or support health care when participants are separated by distance

TELEHEALTH

Groups who are at increased risk of developing physical, mental, or social health problems or who are more likely to have worse outcomes from these health problems than the population as a whole

VULNERABLE POPULATIONS