OB Final

During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective?

"Diet and insulin needs change during pregnancy."

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."

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 represents a typical progression through the phases of a woman's establishing a relationship with the fetus?

"I am pregnant."—"I am going to have a baby."—"I am going to be a mother.

A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the man was her best friend. In an effort to calm the client in order to perform a thorough assessment and physical examination, the nurse acknowledges the client's fear and anxiety and tells her:

"Rape is not limited to strangers and frequently occurs by someone who is known to the victim."

A woman with worsening preeclampsia is admitted to the hospital's labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information?

"Since we will be here for a while, I will call my mother so she can bring the two boys—2 years and 4 years of age—to visit their mother."

A pregnant client experiences severe bleeding at 30 weeks of gestation. While performing the ultrasound, the nurse discovers that the fetus is dead. How does the nurse present this information to the client?

"The baby has no heartbeat."

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse?

"The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later."

Which statement by the client would lead the nurse to believe that labor has been established?

"The contractions in my uterus are getting stronger and closer together."

A newborn in the neonatal intensive care unit (NICU) is dying of a massive infection. The parents speak to the neonatologist, who informs them of their son's prognosis. When the father sees his son, he says, "He looks just fine to me. I can't understand what all this is about." What is the most appropriate response or reaction by the nurse at this time?

"This must be a difficult time for you. Tell me how you're doing."

Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?

"When your baby is born, would you like to see and hold her?"

On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they may hold their infant during his next gavage feeding. Considering that this newborn is physiologically stable, what response should the nurse provide?

"You may hold your baby during the feeding."

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." What is the nurse's most appropriate response?

"You probably didn't ovulate during this cycle."

Which comment by the nurse would be most helpful in instruct the woman on how best to reduce her risk of developing toxic shock syndrome

"You should always leave your diaphragm in place for at 6 hours after intercourse."

During a prenatal examination a 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 questions the nurse as to why, the nurse's best response is:

"Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child."

Describe the diagnostic components/ criteria for preeclampsia

. HTN: BP >140/90 X 2 at least 4 hrs apart2. Protienuria: >300 mg in 24-hr specimen3. Thrombocytopenia: platelet count < 1000,000/ uL4. Impaired liver functions: elevated liver enzyme (transaminases)5. Renal insufficiency: new development of serum creatinine > 1.1 mg/dL6. Pulmonary edema7. Cerebral/ visual disturbances

Which statement regarding the term contraceptive failure rate is the most accurate?

. It varies from couple to couple, depending on the method and the users.

Cardiac output increases up to 50% by the 32nd week of pregnancy. What is the rationale for this change?

. To provide adequate perfusion of the placenta

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity?

.6 to 12 weeks

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)?

.Bed rest in a semi-Fowler position

Which clinical findings would alert the nurse that the neonate is expressing pain?

.Cry face; eyes squeezed; increase in blood pressure

A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries until held. What is the correct nursing diagnosis beginning with "ineffective coping, related to"?

.Environmental stress

When evaluating the preterm infant, the nurse understands that compared with the term infant, what information is important for the nurse to understand?

.Greater surface area in proportion to weight

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)?

.HIV antibody testing

When providing an infant with a gavage feeding, which infant assessment should be documented each time?

.Response to the feeding

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing?

.Trichomoniasis

A woman gave birth to an infant boy 10 hours ago. Where does the nurse expect to locate this womans fundus?

1 centimeter above the umbilicus

Umbilical cord has how many veins and arteries

1 vein 2 arteries

The first trimester is week __ through week __.

1-12

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:

10 weeks

When is a prophylactic cerclage for an incompetent cervix usually placed (in weeks of

12 to 14

At which gestational week(s) does the fetal heart begin to beat?

12 wks

The second trimester is week __ through week __

12-27

At which gestational week(s) can the baby's sex be seen?

16 wks

A new mother asks the nurse when the "soft spot" on her son's head will go away. What is the nurse's best response, based upon her understanding of when the anterior frontal closes?

18 months

The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors?

19-year-old African American who is pregnant with twins

At which gestational week(s) does the mother feel movement (quickening)?

20 wks

At which gestational week(s) do fetal respiratory movements begin?

24 wks

At which gestational week(s) does the fetus begin to open and close his eyes?

28 wks

At which gestational week(s) is surfactant formed?

28 wks

The third trimester is week ___ to ____

28-birth

Pap smears and pelvic exams are recommended every __ year(s) in women over age

3 21

Changes in blood volume after childbirth depend on several factors such as blood loss during childbirth and the amount of extravascular water (physiologic edema) mobilized and excreted. What amount of blood loss does the postpartum nurse anticipate?

300 to 500ml 500 to 1000ml

By which gestational week does the fetus have fingernails and toenails?

32 wks

At which gestational week(s) does the baby get antibodies from the mother?

38+ weeks

At which gestational week(s) does the fetal heart begin to beat?

4 wks

Annual mammograms are recommended for all women age ____ and over.

40

Parents who have not already done so need to make time for newborn follow-up of the discharge. According to the American Academy of Pediatrics (AAP), when should a breastfeeding infant first need to be seen for a follow-up examination?

48 to 72 hours after hospital discharge

At 1 minute after birth a nurse assesses an infant and notes a heart rate of 80 beats per minute, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. Which Apgar score does the nurse calculate based upon these observations and signs?

5

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?

50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

In most healthy newborns, blood glucose levels stabilize at _________ mg/dl during the first hours after birth.

50 to 60

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the woman's cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

6 19

The average volume of amniotic fluid at term is _______

700-800ml

At which gestational week(s) can the fetal heart rate be heard by an ultrasound device?

8 to 12 weeks

By which gestational week are all of the fetus's body organs formed?

8 wks

How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day?

95 to 110

The nurse is caring for clients in a maternity unit. Which client is most likely to experience isolation during the grieving period?

A client who had a miscarriage at 6 weeks of gestation

During the first trimester, a woman can expect which of the following changes in her sexual desire?

A decrease, because of nausea and fatigue

Upon assessment, the nurse finds that the infant has a sunken abdomen, bowel sounds heard in the chest, nasal flaring, and grunting. What clinical condition does the nurse suspect the infant has based on these findings?

A diaphragmatic hernia.

Which information related to a prolonged deceleration is important for the labor nurse to understand?

A disruption to the fetal oxygen supply causes prolonged decelerations.

A mother is changing the diaper of her newborn son and notices that his scrotum appears large and swollen. The client is concerned. What is the best response from the nurse?

A large scrotum and swelling indicate a hydrocele, which is a common finding in male newborns.

Which statement about pregnancy is accurate?

A normal pregnancy lasts about 10 lunar months.

Screening for critical congenital heart disease (CCHD) was added to the uniform screening panel in 2011. The nurse has explained this testing to the new mother. Which action by the nurse related to this test is correct

A passing result is an O2 saturation of 95%.

In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document?

A stands for alternatives.

Which client is most likely to experience strong and uncomfortable afterpains?

A woman who is a gravida 4, para 4-0-0-4

What findings might the nurse expect in a neonate within 30 minutes of birth?

A. Tremors, Nasal flaring, Audible grunting

A mother is pregnant with twins: one boy and one girl. Which type of twins could she be pregnant with?

A. dizygotic twinsRationale: only dizygotic (fraternal) twins can be different genders.

Which statement accurately describes an appropriate-for-gestational age (AGA) weight assessment?

AGA weight assessment falls between the 10th and 90th percentiles for the infants age.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition?

Abdominal distention, temperature instability, and grossly bloody stools

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. Which clinical change does the nurse anticipate?

Abruptio placentae

What it essential for early detection of htn disorders in a pregnant woman?

Accurate measure of BP

What is the role of the nurse as it applies to informed consent?

Act as a client advocate, and help clarify the procedure and the options.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. Which 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

These hazardous agents cause development of abnormal structures in the embryo

Acutane Rubella Radiation

A client gives birth to a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing?

Acute distress

The nurse is caring for an infant with breathing difficulty. Upon auscultating, the infant the nurse finds that the infant has a murmur. What suggestion does the nurse give to the parents about infant care?

Additional cardiac testing is necessary."

With regard to amniocentesis, nurses should be aware that:

Administration RhoD immunoglobulin may be necessary.

In caring for the woman with DIC, which order should the nurse anticipate?

Administration of blood

Of the many factors that influence parental responses, nurses should be aware that all of these statements regarding age are true except:

Adolescent mothers have a higher documented incidence of child abuse.

Which statement regarding the postpartum uterus is correct?

After 2 weeks postpartum, it should be abdominally nonpalpable.

The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin:

After the first missed menstrual period.

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. Based on her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy?

Alcohol

The abuse of which substance during pregnancy is a significant cause of mental retardation in the United States?

Alcohol

Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate resulting from the failure of the primary palate to fuse. Multiple genetic and, to a lesser extent, environmental factors may lead to the development of a cleft lip or palate. Which factors are included?

Alcohol consumption Use of some anticonvulsant medications Maternal cigarette smoking

The AAP recommends pasteurized donor milk for preterm infants if the mothers own milk in not available. Which statements regarding donor milk and milk banking are important for the nurse to understand and communicate to her client?

All milk bank donors are screened for communicable diseases. Donor milk may be given to transplant clients. Donor milk may be used for children with immunoglobulin A (IgA) deficiencies

Prenatal testing for human immunodeficiency virus (HIV) is recommended for:

All women, regardless of risk factors

A woman who is 32 weeks' pregnant is informed by the nurse that a danger sign of pregnancy could be:

Alteration in the pattern of fetal movement

What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern?

Altered fetal cerebral blood flow

Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?

Amenorrhea

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?

Amniocentesis for fetal lung maturity

A client who is breastfeeding has been diagnosed with gonorrhea. Which treatment plan should be instituted?

Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection

Many common drugs of abuse cause significant physiologic and behavioral problems in infants who are breastfed by mothers currently using

Amphetamine Heroin Nicotine PCP

The nurse is assessing digestion and elimination in a newborn. Which enzyme helps the newborn convert starch into maltose?

Amylase in colostrum

Which definition of an acceleration in the fetal heart rate (FHR) is accurate?

An acceleration in the FHR presents a visually apparent and abrupt peak.

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. Which statement regarding this procedure is correct?

An application of nitrous oxide gas is administered for pain relief.

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:

An environment that fosters as much privacy as possible should be created

With regard to hemorrhagic complications that may occur during pregnancy, what information is most accurate?

An incompetent cervix is usually not diagnosed until the woman has lost one or two pregnancies.

With regard to maternal, fetal, and neonatal health problems, nurses should be aware that:

Antepartum fetal deaths can best be prevented by better recognizing and responding to abnormalities of pregnancy and labor

A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse asks about the woman's last menstrual period and whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

Anticonvulsant medications may cause the false-positive test result.

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis?

Appearance of a chancre 2 months after infection

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle feed. During the assessment, the nurse notices that both breasts are swollen, warm, and tender on palpation. Which guidance should the nurse provide to the client at this time?

Apply ice to the breasts for comfort.

Which intervention by the nurse would reduce the risk of abduction of the newborn from the hospital?

Applying an electronic and identification bracelet to the mother and the infant

3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae:

Are benign if they disappear within 48 hours of birth

The umbilical ______ carry deoxygenated blood from the fetus to the mother.

Arteries

The breast-feeding mother should be taught to expect which changes to the condition of the breasts?

As lactation is established, a mass may form that can be distinguished from cancer by its positional shift from day to day In nonlactating mothers, colostrum is present for the first few days after childbirth. If suckling is never begun or is discontinued, then lactation ceases within a few days to a week.

The obstetric nurse is preparing the client for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware of and prepared for the greatest risk of administering general anesthesia to the client. What is this risk?

Aspiration of stomach contents

Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)?

Assertive personality

What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?

Assessing FHR and maternal vital signs

A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide at this time?

Assist her with simple breathing and relaxation instructions.

Which nursing action is most appropriate to correct a boggy uterus that is displaced above and to the right of the umbilicus?

Assist the client in emptying her bladder.

An infant boy was delivered minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. When should the Apgar assessment be performed?

At least twice, 1 minute and 5 minutes after birth

When should discharge instruction, or the teaching plan that tells the woman what she needs to know to care for herself and her newborn, officially begin?

At the time of admission to the nurses unit

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. What do these complications include?

Atherosclerosis Retinopathy Nephropathy Neuropathy

____________________ is the process by which the parent and infant come to love and accept each other.

Attachment

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.

The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another?

Attitude

After delivery, excess hypertrophied tissue in the uterus undergoes a period of self-destruction. What is the correct term for this process?

Autolysis

Which order should the nurse expect for a client admitted with a threatened abortion?

BEd rest

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?

BPP

In many hospitals, new mothers are routinely presented with gift bags containing samples of infant formula. This practice is inconsistent with what?

Baby Friendly Hospital Initiative

What is the rationale for the administration of vitamin K to the healthy full-term newborn?

Bacteria that synthesize vitamin K are not present in the newborns intestinal tract.

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect?

Bacterial vaginosis

Which contraceptive method should the nurse identify as protecting against sexually transmitted infections (STIs) and the human immunodeficiency virus (HIV)?

Barrier methods

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 would tell her:

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."

After birth, 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

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. Which condition is unlikely to be a psychologic consequence of continued abuse?

Bipolar disorder

Which statement related to fetal positioning during labor is correct and important for the nurse to understand?

Birth is imminent when the presenting part is at +4 to +5 cm below the spine.

While assessing a 1-week-old infant, the nurse observes that the newborn has apnea, lethargy, jitteriness, and feeding problems. What could be the possible reason for the infant's symptoms?

Blood glucose level of 38 mg/dl.

The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client?

Boggy uterus with heavy lochia flow

With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that:

Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus.

A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle feeding. Which statement regarding bottle feeding using commercially prepared infant formulas might influence their choice?

Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies.

A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks contractions. What other information is important for the nurse to share?

Braxton Hicks contractions should be painless.

The breastfeeding mother should be taught a safe method to remove the breast from the babys mouth. Which suggestion by the nurse is most appropriate?

Break the suction by inserting your finger into the corner of the infants mouth.

Which statements concerning the benefits or limitations of breastfeeding are accurate?

Breast milk changes over time to meet the changing needs as infants grow. Breast milk and breastfeeding may enhance cognitive development. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Benefits to the infant include a reduced incidence of SIDS

A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. Which findings should the nurse include in the discussion?

Breast tenderness Warmth in the breast Area of redness on the breast often resembling the shape of a pie wedge Fever and flulike symptoms

A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement?

Breastfeed her infant every 2 hours.

A nurse providing couplet care should understand the issue of nipple confusion. In which situation might this condition occur?

Breastfeeding babies receive supplementary bottle feedings

While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the client accordingly. Which statement as part of this discussion would be incorrect?

Breastfeeding costs employers in terms of time lost from work

Which statement regarding the nutrient needs of breastfed infants is correct?

Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months.

The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would provide conflicting information to the client?

Breastfeeding is an effective method of birth control.

Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses, followed by 10 to 15 seconds of compensatory rapid respiration, be experiencing?

Breathing in a respiratory pattern common to premature infants

During an ultrasound, the ultrasound technician sees 2 embryos that each have their own amnion but share the same chorion. The ultrasound tech informs the expecting mother that she is pregnant with:

C. monochorionic-diamniotic twins

Which statement regarding congenital anomalies of the cardiovascular and respiratory systems is correct?

Cardiac disease may demonstrate signs and symptoms of respiratory illness.

Baby Bradley's umbilical cord only has 2 vessels instead of 3. The obstetrician informs his mother that he is at risk for malformations of the following systems:

Cardio Gastro Renal

When attempting to screen and educate parents regarding the treatment of developmental dysplasia of the hip (DDH), which intervention should the nurse perform?

Carefully monitor infants for DDH at follow-up visits.

Intimate partner violence (IPV) is seen in all races, ethnicities, religions, and socioeconomic backgrounds. Which statement is most accurate regarding the reporting of IPV in the United States?

Caucasian women report less IPV than do non-Caucasians.

The nurse observes that the lips, feet, and palms of a newborn are pale blue even 48 hours after birth. What can the nurse suspect from this observation about the newborn's clinical condition?

Central cyanosis

Which presentation is accurately described in terms of both the resenting part and the frequency of occurrence?

Cephalic: occiput, at least 96%

The nurse has received a report regarding a client in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. What is the nurse's interpretation of this assessment?

Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.

What is the drug of choice for the treatment of gonorrhea?

Cetriaxone

Which nursing intervention would result in an increase in maternal cardiac output?

Change in positionj

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the 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. What is the nurses first priority?

Change the womans position

The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share?

Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term.

Which statement most accurately describes the HELLP syndrome?

Characterized by hemolysis, elevated liver enzymes, and low platelets

Which statement is not an expected outcome for the client who attends a reputable childbirth preparation program?

Childbirth preparation programs guarantee a pain-free childbirth.

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated?

Chlamydia

Which sexually transmitted infection (STI) is the most commonly reported in American women?

Chlamydia

What is the most common causative agent of ophthalmia neonatorum?

Chlamydia trachomatis

The placenta develops from the

Chorion

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage?

Chromosomal abnormalities Endocrine imbalanc Systemic disorders Varicella

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. What are possible causes of early miscarriage?

Chromosomal abnormalities Nausea and vomiting in early pregnancy Endocrine imbalance Systemic disorders Varicella

Which statement best describes chronic hypertension?

Chronic hypertension can occur independently of or simultaneously with preeclampsia.

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

Proper documentation of the abuse as reported by the victim is a crucial role of the nurse. Evaluate the following data, which include information from the victim, and choose the best documentation by the nurse. A 34-year-old Caucasian arrives at the emergency department with a black right eye; she also is bleeding from the left side of her head. She reports that her boyfriend has been abusing her physically. The nurse performs a history and physical examination and documents her findings.

Client is a 34-year-old Caucasian female. Presents with periorbital ecchymosis on right side. Laceration of left parietal area, 3 cm long with tissue bridging. Approximately 1 cm deep. Client states that her boyfriend 'threw a brick from 10 feet away, aiming at my head. The corner of the brick hit the left side of my head.' She reports that he also 'hit me in the eye.' Client indicates that the hit was with her boyfriend's closed left fist."

Which client would not be a suitable candidate for internal EFM?

Client who still has intact membranes

As a powerful central nervous system (CNS) stimulant, which of these substances can lead to miscarriage, preterm labor, placental separation (abruption), and stillbirth?

Cocaine

A new mother asks whether she should feed her newborn colostrum, because it is not real milk. What is the nurses most appropriate answer?

Colostrum is high in antibodies, protein, vitamins, and minerals.

Which maternal condition always necessitates delivery by cesarean birth

Complete placenta previa

To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what?

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

Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?

Congenital anomalies in the fetus

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:

Congenital syphilis

A client is concerned that her breasts are engorged and uncomfortable. What is the nurses explanation for this physiologic change?

Congestion of veins and lymphatic vessels

Importantly, the nurse must be aware of which information related to the use of intrauterine devices (IUDs)?

Copper IUDs can serve as an emergency contraception under certain situations.

In appraising the growth and development potential of a preterm infant, the nurse should be cognizant of the information that is best described in which statement?

Correct for milestones, such as motor competencies and vocalizations, until the child is approximately 2 years of age.

What are the legal responsibilities of the perinatal nurses?

Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes

A client is experiencing back labor and complains of intense pain in her lower back. Which measure would best support this woman in labor?

Counterpressure against the sacrum

A nurse is responsible for teaching new parents regarding the hygienic care of their newborn. Which instruction should the nurse provide regarding bathing?

Create a draft-free environment of at least 24 C (75 F) when bathing the infant.

The nurse is caring for a neonate in the nursery. What behavior in the neonate does the nurse recognize as thermogenesis?

Cries and appears restless

With regard to the respiratory development of the newborn, of what should nurses be aware?

Crying increases the distribution of air in the lungs

A woman arrives for evaluation of signs and symptoms that 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. What does this finding indicate?

Cullen sign associated with a ruptured ectopic pregnancy

In caring for an immediate postpartum client, the nurse notes petechiae and oozing from her intravenous (IV) site. The client would be closely monitored for which clotting disorder?

DIC

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 her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time?

Deficient knowledge, related to diabetic pregnancy management

Which action should the nurse first take when meeting with a new client to discuss contraception?

Determine the woman's level of knowledge concerning contraception..

The nurse should have knowledge of the purpose of the pinch test. It is used to:

Determine whether the nipple is everted or inverted.

Which statement concerning the complication of maternal diabetes is the most accurate?

Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

Which statement best describes the rationale for the physiologic anemia that occurs during pregnancy?

Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia.

A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?

Dipstick value of 3+ for protein in her urine

Which is the most accurate description of PPD without psychotic features?

Distinguishable by pervasive sadness along with mood swings

The primary responsibility of the nurse who suspects or confirms any type of violence against a woman is:

Document the incident (or findings) accurately and concisely in the client's record

The primary theme of the feminist perspective on violence against women recognizes the:

Dominance and coercive control over women by men

he 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?

Doppler blood flow analysis

The multiple marker test is used to assess the fetus for which condition?

Down Syndrome

While caring for an infant, which method should the nurse adapt to prevent heat loss due to evaporation?

Dry the infant immediately after the bath.

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that:

During the abdominal examination, the nurse should be alert for supine hypotension.

A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse's plan of care?

During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.

When caring for a newly delivered woman, what is the best measure to prevent abdominal distention after a cesarean birth?

Early and frequent ambulation

To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?

Eat her meals and snacks on a fixed schedule.

With regard to violence against women, intimate partner violence (IPV) nurses should be aware that:

Economic coercion is considered part of IPV

The nurse is caring for an infant after a forceps-assisted birth. Which feature does the nurse attribute to a forceps-assisted birth?

Edema and ecchymosis

Nurses should be cognizant of what information regarding the non-contraceptive medical effects of combination oral contraceptives

Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

Nurses should be cognizant of what regarding the mechanism of labor?

Effects of the forces determining descent are modified by the shape of the woman's pelvis and the size of the fetal head.

The nurse should be aware of what important information regarding systemic analgesics administered during labor?

Effects on the fetus and newborn can include decreased alertness and delayed sucking.

In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care?

Eight to 12 women are placed in gestational-age cohort groups.

Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information regarding nonpharmacologic pain relief is accurate?

Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

Which statement regarding emergency contraception is correct?

Emergency contraception requires that the first dose be taken within 120 hours of unprotected intercourse.

Part of the nurses role is assisting with pushing and positioning. Which guidance should the nurse provide to her client in active labor?

Encourage the womans cooperation in avoiding the supine position.

A woman has been diagnosed with a high risk pregnancy. She and her husband come into the office in a very anxious state. She seems to be coping by withdrawing from the discussion, showing declining interest. The nurse can best help the couple by:

Encouraging her and urging her to continue with childbirth classes.

Which statement regarding the care of a client in labor is correct and important to the nurse as he or she formulates the plan of care?

Endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

The nurse is assisting a client during delivery. What measures does the nurse take to protect the infant from heat loss?

Ensure the infant is dried immediately after birth. Place the naked infant on the mother's bare chest and cover with a blanket. Wrap the infant and cover the head with a cap.

When assisting the mother, father, and other family members to actualize the loss of an infant, which action is most helpful?

Ensuring the baby is clothed or wrapped if the parents choose to visit with the baby

What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids?

Expanding maternal blood volume

The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the:

Expectant father

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.

Pregnancy is a hypercoagulable state in which women are at a fivefold to sixfold increased risk for thromboembolic disease. The tendency for blood to clot is greater, attributable to an increase in various clotting factors. Which of these come into play during pregnancy?

Factor VII Factor VIII Factor IX Fibrinogen

A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine "several times" during the past year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg, her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics place the woman in a high risk category?

Family history, BMI, drug/alcohol abuse

The nurse is examining the external genitalia of a female infant. What finding must the nurse report?

Fecal discharge from vagina

A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. Which information should the nurse provide regarding this feeding plan?

Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.)

Fellatio Unprotected anal intercourse multiple sex partners

Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. Which change in fetal physiologic activity isnot part of this process?

Fetal respiratory movements increase during labor.

A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What are the signs and symptoms of this emergency disorder?

Fever Restlessness

A woman who has undergone an induced abortion be instructed to return to the emergency department when what situation exists?

Fever higher than 38° C Chills Foul-smelling vaginal discharged. Bleeding greater than 2 pads in 2 hour Abdominal tenderness and or pain

The nurse is caring for a neonate immediately after delivery. What does the nurse expect to find while assessing the neonate during the first 30 minutes after birth?

Fine crackles may be present on auscultation.

Which stage of labor varies the most in length?

First

Which description of the four stages of labor is correct for both the definition and the duration?

First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours

Which trimester of pregnancy is the most vulnerable period?

First trimester

The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks?

Flexed posture

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition?

Fluconazole

Which statement, related to the reconditioning of the urinary system after childbirth, should the nurse understand?

Fluid loss through perspiration and increased urinary output accounts for a weight loss of more than 2 kg during the puerperium.

Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest?

Fluid retention

A woman's position is an important component of the labor progress. Which guidance is important for the nurse to provide to the laboring client?

Frequent changes in position help relieve fatigue and increase the comfort of the laboring client.

The nurse should be cognizant of which statement regarding the unique qualities of human breast milk?

Frequent feedings during predictable growth spurts stimulate increased milk production.

Return to the clinic every 1 to 2 weeks.

Frequent, serial casting is tried first.

In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research she found a similar pattern of abuse among many of the women. This concept is now referred to as the Cycle of Violence. Which phase does not belong in this three-cycle pattern of violence?

Frustration followed by violence

As recently as 2005, the AAP revised safe sleep practices to assist in the prevention of SIDS. The nurse should model these practices in the hospital and incorporate this information into the teaching plan for new parents. Which practices are ideal for role modeling?

Fully supine position for all sleep Tummy time for play Infant sleep sacks or buntings

Which finding on a prenatal visit at 10 weeks of gestation might suggest a hydatidiform mole?

Fundal height measurement of 18 cm

Which documentation on a womans chart on postpartum day 14 indicates a normal involution process?

Fundus below the symphysis and nonpalpable

The nurse, responsible for providing health teaching regarding the side effects of combined oral contraceptives (COCs), should discuss what issues? (Select all that apply.)

Gallbladder disease Myocardial infarction Breast tenderness

Which STI does not respond well to antibiotic therapy?

Genital herpes

A mother expresses fear about changing her infants diaper after he is circumcised. What does the client need to be taught to care for her newborn son?

Gently cleanse the penis with water and apply petroleum jelly around the glans after each diaper change.

The Baby Friendly Hospital Initiative endorsed by the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which actions are included in the Ten Steps to Successful Breastfeeding for Hospitals?

Give newborns no food or drink other than breast milk. Have a written breastfeeding policy that is communicated to all staff members. Help mothers initiate breastfeeding within hour of childbirth.

Which finding in the urinalysis of a pregnant woman is considered a variation of normal?

Glycosuria

A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the 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. What is the nurse's most appropriate action?

Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn.

The most important nursing action in preventing neonatal infection is:

Good handwashing

What is the most important nursing action in preventing neonatal infection?

Good handwashing

A nurse caring for a family during a loss might notice that a family member is experiencing survivor guilt. Which family member is most likely to exhibit this guilt?

Grandparents

Conscious relaxation is associated with which method of childbirth preparation?

Grantly Dick-Read childbirth method

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

Group B streptococci (GBS) infection

The nurse is caring for a client whose pregnancy ended in stillbirth 2 months ago. The nurse finds that the client experiences feelings of loneliness, emptiness, and yearning. What additional symptoms of grief may the nurse find in the client?

Guilt Numbness Disorganization

Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate?

HAV is acquired by eating contaminated food or drinking polluted water.

Which hormone is detected in pregnancy testing?

HCG

For what reason would breastfeeding be contraindicated?

HIV positive

Which infection is prevented with the Cervarix and Gardasil vaccines?

HPV

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, "What is that? Can you get rid of it?" Which is the best response for the nurse to provide?

HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer."

What condition indicates concealed hemorrhage when the client experiences abruptio placentae?

Hard, boardlike abdomen

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse's primary concern in planning the client's care?

Harming her infant

A postpartum woman telephones the provider regarding her 5-day-old infant. The client is not scheduled for another weight check until the infant is 14 days old. The new mother is worried about whether breastfeeding is going well. Which statement indicates that breastfeeding is effective for meeting the infants nutritional needs?

Has at least six to eight wet diapers per day

Compared with contraction stress test (CST), nonstress test (NST) for antepartum fetal assessment:

Has no known contraindications

At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse develop a feeding plan for the infant to increase his weight gain. Which change in dietary management will assist the client in meeting this goal?

Have one extra breastfeeding session every 24 hours.

While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

What is the rationale for the use of a blood patch after spinal anesthesia?

Headache

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is approximately twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. Which intervention should the nurse immediately initiate?

Help her breathe into a paper bag.

The nurse is caring for a client who lost her baby immediately after birth. The client blames herself for the loss. Which nursing interventions are designed to promote feelings of self-worth in the client?

Helping the client identify positive coping mechanisms Identifying the client's perception and feeling about fetal death

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition?

Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome

To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia?

Hemolytic disorders

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Which information assists the nurse in developing the plan of care?

Hemorrhage is the primary concern.

Which condition is the most life-threatening virus to the fetus and neonate?

Hepatitis B virus (HBV)

What should the laboring client who receives an opioid antagonist be told to expect?

Her pain will return

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?

Herpes simplex virus 2 (HSV-2)

hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true?

Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome.

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients. Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor, when they become more vocal and request pain relief?

Hispanic

In pregnancy, the developing fetus is called a _________

Homograph

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she doesn't know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate?

Hormonal changes during pregnancy commonly result in mood swings."

Postpartum fatigue (PPF) is more than just feeling tired. It is a complex phenomenon affected by physiologic, psychologic, and situational variables. Which factors contribute to this phenomenon?

Hospital routines Anemia Excitement

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication?

Hydralazine

The nurse is caring for an infant experiencing cold stress. Which complication does the nurse suspect in the

Hyperbilirubinemia

What is the most common medical complication of pregnancy?

Hypertension

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

Hypoglycemia

The nurse is assigned a home care visit of a 5-day-old infant for the treatment of jaundice. A thorough assessment is completed, and a health history is obtained. Which sign or symptom indicates that the infant may be displaying the initial phase of encephalopathy

Hypotonia, lethargy, and poor suck

During the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. In this situation, which condition should the nurse suspect?

Hypovolemia and/or shock

The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late decelerations, or loss of variability is nonreassuring and is associated with which condition?

Hypoxemia

A new mother wants to be sure that she is meeting her daughters needs while feeding the baby commercially prepared infant formula. The nurse should evaluate the mothers knowledge about appropriate infant feeding techniques. Which statement by the client reassures the nurse that correct learning has taken place?

I burp my daughter during and after the feeding as needed.

A nurse is discussing the storage of breast milk with a mother whose infant is preterm and in the special care nursery. Which statement indicates that the mother requires additional teaching?

I can store my breast milk in the refrigerator for 3 months.

After giving birth to a stillborn infant, the woman turns to the nurse and says, "I just finished painting the baby's room. Do you think that caused my baby to die?" What is the nurse's most appropriate response?

I can understand your need to find an answer to what caused this. What else are you thinking about?"

Nurses should be able to teach breastfeeding mothers the signs that the infant has correctly latched on. Which client statement indicates a poor latch?

I hear a clicking or smacking sound.

Pelvic floor exercises, also known as Kegel exercises, will help to strengthen the perineal muscles and encourage healing after childbirth. The nurse requests the client to repeat back instructions for this exercise. Which response by the client indicates successful learning?

I pretend that I am trying to stop the flow of urine in midstream

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. What is the nurses most appropriate response?

I'll warm the soup in the microwave for you.

Nursing follow-up care often includes home visits for the new mother and her infant. Which information related to home visits is correct?

Ideally, the visit is scheduled within 72 hours after discharge.

The diagnosis of pregnancy is based on which positive signs of pregnancy?

Identification of fetal heartbeat Visualization of the fetus Verification of fetal movement

The nurse who elects to practice in the area of women's health must have a thorough understanding of miscarriage. Which statement regarding this condition is most accurate?

If a miscarriage occurs before the 12th week of pregnancy, then it may be observed only as moderate discomfort and blood loss.

To provide the patient with accurate information about dental care during pregnancy, maternity nurses should be aware that:

If dental treatment is necessary, the woman will be most comfortable with it in the second trimester.

The nurse is teaching new parents about metabolic screening for the newborn. Which statement is most helpful to these clients?

If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks.

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. Which nursing diagnosis is most appropriate for the client at this time?

Imbalanced nutrition: less than body requirements

What is the clinical finding most likely to be exhibited in an infant diagnosed with erythroblastosis fetalis?

Immature red blood cells

A pregnant woman is infected with human immunodeficiency virus (HIV), with a viral load of more than 400 copies/ml. It is therefore recommended that she have a caesarean birth at 38 weeks of gestation. On assessment at 36 weeks, the nurse finds that the patient has a viral load of 800 copies/ml and ruptured membranes, and the labor is progressing rapidly. What is the primary health care provider likely to order?

Immediate vaginal birth

The nurse is evaluating the EFM tracing of the client who is in active labor. Suddenly, the FHR drops from its baseline of 125 down to 80 beats per minute. The mother is repositioned, and the nurse provides oxygen, increased IV fluids, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should the nurse take next?

Immediately notify the provider

Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic hernia?

Impaired gas exchange

The nurse is caring for a client whose pregnancy ended in a stillbirth. The client has breast engorgement associated with breast milk production. What information will the nurse first provide to the client?

Importance of a visit to the lactation consultant

As the nurse assists a new mother with breastfeeding, the client asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? What is the nurses best response?

Important immunoglobulins

Many new mothers experience some type of nipple pain during the first weeks of initiating breastfeeding. Should this pain be severe or persistent, it may discourage or inhibit breastfeeding altogether. Which factors might contribute to this pain?

Improper feeding position Fair skin Flat or retracted nipples

With regard to central nervous system injuries to the infant during labor and birth, nurses should be aware that:

In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests

A client with a history of bipolar disorder is called by the postpartum support nurse for follow-up. Which symptoms would reassure the nurse that the client is not experiencing a manic episode

Increased appetite and lack of interest in activities

Which renal system adaptation is an anticipated anatomic change of pregnancy?

Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty.

The nurse expects which maternal cardiovascular finding during labor?

Increased cardiac output

Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client?

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

Which intervention is most important when planning care for a client with severe gestational hypertension?

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

As part of the infant discharge instructions, the nurse is reviewing the use of the infant car safety seat. Which information is the highest priority for the nurse to share?

Infant car seats should be rear facing and placed in the back seat of the car.

Which infant is most likely to express Rh incompatibility?

Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor

What concerns about parenthood are often expressed by visually impaired mothers? Choose all that apply.

Infant safety Transportation Missing out visually needing extra time for parenting activities to accomodate the visual limitations

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that despite what folk wisdom might say:

Infants can learn to distinguish their mother's voice from others soon after birth.

A new mother asks the nurse what the experts say about the best way to feed her infant. Which recommendation of the American Academy of Pediatrics (AAP) regarding infant nutrition should be shared with this client?

Infants should be given only human milk for the first 6 months of life.

With regard to infants who are SGA (small for gestational age) and intrauterine growth restriction (IUGR), the nurse should be aware of which information?

Infants with asymmetric IUGR have the potential for normal growth and development.

According to professional standards (the Association of Womens Health, Obstetric and Neonatal Nurses [AWHONN], 2007), which action cannot be performed by the nonanesthetist registered nurse who is caring for a woman with epidural anesthesia?

Initiating epidural anesthesia

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman spontaneously empty her bladder as soon as possible. If all else fails, what tactic might the nurse use?

Inserting a sterile catheter

Which nursing intervention is necessary before a second-trimester transabdominal ultrasound?

Instruct the woman to drink 1 to 2 quarts of water

In contrast to placenta previa, what is the most prevalent clinical manifestation of abruptio placentae?

Intense abdominal pain

Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client?

Intimate partner violence (IPV)

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital's maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care?

Intrapartum treatment with antiviral medications Cesarean birth .Avoidance of breastfeeding

What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant?

Intrauterine growth restriction

Which neonatal complications are associated with hypertension in the mother?

Intrauterine growth restriction (IUGR) and prematurity

The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?

Intravenous (IV) therapy to correct fluid and electrolyte imbalances

A client who has undergone a D&C for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that her vital signs are stable, that bleeding has been controlled, and that the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, what information should discharge teaching include

Iron supplementation' Referral to a support group, if necessary Emphasizing the need for rest

Which statement most accurately describes complicated grief?

Is an extremely intense grief reaction that persists for a long time

Nurses should be aware that the biophysical profile

Is an indicator of fetal well being

The nurse providing care for the antepartum woman should understand that contraction stress test (CST):

Is considered negative if no late decelerations are observed with the contractions.

Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction?

It diminishes as the spiral arteries are compressed.

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share?

It is highly unlikely that you will become pregnant after the procedure." "Sterilization offers no protection against sexually transmitted infections (STIs)."

What defines gestational hypertension as opposed to preeclampsia

It is the onset of htn after week 20 but absent of protienuria and other diagnostics for preeclampsia> 140/90

The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. This clinical finding may be indicative of what?

It may indicate that the infant has a tracheoesophageal fistula or esophageal atresia.

The nurse is providing instruction to the newly delivered client regarding postbirth uterine and vaginal discharge, called lochia. Which statement is the most appropriate?

It should smell like normal menstrual flow unless an infection is present.

A nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. Which statement regarding this intervention is most appropriate?

Kangaroo care helps infants interact directly with their parents and enhances their temperature regulation.

Which FHR decelerations would require the nurse to change the maternal position?

LAte decelerations Variable decelerations Prolonged decelerations

A nurse is assessing a newborn girl who is 2 hours old. Which finding warrants a call to the health care provider?

Laceration of the cheek

The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?

Lactation is inhibited until the progesterone level declines after birth.

The most serious complication of an infant heelstick is necrotizing osteochondritis resulting from lancet penetration of the bone. What approach should the nurse take when performing the test to prevent this complication?

Lancet should penetrate at the outer aspect of the heel.

Which characteristic correctly matches the type of deceleration with its likely cause?

Late deceleration uteroplacental insufficiency

The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth. Which scenario is not a contributor to this model of care?

Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information

Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include?

Lethargy Decrease in exercise capacity Cold intolerance

Which statement correctly describes the effects of various pain factors?

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

Which changes take place in the woman's reproductive system, days or even weeks before the commencement of labor?

Lightening Bloody show Rupture of membranes

Intervention for the sexual abuse survivor often is not attempted by maternity and women's health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman's care?

Listening and encouraging therapeutic communication skills

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 and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is the nurse's most appropriate action at this time?

Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician

. A woman gave birth to a healthy infant boy 5 days ago. What type of lochia does the nurse expect to find when evaluating this client?

Lochia serosa

A mother reports that her baby's skin always appears flushed. What does the nurse suspect to be the reason for this condition in the infant?

Loss of heat from the body

Two days ago a woman gave birth to a full-term infant. Last night she awakened several times to urinate and noted that her gown and bedding were wet from profuse diaphoresis. Which physiologic alteration is the cause for the diaphoresis and diuresis that this client is experiencing?

Loss of increased blood volume associated with pregnancy

Which nursing diagnosis would be most applicable for battered women?

Loss of trust Ineffective family coping Situational low self-esteem Risk for self-directed violence

In assessing the immediate condition of the newborn after birth, a sample of cord blood may be a useful adjunct to the Apgar score. Cord blood is then tested for pH, carbon dioxide, oxygen, and base deficit or excess. Which clinical situation warrants this additional testing? (Select all that apply.)

Low 5-minute Apgar score Intrauterine growth restriction (IUGR) Maternal thyroid diseased. Intrapartum fever

30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. What screening test should be suggested to her?

MSAFP Maternal serum alpha fetoprotein

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that:

MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition?

Macrosomia

A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until the baby is frantically crying. Which feeding cue would indicate that the baby is ready to eat?

Makes sucking motions

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory?

Massage the womans back.

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. What is the nurses highest priority at this time?

Massaging the womans fundus

Which statement is the best rationale for assessing the maternal vital signs between uterine contractions?

Maternal circulating blood volume temporarily increases during contractions.

Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur?

Maternal fever

Most congenital anomalies of the CNS result from defects in the closure of the neural tube during fetal development. Which factor has the greatest impact on this process?

Maternal folic acid deficiency

The nurse is assessing a neonate born by vacuum extraction. What assessment does the nurse perform to detect possible subgaleal hemorrhage?

Measure serial head circumference.

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate?

Meconium aspiration, hypoglycemia, and dry, cracked skin

Which findings would lead to increased bilirubin levels in the newborn?

Meconium passed after 24 hours Initiation of newborn feedings were delayed following birth Twin to twin transfusion syndrome

A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?

Melasma

____________________, a synthetic opiate, has been the therapy of choice for heroin addiction. It crosses the placenta, leading to significant neonatal abstinence syndrome after birth.

Methadone

With one exception, the safest pregnancy is one during which the woman is drug and alcohol free. What is the optimal treatment for women addicted to opioids?

Methadone maintenance treatment (MMT)

The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding?

Methamphetamines

The use of methamphetamine (meth) has been described as a significant drug problem in the United States. The nurse who provides care to this client population should be cognizant of what regarding methamphetamine use?

Methamphetamines are stimulants with vasoconstrictive characteristics.

Which is the most common technique used for the termination of a pregnancy in the second trimester?

Methotrexate administration

The condition, hypospadias, encompasses a wide range of penile abnormalities. Which information should the nurse provide to the anxious parents of an affected newborn?

Mild cases involve a single surgical procedure.

The management of the pregnant client who has experienced a pregnancy loss depends on the type of miscarriage and the signs and symptoms. While planning care for a client who desires outpatient management after a first-trimester loss, what would the nurse expect the plan to include?

Misoprostol

What is the correct terminology for an abortion in which the fetus dies but is retained within the uterus?

Missed abortion

Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus?

Moderate Coffee consumption

What type of cultural concern is the most likely deterrent to many women seeking prenatal care?

Modesty

The nurse is assessing a neonate immediately after birth. How does the nurse document the presence of bluish-black pigmentation on the neonate's buttocks?

Mongolian spots

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 lb, 6 oz). The nurse's most appropriate action is to:

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

A woman in labor has just received an epidural block. What is the most important nursing intervention at this time?

Monitor the maternal blood pressure for possible hypotension.

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:

Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes.

The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score?

More brisk than expected, slightly hyperactive

A careful 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

The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a "C." This response is known as what?

Moro reflex

The nurse should be cognizant of which important information regarding nerve block analgesia and anesthesia?

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

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

Mother Rh, baby Rh+

Which statement is the best rationale for recommending formula over breastfeeding?

Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.

With regard to the understanding and treatment 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, compounding the infant's difficulties

By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. Which significant symptoms will the infant display when experiencing cold stress?

Mottled skin with acrocyanosis

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

Multifetal gestation Obesity Fetal abnormalities Ectopic pregnancy

Which analysis of maternal serum may predict chromosomal abnormalities in the fetus?

Multiple Marker Screening

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

Mutuality

Which statement by a newly delivered woman indicates that she knows what to expect regarding her menstrual activity after childbirth?

My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles.

Several delivery changes in the integumentary system that appear during pregnancy disappear after birth, although not always completely. What change is almost certain to be completely reversed?

Nail brittleness

The nurse is caring for a baby who is 4 weeks old. The nurse finds that the newborn is breathing through the mouth. What does the nurse expect to be the most likely clinical condition for this observation?

Nasal obstruction

A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate?

Natoxone

A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" What is the nurse's best response?

Nausea and vomiting may be due to changes in hormones."

Which gastrointestinal alteration of pregnancy is a normal finding?a. Insufficient salivation (ptyalism) is caused by increases in estrogen.

Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

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:

Negative

Providing care for the neonate born to a 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

When the nurse is alone with a battered client, the client seems extremely anxious and says, "It was all my fault. The house was so messy when he got home, and I know he hates that." What is the most suitable response by the nurse?

No one deserves to be hurt. It's not your fault. How can I help you?"

Developing a realistic birth plan with the pregnant woman regarding her care is important for the nurse. How would the nurse explain the major advantage of nonpharmacologic pain management?

No side effects or risks to the fetus are involved.

When planning care for an infant with a fractured clavicle, the nurse should recognize that in addition to gentle handling:

No special treatment is necessary

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate?

Nonoxynol-9 does not provide protection against STIs as originally thought"

A labor and delivery nurse should be cognizant of which information regarding how the fetus moves through the birth canal?

Normal attitude of the fetus is called general flexion.

During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute period. Which statement best describes the status of this fetus?

Normal baseline heart rate

Which practices contribute to the prevention of postpartum infection?

Not allowing the mother to walk barefoot at the hospital Having staff members with conditions such as strep throat, conjunctivitis, and diarrhea stay homed. Instructing the mother to change her perineal pad from front to back each time she voids or defecates

During a follow-up home visit, the nurse plans to evaluate whether parents have progressed to the second stage of grieving (phase of intense grief). Which behavior would the nurse not anticipate finding?

Numbness or lack of response

With regard to the initial visit with a client who is beginning prenatal care, nurses should be aware that:

Nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support.

Which statement regarding the probable signs of pregnancy is most accurate?

Observed by the health care provider

A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process in preparation to discuss the implementation of this method?

Obtain a history of the woman's menstrual cycle lengths for the past 6 to 12

The nurse is preparing to administer a hepatitis B virus (HBV) vaccine to a newborn. Which intervention by the nurse is correct?

Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration

Term that describes an amniotic sac that contains less than 400 mL of amniotic fluid at term

Oligohydraminos

How often should breast self examinations (BSE) be performed?

Once a month

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate?

Only one vaccine for the HPV is available

What is the correct term used to describe the mucous plug that forms in the endocervical canal?

Operculum

Parents have asked the nurse about organ donation after that infant's death. Which information regarding organ donation is important for the nurse to understand?

Organ donation can aid grieving by giving the family an opportunity to see something positive about the experience

What is the correct placement of the tocotransducer for effective EFM?

Over the uterine fundus

The Period of Purple Crying is a program developed to educate new parents about infant crying and the dangers of shaking a baby. Each letter in the acronym PURPLE represents a key concept of this program. Which concepts are accurate?

P: peak of crying and painful expression U: unexpected E: evening

A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding?

PKU

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression. Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis?

PPD can easily go undetected

While educating the client regarding the risks and benefits of a vasectomy, which information should the nurse include?

Pain, bleeding, and infection are possible complications. For several months, pregnancy may still be possible. Secondary sex characteristics are unaffected.

Screening questions for alcohol and drug abuse should be included in the overall assessment during the first prenatal visit for all women. The 4 Ps Plus is a screening tool specifically designed to identify the need for a more in-depth assessment. Which are the correct components of the 4 Ps Plus? (Select all that apply.)

Parents Partner Present Pregnancy

With regard to an eventual discharge of the high-risk newborn or the transfer of the newborn to a different facility, which information is essential to provide to the parents?

Parents of high-risk infants need special support and detailed contact information.

Because of its size and rigidity, the fetal head has a major effect on the birth process. Which bones comprise the structure of the fetal skull?

Parietal Temporal Occipital

At least five factors affect the process of labor and birth. These are easily remembered as the five Ps. Which factors are included in this process

Passenger Passageway POwers Psychologic response

The nurse is caring for a patient who is breastfeeding a term newborn. What does the nurse teach the patient about how normal stool should appear on the fourth day after birth?

Pasty yellow to golden stool

The reported incidence of ectopic pregnancy has steadily risen over the past 2 decades. Causes include the increase in sexually transmitted infections (STIs) 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 suspects that a client has early signs of ectopic pregnancy. The nurse should be observing the client for which signs or symptoms?

Pelvic pain Abdominal pain Vaginal spotting or light bleeding Missed period

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she:

Pelvic rock excersises

Which of the following are functions of amniotic fluid?

Permit symmetrical external growth and development of the embryo Act as a cushion to protect the embryo against mechanical injury D. Help control the embryo's temperature Provide fluid for analysis to determine fetal health and maturity

A 3.8-kg infant was vaginally delivered at 39 weeks of gestation after a 30-minute second stage. A nuchal cord occurred. After the birth, the infant is noted to have petechiae over the face and upper back. Based on the nurses knowledge, which information regarding petechiae should be shared with the parents?

Petechiae (pinpoint hemorrhagic areas) are benign if they disappear within 48 hours of childbirth.

The most widespread use of postnatal testing for genetic disease is the routine screening of newborns for inborn errors of metabolism (IEM). Which conditions are considered metabolic disorders?

Phenylketonuria (PKU) Galactosemia Hemoglobinopathy

The nurse who is evaluating the client for potential abuse should be aware that IPV includes a number of different forms of abuse, including which of the following?

Physical Sexual Psychological financial

The nurse who is evaluating the client for potential abuse should be aware that intimate partner violence includes (choose all that apply):

Physical abuse Sexual abuse Emotional abuse .Psychologic abuse .Economic abuse

Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?

Pica

What is the nurses initial action while caring for an infant with a slightly decreased temperature?

Place a cap on the infants head, and have the mother perform kangaroo care.

As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Based on the most recent evidence, which information is incorrect and should be discussed with parents?

Place the infant on his or her abdomen to sleep.

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could the nurse use to increase the clients blood pressure? (Select all that apply.)

Place the woman in a lateral position.' Increase IV fluids. Administer oxygen.

Which assessment is not included in the fetal biophysical profile (BPP)?

Placental Grade

Which adverse prenatal outcomes are associated with the HELLP syndrome?

Placental abruption Renal failure Maternal and fetal death

The baseline 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 clients most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change?

Placental abruption Maternal supine hypotension

Which physiologic alteration of pregnancy most significantly affects glucose metabolism?

Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.

A newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. What is the most appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy?

Placing eye shields over the newborns closed eyes

Which action by the mother will initiate the milk ejection reflex (MER)?

Placing the infant to the breast

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

Platypelloid: flattened, wide, and shallow pelvis; 3%

The nurse can help a father in his transition to parenthood by

Pointing out that the infant turned at the sound of his voice

The nurse clamps the umbilical cord of a preterm infant after 3 minutes of birth. What would be the possible effect in the newborn associated with this action?

Polycythemia

Which risk factors are associated with NEC (Necrotizing enterocolitis)?

Polycythemia Anemia Congenital heart disease

Risk factors tend to be interrelated and cumulative in their effect. While planning the care for a laboring client with diabetes mellitus, the nurse is aware that she is at a greater risk for:a.

Polyhydraminos

Intrauterine growth restriction (IUGR) is associated with numerous pregnancy-related risk factors

Poor nutrition Maternal Collagen disease gestational hypertension Smoking

Which instruction should the nurse provide to reduce the risk of nipple trauma?

Position the infant so the nipple is far back in the mouth.

The nurse is caring for an infant with DDH. Which clinical manifestations should the nurse expect to observe?

Positive Ortolani click Unequal gluteal folds

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:

Postpartum blues

Postpartum overdistention of the bladder and urinary retention can lead to which complications?

Postpartum hemorrhage and urinary tract infection

While providing care to the maternity client, the nurse should be aware that one of these anxiety disorders is likely to be triggered by the process of labor and birth. Which disorder fits this criterion?

Posttraumatic stress disorder (PTSD)

The nurse should be cognizant of which physiologic effect of pain?

Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen.

What is the correct definition of a spontaneous termination of a pregnancy (abortion)?

Pregnancy is less than 20 weeks.

What is preecampsia?

Pregnancy-specific condition in which hypertension and protienuria develop after week 20 in a normotensive pt

Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid?

Premature infants more easily digest breast milk than formula.

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection?

Premature rupture of membranes (PROM) 24 hours or longer before the birth

According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum?

Prenatal depresiion

Which laboratory marker is indicative of DIC?

Presence of fibrin split products

For clinical purposes, the most accurate definition of preterm and post-term infants is defined as what?

Preterm: Before 37 weeks of gestation and postterm beyond 42 weeks of gestation; no matter the size for gestational age at birth

Hearing loss is one of the genetic disorders included in the universal screening program. Auditory screening of all newborns within the first month of life is recommended by the AAP. What is the rationale for having this testing performed? (Select all that

Prevents or reduces developmental delays' Provides early identification and treatment Helps the child communicate better Is recommended by the Joint Committee on Infant Hearing

Which preexisting factor is known to increase the risk of GDM?

Previous birth of large infant

What is the nurse's understanding of the appropriate role of primary and secondary powers?

Primary powers are responsible for the effacement and dilation of the cervix.

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 similar to that of a full-term baby. These infants are at increased risk for which conditions?

Problems with thermoregulation Hyperbilirubinemia Sepsis

Which hormone is essential for maintaining pregnancy?

Progesterone

___________ is referred to the hormone of pregnancy.

Progesterone

Which hormone remains elevated in the immediate postpartum period of the breastfeeding woman?

Prolactin

In which clinical situation would the nurse most likely anticipate a fetal bradycardia?

Prolonged umbilical cord compression

What is the highest priority nursing intervention for an infant born with myelomeningocele?

Protect the sac from injury.

A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time?

Provide opportunities for grieving parents and family members to spend time with the baby

What are the responsibilities of the nurse who suspects or confirms any type of violence against a woman?

Provide resources for domestic violence shelters Call a client advocate who can assist in the client's decision about what actions to take Accurately and concisely document the incident (or findings) in the client's record. Reassure and support the client.

After giving birth to a healthy infant boy, a primiparous woman, 16, 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 woman to bathe her infant after she views an infant bath demonstration

What is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum?

Pudendal

Which term best describes the interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state?

Puerperium, or fourth trimester of pregnancy

If a woman is at risk for thrombus and is not ready to ambulate, which nursing intervention would the nurse use? (

Putting her in antiembolic stockings (thromboembolic deterrent [TED] hose) and/or sequential compression device (SCD) boots Having her flex, extend, and rotate her feet, ankles, and legs Immediately notifying the physician if a positive Homans sign occurs

During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion?

Quickeningd. Ballottemente. Lightening

When assessing the fetus using Leopold's maneuvers, the nurse feels a round, firm, and 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 position of the fetus?

RSA

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

Which type of formula is not diluted with water, before being administered to an infant?

Ready-to-use

As part of the discharge teaching, the nurse can prepare the mother for her upcoming adjustment to her new role by instructing her regarding self-care activities to help prevent PPD. Which statement regarding this condition ismost helpful for the client?

Realize that PPD is a common occurrence that affects many women.

A 30-year-old multiparous woman has a boy who is 2 1/2 years old and now an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home." Which suggestion would best help this woman alleviate sibling rivalry?

Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time

An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, My contractions are so strong, I dont know what to do. Before making a plan of care, what should the nurses first action be?

Recognize that pain is personalized for each individual.

What should the nurses next action be if the clients white blood cell (WBC) count is 25,000/mm3 on her second postpartum day?

Recognize that this count is an acceptable range at this point postpartum.

A family is visiting two surviving triplets. The third triplet died 2 days ago. What action indicates that the family has begun to grieve for the dead infant?

Refers to the dead infant in the past tense

Despite warnings, prenatal exposure to alcohol continues to far exceed exposure to illicit drugs. Which condition is rarely associated with fetal alcohol syndrome (FAS)?

Resp. conditions

Infants of mothers with diabetes are at higher risk for

Respiratory distress syndrome

The nurse should be cognizant of which postpartum physiologic alteration?

Respiratory function returns to nonpregnant levels by 6 to 8 weeks after childbirth.

The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern?

Respiratory rate of 10 breaths per minute

The client has delivered by urgent caesarean birth for fetal compromise. Umbilical cord gases were obtained for acid-base determination. The pH is 6.9, partial pressure of carbon dioxide (PCO2) is elevated, and the base deficit is 11 mmol/L. What type of acidemia is displayed by the infant?

Respiratrory

What are the most common causes for subinvolution of the uterus?

Retained placental fragments and infection

The nurse is caring for a full-term neonate born by cesarean. What is the effect of cesarean birth on the respiratory function of the neonate?

Retention of fluid in the lungs

Which physiologic factors are reliable indicators of impending shock from postpartum hemorrhage?

Retractions Skin Level of consciousness Urinary output

The nurse is instructing a family how to care for their infant in a Pavlik harness to treat DDH. What information should be included in the teaching?

Return to the clinic every 1 to 2 weeks.

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

What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?

Risk for injury to mother and fetus, related to central nervous system (CNS) irritability

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (enzyme immunoassay [EIA] 0.8); hematocrit, 30%. How should the nurse best interpret these data?

Rubella vaccine should be administered.

Nurses who are part of a collaborative team that cares for victims of sexual assault and who have special education and training in forensic nursing are called ______________.

SANE nurses

Breathing patterns are taught to laboring women. Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes?

SLow paced breathing

A first-time mother is concerned about the type of medications she will receive during labor. The client is in a fair amount of pain and is nauseated. In addition, she appears to be very anxious. The nurse explains that opioid analgesics are often used along with sedatives. How should the nurse phrase the rationale for this medication combination?

Sedatives enhance the effect of the pain medication.

The 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

Which alterations in the perception of pain by a laboring client should the nurse understand?

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

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 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. Based on the maternal history, the cause of this newborn's distress is most

Sepsis

Anxiety is commonly associated with pain during labor. Which statement regarding anxiety is correct?

Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on.

Which statement is the most comprehensive description of sexual violence?

Sexual violence encompasses a number of sexual acts.

A pregnant woman who abuses cocaine admits to exchanging sex to finance her drug habit. This behavior places the client at the greatest risk for what?

Sexually transmitted infections (STIs)

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 womans IV fluid for a preprocedural bolus. The nurse reviews her laboratory values and notes that the womans 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 this woman?

She has thrombocytopenia.

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant?

She keeps all prentatal appts

Which information should the nurse provide to a breastfeeding mother regarding optimal self-care?

She should avoid trying to lose large amounts of weight.

The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?

She will have increased lordosis.

Reports have linked third trimester use of selective serotonin uptake inhibitors (SSRIs) with a constellation of neonatal signs. The nurse is about to perform an assessment on the infant of a mother with a history of a mood disorder. Which signs and symptoms in the neonate may be the result of maternal SSRI use? (Select all that apply.)

Shivering Fever Irritability

In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and related behaviors observed in the weeks and months after an episode of rape. Researchers identified three phases related to this condition. Which phase is not displayed in a client with RTS?

Shock/Disbelief: Disorientation Phase

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:

Show the mother how the infant initiates interaction and attends to her

A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?

Slightly above the symphysis pubis

An infant is to receive gastrostomy feedings. Which intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?

Slow, small, warm bolus feedings over 30 minutes

Parents are often asked if they would like to have an autopsy performed on their infant. Nurses who are assisting parents with this decision should be aware of which information?

Some religions prohibit autopsy.

A woman who is 30 weeks of gestation arrives at the hospital with bleeding. Which differential diagnosis would not be applicable for this client?

Spontaneous abortion

What are some causes of perinatal loss? Select all that

Stillbirth infertility miscarriage Intrauterine fetal death death of live born infant soon after birth

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important?

Strategies to enhance condom use

Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?

Striae gravidarum

Which factors influence cervical dilation? (Select

Strong uterine contractions Force of the presenting fetal part against the cervix PRessure applied by the amniotic sac Scarring of the cervix

Common characteristics of a potential batterer include (choose all that

Substance abuse problems Personality disorders

If the newborn has excess secretions, the mouth and nasal passages can be easily cleared with a bulb syringe. How should the nurse instruct the parents on the use of this instrument?

Suction the mouth first.

Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court?

Summary of information

During an inpatient psychiatric hospitalization, what is the most important nursing intervention?

Supervising and guiding visits with her infant

The nurse should be aware that the partner's main role in pregnancy is to:

Support and nurture the pregnant woman.

A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?

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

A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that "labor is getting close to starting." Which finding is an indication that labor may begin soon?

Surge of energy

plan of care for an infant experiencing symptoms of drug withdrawal should include:

Swaddling the infant snugly and holding the baby tightly

Pain should be regularly assessed in all newborns. If the infant is displaying physiologic or behavioral cues that indicate pain, then measures should be taken to manage the pain. Which interventions are examples of nonpharmacologic pain management techniques?

Swaddlng Nonnutritive sucking Skin-to-skin contact with the motherd. Sucrose

According to the National Institute of Child Health and Human Development (NICHD) Three-Tier System of FHR Classification, category III tracings include all FHR tracings not categorized as category I or II. Which characteristics of the FHR belong in category III?

Tachycardia Variable decelerations with other characteristics such as shoulders or overshoots Absent baseline variability with recurrent variable decelerations Bradycardia

A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy?

Take one pill at the same time every day.

A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the womans vital signs, which finding would be of greatest concern to the nurse?

Temperature 37.9 C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy

Tetanus Diptheria Hep B

Which of the following is a means of metabolic and nutrient exchange between the embryonic and maternal circulation?

The Placenta

Why might it be more difficult to diagnose appendicitis during pregnancy?

The appendix is displaced upward and laterally, high and to the right.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum (LDRP) unit for the birth of their first child. The nurse applies 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 babys heart rate should be. What is the nurses best response?

The babys heart rate will fluctuate in response to what is happening during labor.

Which explanation will assist the parents in their decision on whether they should circumcise their son?

The circumcision procedure has pros and cons during the prenatal period.

One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings?

The client should be seated. The client's arm should be placed at the level of the heart. The same arm should be used for every reading.

The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurse's decision is that all women should be informed about

The cycle of violence, which continues and escalates over time once it begins

As relates to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that

The father goes through three phases of acceptance of his own.

When nurses help their expectant mothers assess the daily fetal movement counts, they should be aware that:

The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.

A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol?

The fetus is placed at risk for altered brain growth.

A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy?

The fetus may develop neurologic problems.

A client asks the nurse when her ovaries will begin working again. Which explanation by the nurse is most accurate?

The first menstrual flow after childbirth usually is heavier than normal.

Which client would be an ideal candidate for injectable progestins such as medroxyprogesterone acetate as a contraceptive choice?

The ideal candidate has difficulty remembering to take oral contraceptives daily.

Which statement regarding hemolytic diseases of the newborn is most accurate?

The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.

The nurse notices that a newborn has difficulty breathing. What infant behavior might have led to the nurse to this conclusion?

The infant did not cry after birth.

How should the nurse interpret an Apgar score of 10 at 1 minute after birth?

The infant is having no difficulty adjusting to extrauterine life but should be assessed again at 5 minutes after birth. ANS: DAn initial Apgar score of 10 is a good sign of healthy adaptation; however, the test must be repeated at the 5-minute mark.

In follow-up appointments or visits with parents and their new baby, it is useful if the nurse can identify infant behaviors that can either facilitate or inhibit attachment. What is an inhibiting behavior?

The infant seeks attention from any adult in the room.

A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. How should the client be instructed to position the infant to facilitate correct latch-on?

The infants head and body should be in alignment with the mother.

The client is being induced in response to 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 this taking so long?" What is the nurse's most appropriate response?

The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor."

A perinatal nurse is giving discharge instructions to a woman, status postsuction, and curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. What is the bestresponse by the nurse?

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, then it would make the diagnosis of this cancer more difficult

Which statement by the student nurse about pelvic inflammatory disease (PID) indicates effective learning?

The menstrual period facilitates the development of PID.

What is the importance of obtaining informed consent when educating a client regarding contraceptive methods?

The method chosen has potentially dangerous side effects.

A newly delivered mother who intends to breastfeed tells her nurse, I am so relieved that this pregnancy is over so that I can start smoking again. The nurse encourages the client to refrain from smoking. However, this new mother is insistent that she will resume smoking. How will the nurse adapt her health teaching with this new information?

The mother should always smoke in another room

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 identification (ID) of any person who comes to her room.' Parents should use caution when posting photographs of their infant on the Internet. The mom should request that a second staff member verify the identity of any questionable person.

Where should a nurse remove a child's lock of hair for the parents' memorabilia in the event of perinatal loss?

The nape of the neck

The nurse is completing a physical examination of the newborn 24 hours after birth. Which component of the evaluation is correct?

The nurse can gauge the neonates maturity level by assessing his or her general appearance.

Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving?

The parents are discussing sex and a future pregnancy

A newborn with hypoplastic heart syndrome died after 12 hours of resuscitation. The nurse allows the parents to take the newborn's pictures, and provides a certificate along with the identification band. The nurse also refers the client to memorial services. Which behavior of the parents a month after the loss is an indication of positive outcomes of the above nursing intervention?

The parents do not have intense longing and yearning.

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. What is a facilitating behavior?

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

Describe the pathophysiology of preeclampsia. What is the root cause? What is the main pathogenic factor?

The placenta is the root cause

A pregnant woman is being discharged from the hospital after the placement of a cervical cerclage because of a history of recurrent pregnancy loss, secondary to an incompetent cervix. Which information regarding postprocedural care should the nurse emphasize in the discharge teaching?

The presence of any contractions, rupture of membranes (ROM), or severe perineal pressure should be reported.

The nurse should be cognizant of which important statement regarding care of the umbilical cord?

The stump can become easily infected.

A pregnant woman's biophysical profile score is 8. She asks the nurse to explain the results. The nurse's best response is:

The test results are within normal limits

What is a distinct advantage of external EFM?

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

In comparing the abdominal and transvaginal methods of ultrasound examination, nurses should explain to their clients that:

The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.

A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural no matter what! What is the nurses best response?

The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth.

The nurse's best measure of evaluating care of a rape victim is that:

The victim leaves the health care facility without feeling revictimized

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV?

The woman has injuries on various parts of her body that are in different stages of healing.

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. Which response by the client alerts the nurse that psychosocial outcomes have not been met?

The woman has not given the baby a name.

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

The woman is disinterested in learning about infant care

With regard to the initial physical examination of a woman beginning prenatal care, maternity nurses should be cognizant of:

The woman should empty her bladder before the pelvic examination is performed.

The nurse is caring for a woman who experienced a perinatal loss. The nurse finds that the woman is experiencing an intense stage of grieving. What observation did the nurse find in the client?

The woman weeps when she experiences leakage of breast milk.

Some pregnant clients may report changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings?

These changes are the results of congestion and swelling of the upper respiratory tract.

Why do women often say they were pregnant for 10 months?

They are not calculating weeks gestation, which is based on a lunar calendar, rather than the Julian calendar we use for time.

Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct?

This laboratory test measures the levels of hemoglobin Alc, which should remain at less than 7%.

A new father wants to know what medication was put into his infants eyes and why it is needed. How does the nurse explain the purpose of the erythromycin (Ilotycin) ophthalmic ointment?

This ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes, potentially acquired from the birth canal.

Which information is most important to provide to the client interested in using the lactational amenorrhea method for contraception?

This popular method of birth control works best if the mother is exclusively breastfeeding.

The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method?

This practice is the only contraceptive method acceptable to the Roman Catholic Church.

A woman is in her seventh month of pregnancy. She reports episodes of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?

This respiratory change is normal in pregnancy and caused by an elevated level of estrogen.

A woman arrives at 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 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

Human immunodeficiency virus (HIV) may be perinatally transmitted:

Through the ingestion of breast milk from an infected mother

Which statement is accurate with regard to the emotional state of grief?

Time limit for grief

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 37.3° C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, "I'm so thirsty and warm." What is the nurse's immediate action?

To discontinue the magnesium sulfate infusion

In which situation would the nurse be called on to stimulate the fetal scalp?

To elicit an acceleration in the FHR

During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. What is the nurse's role at this time?

To ensure that the parents, themselves, approve the

The nurse is caring for a client who lost her newborn 8 hours after the birth. The nurse interacts with the client in an isolated room, identifies the client's perception and feelings about death, and refers the client to counseling. What is the rationale behind these interventions?

To improve and maintain the client's self-esteem

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. What goal is the nurse attempting to achieve by performing this practice?

To improve the accuracy of blood loss estimation, which usually is a subjective assessment

What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia?

To prevent convulsions

In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose?

To protect the mother and fetus during pregnancy

What is the primary rationale for nurses wearing gloves when handling the newborn?

To protect the nurse from contamination by the newborn

A woman with preeclampsia has a seizure. What is the nurse's highest priority during a seizure?

To stay with the client and call for help

The nurse performs nasal and oral suctioning of a newborn immediately after birth. What is the reason for this nursing intervention?

To stimulate respiration

Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications

Tobacco

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV?

Topical podofilox 0.5% solution or gel

What is the primary difference between the labor of a nullipara and that of a multipara?

Total duration of labor

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, which diagnostic procedure will the client most likely have performed?

Transvaginal ultrasound for placental location

While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that:

Tub bathing is permitted even in late pregnancy unless membranes have ruptured.

What three measures should the nurse implement to provide intrauterine resuscitation?

Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids.

Which statement about multifetal pregnancy is inaccurate?

Twin pregnancies come to term with the same frequency as single pregnancies.

In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments?

Type 2 diabetes often goes undiagnosed.

The nurse is using intermittent auscultation (IA) to locate the fetal heartbeat. Which statement regarding this method of surveillance is accurate?

Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor.

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 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?

Ultrasound for fetal anomalies

Which of the following provides the circulatory pathway from the placenta to the fetus?

Umbilical Cord

What is the most likely cause for variable FHR decelerations?

Umbilical cord compression

With regard to skeletal injuries sustained by a neonate during labor or birth, nurses should be aware that:

Unless a blood vessel is involved, linear skull fractures heal without special treatment

The nurse is preparing to administer methotrexate to the client. This hazardous drug is most often used for which obstetric complication?

Unruptured ectopic pregnancy

Which actions are examples of appropriate techniques to wake a sleepy infant for breastfeeding?

Unwrapping the infant Changing the diaper Talking to the infant

The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations?

Uteroplacental insufficiency

The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension. Which outcome might occur if the interventions for maternal hypotension are inadequate?

Uteroplacental insufficiency

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider?

Vaginal Bleeding

Signs and symptoms that a woman should report immediately to her health care provider include

Vaginal Bleeding Rupture of membranes Heartburn with severe headache

Which description of postpartum restoration or healing times is accurate?

Vaginal rugae reappear by 3 weeks postpartum.

A laboring woman with no known risk factors suddenly experiences spontaneous ROM. The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline rapidly after the ROM. The nurse should suspect the possibility of what condition?

Vasa previa

What is the basic mechanism for conserving internal heat within infants?

Vasocnstriction

The umbilical _______ carries oxygenated blood from the mother to the fetus.

Vein

The nurse is caring for a healthy caucasian neonate who was born at 37 weeks of gestation. What does the nurse find while performing the skin assessment of the newborn immediately after the birth?

Vernix casesosa covering the body

Which statement regarding human trafficking is correct?

Victims often experience the Stockholm syndrome.

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is what?

Vision

When dealing with parents who have some form of sensory impairment, nurses should realize that all of these statements are true except:

Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact.

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction?

Vomiting and diarrhea

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

Vulva bulges and encircles the fetal head.

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

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn?

Wear gloves

Connective tissue that surrounds the umbilical cord and provides protection against cord compression

Whartons jelly

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. In 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.

Which statement is the most appropriate for the nurse to make when caring for bereaved parents?

What can I do for you?"

A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to verbalize?

What will the baby eat

In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind?

Whatever the position used, the infant is belly to belly with the mothe

Early this morning, an infant boy was circumcised using the PlastiBell method. Based on the nurses evaluation, when will the infant be ready for discharge?

When the infant voids

When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that

While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so

A 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 three times daily, and a stool softener. Which information regarding the clients condition is most closely correlated with these orders?

Woman has an episiotomy.

Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient?

Woman's increased urinary frequency in the first trimester is the result of exaggerated uterine anti-reflexion caused by softening.

What information should the nurse understand fully regarding rubella and Rh status?

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

With regard to a woman's reordering of personal relationships during pregnancy, the maternity nurse should understand that:

Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father.

Historically, what was the justification for the victimization of women?

Women were regarded as possessions.

The nurse suspects that a client with frequent complaints of diarrhea, weight loss, and rash has human immunodeficiency virus (HIV) infection. The client is afraid of having blood drawn for screening purposes. What does the nurse tell the client?

You can provide a saliva sample for testing."

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:

You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month."

According to demographic research, which woman is least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding?

Younger than 25 years of age, African-American, and employed full time outside the home

An infant is being discharged from the NICU after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), requiring surgical treatment. During discharge teaching, the infant's mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. What is the nurse's most appropriate response?

Your baby will need to be corrected for prematurity."

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurse's best response?

Your current medications will reduce the effectiveness of the pill."

A client asks her nurse, "My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean?" The best response by the nurse is:

Your placenta changes as your pregnancy progresses, and it is given a score that indicates the amount of calcium deposits it has. The more calcium deposits, the higher the grade, or number, that is assigned to the placenta. It also means that less blood and oxygen can be delivered to your baby."

Which term best describes the conscious decision concerning deciding when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse?

a. Family planning

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver:

alerts the physician that the infant may have a dislocated hip.

Which statements regarding the HPV are accurate?

are thought to be more common in pregnant women than in women who are not pregnant. were previously called genital warts. may cause cancer.

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that:

articipation in preparation classes helps both siblings and grandparents.

What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor?

b. Molding

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 _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth. What is the correct interpretation of this legislation?

c. 48; 96

Which statement best describes a normal uterine activity pattern in labor?

contractions every 2 to 5 minutes

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:

explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements.

Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium?

headaches

According to the CDC, which of the following are significant causes of maternal death in the United States? (Select

hemorrhage cardio-vascular disease non-cardiovascular conditions hypertensive disorders

When caring for a newborn, the nurse must be alert for signs of cold stress, including:

increased respiratory rate.

A client tells the nurse, "While crying, my baby often moves its hand towards its mouth and also gets startled by the sound of the rattle." What statement given by the nurse best explains this behavior? "The baby:

is consoling itself

Which FHR finding is the most concerning to the nurse who is providing care to a laboring client?

late decelerations

Yolanda is 6 weeks pregnant by dates and is considering abortion. What options might be appropriate for her at this point?

medical abortion with mifepristone and misopristol surgical abortion with aspiration

During an ultrasound, the ultrasound technician sees 2 embryos that share an amnion and a chorion. The ultrasound tech informs the expecting mother that she is pregnant with:

monochorionic-monoamniotic twins

A nurse caring for a woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate. Which condition related to decreased variability is considered benign?

periodic fetal sleep state

Term that describes an amniotic sac that contains more than 2000 mL of amniotic fluid at term

polyhydraminos

What maintains the pregnancy until the placenta has matured enough (at about 11 weeks)?

the corpus luteum

In the first trimester, ultrasonography can be used to gain information on:

the presence of maternal abnormalities

What is a major complication associated with monochorionic-monoamniotic twins?

umbilical cords getting tangled and risk of death in utero

Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion?

variable decelerations