ob test 2

The nurse teaching a group of new mothers and explains that barrier methods of contraception are appropriate if which of the following conditions exist? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Just started an oral contraceptive 2. Is opposed to systemic medications 3. Is lactating 4. Is unconcerned about using contraception 5. Does not smoke and is perimenopausal

Answer: 1, 2, 3, 5 Explanation: 1. A backup method of contraception is needed for a period of time when beginning oral contraceptives. 2. Opposition to taking systemic medications is a reason to use barriers for contraception. 3. Using a barrier method of contraception is appropriate in the early postpartum period or when lactating. 5. Being perimenopausal and smoking make barrier contraception an appropriate choice.

Childbirth preparation offers several advantages including which of the following? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. It helps a pregnant woman and her support person understand the choices in the birth setting. 2. It promotes awareness of available options. 3. It provides tools for a pregnant woman and her support person to use during labor and birth. 4. Women who receive continuous support during labor require more analgesia, and have more cesarean and instrument births. 5. Each method has been shown to shorten labor.

Answer: 1, 2, 3, 5 Explanation: 1. Childbirth preparation offers several advantages. It helps a pregnant woman and her support person understand the choices in the birth setting, promotes awareness of available options, and provides tools for them to use during labor and birth. 2. Childbirth preparation offers several advantages. It helps a pregnant woman and her support person understand the choices in the birth setting, promotes awareness of available options, and provides tools for them to use during labor and birth. 3. Childbirth preparation offers several advantages. It helps a pregnant woman and her support person understand the choices in the birth setting, promotes awareness of available options, and provides tools for them to use during labor and birth. 5. Childbirth preparation offers several advantages. Each method has been shown to shorten labor.

Upon assessing the FHR tracing, the nurse determines that there is fetal tachycardia. The fetal tachycardia would be caused by which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Early fetalhypoxia 2. Prolonged fetal stimulation 3. Fetal anemia 4. Fetal sleep cycle 5. Infection

Answer: 1, 2, 3, 5 Explanation: 1. Early fetal hypoxia can cause fetal tachycardia. 2. Prolonged fetal stimulation can cause fetal tachycardia. 3. Fetal anemia can cause fetal tachycardia. 5. Infection can cause fetal tachycardia.

The culturally sensitive nurse will assess cultural attitudes and beliefs about contraception, which can include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Gender inequities 2. Religion 3. Deference to authority figures 4. Devaluation of large families 5. Attitudes about bleeding

Answer: 1, 2, 3, 5 Explanation: 1. Gender inequities may prohibit some Arab, Latina, and Eastern Indian women 2. The Roman Catholic Church considers all artificial methods of contraception unacceptable. 3. Deference to authority figures is not uncommon in traditional Chinese, Arab, Latina, and East Indian women, especially if the nurse is male. 5. Attitudes toward bleeding affect a woman's duties to her family and partner. Vaginal bleeding may be seen as "unclean" by Muslim and Orthodox Jewish women. Any contraceptive method that involves irregular bleeding might not be acceptable. Among women who feel a monthly period is necessary, any method that ultimately causes amenorrhea would not be acceptable.

21) The nurse is presenting a class for nursing students on multiple-gestation pregnancy. Which statements about multiple-gestation pregnancies are accurate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Hypertension is a major maternal complication. 2. Gestational diabetes occurs more often. 3. Maternal anemia occurs. 4. Pulmonary embolism is 12 times more likely to develop during pregnancy with multiple gestations. 5. Multiple gestations are more likely to acquire HELLP.

Answer: 1, 2, 3, 5 Explanation: 1. Hypertension is a complication in multiple-gestation pregnancies. 2. Gestational diabetes occurs more often in multiple gestations. 3. Maternal anemia occurs because of demands of the multiple gestations. 5. Multiple gestations are more likely to acquire HELLP (hemolytic anemia, elevated liver enzymes, and low platelet count) syndrome, a complication resulting from eclampsia or preeclampsia.

The nurse is teaching a class on reading a fetal monitor to nursing students. The nurse explains that bradycardia is a fetal heart rate baseline below 110 and can be caused by which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Maternal hypotension 2. Prolonged umbilical cord compression 3. Fetal dysrhythmia 4. Central nervous system malformation 5. Late fetal asphyxia

Answer: 1, 2, 3, 5 Explanation: 1. Maternal hypotension results in decreased blood flow to the fetus. 2. Cord compression can cause fetal bradycardia. 3. This will cause fetal bradycardia if there is a fetal heart block. 5. This is a depression of myocardial activity.

The nurse has completed the physical assessment of a client in early labor, and proceeds with the social assessment. A social history of the client would include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use of drugs and alcohol 2. Family violence or sexual assault 3. Current living situation 4. Type of insurance 5. Availability of resources

Answer: 1, 2, 3, 5 Explanation: 1. Risk factors such as the use of drugs or alcohol during the pregnancy can influence the labor and birth. 2. It is imperative to ask the woman about domestic violence and to assess any degree of psychologic or physical harm, either potential or real. 3. A social assessment includes asking about the woman's current living situation. This dialog provides an opportunity for the nurse to continue to build support, to provide information when requested, and to be direct yet supportive. 5. A social assessment includes asking about resources available to the family.

In planning a conference for adolescents, the nurse researches the most common socioeconomic and cultural factors that contribute to adolescent pregnancy. Which true statements should be included in this conference? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Economic status has a relatively low impact on an adolescent's sexual activity. 2. Nearly three quarters of all teens ages 15-19 have had sex at least once. 3. Poor self-esteem contributes to adolescent pregnancy. 4. 38% percent of sexually active students use a condom. 5. Sexual abuse is not an issue with teen mothers.

Answer: 2, 3 Explanation: 2. By 19 years of age, 70% of all teens have had intercourse. 3. This is a true statement. Poor self-esteem is a major contributing factor in adolescent pregnancy.

A nurse is teaching contraception to a group of college students during a health class. What reason will the nurse include as to why couples might choose to use contraception? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Couples use contraception to avoid pregnancy. 2. Couples use contraception to space future pregnancies. 3. Couples use contraception to gain control over the number of children conceived. 4. Couples use contraception to avoid decisions about the number of children to have. 5. Couples use contraception to avoid contracting sexually transmitted diseases.

Answer: 1, 2, 3, 5 Explanation: 1. This is the main reason for the use of contraception. 2. Contraception is used to space children. 3. Contraception is used to control the number of children that a couple desires. 5. Some types of birth control will avoid sexually transmitted diseases—for example, some of the barrier methods.

The nurse is teaching the significance of good nutrition on fetal development to a group of young women. What factors will the nurse discuss? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Vitamins and folic acid are important before conception. 2. Maternal nutrition may predispose to the development of adult coronary heart disease, hypertension, and diabetes. 3. Glucose, amino acids, and fatty acids are of high importance. 4. Nutrition is important only during the first trimester. 5. Maternal nutrition can affect brain and neural tube development.

Answer: 1, 2, 3, 5 Explanation: 1. Vitamins and folic acid supplements taken before conception can reduce the incidence of neural tube defects. 2. This is true. Maternal nutrition may predispose to the development of adult coronary heart disease, hypertension, and diabetes. 3. Amino acids, glucose, and fatty acids are considered to be the primary dietary factors in brain growth. 5. Adequacy of the maternal environment is also important during the periods of rapid embryonic and fetal development. Maternal nutrition can affect brain and neural tube development.

The nurse teaches a client that luteinizing hormone (LH) is important in the ovarian cycle for which purposes? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Proliferation of the endometrial mucosa 2. Ovulation 3. Corpus luteum development 4. Maturation of the ovarian follicle 5. Cyclic changes that allow pregnancy not to occur

Answer: 2, 3 Explanation: 2. During the follicular phase, the primordial follicle matures under the influence of FSH and LH until ovulation occurs. 3. The corpus luteum develops under the influence of LH during the luteal phase.

21) For what common side effects of epidural anesthesia should the nurse watch? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Elevated maternal temperature 2. Urinary retention 3. Nausea 4. Long-term back pain 5. Local itching

Answer: 1, 2, 3, 5 Explanation: 1. Elevated maternal temperature is a potential side effect of epidural anesthesia. 2. Urinary retention is a potential side effect of epidural anesthesia. 3. Nausea is a potential side effect of epidural anesthesia. 5. Pruritus may occur at any time during the epidural infusion. It usually appears first on the face, neck, or torso and is generally the result of the agent used in the epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus.

31) In caring for a client with a uterine rupture, the nurse determines which nursing diagnoses to be appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Gas Exchange, Impaired 2. Fear related to unknown outcome 3. Coping, Ineffective 4. Mobility: Physical, Impaired 5. Anxiety

Answer: 1, 2, 3, 5 Explanation: 1. Gas Exchange, Impaired diagnosis could apply to both mother and fetus. 2. The client would experience fear related to an unknown outcome. 3. Ineffective coping would be due to emergent situation secondary to uterine rupture. 5. There will be anxiety related to emergency procedures and unknown fetal outcome. Page Ref: 617

A client has just arrived in the birthing unit. What steps would be most important for the nurse to perform to gain an understanding of the physical status of the client and her fetus? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Check for ruptured membranes and apply a fetal scalp electrode. 2. Auscultate the fetal heart rate between and during contractions. 3. Palpate contractions and resting uterine tone. 4. Assess the blood pressure, temperature, respiratory rate, and pulse rate. 5. Perform a vaginal exam for cervical dilation, and perform Leopold maneuvers.

Answer: 2, 3 Explanation: 2. Fetal heart rate auscultation gives information about the physical status of the fetus. 3. Contraction palpation provides information about the frequency, duration, and intensity of the contractions.

5) Nonreassuring fetal status often occurs with a tachysystole contraction pattern. Intrauterine resuscitation measures may become warranted and can include which of the following measures? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Position the woman on her right side. 2. Apply oxygen via face mask. 3. Call for anesthesia provider for support. 4. Increase intravenous fluids by at least 700 mL bolus. 5. Call the physician/CNM to the bedside.

Answer: 2, 3, 4 Explanation: 2. The nurse would apply oxygen via face mask. 3. The nurse would call for anesthesia provider for support. 4. The nurse would increase intravenous fluids by at least 500 mL bolus.

Premonitory signs of labor include which of the following? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Braxton Hicks contractions 2. Cervical softening and effacement 3. Weight gain 4. Rupture of membranes 5. Sudden loss of energy

Answer: 1, 2, 4 Explanation: 1. A premonitory sign of labor includes Braxton Hicks contractions. 2. A premonitory sign of labor includes cervical softening and effacement. 4. A premonitory sign of labor includes rupture of membranes.

The nurse is caring for a client in labor. Which signs and symptoms would indicate the client is progressing into the second stage of labor? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Bulging perineum 2. Increased bloody show 3. Spontaneous rupture of the membranes 4. Uncontrollable urge to push 5. Inability to breathe through contractions

Answer: 1, 2, 4 Explanation: 1. As the fetal head continues its descent, the perineum begins to bulge, flatten, and move anteriorly. 2. Bloody show increases as a woman enters the second stage of labor. 4. As the fetal head descends, the woman has the urge to push because of pressure of the fetal head on the sacral and obturator nerves.

The OB-GYN nurse knows that the proliferative phase of the menstrual cycle includes which changes? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Thin, clear cervical mucus 2. Estrogen peaks just before ovulation 3. No ferning pattern of cervical mucus 4. A pH change to 7.5 5. Epithelium warps into folds

Answer: 1, 2, 4 Explanation: 1. Cervical mucus at ovulation becomes thin, clear, watery, and more alkaline, making it more favorable to spermatozoa. 2. Estrogen peaks just before ovulation in the proliferative phase of the menstrual cycle. 4. The cervical mucosa pH increases from below 7 to 7.5 at the time of ovulation.

3) Risk factors for tachysystole include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Cocaine use 2. Placental abruption 3. Low-dose oxytocin titration regimens 4. Uterine rupture 5. Smoking

Answer: 1, 2, 4 Explanation: 1. Cocaine use is a risk factor for tachysystole. 2. Placental abruption is a risk factor for tachysystole. 4. Uterine rupture is a risk factor for tachysystole.

1) The client is undergoing an emergency cesarean birth for fetal bradycardia. The client's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Allow the partner to wheel the baby's crib to the newborn nursery. 2. Allow the partner to be near the operating room where the newborn's first cry can be heard. 3. Have the partner wait in the client's postpartum room. 4. Encourage the partner to be in the nursery for the initial assessment. 5. Teach the partner how to take the client's blood pressure.

Answer: 1, 2, 4 Explanation: 1. Effective measures include allowing the partner to take the baby to the nursery. 2. Effective measures include allowing the partner to be in a place near the operating room, where the newborn's first cry can be heard. 4. Effective measures include involving the partner in postpartum care in the recovery room. Page Ref: 646

A full-term infant has just been born. Which interventions should the nurse perform first? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Placing the infant in a radiant-heated unit 2. Suctioning the infant with a bulb syringe 3. Wrapping the infant in a blanket 4. Evaluating the newborn using the Apgar system 5. Offering a feeding of 5% glucose water

Answer: 1, 2, 4 Explanation: 1. If the newborn is placed in a radiant-heated unit, he or she is dried, laid on a dry blanket, and left uncovered under the radiant heat. 2. Newborns are suctioned with a bulb syringe to clear mucus from the newborn's mouth. 4. The purpose of the Apgar score is to evaluate the physical condition of the newborn at birth.

The nurse is teaching an infertile couple about the causes of infertility. The nurse tells them that infertility can be caused by which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Immunological responses 2. Congenital anomalies 3. Patent fallopian tubes 4. Hypothyroidism 5. Favorable cervical mucus

Answer: 1, 2, 4 Explanation: 1. Immunological responses, such as antisperm antibodies, can cause infertility. 2. Congenital anomalies, such as a septate uterus, can cause infertility. 4. Hypothyroidism is a cause of infertility.

29) What of the following nursing interventions are appropriate when caring for the family experiencing a stillbirth? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use active listening techniques. 2. Avoid the use of clichés. 3. Avoid periods of silence. 4. Wrap the infant in a blanket before the parents see the infant. 5. Do not permit the parents of an infant with birth defects to hold the infant.

Answer: 1, 2, 4 Explanation: 1. It is important to allow the parents to verbalize their concerns. 2. The nurse can facilitate a healthy mourning process for the family by using active listening techniques and avoiding the use of clichés and platitudes. 4. The infant should be wrapped in a blanket to allow parents to see the infant before viewing any deformities. Page Ref: 954, 959, 962

11) Under which circumstances would the nurse remove prostaglandin from the client's cervix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Contractions every 5 minutes 2. Nausea and vomiting 3. Uterine tachysystole 4. Cardiac tachysystole 5. Baseline fetal heart rate of 140-148

Answer: 2, 3, 4 Explanation: 2. A reason to remove prostaglandin from a client's cervix is the presence of nausea and vomiting. 3. A reason to remove prostaglandin from a client's cervix is uterine tachysystole. 4. A reason to remove prostaglandin from a client's cervix is cardiac tachysystole. Page Ref: 627

A nurse working with adolescents recognizes risk factors for pregnancy include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Low socioeconomic status 2. A belief in invulnerability 3. A highly functional family 4. Physical, emotional, or sexual abuse 5. Accurate information about contraception

Answer: 1, 2, 4 Explanation: 1. Poverty is a major risk factor for adolescent pregnancy. 2. The sense of invulnerability and "it won't happen to me" thinking can lead adolescents to participate in sexual activity with an overly optimistic view of the outcomes of the risks associated with their actions. 4. Physical, emotional, or sexual abuse increases the risk of teenage pregnancy.

What are the three functions of the fallopian tubes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Provide transport for the ovum from the ovary to the uterus 2. Serve as a warm, moist, nourishing environment for the ovum or zygote 3. Secrete large amounts of estrogens 4. Provide a site for fertilization to occur 5. Support and protect the pelvic contents

Answer: 1, 2, 4 Explanation: 1. The fallopian tubes provide transport for the ovum from the ovary to the uterus. 2. The fallopian tubes serve as a warm, moist, nourishing environment for the ovum or zygote. 4. The fallopian tubes provide a site for fertilization to occur.

The nurse educator is teaching student nurses what a fetus will look like at various weeks of development. Which descriptions would be typical of a fetus at 20 weeks' gestation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The fetus has a body weight of 435-465 g. 2. Nipples appear over the mammary glands. 3. The kidneys begin to produce urine. 4. Nails are present on fingers and toes. 5. Lanugo covers the entire body.

Answer: 1, 2, 4, 5 Explanation: 1. A fetus at 20 weeks' gestation has a body weight of 435-465 g. 2. A fetus at 20 weeks' gestation has nipples appear over the mammary glands. 4. A fetus at 20 weeks' gestation nails are present on fingers and toes. 5. A fetus at 20 weeks' gestation has lanugo that covers the entire body.

The nurse is discussing the use of contraception with a client who has just become sexually active. What factors should the nurse include when educating the client on contraceptive methods? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Contraindications in the client's health history 2. Religious or moral beliefs 3. Partner's belief in the effectiveness of the choice 4. Personal preferences to use method 5. Future childbearing plans

Answer: 1, 2, 4, 5 Explanation: 1. Decisions about contraception should take into consideration any contraindications the client might have. 2. Religious or moral beliefs often impact which choices are acceptable. 4. Personal preferences need to be considered when deciding on a contraceptive method. 5. Plans for future children should be considered before determining whether sterilization should be performed.

33) When caring for a laboring client with oligohydramnios, what should the nurse be aware of? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased risk of cord compression 2. Decreased variability 3. Labor progress is often more rapid than average 4. Presence of periodic decelerations 5. During gestation, fetal skin and skeletal abnormalities can occur

Answer: 1, 2, 4, 5 Explanation: 1. During the labor and birth, the lessened amounts of fluid reduce the cushioning effect for the umbilical cord, and cord compression is more likely to occur. 2. The nurse should evaluate the EFM tracing for the presence of nonperiodic decelerations or other nonreassuring signs (such as increasing or decreasing baseline, decreased variability, or presence of periodic decelerations). 4. The nurse should evaluate the EFM tracing for the presence of nonperiodic decelerations or other nonreassuring signs (such as increasing or decreasing baseline, decreased variability, or presence of periodic decelerations). 5. During the gestational period, fetal skin and skeletal abnormalities may occur because fetal movement is impaired as a result of inadequate amniotic fluid volume.

The nurse is caring for a client who is showing a sinusoidal fetal heart rate pattern on the monitor. The nurse knows that possible causes for this pattern include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fetal anemia 2. Chronic fetal bleeding 3. Maternal hypotension 4. Twin-to-twin transfusion 5. Umbilical cord occlusion

Answer: 1, 2, 4, 5 Explanation: 1. Fetal anemia can cause a sinusoidal heart rate. 2. Chronic fetal bleeding can cause a sinusoidal heart rate. 4. Twin-to-twin transfusion will cause a sinusoidal heart rate. 5. Umbilical cord occlusion can cause a sinusoidal fetal heart rate.

The nurse is talking with a couple who have been trying to get pregnant for 5 years. They are now at the fertility clinic seeking help. The nurse assesses their emotional responses as part of the workup. Which responses would the nurse expect to hear? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Experiencing a sense of loss of status 2. Feelings of failure because they cannot make a baby 3. Healthy relationship with healthcare partners 4. Stress on the marital and sexual relationship 5. Feelings of frustration

Answer: 1, 2, 4, 5 Explanation: 1. The couple may experience feelings of loss of status and ambiguity as a couple. 2. Feelings of failure are common. 4. The couple may experience stress on the marital and sexual relationship. 5. Tests and treatments may heighten feelings of frustration or anger between partners.

The nurse is holding a class for newly pregnant couples, and discussing good and bad influences on their developing babies. Prenatal influences on the intrauterine environment include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The use of saunas or hot tubs 2. The use of drugs 3. The quality of the sperm or ovum 4. Maternal nutrition 5. Vitamins and folic acid

Answer: 1, 2, 4, 5 Explanation: 1. The use of saunas or hot tubs is associated with maternal hyperthermia. Studies of the effects of maternal hyperthermia during the first trimester have raised concern about possible spontaneous abortion, central nervous system (CNS) defects, and failure of neural tube closure. 2. The use of drugs can have teratogenic effects. 4. Maternal nutrition affects brain and neural tube development. 5. Vitamins and folic acid supplements taken before conception can reduce the incidence of neural tube defects.

2) The nurse is assessing a client before administering an analgesic. What are some of the factors the nurse should consider? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client is willing to receive medication after being advised about it. 2. The client's vital signs are stable. 3. The partner agrees to use of the medication. 4. The client has no known allergies to the medication. 5. The client is aware of the contraindications of the medication.

Answer: 1, 2, 4, 5 Explanation: 1. Medication should be explained to the client before it is administered. 2. Vital signs need to be stable before any analgesic medication is administered. 4. Ask the client about allergies before administering any medications. 5. Clients should always be aware of the contraindications of the medication.

When caring for a 13-year-old client in labor, how would the nurse provide sensitive care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Using simple and concrete instructions 2. Providing soothing encouragement and comfort measures 3. Making all decisions for the client when she expresses a feeling of helplessness 4. Deciding whom the client should allow in the room 5. Providing encouragement and support of the client's decisions

Answer: 1, 2, 5 Explanation: 1. A client at this developmental stage will need concrete and simplified instructions. 2. Touch, soothing encouragement, and measures to promote her comfort help her maintain control and meet her needs for dependence. 5. Establishing rapport without recrimination will provide emotional support and encouragement.

17) The nurse is caring for a client who has just experienced a stillbirth. Which factors does the nurse recognize as potentially complicating the parents' response to this loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Unsupportive family 2. Adolescent mother 3. Strong religious faith 4. Open communication between the parents 5. Persistent denial of the situation

Answer: 1, 2, 5 Explanation: 1. Features of bereaved individuals' circumstances that will put them at risk include an unsupportive or unavailable family. 2. With regard to age, adolescent parents probably pose the greatest challenge to nursing interventions. 5. Persistent denial hampers the grieving and healing processes. Page Ref: 947, 948

The client presents to the labor and delivery unit stating that her water broke 2 hours ago. Indicators of normal labor include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fetal heart rate of 130 with average variability 2. Blood pressure of 130/80 3. Maternal pulse of 160 4. Protein of +1 in urine 5. Odorless, clear fluid on underwear

Answer: 1, 2, 5 Explanation: 1. Fetal heart rate (FHR) of 110-160 with average variability is a normal indication. 2. Maternal vital sign of blood pressure below 140/90 is a normal indication. 5. Fluid clear and without odor if membranes ruptured is a normal indication.

The nurse is planning a prenatal class for a group of pregnant adolescents. The nurse will establish which goals for the class? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Provide anticipatory guidance 2. Prepare the participants for labor and birth 3. Avoid discussion of the client's conflicts 4. Provide community resources if asked 5. Help the participants develop coping skills

Answer: 1, 2, 5 Explanation: 1. Goals for a prenatal class designed for adolescents must include anticipatory guidance. 2. Goals for a prenatal class designed for adolescents must include preparing the participants for labor and the birth of their baby. 5. Goals for a prenatal class designed for adolescents must include helping the participants develop adequate coping skills.

Fetal factors that possibly indicate electronic fetal monitoring include which of the following? Select all that apply. 1. Meconium passage 2. Multiple gestation 3. Preeclampsia 4. Grand multiparity 5. Decreased fetal movement

Answer: 1, 2, 5 Explanation: 1. Meconium passage is an indicator for electronic fetal monitoring. 2. Multiple gestation is an indicator for electronic fetal monitoring. 5. Decreased fetal movement is an indicator for electronic fetal monitoring.

Ovarian hormones include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Estrogens 2. Progesterone 3. Parathyroid hormone 4. Luteinizing hormone 5. Testosterone

Answer: 1, 2, 5 Explanation: 1. Ovarian hormones include the estrogens, progesterone, and testosterone. 2. Ovarian hormones include the estrogens, progesterone, and testosterone. 5. Ovarian hormones include the estrogens, progesterone, and testosterone.

3) A client in labor is requesting pain medication. The nurse assesses her labor status first, focusing on which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Contraction pattern 2. Amount of cervical dilatation 3. When the labor began 4. Whether the membranes are intact or ruptured 5. Fetal presenting part

Answer: 1, 2, 5 Explanation: 1. The client should have a good contraction pattern before receiving an analgesic. 2. The nurse should evaluate the amount of cervical dilatation before analgesic medication is administered. 5. If normal parameters are absent or if nonreassuring maternal or fetal factors are present, the nurse may need to complete further assessments with the physician/CNM.

26) During labor, the client at 4 cm suddenly becomes short of breath, cyanotic, and hypoxic. The nurse must prepare or arrange immediately for which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Intravenous access 2. Cesarean delivery 3. Immediate vaginal delivery 4. McRoberts maneuver 5. A crash cart

Answer: 1, 2, 5 Explanation: 1. When an amniotic fluid embolism is suspected, intravenous access is obtained as quickly as possible. 2. Shortness of breath, cyanosis, and hypoxia are symptoms of an amniotic fluid embolus, which necessitates immediate cesarean delivery. 5. The chances of a code are high, so the crash cart needs to be available. Page Ref: 616

8) A couple request to see their stillborn infant. How should the nurse prepare the infant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Wrapping the infant in a blanket 2. Removing all blankets from the infant 3. Placing a hat on the infant 4. Removing any identification from the infant 5. Placing a diaper on the infant

Answer: 1, 3 Explanation: 1. After bathing, the infant should be placed in a suitable-sized gown and then wrapped in a blanket. Many parents will eventually remove the covering to inspect the infant; however, applying a covering allows them time to adjust to the appearance at their own pace. 3. A hat can be applied to cover birth defects. This allows the parents an opportunity to view the infant before seeing the birth defect. Page Ref: 959

8) What are the primary complications of placenta accrete? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Maternal hemorrhage 2. Insomnia 3. Failure of the placenta to separate following birth of the infant 4. Autonomic dysreflexia 5. Shoulder dystocia

Answer: 1, 3 Explanation: 1. The primary complications of placenta accreta are maternal hemorrhage and failure of the placenta to separate following birth of the infant. 3. The primary complications of placenta accreta are maternal hemorrhage and failure of the placenta to separate following birth of the infant.

Before performing Leopold maneuvers, what would the nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Have the client empty her bladder. 2. Place the client in Trendelenburg position. 3. Have the client lie on her back with her feet on the bed and knees bent. 4. Turn the client to her left side. 5. Have the client lie flat with her ankles crossed.

Answer: 1, 3 Explanation: 1. The woman should have recently emptied her bladder before performing Leopold maneuvers. 3. The woman should lie on her back with her abdomen uncovered. To aid in relaxation of the abdominal wall, the shoulders should be raised slightly on a pillow and the knees drawn up a little.

Which statements might a pregnant teenager be likely to make at her initial prenatal examination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I didn't know I could get pregnant the first time I had sex." 2. "Several of my friends go to clinics to get contraception." 3. "It's no big deal; two of my best friends have babies, too." 4. "I was 13 years old when I had sex the first time." 5. "My family and my boyfriend are really happy and supportive."

Answer: 1, 3, 4 Explanation: 1. Many factors contribute to the high teenage pregnancy rate, and one of them is lack of knowledge about conception. 3. Many factors contribute to the high teenage pregnancy rate, and one of them is a decreased social stigma of being a young and single mother. 4. Many factors contribute to the high teenage pregnancy rate, and one of them is a younger age at onset of sexual activity.

The nurse in the OB-GYN clinic counsels a couple that in autosomal dominant inheritance, which of the following occur? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. An affected individual might have an affected parent. 2. The affected individual has a 75% chance of passing on the abnormality. 3. Males and females are equally affected by the gene. 4. A father can pass the defective gene to a son. 5. There are no variances in the genetic pattern for autosomal dominant disorders.

Answer: 1, 3, 4 Explanation: 1. The family pedigree usually shows multiple generations having the disorder. 3. Males and females are equally affected in autosomal dominant disorders. 4. In autosomal dominant disorders, the father can pass the defective gene to a son.

5) The client in the first trimester of pregnancy questions the nurse about the causes of fetal death. The nurse explains that factors associated with perinatal loss include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Maternal diabetes 2. Paternal hypertension 3. Fetal chromosomal disorders 4. Maternal infections 5. Placental abnormalities

Answer: 1, 3, 4, 5 Explanation: 1. Fetal loss can be a result of a number of physiologic maladaptations, including maternal diabetes. 3. Chromosomal abnormalities can be associated with fetal loss. 4. Infections such as human parvovirus B19, syphilis, streptococcal infection, and Listeria can lead to fetal loss. 5. Placental abnormalities such as abruptio placentae and placenta previa can result in fetal death. Page Ref: 943, 944

36) The nurse is planning care for a client with hydramnios. For which interventions might the nurse need to prepare the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Artificial rupture of the membranes 2. Amnioinfusion 3. Amniocentesis 4. Administration of prostaglandin synthesis inhibitor 5. Administration of indomethacin

Answer: 1, 3, 4, 5 Explanation: 1. Artificial rupture may be performed to remove the excessive fluid. 3. Amniocentesis may be performed to remove some excess fluid. 4. A prostaglandin synthesis inhibitor is used to treat hydramnios. 5. Indomethacin can decrease amniotic fluid by decreasing fetal urine output.

Usually, the family is advised to arrive at the birth setting at the beginning of the active phase of labor or when which of the following occur? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Rupture of membranes (ROM) 2. Increased fetal movement 3. Decreased fetal movement 4. Any vaginal bleeding 5. Regular, frequent uterine contractions (UCs)

Answer: 1, 3, 4, 5 Explanation: 1. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when the membranes rupture. 3. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there is decreased fetal movement. 4. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there is any vaginal bleeding. 5. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there are regular, frequent uterine contractions.

1) The nurse has admitted a woman with cervical insufficiency. The nurse is aware that causes of this condition include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Congenital factors 2. Intercourse during pregnancy 3. Infection 4. Increased uterine volume 5. Past cervical surgeries

Answer: 1, 3, 4, 5 Explanation: 1. Congenitally incompetent cervix may be found in women exposed to diethylstilbestrol (DES) or those with a bicornuate uterus. 3. Infection or trauma can cause acquired cervical incompetence. 4. Cervical insufficiency can occur in multiple-gestation pregnancies. 5. Previous elective abortion or cervical manipulation can lead to cervical insufficiency.

24) When general anesthesia is necessary for a cesarean delivery, what should the nurse be prepared to do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Administer an antacid to the client. 2. Place a wedge under her thigh. 3. Apply cricoid pressure during anesthesia intubation. 4. Preoxygenate for 3-5 minutes before anesthesia. 5. Place a Foley catheter in the client's bladder

Answer: 1, 3, 4, 5 Explanation: 1. Prophylactic antacid therapy is given to reduce the acidic content of the stomach before general anesthesia. 3. During the process of rapid induction of anesthesia, the nurse applies cricoid pressure. 4. The woman should be preoxygenated with 3 to 5 minutes of 100% oxygen. 5. Urinary retention can be treated with the placement of an indwelling Foley catheter.

A first-time 22-year-old single labor client, accompanied by her boyfriend, is admitted to the labor unit with ruptured membranes and mild to moderate contractions. She is determined to be 2 centimeters dilated. Which nursing diagnoses might apply during the current stage of labor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fear/Anxiety related to discomfort of labor and unknown labor outcome 2. Knowledge, Deficient, related to lack of information about pushing methods 3. Pain, Acute, related to uterine contractions, cervical dilatation, and fetal descent 4. Pain, Acute, related to perineal trauma 5. Coping: Family, Compromised, related to labor process

Answer: 1, 3, 5 Explanation: 1. A Fear/Anxiety diagnosis would apply to the first stage of labor for a first-time labor client. 3. Contractions become more regular in frequency and duration, increasing discomfort and pain. 5. The woman and her boyfriend are about to undergo one of the most meaningful and stressful events in life together. Physical and psychologic resources, coping mechanisms, and support systems will all be challenged.

The OB-GYN nurse teaches a first-time pregnant client that functions of the amniotic fluid include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Allowing fetal freedom of movement 2. Releasing heat to control fetal temperature 3. Acting as an extension of fetal extracellular space 4. Providing a water source for the fetus to swallow 5. Acting as a wedge during labor

Answer: 1, 3, 5 Explanation: 1. Amniotic fluid permits fetal freedom of movement. 3. A primary function of amniotic fluid is to act as an extension of fetal extracellular space. 5. A primary function of amniotic fluid is to act as a wedge during labor.

Student nurses in their obstetrical rotation are learning about fertilization and implantation. The process of implantation is characterized by which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The trophoblast attaches itself to the surface of the endometrium. 2. The most frequent site of attachment is the lower part of the anterior uterine wall. 3. Between days 7 and 10 after fertilization, the zona pellucida disappears, and the blastocyst implants itself by burrowing into the uterine lining. 4. The lining of the uterus thins below the implanted blastocyst. 5. The cells of the trophoblast grow down into the uterine lining, forming the chorionic villi.

Answer: 1, 3, 5 Explanation: 1. During implantation, the trophoblast attaches itself to the surface of the endometrium for further nourishment. 3. Between days 7 and 10 after fertilization, the zona pellucida disappears, and the blastocyst implants itself by burrowing into the uterine lining and penetrating down toward the maternal capillaries until it is completely covered. 5. The cells of the trophoblast grow down into the thickened lining, forming the chorionic villi.

18) The nurse is caring for a client who finally conceived after several unsuccessful attempts at in vitro fertilization. The client has just been diagnosed with a perinatal loss. What should the nurse's plan of care include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Giving accurate and honest information 2. Encouraging the couple to try right away to get pregnant again 3. Validating the many losses the client has experienced 4. Providing possible explanations for the fetal demise 5. Assessing where the client is in the grieving process, and communicating with compassion

Answer: 1, 3, 5 Explanation: 1. Families can cope with extreme situations when they are properly informed in an honest and forthright manner. 3. The nurse should be compassionate, give accurate and honest information, and validate the many losses incurred. 5. The nurse caring for a couple who has had a previous loss needs to be kind, compassionate, and patient. Page Ref: 952, 963, 964

A nurse is teaching a group of college students at a Catholic university about natural family planning (NFP). Teaching was successful if the students say natural family planning is which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. "It is free, safe, and acceptable according to our religion." 2. "It includes breastfeeding for 1 year." 3. "It is useful in helping us plan pregnancies." 4. "It allows us to safely have intercourse during our fertile days." 5. "It does not involve the use of artificial substances or devices."

Answer: 1, 3, 5 Explanation: 1. NFP is free, safe, and acceptable to many whose religious beliefs prohibit other methods.

The nurse is teaching a group of adolescents that sperm must undergo the process of capacitation in order to fertilize the ova. The characteristics of sperm that have undergone capacitation include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Ability to undergo an acrosomal reaction 2. Ability to block polyspermy 3. Ability to bind to the zona pellucida 4. Ability to release norepinephrine 5. Acquisition of hypermotility

Answer: 1, 3, 5 Explanation: 1. Sperm that undergo capacitation take on the ability to undergo the acrosomal reaction. 3. Sperm that undergo capacitation take on the ability to bind to the zona pellucida. 5. Sperm that undergo capacitation have the acquisition of hypermotility.

28) Which nursing interventions would be included in the plan of care for a family that has just been informed of a perinatal loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Provide the parents with a private place and time to express their grief. 2. Offer reassurance that parents can have a subsequent successful pregnancy. 3. Allow the parents to participate in personal grief rituals. 4. Encourage interaction with other families. 5. Offer to give the family mementos of the infant such as footprints, crib card, and lock of hair.

Answer: 1, 3, 5 Explanation: 1. The couple with a known or suspected fetal demise should immediately be placed in a private room. When possible, the woman should be in a room that is farthest away from other laboring women. 3. The nurse should assist the couple in exploring their feelings and help them to make decisions about who will be present and what rituals will occur during and following the birth. 5. In a fetal demise, mementos are some of the few memories the parents have to provide them comfort after the death of their baby. Every effort should be made to offer as many quality mementos as possible, such as pictures and hand- or footprint molds and cards. Page Ref: 955, 957, 960

The nurse recognizes the importance of the interaction between the nervous and endocrine systems in the female reproductive cycle. The interaction involves which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Hypothalamus 2. Adrenal cortex 3. Ovaries 4. Thyroid 5. Anterior pituitary

Answer: 1, 3, 5 Explanation: 1. The female reproductive cycle is controlled by complex interactions between the nervous and endocrine systems and their target tissues. These interactions involve the hypothalamus. 3. The female reproductive cycle is controlled by complex interactions between the nervous and endocrine systems and their target tissues. These interactions involve the ovaries. 5. The female reproductive cycle is controlled by complex interactions between the nervous and endocrine systems and their target tissues. These interactions involve the anterior pituitary.

30) The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Rh sensitization 2. Postmaturity syndrome 3. Renal malformation or dysfunction 4. Maternal diabetes 5. Large-for-gestational-age infants

Answer: 1, 4 Explanation: 1. Hydramnios is associated with Rh sensitization. 4. Hydramnios is associated with maternal diabetes.

A clinic nurse is preparing diagrams of pelvic shapes. Which pelvic shapes are considered least adequate for vaginal childbirth? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Android 2. Anthropoid 3. Gynecoid 4. Platypelloid 5. Lambdoidal suture

Answer: 1, 4 Explanation: 1. In the android and platypelloid types, the pelvic diameters are diminished. Labor is more likely to be difficult (longer) and a cesarean birth is more likely. 4. In the android and platypelloid types, the pelvic diameters are diminished. Labor is more likely to be difficult (longer) and a cesarean birth is more likely.

A client who was raped is in the emergency department. She asks the nurse what her alternatives are for emergency contraception. The nurse tells her she can receive which of the following treatments? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Take levonorgestrel and ethinyl estradiol. 2. Have Essure implanted. 3. Have a laparoscopic tubal ligation. 4. Take levonorgestrel alone, but in a high dose. 5. Take high doses of male hormones.

Answer: 1, 4 Explanation: 1. Preparations for EC include high doses of levonorgestrel and ethinyl estradiol (Yuzpe regimen). 4. Preparations for EC include high doses of levonorgestrel (Plan B).

The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor most likely will include which of the following? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Contractions that do not intensify while walking 2. An increase in the intensity and frequency of contractions 3. Progressive cervical effacement and dilatation 4. Pain in the abdomen that does not radiate 5. Contractions are at regular intervals

Answer: 1, 4 Explanation: 1. True labor contractions intensify while walking. 4. The discomfort of true labor contractions usually starts in the back and radiates around to the abdomen.

12) The nurse knows that the Bishop scoring system for cervical readiness includes which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fetal station 2. Fetal lie 3. Fetal presenting part 4. Cervical effacement 5. Cervical softness

Answer: 1, 4, 5 Explanation: 1. Fetal station is one of the components evaluated by the Bishop scoring system. 4. Cervical effacement is one of the components evaluated by the Bishop scoring system. 5. Cervical consistency is one of the components evaluated by the Bishop scoring system. Page Ref: 628

The nurse is evaluating the expected outcomes of care for a pregnant adolescent. For the evaluation, the nurse will ask which of the following questions? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Was a trusting relationship developed? 2. Did the adolescent explore financial options open to teen parents? 3. Did the adolescent make plans for continuing her education? 4. Can the adolescent problem-solve? 5. Did the adolescent follow recommendations?

Answer: 1, 4, 5 Explanation: 1. A trusting relationship must be developed with the adolescent client. 4. The adolescent must be able to appropriately problem-solve. 5. The adolescent must follow the recommendations of the healthcare team to deliver a healthy baby.

The nurse's goals for prenatal classes may include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Increasing self-esteem 2. Preparing the participants for childrearing 3. Offering information on the risks of breastfeeding 4. Providing anticipatory guidance about pregnancy 5. Helping participants develop more adaptive coping skills

Answer: 1, 4, 5 Explanation: 1. Goals for prenatal classes would include increasing self-esteem. 4. Goals for prenatal class would include providing anticipatory guidance about pregnancy. 5. Goals for prenatal class would include helping participants develop more adaptive coping skills.

The clinic nurse assesses a newborn that is not progressing as expected. Genetic tests are ordered. The nurse explains to the parents that the laboratory tests to be done include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Chromosome analysis 2. Complete blood count 3. Phenylketonuria 4. Enzyme assay 5. Antibody titers

Answer: 1, 4, 5 Explanation: 1. Laboratory analysis includes chromosome analysis. 4. Laboratory analysis includes enzyme assay for inborn errors of metabolism. 5. Laboratory analysis includes antibody titers for infectious teratogens.

The nurse is planning a group session for clients who are beginning infertility evaluation. Which statements should be included in this session? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Infertility can be stressful for a marriage." 2. "The doctor will be able to tell why you have not conceived." 3. "Your insurance will pay for the infertility treatments." 4. "Keep communicating with one another through this process." 5. "Support organizations can be helpful to deal with the emotional issues associated with infertility."

Answer: 1, 4, 5 Explanation: 1. Often an intact marriage will become stressed by the intrusive but necessary infertility procedures and treatments. 4. Communication is important; clients should communicate verbally and share feelings and support. 5. Referral to mental health professionals is helpful when the emotional issues become too disruptive in the couple's relationship or life. Couples should be made aware of infertility support and education organizations, which may help meet some of these needs and validate their feelings.

27) Which nursing diagnoses can apply to the couple experiencing a perinatal loss? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Grieving related to the imminent loss of a child 2. Fear related to discomfort of labor and unknown outcome 3. Knowledge, Deficient related to lack of information about involution 4. Powerlessness related to lack of control in current situational crisis 5. Spiritual Distress, Risk for related to intense suffering secondary to unexpected fetal loss

Answer: 1, 4, 5 Explanation: 1. The nurse should anticipate that the family will experience the grieving process for the lost fetus. 4. The parents are faced with the sudden and unanticipated death of the unborn child, which occurred without any input or control on their part. 5. Spiritual distress is a common reaction of parents who experience an unanticipated loss. Page Ref: 954

A client who is having false labor most likely would have which of the following? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Contractions that do not intensify while walking 2. An increase in the intensity and frequency of contractions 3. Progressive cervical effacement and dilatation 4. Pain in the abdomen that does not radiate 5. Contractions that lessen with rest and warm tub baths

Answer: 1, 4, 5 Explanation: 1. True labor contractions intensify while walking. 4. True labor results in progressive dilation, increased intensity and frequency of contractions, and pain in the back that radiates to the abdomen. 5. In true labor, contractions do not lessen with rest and warm tub baths.

12) A client at 32 weeks' gestation is admitted with painless vaginal bleeding. Placenta previa has been confirmed by ultrasound. What should be included in the nursing plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. No vaginal exams 2. Encouraging activity 3. No intravenous access until labor begins 4. Evaluating fetal heart rate with an external monitor 5. Monitoring blood loss, pain, and uterine contractility

Answer: 1, 4, 5 Explanation: 1. Expectant management of placenta previa is made by localizing the placenta via tests that require no vaginal examination. 4. Expectant management of placenta previa, when the client is at less than 37 weeks' gestation, includes evaluating FHR with an external monitor. 5. Expectant management of placenta previa, when the client is at less than 37 weeks' gestation, includes monitoring blood loss, pain, and uterine contractility.

The nurse explains the functions of the male reproductive organs to a client. Which correct functions will the nurse include? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Ejaculatory ducts move semen and seminal fluid. 2. The adrenal gland is the major source of testosterone. 3. The vas deferens ends before reaching the prostate gland. 4. Sertoli's cells nourish spermatozoa. 5. The testes house seminiferous tubules.

Answer: 1, 5 Explanation: 1. Ejaculatory ducts provide a passageway for semen and seminal fluid into the urethra. 5. The testes house seminiferous tubules and the gonads.

Methods to increase fertility awareness include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Home assessment of cervical mucus 2. Pharmacologic agents 3. Therapeutic insemination 4. IVF 5. Basal body temperature (BBT) recordings

Answer: 1, 5 Explanation: 1. Methods to increase fertility awareness include home assessment of cervical mucus and basal body temperature (BBT) recordings. 5. Methods to increase fertility awareness include home assessment of cervical mucus and basal body temperature (BBT) recordings.

The nurse is caring for a client in the transition phase of labor and notes that the fetal monitor tracing shows average short-term and long-term variability with a baseline of 142 beats per minute. What actions should the nurse take in this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Provide caring labor support. 2. Administer oxygen via face mask. 3. Change the client's position. 4. Speed up the client's intravenous. 5. Reassure the client and her partner that she is doing fine.

Answer: 1, 5 Explanation: 1. The tracing is normal, so the nurse can continue support of the labor. 5. The nurse can reassure the client at this time, as the tracing is normal.

15) The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client? 1. Apply an internal fetal monitor. 2. Monitor the client using electronic fetal monitoring. 3. Withhold oral intake and start intravenous fluids. 4. Place the client in a upright, sitting position.

Answer: 2 2. The client should be monitored using electronic fetal monitoring for at least 30 minutes and up to 2 hours after placement to assess the contraction pattern and the fetal status. Page Ref: 626

3) The community nurse has identified that the mother who gave birth to a stillborn baby last week is an intuitive griever. Which behavior has the nurse encountered that would lead to this assessment? 1. The mother verbalized that her problem-solving skills have been helpful during this process. 2. The mother repeatedly talks about her thoughts, feelings, and emotions about losing her child. 3. The mother talks little about her experience, and appears detached and unaffected by the loss of her child. 4. The mother has asked close friends, co-workers, and relatives not to call or visit.

Answer: 2 Explanation: 2. Intuitive grievers tend to feel their way through the loss and seek emotional and psychosocial support. Page Ref: 948

28) What type of forceps are designed to be used with a breech presentation? 1. Midforceps 2. Piper 3. Low 4. High

Answer: 2 Explanation: 2. Piper forceps are designed to be used with a breech presentation. They are applied after the birth of the body, when the fetal head is still in the birth canal and assistance is needed. Page Ref: 637

6) A woman has just delivered a stillborn child at 26 weeks' gestation. Which nursing action is appropriate at this time? 1. Remind the mother that she will be able to have another baby in the future. 2. Dress the infant in a gown and swaddle it in a receiving blanket. 3. Ask the woman whether she would like the doctor to prescribe a sedative for her. 4. Remove the baby from the delivery room as soon as possible.

Answer: 2 Explanation: 2. After bathing, the infant should be placed in a suitable-sized gown and then wrapped in a blanket. Page Ref: 959

33) The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The physician requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth? 1. Elation, euphoria, and talkativeness 2. A sense of failure and loss 3. Questions about whether or not to circumcise 4. Uncertainty surrounding the baby's name

Answer: 2 Explanation: 2. Clients who participate in childbirth classes that stress the normalcy of birth may feel a sense of loss or failure if an intervention is used during their labor or birth. Page Ref: 639

26) The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring client who will have a forceps delivery. Which action or assessment finding requires intervention? 1. Regional anesthesia is administered via pudendal block. 2. The client is instructed to push between contractions. 3. Fetal heart tones are consistently between 110 and 115. 4. The client's bladder is emptied using a straight catheter. Answer: 2

Answer: 2 Explanation: 2. During the contraction, as the forceps are applied, the woman should avoid pushing. Page Ref: 639

29) The physician has determined the need for forceps. The nurse should explain to the client that the use of forceps is indicated because of which of the following? 1. Her support person is exhausted 2. Premature placental separation 3. To shorten the first stage of labor 4. To prevent fetal distress

Answer: 2 Explanation: 2. Fetal conditions indicating the need for forceps include premature placental separation, prolapsed umbilical cord, and nonreassuring fetal status.

30) The physicians/CNM opts to use a vacuum extractor for a delivery. What does the nurse understand? 1. There is little risk with vacuum extraction devices. 2. There should be further fetal descent with the first two "pop-offs." 3. Traction is applied between contractions. 4. The woman often feels increased discomfort during the procedure

Answer: 2 Explanation: 2. If more than three "pop-offs" occur (the suction cup pops off the fetal head), the procedure should be discontinued. Page Ref: 641

27) The need for forceps has been determined. The client's cervix is dilated to 10 cm, and the fetus is at +2 station. What category of forceps application would the nurse anticipate? 1. Input 2. Low 3. Mid 4. Outlet

Answer: 2 Explanation: 2. Low forceps are applied when the leading edge of the fetal head is at +2 station. Page Ref: 638

4) The nurse is anticipating the arrival of a couple in the labor unit. It has been determined that the 37-week fetus has died in utero from unknown causes. What should the nurse include in the plan of care for this couple? 1. Allow the couple to adjust to the labor unit in the waiting area. 2. Place the couple in a labor room at the end of the hall with an empty room next door. 3. Encourage the father to go home and rest for a few hours. 4. Contact the mother's emergency contact person and explain the situation.

Answer: 2 Explanation: 2. Upon arrival to the facility, the couple with a known or suspected fetal demise should immediately be placed in a private room. When possible, the woman should be in a room that is farthest away from other laboring women. Page Ref: 955

Approximately 80% of anovulatory women have which condition? 1. Turner syndrome 2. Polycystic ovary syndrome (PCOS) 3. Klinefelter syndrome 4. Fragile X syndrome

Answer: 2 Explanation: 2. Approximately 80% of anovulatory women have polycystic ovary syndrome (PCOS), causing insulin resistance and hyperinsulinemia.

Upon delivery of the newborn, what nursing intervention most promotes parental attachment? 1. Placing the newborn under the radiant warmer. 2. Placing the newborn on the mother's abdomen. 3. Allowing the mother a chance to rest immediately after delivery. 4. Taking the newborn to the nursery for the initial assessment.

Answer: 2 Explanation: 2. As the baby is placed on the mother's abdomen or chest, she frequently reaches out to touch and stroke her baby. When the newborn is placed in this position, the father or partner also has a very clear, close view and can also reach out to touch the baby.

The labor and delivery nurse is reviewing charts. The nurse should inform the supervisor about which client? 1. Client at 5 cm requesting labor epidural analgesia 2. Client whose cervix remains at 6 cm for 4 hours 3. Client who has developed nausea and vomiting 4. Client requesting her partner to stay with her

Answer: 2 Explanation: 2. Average cervical change in the active phase of the first stage of labor is 1.2 cm/hour; thus, this client's lack of cervical change is unexpected, and should be reported to the supervisor.

A woman in labor asks the nurse to explain the electronic fetal heart rate monitor strip. The fetal heart rate baseline is 150 with accelerations to 165, variable decelerations to 140, and moderate long-term variability. Which statement indicates that the client understands the nurse's teaching? 1. "The most important part of fetal heart monitoring is the absence of variable decelerations." 2. "The most important part of fetal heart monitoring is the presence of variability." 3. "The most important part of fetal heart monitoring is the fetal heart rate baseline." 4. "The most important part of fetal heart monitoring is the depth of decelerations."

Answer: 2 Explanation: 2. Baseline variability is a reliable indicator of fetal cardiac and neurologic function and well-being. The opposing "push-pull" balancing between the sympathetic nervous system and the parasympathetic nervous system directly affects the FHR.

The laboring client is having moderately strong contractions lasting 60 seconds every 3 minutes. The fetal head is presenting at a -2 station. The cervix is 6 cm and 100% effaced. The membranes spontaneously ruptured prior to admission, and clear fluid is leaking. Fetal heart tones are in the 140s with accelerations to 150. Which nursing action has the highest priority? 1. Encourage the husband to remain in the room. 2. Keep the client on bed rest at this time. 3. Apply an internal fetal scalp electrode. 4. Obtain a clean-catch urine specimen.

Answer: 2 Explanation: 2. Because the membranes are ruptured and the head is high in the pelvis at a -2 station, the client should be maintained on bed rest to prevent cord prolapse.

The nurse is presenting a class to pregnant clients. The nurse asks, "The fetal brain is developing rapidly, and the nervous system is complete enough to provide some regulation of body function on its own, at which fetal development stage?" It is clear that education has been effective when a participant makes which response? 1. "The 17th-20th week" 2. "The 25th-28th week" 3. "The 29th-32nd week" 4. "The 33rd-36th week"

Answer: 2 Explanation: 2. Between the 25th and 28th week, the brain is developing rapidly, and the nervous system is complete enough to provide some degree of regulation of body functions.

Extended use combined oral contraceptives (COCs) reduce the side effects of COCs such as which of the following? 1. Cramping 2. Hypertension 3. Breast tenderness 4. Bloating

Answer: 2 Explanation: 2. Complications of COCs include: myocardial infarction, stroke, blood clots, and hypertension.

39) What is required for any women receiving oxytocin (Pitocin)? 1. CPR 2. Continuous electronic fetal monitoring 3. Administering oxygen by mask 4. Nonstress test

Answer: 2 Explanation: 2. Continuous electronic fetal monitoring (EFM) is required for any women receiving oxytocin (Pitocin). Page Ref: 598

A 16-year-old is making her first prenatal visit to the clinic in her fourth month of pregnancy. What is the nurse's first responsibility? 1. Contact the social worker. 2. Develop a trusting relationship. 3. Schedule the client for prenatal classes. 4. Teach the client about proper nutrition.

Answer: 2 Explanation: 2. Developing a trusting relationship with the pregnant adolescent is essential. Honesty and respect for the individual and a caring attitude promote the client's self-esteem.

15) When planning care for a client who has undergone an episiotomy, it would be important for the nurse to include a goal that addresses the need for pain relief of which part of the body? 1. Mons pubis 2. Perineal body 3. Labia minora 4. Hymen

Answer: 2 Explanation: 2. During the last part of labor, the perineal body thins out until it is just a few centimeters thick. This tissue is often the site of an episiotomy or lacerations during childbirth.

A client is admitted to the labor unit with contractions 1-2 minutes apart lasting 60-90 seconds. The client is apprehensive and irritable. This client is most likely in what phase of labor? 1. Active 2. Transition 3. Latent 4. Second

Answer: 2 Explanation: 2. During transition, contractions have a frequency of 1 1/2 to 2 minutes, a duration of 60 to 90 seconds, and are strong in intensity. When the woman enters the transition phase, she may demonstrate significant anxiety.

22) What can be determined based on ultrasound visualization or the lack of visualization of an intertwin membrane? 1. Toxicity 2. Amnionicity 3. Variability 4. Prematurity

Answer: 2 Explanation: 2. Evidence supports the use of ultrasound for accurately determining chorionicity and amnionicity in multiple pregnancies. Determination of amnionicity is based on ultrasound visualization or the lack of visualization of an intertwin membrane.

A pregnant woman tells the nurse-midwife, "I've heard that if I eat certain foods during my pregnancy, the baby will be a boy." The nurse-midwife's response should explain that this is a myth, and that the sex of the baby is determined at what time? 1. At the time of ejaculation 2. At fertilization 3. At the time of implantation 4. At the time of differentiation

Answer: 2 Explanation: 2. Fertilization is the point at which the sex of the zygote is determined.

The client is in the second stage of labor. The fetal heart rate baseline is 170, with minimal variability present. The nurse performs fetal scalp stimulation. The client's partner asks why the nurse did that. What is the best response by the nurse? 1. "I stimulated the top of the fetus's head to wake him up a little." 2. "I stimulated the top of the fetus's head to try to get his heart rate to accelerate." 3. "I stimulated the top of the fetus's head to calm the fetus down before birth." 4. "I stimulated the top of the fetus's head to find out whether he is in distress."

Answer: 2 Explanation: 2. Fetal scalp stimulation is done when there is a question regarding fetal status. An acceleration indicates fetal well-being.

During a class on genetics for pregnant families, the nurse is discussing the how the egg and sperm are formed before fertilization takes place. The nurse explains that these cells have only half the number of chromosomes, so when fertilization takes place, there will be the correct number. What is the process by which the egg and sperm are formed called? 1. Oogenesis 2. Gametogenesis 3. Meiosis 4. Spermatogenesis

Answer: 2 Explanation: 2. Gametogenesis is the process by which ovum and sperm are produced.

The nurse is working in a teen pregnancy clinic. In order to give the pregnant adolescent a role in her prenatal care, the nurse should allow the teen to do which of the following? 1. Choose the type of prenatal vitamin she takes 2. Measure and record her weight at each visit 3. Choose the schedule of her prenatal visits 4. Decide whether she wants her labor to be induced

Answer: 2 Explanation: 2. Having the client weigh herself and record her weight provides her the opportunity to participate in her own care plan.

31) The nurse is admitting a client with possible hydramnios. When is hydramnios most likely suspected? 1. Hydramnios is most likely suspected when there is less amniotic fluid than normal for gestation. 2. Hydramnios is most likely suspected when the fundal height increases disproportionately to the gestation. 3. Hydramnios is most likely suspected when the woman has a twin gestation. 4. Hydramnios is most likely suspected when the quadruple screen comes back positive.

Answer: 2 Explanation: 2. Hydramnios should be suspected when the fundal height increases out of proportion to the gestational age.

32) If oligohydramnios occurs in the first part of pregnancy, the nurse knows that there is a danger of which of the following? 1. Major congenital anomalies 2. Fetal adhesions 3. Maternal diabetes 4. Rh sensitization

Answer: 2 Explanation: 2. If oligohydramnios occurs in the first part of pregnancy, there is a danger of fetal adhesions (one part of the fetus may adhere to another part).

A nurse teaches newly pregnant clients that if an ovum is fertilized and implants in the endometrium, the hormone the fertilized egg begins to secrete is which of the following? 1. Estrogen 2. Human chorionic gonadotropin (hCG) 3. Progesterone 4. Luteinizing hormone

Answer: 2 Explanation: 2. If the ovum is fertilized and implants in the endometrium, the fertilized egg begins to secrete human chorionic gonadotropin (hCG), which is needed to maintain the corpus luteum.

A client is to receive fertility drugs prior to in vitro fertilization. What is the expected action of this medication? 1. Prolonging of the luteal phase 2. Stimulation of ovulation 3. Suppression of menstruation 4. Promotion of cervical mucus production

Answer: 2 Explanation: 2. In IVF, a woman's ovaries are stimulated by a combination of medications, one or more oocytes are aspirated from her ovaries and fertilized in the laboratory, and then they are placed into her uterus after normal embryo development has begun.

A client arrives in the labor and delivery unit and describes her contractions as occurring every 10-12 minutes, lasting 30 seconds. She is smiling and very excited about the possibility of being in labor. On exam, her cervix is dilated 2 cm, 100% effaced, and -2 station. What best describes this labor? 1. Second phase 2. Latent phase 3. Active phase 4. Transition phase

Answer: 2 Explanation: 2. In the early or latent phase of the first stage of labor, contractions are usually mild. The woman feels able to cope with the discomfort. The woman is often talkative and smiling and is eager to talk about herself and answer questions.

The laboring client and her partner have arrived at the birthing unit. Which step of the admission process should be undertaken first? 1. The sterile vaginal exam 2. Welcoming the couple 3. Auscultation of the fetal heart rate 4. Checking for ruptured membranes

Answer: 2 Explanation: 2. It is important to establish rapport and to create an environment in which the family feels free to ask questions. The support and encouragement of the nurse in maintaining a caring environment begin with the initial admission.

A client calls the labor and delivery unit and tells the nurse that she is 39 weeks pregnant and that over the last 4 or 5 days, she has noticed that although her breathing has become easier, she is having leg cramps, a slight amount of edema in her lower legs, and an increased amount of vaginal secretions. The nurse tells the client that she has experienced which of the following? 1. Engagement 2. Lightening 3. Molding 4. Braxton Hicks contractions

Answer: 2 Explanation: 2. Lightening describes the effect occurring when the fetus begins to settle into the pelvic inlet.

33) The community nurse is planning care for a family that experienced the loss of twins at 20 weeks. Which of these steps should be part of the nurse's care of this family? 1. Base care on the reactions of previous clients who experienced stillbirth. 2. Express the belief that the family will be able to get through this experience. 3. Encourage the couple to keep their feelings to themselves. 4. Honor the birth by reminding the couple that their babies are happy in heaven.

Answer: 2 Explanation: 2. Maintaining belief is defined as believing in the parents' capacity to get through the event and face a future with meaning and it is one of the attributes of caring theory. Page Ref: 955

A couple who have sought fertility counseling have been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which condition occurs? 1. The vas deferens is ligated. 2. Male obesity is present. 3. The prostate gland is enlarged. 4. The flagella are segmented.

Answer: 2 Explanation: 2. Male obesity is associated with poor spermatogenesis and increased amount of time to conception.

The nurse is preparing a class on reproduction. What is the cell division process that results in two identical cells, each with the same number of chromosomes as the original cell called? 1. Meiosis 2. Mitosis 3. Oogenesis 4. Gametogenesis

Answer: 2 Explanation: 2. Mitosis results in the production of diploid body (somatic) cells, which are exact copies of the original cell.

16) The nurse is caring for a client who experienced the birth of a stillborn son earlier in the day. The client is from a culture where a woman's status is dominated by themes of motherhood and childrearing. What behavior would the nurse expect in this client? 1. Crying inconsolably 2. Expressing feelings of failure as a woman 3. Requesting family members to be present 4. Showing little emotion

Answer: 2 Explanation: 2. Mothers will often blame themselves, whether by commission or omission, particularly in cultures where a woman's status is dominated by themes of motherhood and childrearing. Page Ref: 952

A client who is currently 12 weeks pregnant is seeking information on pregnancy termination. The nurse is teaching the client about the risks involved if she were to take the medication mifepristone. Which adverse signs would the client need to know and report immediately to a physician? 1. Fatigue, lack of appetite, and inability to concentrate 2. Nausea, diarrhea, vomiting, and stomach pain 3. Increase in heart rate, inability to sit still, and lack of appetite 4. Headache, fatigue, and hunger

Answer: 2 Explanation: 2. Nausea, diarrhea, vomiting, and stomach pain are the symptoms that must be reported immediately to the physician.

Which of the following is the most prevalent medical complication of pregnant adolescents? 1. Constipation 2. Preeclampsia-eclampsia 3. Heartburn 4. Rapid enlargement and sensitivity of breasts

Answer: 2 Explanation: 2. Preeclampsia-eclampsia is the most prevalent medical complication of pregnant adolescents and is typically characterized by high blood pressure, proteinuria, and edema.

Couples at risk for having a detectable single gene or chromosomal anomaly may wish to undergo which procedure? 1. Preimplantation genetic screening (PGS) 2. Preimplantation genetic diagnosis (PGD) 3. Intracytoplasmic sperm injection (ICSI) 4. Gamete intrafallopian transfer (GIFT)

Answer: 2 Explanation: 2. Preimplantation genetic diagnosis (PGD) is a term used when one or both genetic parents carry a gene mutation and testing is performed to determine whether that mutation or unbalanced chromosomal compliment has been passed to the oocyte or embryo.

The nurse is reviewing assessment data from several different male clients. Which one should receive information about causes of infertility? 1. Circumcised client 2. Client with a history of premature ejaculation 3. Client with a history of measles at age 12 4. Client employed as an engineer

Answer: 2 Explanation: 2. Premature ejaculation is a possible cause of infertility.

A woman has been unable to complete a full-term pregnancy because the fertilized ovum failed to implant in the uterus. This is most likely due to a lack of which hormone? 1. Estrogen 2. Progesterone 3. FSH 4. LH

Answer: 2 Explanation: 2. Progesterone is often called the hormone of pregnancy because it inhibits uterine contractions and relaxes smooth muscle to cause vasodilation, allowing pregnancy to be maintained.

Four minutes after the birth of a baby, there is a sudden gush of blood from the mother's vagina, and about 8 inches of umbilical cord slides out. What action should the nurse take first? 1. Place the client in McRoberts position. 2. Watch for the emergence of the placenta. 3. Prepare for the delivery of an undiagnosed twin. 4. Place the client in a supine position.

Answer: 2 Explanation: 2. Signs of placental separation usually appear around 5 minutes after birth of the infant, but can take up to 30 minutes to manifest. These signs are (1) a globular-shaped uterus, (2) a rise of the fundus in the abdomen, (3) a sudden gush or trickle of blood, and (4) further protrusion of the umbilical cord out of the vagina.

13) A pregnant couple have been notified that their 32-week fetus is dead. The father is yelling at the staff, and his wife is crying uncontrollably. Their 5-year-old daughter is banging the head of her doll on the floor. Which nursing action would be most helpful at this time? 1. Tell the father that his behavior is inappropriate. 2. Sit with the family and quietly communicate sorrow at their loss. 3. Help the couple to understand that their daughter is acting inappropriately. 4. Encourage the couple to send their daughter to her grandparents.

Answer: 2 Explanation: 2. Sitting down for a moment with the woman and her partner and acknowledging the loss in the event of a known demise or impending death will go a long way toward establishing a relationship of trust between the nurse and the parents. Page Ref: 955

The nurse educator is planning a class about contraception, and includes information about the effects of various contraceptive methods on sexually transmitted diseases. Which statement will the nurse include concerning spermicides? 1. "Spermicides are effective against gonorrhea and chlamydia, but not against HIV." 2. "Spermicides are not effective against sexually transmitted diseases, and can increase a woman's susceptibility to HIV." 3. "Spermicides are effective against HIV, but are not effective against the other sexually transmitted diseases." 4. "Whether or not spermicides are effective against sexually transmitted diseases depends on where the woman is in her cycle."

Answer: 2 Explanation: 2. Spermicides are not effective against any sexually transmitted disease. Spermicides have a negative effect on the integrity of vaginal cells, making them more susceptible

3) A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered? 1. To provide analgesia 2. To relax the uterus 3. To induce labor 4. To prevent hemorrhage

Answer: 2 Explanation: 2. Terbutaline is administered to achieve uterine relaxation. Page Ref: 624

A nurse working in an adolescent clinic that deals with birth control, pregnancy, and referrals for adoption has a number of clients in early adolescence. Clients in that age group are how old? 1. 11-16 years old 2. 11-14 years old 3. 14 and 15 years old 4. 12-15 years old

Answer: 2 Explanation: 2. The age range for early adolescence is age 14 and under.

The laboring client is at 7 cm, with the vertex at a +1 station. Her birth plan indicates that she and her partner took Lamaze prenatal classes, and they have planned on a natural, unmedicated birth. Her contractions are every 3 minutes and last 60 seconds. She has used relaxation and breathing techniques very successfully in her labor until the last 15 minutes. Now, during contractions, she is writhing on the bed and screaming. Her labor partner is rubbing the client's back and speaking to her quietly. Which nursing diagnosis should the nurse incorporate into the plan of care for this client? 1. Fear/Anxiety related to discomfort of labor and unknown labor outcome 2. Pain, Acute, related to uterine contractions, cervical dilatation, and fetal descent 3. Coping: Family, Compromised, related to labor process 4. Knowledge, Deficient, related to lack of information about normal labor process and comfort measures

Answer: 2 Explanation: 2. The client is exhibiting signs of acute pain, which is both common and expected in the transitional phase of labor.

The nurse is admitting a client to the birthing unit. What question should the nurse ask to gain a better understanding of the client's psychosocial status? 1. "How did you decide to have your baby at this hospital?" 2. "Who will be your labor support person?" 3. "Have you chosen names for your baby yet?" 4. "What feeding method will you use for your baby?"

Answer: 2 Explanation: 2. The expectant mother's partner or support person is an important member of the birthing team, and assessments of the couple's coping, interactions, and teamwork are integral to the nurse's knowledge base. The nurse's physical presence with the laboring woman provides the best opportunity for ongoing assessment.

The external and internal female reproductive organs develop and mature in response to what hormones? 1. Adrenocorticotropic hormones (ACTH) 2. Estrogen and progesterone 3. Steroid hormones 4. Luteinizing hormones (LH)

Answer: 2 Explanation: 2. The external and internal female reproductive organs develop and mature in response to estrogen and progesterone.

The female and male reproductive organs are homologous, which means what? 1. They are believed to cause vasoconstriction and muscular contraction 2. They are fundamentally similar in function and structure 3. They are rich in sebaceous glands 4. They are target organs for estrogenic hormones

Answer: 2 Explanation: 2. The female and male reproductive organs are homologous; that is, they are fundamentally similar in function and structure.

35) The client at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching about the condition has been effective? 1. "My gestational diabetes might have caused this problem to develop." 2. "When I go into labor, I should come to the hospital right away." 3. "This problem was diagnosed with blood and urine tests." 4. "Women with this condition usually do not have a cesarean birth."

Answer: 2 Explanation: 2. The incidence of cord compression and resulting fetal distress is high when there is an inadequate amount of amniotic fluid. The client with oligohydramnios should come to the hospital in early labor.

2) Dystocia encompasses many problems in labor. What is the most common? 1. Meconium-stained amniotic fluid 2. Dysfunctional uterine contractions 3. Cessation of contractions 4. Changes in the fetal heart rate

Answer: 2 Explanation: 2. The most common problem is dysfunctional (or uncoordinated) uterine contractions that result in a prolongation of labor.

10) How does the nurse consider the spiritual needs of a couple experiencing a fetal loss? 1. Explaining the fetal loss in terms of the nurse's own religious beliefs 2. Providing an atmosphere of acceptance regarding the couple's spiritual rites 3. Referring the couple to the hospital chaplain at discharge 4. Informing the couple of religious rituals that have helped other couples to cope with fetal loss

Answer: 2 Explanation: 2. The nurse can facilitate the spiritual needs of the couple by providing an atmosphere of acceptance regarding spiritual rites and encouraging the couple's use of spiritual writings, prayers, and observances. Page Ref: 949

An infertile couple confides in the nurse at the infertility clinic that they feel overwhelmed with the decisions facing them. Which nursing strategy would be most appropriate? 1. Refer them to a marriage counselor. 2. Provide them with information and instructions throughout the diagnostic and therapeutic process. 3. Express concern and caring. 4. Inquire about the names they have chosen for their baby.

Answer: 2 Explanation: 2. The nurse can provide comfort to couples by offering a sympathetic ear, a nonjudgmental approach, and appropriate information and instruction throughout the diagnostic and therapeutic processes.

31) The nurse is working with a laboring woman who has a known intrauterine fetal demise. To facilitate the family's acceptance of the fetal loss, after delivery the nurse should do which of the following? 1. Encourage the parents to look at the infant from across the room. 2. Offer the parents the choice of holding the infant in their arms. 3. Take the infant to the morgue immediately. 4. Call family members and inform them of the birth.

Answer: 2 Explanation: 2. The nurse should offer the couple the opportunity to see and hold the infant and reassure the couple that any decision they make for themselves is the right one. Page Ref: 959

During a prenatal examination, an adolescent client asks, "How does my baby get air?" What correct information would the nurse give? 1. "The lungs of the fetus carry out respiratory gas exchange in utero similar to what an adult experiences." 2. "The placenta assumes the function of the fetal lungs by supplying oxygen and allowing the excretion of carbon dioxide into your bloodstream." 3. "The blood from the placenta is carried through the umbilical artery, which penetrates the abdominal wall of the fetus." 4. "The fetus is able to obtain sufficient oxygen due to the fact that your hemoglobin concentration is 50% greater during pregnancy."

Answer: 2 Explanation: 2. The placenta assumes the function of the fetal lungs by supplying oxygen and allowing the excretion of carbon dioxide into the maternal bloodstream.

The nurse teaching a high school class explains that during the menstrual cycle, the endometrial glands begin to enlarge under the influence of estrogen and cervical mucosal changes occur; the changes peak at ovulation. In which phase of the menstrual cycle does this occur? 1. Menstrual 2. Proliferative 3. Secretory 4. Ischemic

Answer: 2 Explanation: 2. The proliferative phase begins when the endometrial glands begin to enlarge under the influence of estrogen and cervical mucosal changes occur; the changes peak at ovulation.

The nurse is teaching the students in their obstetric rotation about fertilization. What processes must the sperm undergo before fertilization can occur? 1. Capacitation and ovulation 2. Capacitation and the acrosomal reaction 3. Oogenesis and the acrosomal reaction 4. Gametogenesis and capacitation

Answer: 2 Explanation: 2. The sperm must undergo two processes before fertilization can occur: capacitation and the acrosomal reaction.

A client is using the contraceptive sponge as a birth control method. What action is important in order to maintain the sponge's effectiveness? 1. Insert the sponge at least 1 hour before intercourse. 2. Thoroughly moisten the sponge with water before inserting. 3. Spermicidal jelly must be inserted at the same time the sponge is inserted. 4. A new sponge must be inserted every time a couple has intercourse.

Answer: 2 Explanation: 2. The sponge is moistened thoroughly with water before use to activate the spermicide.

The neonate was born 5 minutes ago. The body is bluish. The heart rate is 150. The infant is crying strongly. The infant cries when the sole of the foot is stimulated. The arms and legs are flexed, and resist straightening. What should the nurse record as this infant's Apgar score? 1. 7 2. 8 3. 9 4. 10

Answer: 2 Explanation: 2. The strong cry earns 2 points. The crying with foot sole stimulation earns 2 points. The limb flexion and resistance earn 2 points each. Bluish color earns 0 points. The Apgar score is 8.

The true moment of fertilization occurs when what happens? 1. Cortical reaction occurs 2. Nuclei unite 3. Spermatozoa propel themselves up the female tract 4. Sperm surrounding the ovum release their enzymes

Answer: 2 Explanation: 2. The true moment of fertilization occurs as the nuclei unite. Their individual nuclear membranes disappear, and their chromosomes pair up to produce the diploid zygote.

Which client requires immediate intervention by the labor and delivery nurse? 1. Client at 8 cm, systolic blood pressure has increased 35 mm Hg 2. Client who delivered 1 hour ago with WBC of 50,000 3. Client at 5 cm with a respiratory rate of 22 between contractions 4. Client in active labor with polyuria

Answer: 2 Explanation: 2. The white blood cell (WBC) count increases to 25,000/mm3 to 30,000/mm3 during labor and early postpartum. This count is abnormally high, and requires further assessment and provider notification.

The client at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best? 1. "Unless you have pain with urination, we don't need to worry about it." 2. "These symptoms usually mean the baby's head has descended further." 3. "Come in for an appointment today and we'll check everything out." 4. "This might indicate that the baby is no longer in a head-down position."

Answer: 2 Explanation: 2. This is the best response because it most directly addresses what the client has reported.

A woman pregnant with twins asks the nurse about differences between identical and fraternal twins. The nurse explains that since it has been determined that she is having a boy and a girl, they are fraternal, and will have with of the following? 1. One placenta, two amnions, and two chorions 2. Two placentas, two amnions, and two chorions 3. Two placentas, one amnion, and two chorions 4. Two placentas, two amnions, one chorion

Answer: 2 Explanation: 2. This is the correct answer. Fraternal twins have two placentas, two amnions, and two chorions, however, the placentas sometimes fuse and look as if they are one.

The nurse is working with a pregnant adolescent. The client asks the nurse how the baby's condition is determined during labor. The nurse's best response is that during labor, the nurse will do which of the following? 1. Check the client's cervix by doing a pelvic exam every 2 hours. 2. Assess the fetus's heart rate with an electronic fetal monitor. 3. Look at the color and amount of bloody show that the client has. 4. Verify that the client's contractions are strong but not too close together.

Answer: 2 Explanation: 2. This statement best answers the question the client has asked.

Before applying a cord clamp, the nurse assesses the umbilical cord. The mother asks why the nurse is doing this. What should the nurse reply? 1. "I'm checking the blood vessels in the cord to see whether it has one artery and one vein." 2. "I'm checking the blood vessels in the cord to see whether it has two arteries and one vein." 3. "I'm checking the blood vessels in the cord to see whether it has two veins and one artery." 4. "I'm checking the blood vessels in the cord to see whether it has two arteries and two veins."

Answer: 2 Explanation: 2. Two arteries and one vein are present in a normal umbilical cord.

28) The nurse is caring for a client with hydramnios. What will the nurse watch for? 1. Possible intrauterine growth restriction 2. Newborn congenital anomalies 3. Newborn postmaturity and renal malformations 4. Fetal adhesions

Answer: 2 Explanation: 2 . Newborn congenital anomalies occur with hydramnios.

11) Narcotic analgesia is administered to a laboring client at 10:00 a.m. The infant is delivered at 12:30 p.m. What would the nurse anticipate that the narcotic analgesia could do? 1. Be used in place of preoperative sedation 2. Result in neonatal respiratory depression 3. Prevent the need for anesthesia with an episiotomy 4. Enhance uterine contractions

Answer: 2 Explanation: 2. Analgesia given too late is of no value to the woman and may cause neonatal respiratory depression.

13) During labor, the fetus was in a brow presentation, but after a prolonged labor, the fetus converted to face presentation and was delivered vaginally with forceps assist. What should the nurse explain to the parents? 1. The infant will need to be observed for meconium aspiration. 2. Facial edema and head molding will subside in a few days. 3. The infant will be given prophylactic antibiotics. 4. Breastfeeding will need to be delayed for a day or two

Answer: 2 Explanation: 2. Any facial edema and head molding that result from the use of forceps at birth will subside in a few days. Page Ref: 605

25) The client at 39 weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate intervention? 1. The baby's hands and feet are blue at 1 minute after birth. 2. The fetal heart rate is 70 prior to making the skin incision. 3. Clear fluid is obtained from the baby's oropharynx. 4. The neonate cries prior to delivery of the body.

Answer: 2 Explanation: 2. Fetal bradycardia occurs when the fetal heart rate falls below 110 beats/minute during a 10-minute period of continuous monitoring. When fetal bradycardia is accompanied by decreased variability, it is considered ominous and could be a sign of fetal compromise. Page Ref: 558

19) The client has undergone an ultrasound, which estimated fetal weight at 4500 g (9 pounds 14 ounces). Which statement indicates that additional teaching is needed? 1. "Because my baby is big, I am at risk for excessive bleeding after delivery." 2. "Because my baby is big, his blood sugars could be high after he is born." 3. "Because my baby is big, my perineum could experience trauma during the birth." 4. "Because my baby is big, his shoulders could get stuck and a collarbone broken."

Answer: 2 Explanation: 2. Hypoglycemia, not hyperglycemia, is a potential complication experienced by a macrosomic fetus.

40) The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed? 1. "Because the scar on my belly goes down from my navel, I am not a candidate for a VBAC." 2. "My first baby was in a breech position, so for this pregnancy, I can try a VBAC if the baby is head-down." 3. "Because my hospital is so small and in a rural area, they won't let me attempt a VBAC." 4. "The rate of complications from VBAC is lower than the rate of complications from a cesarean."

Answer: 1 Explanation: 1. Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding whether VBAC is advisable. The classic vertical incision was commonly done in the past and is associated with increased risk of uterine rupture in subsequent pregnancies and labor. Page Ref: 643

35) After being in labor for several hours with no progress, a client is diagnosed with CPD (cephalopelvic disproportion), and must have a cesarean section. The client is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the client would receive what type of incision? 1. Transverse 2. Infraumbilical midline 3. Classic 4. Vertical

Answer: 1 Explanation: 1. The transverse incision is made across the lowest and narrowest part of the abdomen and is the most common lower uterine segment incision. Page Ref: 643

24) The home health nurse is admitting a client at 18 weeks who is pregnant with twins. Which nursing action is most important? 1. Teach the client about foods that are good sources of protein. 2. Assess the client's blood pressure in her upper right arm. 3. Determine whether the pregnancy is the result of infertility treatment. 4. Collect a cervicovaginal fetal fibronectin (fFN) specimen.

Answer: 1 Explanation: 1. A daily intake of 4000 kcal (minimum) and 135 g protein is recommended for a woman with normal-weight twins.

The nurse auscultates the FHR and determines a rate of 112 beats/min. Which action is appropriate? 1. Inform the maternal client that the rate is normal. 2. Reassess the FHR in 5 minutes because the rate is low. 3. Report the FHR to the doctor immediately. 4. Turn the maternal client on her side and administer oxygen.

Answer: 1 Explanation: 1. A fetal heart rate of 112 beats/min. falls within the normal range of 110-160 beats/min., so there is no need to inform the doctor.

6) The nurse is making client assignments for the next shift. Which client is most likely to experience a complicated labor pattern? 1. 34-year-old woman at 39 weeks' gestation with a large-for-gestational-age (LGA) fetus 2. 22-year-old woman at 23 weeks' gestation with ruptured membranes 3. 30-year-old woman at 41 weeks' gestation and estimated fetal weight 7 pounds 8 ounces 4. 43-year-old woman at 37 weeks' gestation with hypertension

Answer: 1 Explanation: 1. A risk factor for hypotonic uterine contraction patterns includes a large-for-gestational-age (LGA) fetus.

A client and her husband have contacted their physician about fertility problems. At the initial visit, the nurse instructs them about the infertility workup. Which statement by the client would indicate that the instructions have been successful? 1. "The first test that we need to schedule is a semen analysis." 2. "We need to schedule the Pap smear test first." 3. "We need to schedule an appointment with the social worker in order to adopt." 4. "We need to schedule an appointment with a marriage counselor."

Answer: 1 Explanation: 1. A semen analysis is one of the first diagnostic tests, prior to doing invasive procedures.

How would the nurse best analyze the results from a client's sonogram that shows the fetal shoulder as the presenting part? 1. Breech, transverse 2. Breech, longitudinal 3. Breech, frank 4. Vertex, transverse

Answer: 1 Explanation: 1. A shoulder presentation is one type of breech presentation, and is also called a transverse lie.

15) The postpartum unit nurse is caring for a client who delivered a term stillborn infant yesterday. The mother is heard screaming at the nutrition services worker, "This food is horrible! You people are incompetent and can't cook a simple edible meal!" The nurse understands this as which of the following? 1. An indication the mother is in the anger phase of grief. 2. An abnormal response to the loss of the child. 3. Reactive stress management techniques in use. 4. Denial of the death of the child she delivered yesterday.

Answer: 1 Explanation: 1. Anger, resulting from feelings of loss, loneliness, and, perhaps, guilt, is a common reaction. Anger may be projected at significant others and/or healthcare team members. Page Ref: 946, 947

4) The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client's chart requires immediate intervention? 1. Previous birth by cesarean 2. Frank breech ballotable 3. 37 weeks, complete breech 4. Failed ECV last week

Answer: 1 Explanation: 1. Any previous uterine scar is a contraindication to ECV. Prior scarring of the uterus may increase the risk of uterine tearing or uterine rupture. Page Ref: 623, 624

A couple is requesting fertility counseling. The nurse practitioner has identified the factors listed below in the woman's health history, and knows which of them could be contributing to the couple's infertility? 1. The client is 38 years old. 2. The client was 13 years old when she started her menses. 3. The client works as a dental hygienist 3 days a week. 4. The client jogs 2 miles a day.

Answer: 1 Explanation: 1. As the eggs of older women age, their fertility is reduced.

18) A pregnant client is admitted to the emergency department with bleeding. The nurse realizes that the client might have placenta previa. Which signs would be suggestive of placenta previa? 1. Bright red vaginal bleeding 2. Sudden onset of vaginal bleeding 3. Firm and hard uterus 4. Change in the size of abdomen

Answer: 1 Explanation: 1. As the lower uterine segment contracts and dilates, the placental villi are torn from the uterine wall, causing bright red bleeding.

34) The nurse knows that a baby born to a mother who had oligohydramnios could show signs of which of the following? 1. Respiratory difficulty 2. Hypertension 3. Heart murmur 4. Decreased temperature

Answer: 1 Explanation: 1. Because there is less fluid available for the fetus to use during fetal breathing movements, pulmonary hypoplasia may develop.

At her first prenatal visit, a woman is discussing fetal development with the nurse. The client asks, "When will my baby actually have a heartbeat?" The nurse should say the heartbeat of an embryo is distinguishable by what time? 1. "The fourth week" 2. "The sixth week" 3. "The eighth week" 4. "The twelfth week"

Answer: 1 Explanation: 1. By the end of the fourth week, embryonic blood is circulating between the embryo and the chorionic villi.

A nurse needs to evaluate the progress of a woman's labor. The nurse obtains the following data: cervical dilatation 6 cm; contractions mild in intensity, occurring every 5 minutes, with a duration of 30-40 seconds. Which clue in this data does not fit the pattern suggested by the rest of the clues? 1. Cervical dilatation 6 cm 2. Mild contraction intensity 3. Contraction frequency every 5 minutes 4. Contraction duration 30-40 seconds

Answer: 1 Explanation: 1. Cervical dilatation of 6 cm indicates the active phase of labor. During this phase the cervix dilates from about 4 to 7 cm and contractions and pain intensify.

During a counseling session on natural family planning techniques, the nurse explains that cervical mucus at the time of ovulation should be of what consistency? 1. Egg white appearance and stretchable 2. Opaque and acidic 3. High in leukocytes 4. Lacking in quantity

Answer: 1 Explanation: 1. Cervical mucus at the time of ovulation has an "egg white" appearance and is known as fertile mucus; it is friendly to sperm because it assists passage through the cervix and uterus up into the fallopian tubes.

What type of testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG? 1. Chlamydia trachomatis IgG antibody testing 2. Preimplantation genetic testing 3. Noninvasive prenatal testing (NIPT) 4. DNA testing

Answer: 1 Explanation: 1. Chlamydia trachomatis IgG antibody testing is an inexpensive way to predict the presence of tubal disease and may be more predictive of infertility than an abnormal HSG.

8) A laboring client's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The client asks, "What are the advantages of doing this?" What should the nurse cite in response? 1. Contractions elicited are similar to those of spontaneous labor. 2. Amniotomy decreases the chances of a prolapsed cord. 3. Amniotomy reduces the pain of labor and makes it easier to manage. 4. The client will not need an episiotomy.

Answer: 1 Explanation: 1. Contractions after amniotomy are similar to those of spontaneous labor. Page Ref: 633

14) The client at 37 weeks' gestation calls the clinic nurse to report that neither she nor her partner has felt fetal movement for the past 48 hours. The nurse anticipates that the physician will order which test to assess fetal viability? 1. Ultrasound 2. Serum progesterone levels 3. Computed tomography (CT) scan 4. Contraction stress test

Answer: 1 Explanation: 1. Diagnosis of intrauterine fetal death (IUFD) is confirmed by visualization of the fetal heart with absence of heart action on ultrasound. Page Ref: 944

1) What would be a normal cervical dilatation rate in a first-time mother ("primip")? 1. 1.5 cm per hour 2. Less than 1 cm cervical dilatation per hour 3. 1 cm per hour 4. Less than 0.5 cm per hour

Answer: 1 Explanation: 1. Dilatation in a "multip" is about 1.5 cm per hour.

19) A client has delivered a stillborn child at 26 weeks' gestation. She tells the nurse that none of her friends have called or visited, and that her husband's parents seem unwilling to talk about the loss. The nurse recognizes the mother's grief as which of the following? 1. Disenfranchised grief 2. Bereavement 3. An intuitive style of coping 4. Denial

Answer: 1 Explanation: 1. Disenfranchised grief is not supported by the usual societal customs. People are uncomfortable discussing the loss with the parents and often pull away when their support is most needed. Page Ref: 945

The nurse is working with a client who has experienced a fetal death in utero at 20 weeks. The client asks what her baby will look like when it is delivered. Which statement by the nurse is best? 1. "Your baby will be covered in fine hair called lanugo." 2. "Your child will have arm and leg buds, not fully formed limbs." 3. "A white, cheesy substance called vernix caseosa will be on the skin." 4. "The genitals of the baby will be ambiguous."

Answer: 1 Explanation: 1. Downy fine hair called lanugo covers the body of a 20-week fetus.

The charge nurse is looking at the charts of laboring clients. Which client is in greatest need of further intervention? 1. Woman at 7 cm, fetal heart tones auscultated every 90 minutes 2. Woman at 10 cm and pushing, external fetal monitor applied 3. Woman with meconium-stained fluid, internal fetal scalp electrode in use 4. Woman in preterm labor, external monitor in place

Answer: 1 Explanation: 1. During active labor, the fetal heart tones should be auscultated every 30 minutes; every 90 minutes is not frequent enough.

The client has been pushing for 3 hours, and the fetus is making a slow descent. The partner asks the nurse whether pushing for this long is normal. How should the nurse respond? 1. "Your baby is taking a little longer than average, but is making progress." 2. "First babies take a long time to be born. The next baby will be easier." 3. "The birth would go faster if you had taken prenatal classes and practiced." 4. "Every baby is different; there really are no norms for labor and birth."

Answer: 1 Explanation: 1. Establishing rapport and a trusting relationship and providing information that is true is best response.

The nurse is working with male teens whose partners are pregnant. What statement by the father-to-be requires that the nurse intervene? 1. He will be the only other person who will be present for the birth, although his girlfriend wants her mother to be with her. 2. He was very sexually active at an earlier age and he has had more sexual partners than his girlfriend. 3. The pregnancy does not seem real to him, and he is not sure what he should do to plan for the future. 4. He does not want to be married.

Answer: 1 Explanation: 1. Even if the adolescent father has been included in the health care of the client throughout the pregnancy, it is not unusual for her to want her mother as her primary support person during labor and birth. Overriding his girlfriend's expressed desire could be an indication that their relationship is abusive.

26) The nurse is supervising care by a new graduate nurse who is working with a couple who have experienced a stillbirth. Which statement made by the new nurse indicates that further instruction is necessary? 1. "I should stay out of their room as much as possible." 2. "The parents might express their grief differently from each other." 3. "My role is to help the family communicate and cope." 4. "Hopelessness might be expressed by this family."

Answer: 1 Explanation: 1. Families experiencing perinatal loss need support. The nurse should stay with the couple so they do not feel alone and isolated; however, cues that the couple wants to be alone should be assessed continuously. Page Ref: 956

The nurse is teaching a woman about her menstrual cycle. Which is the most important change that happens during the follicular phase of the menstrual cycle? 1. Maturation of the primordial follicle 2. Multiplication of the fimbriae 3. Secretion of human chorionic gonadotropin 4. Growth of the endometrium

Answer: 1 Explanation: 1. Follicle-stimulating hormone is elevated during the follicular phase, and the primordial follicle matures.

The 19-year-old pregnant woman begins a job to "save money for the baby." What is the most significant developmental task the nurse understands this statement to demonstrate? 1. Striving for gaining autonomy and independence 2. Completed development of a sense of identity 3. Attainment of a sense of achievement 4. Having developed an intimate relationship

Answer: 1 Explanation: 1. Having a job is how most teens develop financial independence and autonomy.

A client delivered 30 minutes ago. Which postpartal assessment finding would require close nursing attention? 1. A soaked perineal pad since the last 15-minute check 2. An edematous perineum 3. The client experiencing tremors 4. A fundus located at the umbilicus

Answer: 1 Explanation: 1. If the perineal pad becomes soaked in a 15-minute period or if blood pools under the buttocks, continuous observation is necessary. As long as the woman remains in bed during the first hour, bleeding should not exceed saturation of one pad.

The nurse is planning to teach couples factors that influence fertility. Which factor should not be included in the teaching plan? 1. Sexual intercourse should occur every day of the week. 2. Get up to urinate 1 hour after intercourse. 3. Do not douche. 4. Institute stress-reduction techniques.

Answer: 1 Explanation: 1. It is optimal if sexual intercourse occurs every other day during the fertile period.

The nurse is working with a group of pregnant teens. Which statement indicates that teaching has been successful? 1. "Pregnant teens are more likely to quit school prior to graduation." 2. "Because I am young, I have a low risk for preeclampsia." 3. "My baby could come late because I am a teenager." 4. "I am more likely to use birth control after I have this baby."

Answer: 1 Explanation: 1. Many teenage mothers drop out of school during their pregnancy and then are less likely to complete their schooling.

The nurse seeks to involve the adolescent father in the prenatal care of his girlfriend. What is the rationale for this nursing strategy? 1. Having the father more involved with the birth 2. Avoiding conflict between the adolescent father and pregnant teenager 3. Including his name of the birth certificate 4. Avoiding legal action by the adolescent father's family

Answer: 1 Explanation: 1. Many young fathers genuinely want to be involved with their children and would have more contact and input if they could.

The client at 20 weeks' gestation thinks she might have been exposed to a toxin at work that could affect fetal development. The client asks the nurse what organs might be affected at this point in pregnancy. What is the nurse's best response? 1. "The brain is developing now, and could be affected." 2. "Because you are in the second trimester, there is no danger." 3. "The internal organs like the heart and lungs could be impacted." 4. "It's best to not worry about possible problems with your baby."

Answer: 1 Explanation: 1. Maximum brain growth and myelination are occurring at this point in fetal development.

The nurse in a fertility clinic is working with a woman who has been undergoing infertility treatment with clomiphene citrate. Which statement would the nurse expect the woman to make? 1. "I feel moody so much of the time." 2. "If this doesn't work, I think my husband will leave me." 3. "This medication will guarantee a pregnancy." 4. "My risk of twins or triplets is the same as for the general population."

Answer: 1 Explanation: 1. Mood swings are a side effect of clomiphene citrate.

The nurse teaching the expectant parents about the placenta also talks about the circulation and how the fetus gets its oxygen. She will include in this teaching which important fact? 1. The placenta functions as the lungs for the fetus. 2. The fetus obtains its oxygen from the amniotic fluid. 3. The fetus receives its oxygen by osmosis from the mother's bloodstream. 4. Fetal circulation delivers the highest amount of oxygen to the abdomen and lower body of the fetus.

Answer: 1 Explanation: 1. Most of the blood supply bypasses the fetal lungs because they do not carry out respiratory gas exchange. The placenta assumes the function of the fetal lungs by supplying oxygen and allowing the fetus to excrete carbon dioxide into the maternal bloodstream.

22) The nurse is working with a family who experienced the stillbirth of a son 2 months ago. Which statement by the mother would be expected? 1. "I seem to keep crying for no reason." 2. "The death of my son hasn't changed my life." 3. "I have not visited my son's gravesite." 4. "I feel happy all the time."

Answer: 1 Explanation: 1. Mourning may be manifested by certain behaviors and rituals, such as weeping, which help the person experience, accept, and adjust to the loss. Page Ref: 945

The nurse is caring for a client pregnant with twins. Which statement indicates that the client needs additional information? 1. "Because both of my twins are boys, I know that they are identical." 2. "If my twins came from one fertilized egg that split, they are identical." 3. "If I have one boy and one girl, I will know they came from two eggs." 4. "It is rare for both twins to be within the same amniotic sac."

Answer: 1 Explanation: 1. Not all same-sex twins are identical or monozygotic, because fraternal, or dizygotic, twins can be the same gender or different genders.

The nurse administered oxytocin 20 units at the time of placental delivery. Why was this primarily done? 1. To contract the uterus and minimize bleeding 2. To decrease breast milk production 3. To decrease maternal blood pressure 4. To increase maternal blood pressure

Answer: 1 Explanation: 1. Oxytocin is given to contract the uterus and minimize bleeding.

4) A woman has been having contractions since 4 a.m. At 8 a.m., her cervix is dilated to 5 cm. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (CPD) has been ruled out. After giving the mother some sedation so she can rest, what would the nurse anticipate preparing for? 1. Oxytocin induction of labor 2. Amnioinfusion 3. Increased intravenous infusion 4. Cesarean section

Answer: 1 Explanation: 1. Oxytocin is the drug of choice for labor augmentation or labor induction and may be administered as needed for hypotonic labor patterns.

The nurse is preparing to assess the fetus of a laboring client. Which assessment should the nurse perform first? 1. Perform Leopold maneuvers to determine fetal position. 2. Count the fetal heart rate between, during, and for 30 seconds following a uterine contraction (UC). 3. Dry the maternal abdomen before using the Doppler. 4. The diaphragm should be cooled before using the Doppler.

Answer: 1 Explanation: 1. Performing Leopold maneuvers is the first step.

25) The labor and delivery nurse is caring for a client whose labor is being induced due to fetal death in utero at 35 weeks' gestation. In planning intrapartum care for this client, which nursing diagnosis is most likely to be applied? 1. Powerlessness 2. Urinary Elimination, Impaired 3. Coping: Family, Readiness for Enhanced 4. Skin Integrity, Impaired

Answer: 1 Explanation: 1. Powerlessness is commonly experienced by families who face fetal loss. Powerlessness is related to lack of control in current situational crisis. Page Ref: 954

When assessing a client asking about birth control, the nurse knows that the client would not be a good candidate for Depo-Provera (DMPA) if which of the following is true? 1. She wishes to get pregnant within 3 months. 2. She is a nursing mother. 3. She has a vaginal prolapse. 4. She weighs 200 pounds.

Answer: 1 Explanation: 1. Return of fertility after use may be delayed for an average of 10 months.

A pregnant client asks the nurse, "What is this "knuckle test" that is supposed to tell whether my baby has a genetic problem?" What does the nurse correctly explain? 1. "In the first trimester, the nuchal translucency measurement is added to improve the detection rate for Down syndrome and trisomy 18." 2. "You will need to ask the physician for an explanation." 3. "It tests for hemophilia A or B." 4. "It tests for Duchenne muscular dystrophy."

Answer: 1 Explanation: 1. Screening tests, such as nuchal translucency ultrasound are designed to gather information about the risk that the pregnancy could have chromosome abnormalities or open spina bifida.

A client tells you that her mother was a twin, two of her sisters have twins, and several cousins either are twins or gave birth to twins. The client, too, is expecting twins. Because there is a genetic predisposition to twins in her family, there is a good chance that the client will have what type of twins? 1. Dizygotic twins 2. Monozygotic twins 3. Identical twins 4. Nonzygotic twins

Answer: 1 Explanation: 1. Studies indicate that dizygotic twins tend to occur in certain families, perhaps because of genetic factors that result in elevated serum gonadotropin levels leading to double ovulation.

The nurse discussing different pregnancy programs explains that which of the following is critical to the success of an adolescent pregnancy-prevention program? 1. Including role models from the same cultural and racial backgrounds 2. Focusing on the adolescent female 3. Having short-term, informal programs available twice per year 4. Focusing on the expectations of the adolescents' parents

Answer: 1 Explanation: 1. The National Campaign to Prevent Teen and Unplanned Pregnancy's task forces found that the programs most effective at preventing teen pregnancy include models from the same cultural and racial backgrounds as the participants.

A client in the women's clinic asks the nurse, "How is the cervical mucus method of contraception different from the rhythm method?" The appropriate response by the nurse is that the cervical mucus method is which of the following? 1. More effective for women with irregular cycles 2. Not acceptable to women of many different religions 3. Harder to work with than is the rhythm method 4. Requires an artificial substance or device

Answer: 1 Explanation: 1. The cervical mucus method (Billings Ovulation Method) can be used by women with irregular cycles.

7) Two hours ago, a client at 39 weeks' gestation was 3 cm dilated, 40% effaced, and +1 station. Frequency of contractions was every 5 minutes with duration 40 seconds and intensity 50 mmHg. The current assessment is 4 cm dilated, 40% effaced, and +1 station. Frequency of contractions is now every 3 minutes with 40-50 seconds' duration and intensity of 40 mmHg. What would the priority intervention be? a) begin oxytocin after assessing for CPD b) gie terbutaline to stop the preterm labor c) start oxygen at 8L/min d) Have the anesthesiologist give the client and epidural

Answer: 1 Explanation: 1. The client is having hypertonic contractions. Cephalopelvic disproportion (CPD) must be excluded. If CPD exists, oxytocin (Pitocin) augmentation should not be used. Oxytocin is the drug of choice for labor augmentation or labor induction.

A nurse is providing contraceptive counseling to a perimenopausal client in a monogamous relationship. What comment by the client indicates that further teaching is necessary? 1. "The calendar method is the most reliable method for me to use." 2. "If I use the IUC, I will be at minimal risk for pelvic inflammatory disease." 3. "I should still use birth control, even though I had only three periods last year." 4. "The contraceptive skin patch contains both estrogen and progesterone."

Answer: 1 Explanation: 1. The client who believes the calendar method is the most reliable method requires more teaching. The menstrual cycle of perimenopausal women is irregular, and it is difficult to determine safe and unsafe times.

The laboring client's fetal heart rate baseline is 120 beats per minute. Accelerations are present to 135 beats/min. During contractions, the fetal heart rate gradually slows to 110, and is at 120 by the end of the contraction. What nursing action is best? 1. Document the fetal heart rate. 2. Apply oxygen via mask at 10 liters. 3. Prepare for imminent delivery. 4. Assist the client into Fowler's position.

Answer: 1 Explanation: 1. The described fetal heart rate has a normal baseline; the presence of accelerations indicates adequate fetal oxygenation, and early decelerations are normal. No intervention is necessary.

The school nurse is planning a presentation on pregnancy for 13- and 14-year-olds who are currently pregnant. When planning the content of this presentation, what should the nurse keep in mind about these teens? 1. They are working on independence and autonomy. 2. They are no longer developing a sense of achievement. 3. They are confident in their own identity. 4. They are in control of their impulses.

Answer: 1 Explanation: 1. The developmental tasks of adolescence include developing an identity, gaining autonomy and independence, developing intimacy in a relationship, developing comfort with one's own sexuality, and developing a sense of achievement. Teens in early adolescence will not have achieved all of these tasks yet.

To identify the duration of a contraction, the nurse would do which of the following? 1. Start timing from the beginning of one contraction to the completion of the same contraction. 2. Time between the beginning of one contraction and the beginning of the next contraction. 3. Palpate for the strength of the contraction at its peak. 4. Time from the beginning of the contraction to the peak of the same contraction.

Answer: 1 Explanation: 1. The duration of each contraction is measured from the beginning of the contraction to the completion of the contraction.

The pregnant client who is at 14 weeks' gestation asks the nurse why the doctor used to call her baby an embryo, and now calls it a fetus. What is the best answer to this question? 1. "A fetus is the term used from the ninth week of gestation and onward." 2. "We call a baby a fetus when it is larger than an embryo." 3. "An embryo is a baby from conception until the eighth week." 4. "The official term for a baby in utero is really zygote."

Answer: 1 Explanation: 1. The fetal stage begins in the ninth week.

The fetal heart rate baseline is 140 beats/min. When contractions begin, the fetal heart rate drops suddenly to 120, and rapidly returns to 140 before the end of the contraction. Which nursing intervention is best? 1. Assist the client to change position. 2. Apply oxygen to the client at 2 liters per nasal cannula. 3. Notify the operating room of the need for a cesarean birth. 4. Determine the color of the leaking amniotic fluid.

Answer: 1 Explanation: 1. The fetus is exhibiting variable decelerations, which are caused by cord compression. Sometimes late or variable decelerations are due to the supine position of the laboring woman. In this case, the decrease in uterine blood flow to the fetus may be alleviated by raising the woman's upper trunk or turning her to the side to displace pressure of the gravid uterus on the inferior vena cava.

A client using oral contraceptives tells the nurse that her family is complete, and she now desires permanent contraception. Which statement should the nurse include in teaching this client about sterilization options? 1. "Essure becomes effective 3 months after insertion." 2. "Vasectomy is effective immediately after the procedure." 3. "Tubal ligation cannot be performed until the client is age 35." 4. "Oral contraception should be taken until menopause."

Answer: 1 Explanation: 1. The insertion of Essure creates a tissue response that results in tubal occlusion in about 3 months.

The OB-GYN nurse knows that the most common shape for the female pelvis is which of the following? 1. Gynecoid type 2. Android type 3. Anthropoid type 4. Platypelloid type

Answer: 1 Explanation: 1. The most common female pelvis is the gynecoid type. The inlet is rounded with the anteroposterior diameter a little shorter than the transverse diameter.

17) What is the most significant maternal risk factor for preterm birth? 1. Previous preterm birth 2. Smoking 3. Stress 4. Substance abuse

Answer: 1 Explanation: 1. The most significant maternal risk factor for preterm birth is a previous preterm birth.

The nurse in the OB-GYN office is explaining the benefits and risks associated with Essure to a client and her husband. What statement made by the client indicates that additional education is needed? 1. "A stainless steel microinsert is placed into the distal section of one fallopian tube." 2. "The Essure method of permanent sterilization requires no surgical incision." 3. "The steel microinserts create a benign tissue response that occludes the fallopian tubes." 4. "Women allergic to nickel should consult their physician before placement."

Answer: 1 Explanation: 1. The stainless steel microinsert is placed in the proximal section of both fallopian tubes.

24) The nurse is present when a mother and her partner are told that their 35-week fetus has died. Which nursing intervention should the nurse perform first? 1. Encourage open communication with the family and the healthcare team. 2. Ask the family to withhold questions until the next day. 3. Request that another nurse come and care for this family. 4. Contact a local funeral home to help the family with funeral plans.

Answer: 1 Explanation: 1. The top priority for the nurse is to encourage open communications. The nurse functions as an advocate for the family in organizing interdisciplinary involvement, maintaining continuity of care, offering the opportunity for open communication, and ensuring that the family's wishes regarding their loss experience are honored. Page Ref: 965

The nurse teaching a class on reproductive anatomy knows that no further instruction is needed when a student shows an understanding of the pelvic cavity divisions by making which statement? 1. "The true pelvis is made up of the sacrum, coccyx, and innominate bones." 2. "The false pelvis consists of the inlet, the pelvic cavity, and the outlet." 3. "The true pelvis is the portion above the pelvic brim." 4. "The relationship between the false pelvis and the fetal head is of paramount importance."

Answer: 1 Explanation: 1. The true pelvis is made up of the sacrum, the coccyx, and the two innominate bones.

The laboring client is complaining of tingling and numbness in her fingers and toes, dizziness, and spots before her eyes. The nurse recognizes that these are clinical manifestations of which of the following? 1. Hyperventilation 2. Seizure auras 3. Imminent birth 4. Anxiety

Answer: 1 Explanation: 1. These symptoms all are consistent with hyperventilation.

The nurse educator is presenting a program to college students about factors that can cause congenital malformations. What should the nurse tell them? 1. The growing embryo is considered most vulnerable to hazardous agents during the first months of pregnancy. 2. Spontaneous abortion always occurs if the fetus is affected by a teratogen. 3. Potential teratogens can cause malformations of the heart, limbs, eyes, and other organ systems only in the second trimester. 4. Teratogen agents are primarily drugs.

Answer: 1 Explanation: 1. This is true. Because organs are formed primarily during embryonic development, the growing embryo is considered most vulnerable to hazardous agents during the first months of pregnancy.

After explaining how meiotic division occurs within the ovum, the nurse knows that the pregnant client understands when she makes what statement? 1. "The second meiotic division is arrested until and unless the oocyte is fertilized." 2. "Meiosis in the oocyte begins at puberty." 3. "The first meiotic division continues when the female infant is born." 4. "Fertilization does not take place in the secondary oocyte."

Answer: 1 Explanation: 1. This is true. The secondary oocyte moves into the metaphase stage of cell division, where its meiotic division is arrested until and unless the oocyte is fertilized.

A woman is asking the nurse about using the calendar method of contraception. She reports that her last six menstrual cycles were 28, 32, 29, 36, 30, and 27 days long, respectively. Based on this information, when should the nurse tell the client to abstain from intercourse? 1. Days 9-25 2. Days 9-15 3. Days 10-21 4. Days 10-16

Answer: 1 Explanation: 1. To calculate the period of abstinence, the nurse must subtract 18 from the shortest cycle length and 11 from the longest cycle length.

By inquiring about the expectations and plans that a laboring woman and her partner have for the labor and birth, the nurse is primarily doing which of the following? 1. Recognizing the client as an active participant in her own care. 2. Attempting to correct any misinformation the client might have received. 3. Acting as an advocate for the client. 4. Establishing rapport with the client.

Answer: 1 Explanation: 1. Understanding the couple's expectations and plans helps the nurse provide optimal nursing care and facilitate the best possible birth experience.

2) The client tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure? 1. A version 2. An amniotomy 3. Leopold maneuvers 4. A ballottement

Answer: 1 Explanation: 1. Version, or turning the fetus, is a procedure used to change the fetal presentation by abdominal or intrauterine manipulation. Page Ref: 621

After telling a mother that her 13-year-old daughter is pregnant, the nurse would expect the mother to respond with which statement? 1. "We had such high hopes for you." 2. "But you have always been a happy child." 3. "I've always liked that boy." 4. "This is just one of those things that happen."

Answer: 1 Explanation: 1. When an adolescent pregnancy is first revealed to the teen's mother, the result is often anger, shame, or sorrow. The degree of negative response will be determined by the age of the teen, the family expectations for the teen, and the presence or absence of other teen pregnancies in the family or support network.

The laboring client presses the call light and reports that her water has just broken. What would the nurse's first action be? 1. Check fetal heart tones. 2. Encourage the mother to go for a walk. 3. Change bed linens. 4. Call the physician.

Answer: 1 Explanation: 1. When the membranes rupture, the nurse notes the color and odor of the amniotic fluid and the time of rupture and immediately auscultates the FHR.

Two hours after delivery, a client's fundus is boggy and has risen to above the umbilicus. What is the first action the nurse would take? 1. Massage the fundus until firm 2. Express retained clots 3. Increase the intravenous solution 4. Call the physician

Answer: 1 Explanation: 1. When the uterus becomes boggy, pooling of blood occurs within it, resulting in the formation of clots. Anything left in the uterus prevents it from contracting effectively. Thus if it becomes boggy or appears to rise in the abdomen, the fundus should be massaged until firm.

The client has asked the nurse why her cervix has only changed from 1 to 2 cm in 3 hours of contractions occurring every 5 minutes. What is the nurse's best response to the client? 1. "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress." 2. "When your perineal body thins out, your cervix will begin to dilate much faster than it is now." 3. "What did you expect? You've only had contractions for a few hours. Labor takes time." 4. "The hormones that cause labor to begin are just getting to be at levels that will change your cervix."

Answer: 1 Explanation: 1. With each contraction, the muscles of the upper uterine segment shorten and exert a longitudinal traction on the cervix, causing effacement. Effacement is the taking up (or drawing up) of the internal os and the cervical canal into the uterine side walls.

13) The nurse knows that a contraindication to the induction of labor is which of the following? 1. Placenta previa 2. Isoimmunization 3. Diabetes mellitus 4. Premature rupture of membranes

Answer: 1 Explanation: 1. Placenta previa is a contraindication to the induction of labor. Page Ref: 626

In evaluating information taught about conception and fetal development, the client verbalizes understanding about transportation time of the zygote through the fallopian tube and into the cavity of the uterus with which statement? 1. "It will take at least 3 days for the egg to reach the uterus." 2. "It will take 8 days for the egg to reach the uterus." 3. "It will only take 12 hours for the egg to go through the fallopian tube." 4. "It will take 18 hours for the fertilized egg to implant in the uterus."

Answer: 1 Explanation: 1. "It will take at least 3 days for the egg to reach the uterus" is the correct statement.

24) A woman is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150 beats/min. Her membranes rupture spontaneously, and the FHR drops to 90 beats/min with variable decelerations. What would the initial response from the nurse be? 1. Perform a vaginal exam. 2. Notify the physician. 3. Place the client in a left lateral position. 4. Administer oxygen at 2 L per nasal cannula.

Answer: 1 Explanation: 1. A drop in fetal heart rate accompanied by variable decelerations is consistent with a prolapsed cord. The nurse would assess for prolapsed cord via vaginal examination. Page Ref: 615

32) To reduce possible side effects from a cesarean section under general anesthesia, clients are routinely given which type of medication? 1. Antacids 2. Tranquilizers 3. Antihypertensives 4. Anticonvulsants

Answer: 1 Explanation: 1. Antacids are routinely administered before surgery for a cesarean section.

27) On assessment, a labor client is noted to have cardiovascular and respiratory collapse and is unresponsive. What should the nurse suspect? 1. An amniotic fluid embolus 2. Placental abruption 3. Placenta accreta 4. Retained placenta

Answer: 1 Explanation: 1. Cardiovascular and respiratory collapse are symptoms of an amniotic fluid embolus and cor pulmonale. Page Ref: 616

9) A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of anesthesia? 1. Spinal 2. Pudendal 3. General 4. Epidural

Answer: 1 Explanation: 1. Following the birth, the woman may be kept flat. Although the effectiveness of the supine position to avoid headache following a spinal is controversial, the physician's orders may include lying flat for 6 to 12 hours.

33) The nurse is caring for a laboring client with thrombocytopenia. During labor, it is determined that the client requires a cesarean delivery. The nurse is preparing the client for surgery, and should instruct the client that the recommended method of anesthesia is which of the following? 1. General anesthesia 2. Epidural anesthesia 3. Spinal anesthesia 4. Regional anesthesia

Answer: 1 Explanation: 1. General anesthesia will be recommended. Women with thrombocytopenia should avoid regional blocks.

5) An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was effective? 1. The client dozes between contractions. 2. The client is moaning during contractions. 3. The contractions decrease in intensity. 4. The contractions decrease in frequency.

Answer: 1 Explanation: 1. If the client dozes between contractions, the analgesic is effective. Analgesics decrease discomfort and increase relaxation.

35) The client gave birth to a 7 pound, 14 ounce female 30 minutes ago. The placenta has not yet delivered. Manual removal of the placenta is planned. What should the nurse prepare to do? 1. Start an IV of lactated Ringer's. 2. Apply anti-embolism stockings. 3. Bottle-feed the infant. 4. Send the placenta to pathology.

Answer: 1 Explanation: 1. In women who do not have an epidural in place, intravenous sedation may be required because of the discomfort caused by the procedure. An IV is necessary. Page Ref: 618

4) A woman in active labor is given nalbuphine hydrochloride (Nubain) 14 mg IV for pain relief. Half an hour later, her respirations are at 8 per minute. The physician would likely order which medication for this client? 1. Narcan 2. Reglan 3. Benadryl 4. Vistaril

Answer: 1 Explanation: 1. Narcan is useful for respiratory depression caused by nalbuphine (Nubain).

16) The laboring client brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 cm and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" What is the nurse's best response? 1. "The narcotic in the epidural will make both you and the baby sleepy." 2. "It is unlikely that an epidural will decrease your baby's heart rate." 3. "Epidurals tend to cause low blood pressure in babies after birth." 4. "I can't get you an epidural, because of your birth plan."

Answer: 2 Explanation: 2. Maternal hypotension results in uteroplacental insufficiency in the fetus, which is manifested as late decelerations on the fetal monitoring strip. The risk of hypotension can be minimized by hydrating the vascular system with 500 to 1000 mL of IV solution before the procedure and changing the woman's position and/or increasing the IV rate afterward.

30) The nurse is inducing the labor of a client with severe preeclampsia. As labor progresses, fetal intolerance of labor develops. The induction medication is turned off, and the client is prepared for cesarean birth. Which statement should the nurse include in her preoperative teaching? 1. "Because of your preeclampsia you are at higher risk for hypotension after an epidural anesthesia." 2. "Because of your preeclampsia you might develop hypertension after a spinal anesthesia." 3. "Because of your preeclampsia your baby might have decreased blood pressure after birth." 4. "Because of your preeclampsia your husband will not be allowed into the operating room."

Answer: 1 Explanation: 1. Pregnancies complicated by preeclampsia are high-risk situations. The woman with mild preeclampsia usually may have the analgesia or anesthesia of choice, although the incidence of hypotension with epidural anesthesia is increased. If hypotension occurs with the epidural block, it provides further stress on an already compromised cardiovascular system.

8) A client is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes, and FHR of 150 bpm. Her membranes rupture spontaneously, and the FHR drops to 90 bpm with variable decelerations. What would the nurse's initial response be? 1. Perform a vaginal exam 2. Notify the physician 3. Place the client in a left lateral position 4. Administer oxygen at 2 L per nasal cannula

Answer: 1 Explanation: 1. Prolapsed umbilical cord can occur when the membranes rupture. The fetus is more likely to experience variable decelerations because the amniotic fluid is insufficient to keep pressure off the umbilical cord. A vaginal exam is the best way to confirm.

23) A client received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This client is at increased risk for which problem during the fourth stage of labor? 1. Nausea 2. Bladder distention 3. Uterine atony 4. Hypertension

Answer: 2 Explanation: 2. Nursing care following an epidural block includes frequent assessment of the bladder to avoid bladder distention.

15) The nurse should anticipate the labor pattern for a fetal occiput posterior position to be which of the following? 1. Shorter than average during the latent phase 2. Prolonged as regards the overall length of labor 3. Rapid during transition 4. Precipitous

Answer: 2 Explanation: 2. Occiput posterior (OP) position of the fetus is the most common fetal malposition and occurs when the head remains in the direct OP position throughout labor. This can prolong the overall length of labor. Page Ref: 601, 602

36) The client delivered 30 minutes ago. Her blood pressure and pulse are stable. Vaginal bleeding is scant. The nurse should prepare for which procedure? 1. Abdominal hysterectomy 2. Manual removal of the placenta 3. Repair of perineal lacerations 4. Foley catheterization

Answer: 2 Explanation: 2. Retention of the placenta beyond 30 minutes after birth is termed retained placenta. Manual removal of the placenta is then performed. Page Ref: 618

34) The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased health care costs in clients undergoing cesarean birth by request? 1. Increased abnormal placenta implantation in subsequent pregnancies 2. Decreased use of general anesthesia with greater use of epidural anesthesia 3. Prolonged anemia, requiring blood transfusions every few months 4. Coordination of career projects of both partners leading to increased income

Answer: 1 Explanation: 1. Repeat cesarean births are associated with greater risks including increased incidence of abnormal placentation in subsequent pregnancies and the increased risk of mortality secondary to surgery, which would contribute to increased health care costs. Page Ref: 646

14) What is the major adverse side effect of epidural anesthesia? 1. Maternal hypotension 2. Decrease in variability of the FHR 3. Vertigo 4. Decreased or absent respiratory movements

Answer: 1 Explanation: 1. The major adverse effect of epidural anesthesia is maternal hypotension caused by a spinal blockade, which lowers peripheral resistance, decreases venous return to the heart, and subsequently lessens cardiac output and lowers blood pressure.

1) Which of the following is a common barbiturate used in labor? 1. Seconal 2. Valium 3. Phenergan 4. Vistaril

Answer: 1 Explanation: 1. The most common barbiturates used in labor are secobarbital (Seconal) and zolpidem tartrate (Ambien).

17) After administration of an epidural anesthetic to a client in active labor, it is most important to assess the mother immediately for which of the following? 1. Hypotension 2. Headache 3. Urinary retention 4. Bradycardia

Answer: 1 Explanation: 1. The most common complication of an epidural is maternal hypotension.

34) What is one of the most common initial signs of nonreassuring fetal status? 1. Meconium-stained amniotic fluid 2. Cyanosis 3. Dehydration 4. Arrest of descent

Answer: 1 Explanation: 1. The most common initial signs of nonreassuring fetal status are meconium-stained amniotic fluid and changes in the fetal heart rate (FHR). Page Ref: 611

2) The nurse is admitting a client for a cerclage procedure. The client asks for information about the procedure. What is the nurse's most accurate response? 1. "A stitch is placed in the cervix to prevent a spontaneous abortion or premature birth." 2. "The procedure is done during the third trimester." 3. "Cerclage is always placed after the cervix has dilated and effaced." 4. "An uncomplicated elective cerclage may is done on inpatient basis."

Answer: 1 Explanation: 1. This is the correct description of cerclage.

20) The labor nurse is caring for a client at 38 weeks' gestation who has been diagnosed with symptomatic placenta previa. Which physician order should the nurse question? 1. Begin oxytocin drip rate at 0.5 milliunits/min. 2. Assess fetal heart rate every 10 minutes. 3. Weigh all vaginal pads. 4. Assess hematocrit and hemoglobin.

Answer: 1 Explanation: 1. This order should be questioned, as this client is not a good candidate for labor induction.

30) A 26-year-old client is having her initial prenatal appointment. The client reports to the nurse that she suffered a pelvic fracture in a car accident 3 years ago. The client asks whether her pelvic fracture might affect her ability to have a vaginal delivery. What response by the nurse is best? 1. "It depends on how your pelvis healed." 2. "You will need to have a cesarean birth." 3. "Please talk to your doctor about that." 4. "You will be able to delivery vaginally."

Answer: 1 Explanation: 1. Women with a history of pelvic fractures may also be at risk for cephalopelvic disproportion (CPD). Page Ref: 617

25) A client attending a prenatal class asks why episiotomies are performed. The nurse explains that risk factors that predispose women to episiotomies include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Large or macrosomic fetus 2. Use of forceps 3. Shoulder dystocia 4. Maternal health 5. Shorter second stage

Answer: 1, 2, 3 Explanation: 1. A large fetus places a woman at risk for an episiotomy to prevent lacerations. 2. Use of forceps or vacuum extractor is a risk factor that predisposes women to episiotomies. 3. Shoulder dystocia is a risk factor that predisposes women to episiotomies. Page Ref: 636

What issues should the nurse consider when counseling a client on contraceptive methods? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Cultural perspectives on menstruation and pregnancy 2. Effectiveness of the method 3. Future childbearing plans 4. Whether the client is a vegetarian 5. Age at menarche

Answer: 1, 2, 3 Explanation: 1. Decisions about contraception should be made voluntarily with full knowledge of advantages, disadvantages, effectiveness, side effects, contraindications, and long-term effects. Many outside factors influence this choice, including cultural practices, religious beliefs, personality, cost, effectiveness, availability, misinformation, practicality of method, and self-esteem.

11) The nurse is caring for a client who has just been informed of the demise of her unborn fetus. Which common cognitive responses to loss would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Denial and disbelief 2. Sense of unreality 3. Poor concentration 4. Palpitations 5. Loss of appetite

Answer: 1, 2, 3 Explanation: 1. Denial and disbelief are common cognitive responses to fetal loss. 2. A sense of unreality is a common cognitive response to fetal loss. 3. Poor concentration is a common cognitive response to loss. Page Ref: 947

The labor nurse would not encourage a mother to bear down until the cervix is completely dilated, to prevent which of the following? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Maternal exhaustion 2. Cervical edema 3. Tearing and bruising of the cervix 4. Enhanced perineal thinning 5. Having to perform an episiotomy

Answer: 1, 2, 3 Explanation: 1. If the cervix is not completely dilated, maternal exhaustion can occur. 2. If the cervix is not completely dilated, cervical edema can occur. 3. If the cervix is not completely dilated, tearing and bruising of the cervix can occur.

15) A client is admitted to the labor and delivery unit in active labor. What nursing diagnoses might apply to the client with suspected abruptio placentae? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fluid Volume, Deficient, Risk for, related to hypovolemia secondary to excessive blood loss 2. Tissue Perfusion: Peripheral, Ineffective, related to blood loss secondary to uterine atony following birth 3. Anxiety related to concern for own personal status and the baby's safety 4. Knowledge, Deficient related to lack of information about inherited genetic defects 5. Alteration in Respiratory Function related to blood loss

Answer: 1, 2, 3 Explanation: 1. Maternal and perinatal fetal mortality are concerns due to hypoxia. 2. Maternal and perinatal fetal mortality are concerns due to blood loss. 3. This mother would be anxious for herself and her baby.

The nurse is teaching about reproduction, and explains that which of the following are the purposes of meiosis? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Produce gametes 2. Reduce the number of chromosomes 3. Introduce genetic variability 4. Produce cells for growth and development 5. Divide somatic cells into new cells with identical characteristics

Answer: 1, 2, 3 Explanation: 1. Meiosis is a special type of cell division by which diploid cells give rise to gametes (sperm and ova). 2. The cells contain half the genetic material of the parent cell-only 23 chromosomes-the haploid number of chromosomes. 3. During meiosis new combinations of cells are provided by the newly formed chromosomes; these combinations account for the wide variation of traits.

The nurse is educating a client on intrauterine contraception (IUC). Which advantages of IUC will the nurse include? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. It is effective, continuous contraception. 2. It is relatively inexpensive over time. 3. It does not need to be inserted immediately prior to coitus. 4. Small amounts of estrogen are released daily. 5. It slightly increases the risk of ectopic pregnancy.

Answer: 1, 2, 3 Explanation: 1. One advantage of IUC is a high rate of effectiveness. 2. One advantage of IUC is that it is inexpensive over time. 3. It is non-coitus-related contraception.

In planning a program to reduce teen pregnancy rates, the nurse uses an evidence-based approach. The nurse learns that more research is needed for which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Teen pregnancy rate in the United States 2. Use of birth control by adolescents 3. Prevention of sexually transmitted infections 4. Long-active, reversible contraception is highly effective for teens 5. Intrauterine devices are safe and effective when used by adolescents

Answer: 1, 2, 3 Explanation: 1. The teen pregnancy rate in the United States requires more research. 2. The use of birth control by adolescents requires more research. 3. Preventing sexually transmitted infections in teenagers requires more research.

32) A fetal weight is estimated at 4490 grams in a client at 38 weeks' gestation. Counseling should occur before labor regarding which of the following? 1. Mother's undiagnosed diabetes 2. Likelihood of a cesarean delivery 3. Effectiveness of epidural anesthesia with a large fetus 4. Need for early delivery

Answer: 2 Explanation: 2. The likelihood of a cesarean delivery with a fetus over 4000 grams is high. This should be discussed with the client before labor. Page Ref: 610

28) A cesarean section is ordered for the laboring client with whom the nurse has worked all shift. The client will receive general anesthesia. The nurse knows that potential complications of general anesthesia include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Fetal depression that is directly proportional to the depth and duration of the anesthesia 2. Poor fetal metabolism of anesthesia, which inhibits use with preterm infants 3. Uterine relaxation 4. Increased gastric motility 5. Itching of the face and neck

Answer: 1, 2, 3 Explanation: 1. A primary danger of general anesthesia is fetal depression, because the medication reaches the fetus in about 2 minutes. The depression is directly proportional to the depth and duration of anesthesia. 2. The poor fetal metabolism of general anesthetic agents is similar to that of analgesic agents administered during labor. General anesthesia is not advocated when the fetus is considered to be at high risk, particularly in preterm birth. 3. Most general anesthetic agents cause some degree of uterine relaxation.

7) During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. What would the nurse's priority action be? 1. To help the fetal head descend faster 2. To use gravity and manipulation to relieve compression on the cord 3. To facilitate dilation of the cervix with prostaglandin gel 4. To prevent head compression

Answer: 2 Explanation: 2. The top priority is to relieve compression on the umbilical cord to allow blood flow to reach the fetus. It is because some obstetric maneuvers to relieve cord compression are complicated that cesarean birth is sometimes necessary.

30) The nurse is caring for a 15-year-old who just delivered a 32-weeks'-gestation stillborn infant with numerous defects. In caring for this client, the nurse knows which of the following? 1. The client will likely do no grieving, as she is so young and the pregnancy was probably a mistake in any case. 2. Adolescents have a sense of invulnerability, an "It can't happen to me" mentality. 3. The client's mother will handle her daughter's grief, so the nurse doesn't need to be concerned. 4. The nurse will remove the baby before the client sees it.

Answer: 2 Explanation: 2. Though adolescents have a mature concept of death, it is often clouded by their sense of invulnerability, an "It can't happen to me" mentality. Page Ref: 947

32) The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance? 1. "A small cup will be put onto the baby's head, and a gentle suction will be applied." 2. "I can stop pushing and just rest if the vacuum extractor is used." 3. "The baby's head might have some swelling from the vacuum cup." 4. "The vacuum will be applied for a total of ten minutes or less."

Answer: 2 Explanation: 2. Vacuum extraction is an assistive delivery. The physician/CNM applies traction in coordination with uterine contractions. Page Ref: 639

1) The nurse is planning an in-service presentation about perinatal loss. Which statements should the nurse include in this presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Perinatal loss refers to third-trimester fetal death in utero." 2. "Perinatal loss occurs more frequently in assisted reproduction." 3. "Perinatal loss rates have declined in the United States over the past few years." 4. "Perinatal loss includes 25% of stillbirths occurring before the onset of labor." 5. "Perinatal loss rarely causes an emotional problem for the family."

Answer: 2, 3 Explanation: 2. Pregnancies conceived by in vitro fertilization have higher rates of pregnancy loss and pregnancy complications. 3. Perinatal loss in industrialized countries has declined in recent years as early diagnosis of congenital anomalies and advances in genetic testing techniques have increased the use of elective termination. Page Ref: 943

13) The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (DIC). The nurse should identify which conditions as risk factors for developing DIC? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Diabetes mellitus 2. Abruptio placentae 3. Fetal demise 4. Multiparity 5. Preterm labor

Answer: 2, 3 Explanation: 2. As a result of the damage to the uterine wall and the retroplacental clotting with covert abruption, large amounts of thromboplastin are released into the maternal blood supply, which in turn triggers the development of disseminated intravascular coagulation (DIC) and the resultant hypofibrinogenemia. 3. Perinatal mortality associated with abruptio placentae is approximately 25%. If fetal hypoxia progresses unchecked, irreversible brain damage or fetal demise may result.

29) The nurse is caring for a client who could be at risk for uterine rupture. The nurse is monitoring the fetus closely for which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Late decelerations 2. Bradycardia 3. Loss of ability to determine fetal station 4. Tachycardia 5. Early decelerations

Answer: 1, 2, 3 Explanation: 1. Late decelerations could be seen with uterine rupture. 2. Bradycardia is seen if there is uterine rupture. 3. The uterus is not holding the fetus in place anymore if the uterus ruptures. Page Ref: 617

23) What fetal factors require a cesarean birth? CHECK THIS ONE 592 1. Severe intrauterine growth restriction (IUGR) 2. Fetal anomalies 3. Unfavorable fetal position or presentation 4. Preterm birth 5. Lack of maternal attachment Check all that apply

Answer: 1, 2, 3, 4 Explanation: 1. Fetal factors such as severe intrauterine growth restriction (IUGR), preterm birth, fetal anomalies, nonreassuring fetal status, or unfavorable fetal position or presentation require cesarean birth. 2. Fetal factors such as severe intrauterine growth restriction (IUGR), preterm birth, fetal anomalies, nonreassuring fetal status, or unfavorable fetal position or presentation require cesarean birth. 3. Fetal factors such as severe intrauterine growth restriction (IUGR), preterm birth, fetal anomalies, nonreassuring fetal status, or unfavorable fetal position or presentation require cesarean birth. 4. Fetal factors such as severe intrauterine growth restriction (IUGR), preterm birth, fetal anomalies, nonreassuring fetal status, or unfavorable fetal position or presentation require cesarean birth.

The nurse is caring for a client who is having fetal tachycardia. The nurse knows that possible causes include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Maternal dehydration 2. Maternal hyperthyroidism 3. Fetal hypoxia 4. Prematurity 5. Anesthesia or regional analgesia

Answer: 1, 2, 3, 4 Explanation: 1. Maternal dehydration can cause fetal tachycardia. 2. Maternal hyperthyroidism can cause fetal tachycardia. 3. Fetal tachycardia can indicate fetal hypoxia. 4. Prematurity can cause fetal tachycardia.

21) The nurse caring for a client in labor anticipates fetal macrosomia and shoulder dystocia. Appropriate management of shoulder dystocia is essential in order to prevent which fetal complications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Brachial plexus injury 2. Fractured clavicle 3. Asphyxia 4. Neurological damage 5. Puerperal infection

Answer: 1, 2, 3, 4 Explanation: 1. Brachial plexus injury occurs due to improper or excessive traction applied to the fetal head. 2. Complications in macrosomia include fractured clavicles. 3. Complications in macrosomia include asphyxia of the fetus. 4. Neurological damage is a complication of macrosomia. Page Ref: 610

10) The nurse is presenting a class on preterm labor, its causes, and treatments to a group of newly pregnant couples. Which statements regarding preterm labor are true? Note: Credit will be given only of all correct choices and no incorrect choices are selected. Select all that apply. 1. Antepartum hemorrhage can cause preterm labor. 2. Trauma can cause preterm labor. 3. Infection can cause preterm labor. 4. Magnesium sulfate is a drug used to stop contractions. 5. Sedatives and narcotics may be given to stop labor.

Answer: 1, 2, 3, 4 Explanation: 1. Hemorrhage from placenta previa or abruption can cause preterm labor. 2. Trauma to the abdomen or uterus can cause preterm labor. 3. Infections such as urinary tract infections can cause preterm labor. 4. Magnesium sulfate acts as a CNS depressant by decreasing the quantity of acetylcholine released by motor nerve impulses and thereby blocking neuromuscular transmission.

9) During a visit to the obstetrician, a pregnant client questions the nurse about the potential need for an amniotomy. The nurse explains that an amniotomy is performed to do which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Stimulate the beginning of labor 2. Augment labor progression 3. Allow application of an internal fetal electrode 4. Allow application of an external fetal monitor 5. Allow insertion of an intrauterine pressure catheter

Answer: 1, 2, 3, 5 Explanation: 1. Amniotomy is the artificial rupture of the amniotic membranes and can be used to induce labor. 2. Amniotomy can be done to augment labor. 3. Amniotomy allows access to the fetus in order to apply an internal fetal electrode to the fetal scalp. 5. Amniotomy may be performed during labor to allow an intrauterine pressure catheter to be inserted. Page Ref: 633

38) A prenatal client asks the nurse about conditions that would necessitate a cesarean delivery. The nurse explains that cesarean delivery generally is performed in the presence of which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Complete placenta previa 2. Placental abruption 3. Umbilical cord prolapse 4. Precipitous labor 5. Failure to progress

Answer: 1, 2, 3, 5 Explanation: 1. When the placenta completely covers the uterine opening, a cesarean is performed. 2. Premature separation of the placenta from the uterine wall requires an immediate cesarean. 3. A prolapsed cord is an emergency requiring an immediate cesarean. 5. Failure to progress in labor can necessitate a cesarean birth. Page Ref: 642

The nurse is preparing an in-service presentation for a group of middle-school nurses. Which statements by the nurse would indicate that the middle-school nurse understood the role of culture in adolescent pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Studies show that 85% of teen mothers are middle class, and give birth to gain adult status." 2. "Teenage pregnancy is the leading reason why adolescent women drop out of school." 3. "Teens of color are more likely to become pregnant." 4. "Intelligence and academic ability are positively associated with delayed sexual activity, greater use of contraception, and lower rates of pregnancy." 5. "Over 50% of adolescents who have had an abortion or recent birth become pregnant again within two years."

Answer: 2, 3, 4 Explanation: 2. An estimated 30% to 40% of female teenage dropouts are mothers. 3. In the United States, the adolescent birth rate is higher among African American and Hispanic teens than among white teens. To some degree, the higher teenage pregnancy rate in these groups reflects the impact of poverty because a disproportionately higher number of African American and Hispanic youths live in poverty. 4. Teens with future goals (i.e., college or job) tend to use birth control more consistently compared with other teens; if they become pregnant, they are also more likely to have abortions.

19) The nurse knows that which of the following are advantages of spinal block? Note: Credit will be given only if all correct answers and no incorrect answers are selected. Select all that apply. 1. Intense blockade of sympathetic fibers 2. Relative ease of administration 3. Maternal compartmentalization of the drug 4. Immediate onset of anesthesia 5. Larger drug volume

Answer: 2, 3, 4 Explanation: 2. One of advantages of spinal block is the relative ease of administration. 3. One of the advantages of spinal block is the maternal compartmentalization of the drug. 4. One of the advantages of spinal block is the immediate onset of anesthesia.

The nurse educator teaching reproductive anatomy wants to make sure the students understand what stabilizes the uterus. Which statements about the individual ligaments would the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The infundibulopelvic ligaments suspend and support the uterus. 2. The broad ligament keeps the uterus centrally placed. 3. The uterosacral ligaments sweep back around the rectum and insert on the sides of the first and second sacral vertebrae. 4. The ovarian ligaments anchor the ovary to the uterus. 5. The cardinal ligaments prevent uterine prolapse and support the upper vagina.

Answer: 2, 3, 4, 5 Explanation: 2. The broad ligament keeps the uterus centrally placed. 3. The uterosacral ligaments sweep back around the rectum and insert on the sides of the first and second sacral vertebrae. 4. The ovarian ligaments anchor the ovary to the uterus. 5. The cardinal ligaments prevent uterine prolapse and support the upper vagina.

The nurse is aware of the different breathing techniques that are used during labor. Why are breathing techniques used during labor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. They are a form of anesthesia. 2. They are a source of relaxation. 3. They increase the ability to cope with contractions. 4. They are a source of distraction. 5. They increase a woman's pain threshold.

Answer: 2, 3, 4, 5 Explanation: 2. When used correctly, breathing techniques can encourage relaxation. 3. When used correctly, breathing techniques can enhance the ability to cope with uterine contractions. 4. When used correctly, breathing techniques provide some distraction from the pain. 5. When used correctly, breathing techniques increase a woman's pain threshold.

11) The nurse knows that the maternal risks associated with postterm pregnancy include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Polyhydramnios 2. Maternal hemorrhage 3. Maternal anxiety 4. Forceps-assisted delivery 5. Perineal damage

Answer: 2, 3, 4, 5 Explanation: 2. Maternal symptoms and complications in postterm pregnancy may include maternal hemorrhage. 3. Maternal symptoms and complications in postterm pregnancy may include maternal anxiety. 4. Maternal symptoms and complications in postterm pregnancy may include an operative vaginal birth with forceps or vacuum extractor. 5. Maternal symptoms and complications in postterm pregnancy may include perineal trauma and damage.

17) Which of the following potential problems would the nurse consider when planning care for a client with a persistent occiput posterior position of the fetus? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased fetal mortality 2. Severe perineal lacerations 3. Ceasing of labor progress 4. Fetus born in posterior position 5. Intense back pain during labor

Answer: 2, 3, 4, 5 Explanation: 2. The woman can have third- or fourth-degree perineal laceration or extension of a midline episiotomy. 3. Sometimes labor progress ceases if the fetus fails to rotate to an occiput anterior position. 4. Occiput posterior positions are associated with a higher incidence of vacuum-assisted births. 5. The woman usually experiences intense back pain in the small of her back throughout labor. Page Ref: 602

A client in the clinic asks the nurse about available contraceptives. Before responding, the nurse must assess which of the following factors? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. When menarche occurred 2. How frequently the client has intercourse 3. Whether the client has a history of thrombophlebitis 4. What the client's partner prefers 5. Whether the client is in a monogamous relationship

Answer: 2, 3, 5 Explanation: 2. A factor to consider when choosing a method of contraception is how frequently the client has intercourse

A pregnant client at 28 weeks' gestation asks the nurse what her baby is like at this stage of pregnancy. How would the nurse describe the fetus? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. The fetus is developing subcutaneous fat. 2. The fetus is now opening and closing her eyes. 3. The baby could now breathe on her own, if she were born. 4. The fetus has fingernails and toenails. 5. The fetus is forming surfactant needed for lung function.

Answer: 2, 3, 5 Explanation: 2. At 28 weeks, the eyes begin to open and close. 3. At 28 weeks, the delivered baby can breathe. 5. At 28 weeks, the fetus has the surfactant formed needed for breathing.

The OB-GYN nurse is teaching a client at the clinic that use of a spermicide has an increased effectiveness if used with which other items? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. A non-water-based lubricant 2. A diaphragm 3. A contraceptive sponge 4. Prophylactic antibiotics 5. A condom

Answer: 2, 3, 5 Explanation: 2. Barrier contraceptives such as a diaphragm act by blocking the transport of sperm and are often used in conjunction with a spermicide. 3. Barrier contraceptives such as the contraceptive sponge act by blocking the transport of sperm and are often used in conjunction with a spermicide. 5. Barrier contraceptives such as the condom act by blocking the transport of sperm and are often used in conjunction with a spermicide.

The nurse working with pediatric clients knows that the primary hormone secretions that induce puberty include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Thyroid hormone 2. Follicle-stimulating hormone 3. Leuteinizing hormone 4. Adrenocorticotropic hormone 5. Gonadotropin-releasing hormones

Answer: 2, 3, 5 Explanation: 2. Follicle-stimulating hormone (FSH) is part of the process that induces puberty. 3. The luteinizing hormone (LH) is a part of the process that induces puberty. 5. The central nervous system releases a neurotransmitter that stimulates the hypothalamus to synthesize and release gonadotropin-releasing hormone (GnRH).

The nurse is working with a community group to reduce teen pregnancy rates. Alternatives for the group to consider include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Avoidance of sex education in schools 2. High-quality reproductive health services 3. Developmentally appropriate sex education 4. Sexuality curriculum based on community beliefs 5. Provision of strategies to enhance life skills

Answer: 2, 3, 5 Explanation: 2. Having access to high-quality reproductive health services is important in reducing adolescent pregnancy rates. 3. Providing developmentally appropriate sex education is an approach that reduces adolescent pregnancy. 5. Programs that provide strategies to enhance life skills are more successful in reducing adolescent pregnancy rates.

When working with pregnant adolescents, the nurse plans on assessing which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. High-birth-weight infants 2. Pelvic measurements 3. For sexually transmitted infections 4. Low blood pressure readings 5. Hemoglobin and hematocrit

Answer: 2, 3, 5 Explanation: 2. Teenagers are more likely to have cephalopelvic disproportion. 3. Teenagers are more likely to have sexually transmitted infections. 5. Teenagers are more likely to be anemic, so the hemoglobin and hematocrit must be assessed.

Under the influence of progesterone, which of the following occur? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Temperature decreases 2. Cervix secretes thick, viscous mucus 3. Breasts prepare for lactation 4. Breast glandular tissue decreases in size 5. Vaginal epithelium proliferates

Answer: 2, 3, 5 Explanation: 2. Under the influence of progesterone, the cervix secretes thick, viscous mucus. 3. Under the influence of progesterone, breasts prepare for lactation. 5. Under the influence of progesterone, vaginal epithelium proliferates.

16) Maternal risks of occiput posterior (OP) malposition include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood loss greater than 1000 mL 2. Postpartum infection 3. Anal sphincter injury 4. Higher rates of vaginal birth 5. Instrument delivery

Answer: 2, 3, 5 Explanation: 2. Postpartum infection is a maternal risk of OP. 3. Anal sphincter injury is a maternal risk of OP. 5. Instrument delivery is a maternal risk of OP.

19) In which clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Placental abruption 2. Meconium-stained fluid 3. Polyhydramnios 4. Variable decelerations 5. Early decelerations

Answer: 2, 4 Explanation: 2. The physician may order amnioinfusion for meconium-stained fluid. 4. Amnioinfusion is sometimes done to prevent the possibility of variable decelerations. Page Ref: 635

A male client visits the infertility clinic for the results of his comprehensive exam. The exam indicated oligospermia. The client asks the nurse which procedure would assist him and his wife to conceive. The nurse's best response would include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "You might want to consider adoption." 2. "An option you might consider is in vitro fertilization." 3. "Surrogacy might be your best option." 4. "Many couples utilize therapeutic husband insemination." 5. "The GIFT procedure has had much success."

Answer: 2, 4 Explanation: 2. The in vitro fertilization procedure is used in cases in which infertility has resulted from male infertility. 4. Therapeutic husband insemination is generally indicated for such seminal deficiencies as oligospermia.

A couple is at the clinic for preconceptual counseling. Both parents are 40 years old. The nurse knows that the education session has been successful when the wife makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We are at low risk for having a baby with Down syndrome." 2. "Our children are more likely to have genetic defects." 3. "Children born to parents this age have sex-linked disorders." 4. "The tests for genetic defects can be done early in pregnancy." 5. "It will be almost impossible for us to conceive a child."

Answer: 2, 4 Explanation: 2. Women 35 or older are at greater risk for having children with chromosome abnormalities. 4. Genetic testing such as amniocentesis and chorionic villus sampling are done in the first trimester.

20) The nurse is monitoring a client who is receiving an amnioinfusion. Which assessments must the nurse perform to prevent a serious complication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Color of amniotic fluid 2. Maternal blood pressure 3. Cervical effacement 4. Uterine resting tone 5. Fluid leaking from the vagina

Answer: 2, 4, 5 Explanation: 2. Blood pressure should be monitored along with other vital signs. 4. The nurse should monitor contraction status (frequency, duration, intensity, resting tone, and associated maternal discomfort). 5. The nurse should continually check to make sure the infused fluid is being expelled from the vagina.

17) A client at 40 weeks' gestation is to undergo stripping of the membranes. The nurse provides the client with information about the procedure. Which information is accurate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Intravenous administration of oxytocin will be used to initiate contractions. 2. The physician/CNM will insert a gloved finger into the cervical os and rotate the finger 360 degrees. 3. Stripping of the membranes will not cause discomfort, and is usually effective. 4. Labor should begin within 24-48 hours after the procedure. 5. Uterine contractions, cramping, and a bloody discharge can occur after the procedure.

Answer: 2, 4, 5 Explanation: 2. This motion separates the amniotic membranes that are lying against the lower uterine segment and internal os from the distal part of the lower uterine segment. 4. If labor is initiated, it typically begins within 24-48 hours. 5. Uterine contractions, cramping, scant bleeding, and bloody discharge can occur after stripping of the membranes. Page Ref: 628, 629

The nurse determines that a client is carrying her fetus in the vertical (longitudinal) lie. The nurse's judgment should be questioned if the fetal presenting part is which of the following? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Sacrum 2. Left arm 3. Mentum 4. Left scapula 5. Right scapula

Answer: 2, 4, 5 Explanation: 2. A fetus with an arm presenting is likely in a horizontal lie. 4. A fetus with a left scapula presenting is in a horizontal lie. 5. A fetus with a right scapula presenting is in a horizontal lie.

9) Risk factors for labor dystocia include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Tall maternal height 2. Labor induction 3. Small-for-gestational-age (SGA) fetus 4. Malpresentation 5. Prolonged latent phase

Answer: 2, 4, 5 Explanation: 2. Labor induction is a risk factor of dystocia. 4. Malpresentation is a risk factor of dystocia. 5. Prolonged latent phase is a risk factor of dystocia.

What are the three functions of cervical mucosa? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Form the relatively fixed axis of the birth passage 2. Provide lubrication for the vaginal canal 3. Provide nourishment and protective maternal antibodies to infants 4. Provide an alkaline environment to shelter deposited sperm from the acidic vaginal secretions 5. Act as a bacteriostatic agent

Answer: 2, 4, 5 Explanation: 2. The cervical mucosa provides lubrication for the vaginal canal. 4. The cervical mucosa provides an alkaline environment to shelter deposited sperm from the acidic vaginal secretions. 5. The cervical mucosa acts as a bacteriostatic agent.

7) Amniotomy as a method of labor induction has which of the following advantages? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The danger of a prolapsed cord is decreased. 2. There is usually no risk of hypertonus or rupture of the uterus. 3. The intervention can cause a decrease in pain. 4. The color and composition of amniotic fluid can be evaluated. 5. The contractions elicited are similar to those of spontaneous labor.

Answer: 2, 4, 5 Explanation: 2. There is usually no risk of hypertonus or rupture of the uterus and this is an advantage of amniotomy. 4. The color and composition of amniotic fluid can be evaluated and this is an advantage of amniotomy. 5. The contractions elicited are similar to those of spontaneous labor and this is an advantage of amniotomy. Page Ref: 633

The primary care provider is performing a fetal scalp stimulation test. What result would the nurse hope to observe? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Spontaneous fetal movement 2. Fetal heart acceleration 3. Increase in fetal heart variability 4. Resolution of late decelerations 5. Reactivity associated with the stimulation

Answer: 2, 5 Explanation: 2. The fetal heart rate should accelerate with stimulation. 5. There will be some reaction with the stimulation.

The nurse in the community clinic instructs a client starting on a combined oral contraceptive that she must immediately report which of the following symptoms? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Only four withdrawal bleeds per year 2. Speech problems 3. Unscheduled bleeding 4. Blood pressure of 126/84 5. New lumps in her breast

Answer: 2, 5 Explanation: 2. The woman using combined oral contraceptives should contact her healthcare provider if she develops speech problems. 5. The woman using combined oral contraceptives should contact her healthcare provider if she develops a breast lump.

1) An anesthesiologist informs the nurse that a client scheduled for a caesarean section will be having general anesthesia with postoperative self-controlled analgesia. For which clients would a general anesthesia be recommended? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client with a history of hypertension 2. The client who has had a lower back fusion 3. The client who is 13 years old 4. The client who is allergic to morphine sulfate 5. The client who has had surgery for scoliosis

Answer: 2, 5 Explanation: 2. Contraindications for epidural block include patients with previous back surgery. 5. Contraindications for epidural block include patients with previous back surgery.

35) The primary physician orders a narcotic analgesic for a client in labor. Which situations would lead the nurse to hold the medication? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Contraction pattern every 3 minutes for 60 seconds 2. Fetal monitor tracing showing late decelerations 3. Client sleeping between contractions 4. Blood pressure 150/90 5. Blood pressure 80/42

Answer: 2, 5 Explanation: 2. Maternal hypotension results in uteroplacental insufficiency in the fetus, which is manifested as late decelerations on the fetal monitoring strip. 5. This would be a contraindication, as a narcotic can lower the blood pressure even more.

36) The client demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states which of the following? 1. "The next time I have a baby, I can try to deliver vaginally." 2. "The risk of rupturing my uterus is too high for me to have any more babies." 3. "Every time I have a baby, I will have to have a cesarean delivery." 4. "I can only have one more baby."

Answer: 3 Explanation: 3. A classic uterine incision is made in the upper uterine segment and is associated with an increased risk of rupture in subsequent pregnancy, labor, and birth. Therefore, subsequent deliveries will be done by cesarean. Page Ref: 643

22) The client requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the client asks the nurse to describe the episiotomy. What does the nurse respond? 1. "The episiotomy goes straight back toward your rectum." 2. "The episiotomy is from your vagina toward the urethra." 3. "The episiotomy is cut diagonally away from your vagina." 4. "The episiotomy extends from your vagina into your rectum."

Answer: 3 Explanation: 3. A mediolateral episiotomy is angled from the vaginal opening toward the buttock. It begins in the midline of the posterior fourchette and extends at a 45-degree angle downward to the right or left.

23) The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the client asks for another. What is the best response from the nurse? 1. "I'll get you one right away." 2. "You only need to use one ice pack." 3. "You need to leave it off for at least 20 minutes and then reapply." 4. "I'll bring you an extra so that you can change it when you are ready."

Answer: 3 Explanation: 3. For optimal effect, the ice pack should be applied for 20 to 30 minutes and removed for at least 20 minutes before being reapplied. Page Ref: 637

2) The nurse has returned from working as a maternal-child nurse volunteer for a nongovernmental organization. After completing a community presentation about this experience, the nurse knows that learning has occurred when a participant states which of the following? 1. "Malaria is a chronic disease, and rarely causes fetal loss." 2. "Escherichia coli bacteria can cause diarrhea but not stillbirth." 3. "Group B streptococci can cause infection and the death of the fetus." 4. "Viral infections don't cause fetal death in developing nations."

Answer: 3 Explanation: 3. Group B streptococci can cause ascending infections prior to or after rupture of membranes. Page Ref: 943

24) Major perineal trauma (extension to or through the anal sphincter) is more likely to occur if what type of episiotomy is performed? 1. Mediolateral 2. Episiorrhaphy 3. Midline 4. Medical

Answer: 3 Explanation: 3. Major perineal trauma is more likely to occur if a midline episiotomy is performed. The major disadvantage is that a tear of the midline incision may extend through the anal sphincter and rectum. Page Ref: 636

14) Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important? 1. Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours. 2. Place dinoprostone (Prepidil) vaginal gel and ambulate client for 1 hour. 3. Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec). 4. Prepare to induce labor after administering a tap water enema.

Answer: 3 Explanation: 3. Pitocin should not administered less than 4 hours after the last Cytotec dose. Page Ref: 625

9) Which of the following may lead to the development of disseminated intravascular coagulation (DIC), also called consumption coagulopathy, in the mother? 1. Hypertensive disorders 2. Abruptio placentae 3. Prolonged retention of the dead fetus 4. Heritable thrombophilias

Answer: 3 Explanation: 3. Prolonged retention of the dead fetus may lead to the development of disseminated intravascular coagulation (DIC), also called consumption coagulopathy, in the mother. Page Ref: 944

7) The nurse is teaching a class on perinatal loss to student nurses. What would the nurse explain about the relationship between attachment and the grief response? 1. The mother has no attachment to the fetus before it is born. 2. The severity of the grieving has nothing to do with attachment to the fetus. 3. The intensity of the grief response can be assessed by determining the level of attachment to the anticipated infant. 4. The mother would feel grief only if it were a planned pregnancy.

Answer: 3 Explanation: 3. The intensity to which the grief will be experienced is best understood from the aspect of the level of attachment the grieving person had to the deceased and usually entails finding personal meaning in the loss for successful integration into the grieving person's life. Page Ref: 946

31) The client has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal? 1. The head is delivered after eight "pop-offs" during contractions. 2. A cephalohematoma is present on the fetal scalp. 3. The location of the vacuum is apparent on the fetal scalp after birth. 4. Positive pressure is applied by the vacuum extraction during contractions.

Answer: 3 Explanation: 3. The parents need to be informed that the caput (chignon) on the baby's head will disappear within 2 to 3 days. Page Ref: 642

39) A client is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the client requires more information about VBAC? 1. "I can try a vaginal birth because my uterine incision is a low segment transverse incision." 2. "The vertical scar on my skin doesn't mean that the scar on my uterus goes in the same direction." 3. "There is about a 90% chance of giving birth vaginally after a cesarean." 4. "Because my hospital has a surgery staff on call 24 hours a day, I can try a VBAC there."

Answer: 3 Explanation: 3 . Women whose previous cesarean was performed because of nonrecurring indications have been reported to have approximately a 60% to 80% chance of success with VBAC. Page Ref: 646

25) When counseling a newly pregnant client at 8 weeks' gestation of twins, the nurse teaches the woman about the need for increased caloric intake. What would the nurse tell the woman that the minimum recommended intake should be? 1. 2500 kcal and 120 grams protein 2. 3000 kcal and 150 grams protein 3. 4000 kcal and 135 grams protein 4. 5000 kcal and 190 grams protein

Answer: 3 Explanation: 3. 4000 kcal and 135 grams protein is the recommended caloric and protein intake in a twin-gestation pregnancy.

The nurse is aware that a fetus that is not in any stress would respond to a fetal scalp stimulation test by showing which change on the monitor strip? 1. Late decelerations 2. Early decelerations 3. Accelerations 4. Fetal dysrhythmia

Answer: 3 Explanation: 3. A fetus that is not experiencing stress responds to scalp stimulation with an acceleration of the FHR.

A client calls the urologist's office to receive instructions about semen analysis. What does the nurse instruct the client to do? 1. Avoid sexual intercourse 24 hours prior to obtaining a specimen. 2. Use a latex condom to collect the specimen. 3. Expect that a repeat test might be required. 4. Expect a small sample.

Answer: 3 Explanation: 3. A repeat semen analysis might be required to adequately assess the man's fertility potential.

A 58-year-old father and a 45-year-old mother gave birth to a baby boy 2 days ago. The nurse assesses a single palmar crease and low-set ears on the newborn. The nurse plans to counsel the couple about which chromosomal abnormality? 1. Trisomy 13 2. Trisomy 18 3. Trisomy 21 4. Trisomy 26

Answer: 3 Explanation: 3. A single palmar crease and low-set ears are characteristics of trisomy 21 (Down syndrome).

The nurse is developing a teaching plan for a client undergoing a tubal ligation. What information should be included in the plan? 1. The surgical procedure is easily reversible. 2. Laparotomy is performed following a vaginal birth. 3. Minilaparotomy is performed in the postpartum period soon after a vaginal birth. 4. Tubal ligation can be done at any time the woman is either pregnant or not pregnant

Answer: 3 Explanation: 3. A tubal ligation minilaparotomy is performed in the postpartum period soon after a vaginal birth.

6) A laboring client's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed? 1. Maternal temperature, BP, and pulse 2. Estimation of fetal birth weight 3. Fetal presentation, position, and station 4. Biparietal diameter

Answer: 3 Explanation: 3. Before an amniotomy is performed, the fetus is assessed for presentation, position, station, and FHR. Page Ref: 633

14) The client at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes which of the following? 1. Limiting vaginal exams to only one per 24-hour period. 2. Evaluating the fetal heart rate with an internal monitor. 3. Monitoring for blood loss, pain, and uterine contractibility. 4. Assessing blood pressure every 2 hours.

Answer: 3 Explanation: 3. Blood loss, pain, and uterine contractibility need to be assessed for client comfort and safety.

The nurse is preparing a client education handout on the differences between false labor and true labor. What information is most important for the nurse to include? 1. True labor contractions begin in the back and sweep toward the front. 2. False labor often feels like abdominal tightening, or "balling up." 3. True labor can be diagnosed only if cervical change occurs. 4. False labor contractions do not increase in intensity or duration.

Answer: 3 Explanation: 3. Cervical change is the only factor that actually distinguishes false from true labor. The contractions of true labor produce progressive dilatation and effacement of the cervix. The contractions of false labor do not produce progressive cervical effacement and dilatation.

The nurse who is counseling a group of middle-school girls on pregnancy avoidance should include which statement? 1. "Although sexuality is common in the media, peer pressure to have sex is not an important factor." 2. "It has become far less acceptable to give birth during your teenage years than it used to be." 3. "Although condom use is growing, there is still an increasing rate of STIs among teens." 4. "You have learned enough from your friends and families to understand how pregnancy occurs."

Answer: 3 Explanation: 3. Condom use is increasing, but the rate of STI infections, including HIV, is also rising.

The nurse is planning an educational session about contraception. What will the nurse emphasize as being the most significant factor in determining the effectiveness of a specific method of contraception to avoid pregnancy? 1. Reliability 2. Ease of use 3. Consistency of use 4. Cost

Answer: 3 Explanation: 3. Consistency of use is the most important factor for determining the effectiveness of a specific type of contraception.

The nurse educator is lecturing on the changes that take place during puberty. What is a change that girls experience? 1. Elongation of the hips 2. Deepening of the voice 3. Broadening of the hips and budding of breasts 4. Preparation of the uterus for pregnancy

Answer: 3 Explanation: 3. During puberty, girls' hips start to broaden and their breasts begin to form.

The client in early labor asks the nurse what the contractions are like as labor progresses. What would the nurse respond? 1. "In normal labor, as the uterine contractions become stronger, they usually also become less frequent." 2. "In normal labor, as the uterine contractions become stronger, they usually also become less painful." 3. "In normal labor, as the uterine contractions become stronger, they usually also become longer in duration." 4. "In normal labor, as the uterine contractions become stronger, they usually also become shorter in duration."

Answer: 3 Explanation: 3. During the active and transition phases, contractions become more frequent, are longer in duration, and increase in intensity.

The nurse is preparing a presentation on the menstrual cycle for a group of high school students. Which statement should the nurse include in this presentation? 1. "The menstrual cycle has five distinct phases that occur during the month." 2. "One hormone controls the phases of the menstrual cycle." 3. "The secretory phase occurs when a woman is most fertile." 4. "Menstrual cycle phases vary in order from one woman to another."

Answer: 3 Explanation: 3. During the secretory phase, the vascularity of the entire uterus increases greatly, providing a nourishing bed for implantation.

Persistent early decelerations are noted. What would the nurse's first action be? 1. Turn the mother on her left side and give oxygen. 2. Check for prolapsed cord. 3. Do nothing. This is a benign pattern. 4. Prepare for immediate forceps or cesarean delivery.

Answer: 3 Explanation: 3. Early decelerations are considered benign, and do not require any intervention.

The laboring client with meconium-stained amniotic fluid asks the nurse why the fetal monitor is necessary, as she finds the belt uncomfortable. Which response by the nurse is most important? 1. "The monitor is necessary so we can see how your labor is progressing." 2. "The monitor will prevent complications from the meconium in your fluid." 3. "The monitor helps us to see how the baby is tolerating labor." 4. "The monitor can be removed, and oxygen given instead."

Answer: 3 Explanation: 3. Electronic fetal monitoring (EFM) provides a continuous tracing of the fetal heart rate (FHR), allowing characteristics of the FHR to be observed and evaluated.

The student nurse encounters a 15-year-old girl who reports that she has no pubic or axillary hair and has not yet experienced growth of her breasts. The student asks the nurse about the physiology of this occurrence. The nurse explains that the client probably lacks which hormone? 1. Testosterone 2. Progesterone 3. Estrogen 4. Prolactin

Answer: 3 Explanation: 3. Estrogens influence the development of secondary sex characteristics.

The client is being admitted to the birthing unit. As the nurse begins the assessment, the client's partner asks why the fetus's heart rate will be monitored. After the nurse explains, which statement by the partner indicates a need for further teaching? 1. "The fetus's heart rate will vary between 110 and 160." 2. "The heart rate is monitored to see whether the fetus is tolerating labor." 3. "By listening to the heart, we can tell the gender of the fetus." 4. "After listening to the heart rate, you will contact the midwife."

Answer: 3 Explanation: 3. Fetal heart rate is not a predictor of gender.

21) As the couple and their families begin to confront the pain of their loss, many normal manifestations of grief may be present. Which of the following would indicate an emotional response to the loss? 1. Lack of meaning or direction 2. Preoccupation 3. Flat affect 4. Dreams of the deceased

Answer: 3 Explanation: 3. Flat affect would be an emotional response to loss. Page Ref: 947

The nurse is reviewing preconception questionnaires in charts. Which couple are the most likely candidates for preconceptual genetic counseling? 1. Wife is 30 years old, husband is 31 years old 2. Wife and husband are both 29 years old, first baby for husband, wife has a normal 4-year-old 3. Wife's family has a history of hemophilia 4. Single 32-year-old woman is using donor sperm

Answer: 3 Explanation: 3. For families in which the woman is a known or possible carrier of an X-linked disorder, such as hemophilia, the risk of having an affected male fetus is 25%.

A client's labor has progressed so rapidly that a precipitous birth is occurring. What should the nurse do? 1. Go to the nurse's station and immediately call the physician. 2. Run to the delivery room for an emergency birth pack. 3. Stay with the client and ask auxiliary personnel for assistance. 4. Hold back the infant's head forcibly until the physician arrives for the delivery.

Answer: 3 Explanation: 3. If birth is imminent, the nurse must not leave the client alone.

A 14-year-old girl is brought to the clinic by her mother. The nurse determines that the teen is about 28 weeks pregnant. The mother states, "We knew she was gaining weight, but we can't tell anyone she is pregnant." The nurse understands that the client's mother's behavior exemplifies which of the following? 1. Low self-esteem 2. Anger 3. Shame 4. Ignorance

Answer: 3 Explanation: 3. In families who foster educational and career goals for their children, adolescent pregnancy is often a shock. Anger, shame, and sorrow are common reactions.

A woman is experiencing mittelschmerz and increased vaginal discharge. Her temperature has increased by 0.6°C (1.0°F) over the past 36 hours. This most likely indicates what? 1. Menstruation is about to begin. 2. Ovulation will occur soon. 3. Ovulation has occurred. 4. She is pregnant, and will not menstruate.

Answer: 3 Explanation: 3. In some women, ovulation is accompanied by mid-cycle pain, known as mittelschmerz. This pain may be caused by a thick tunica albuginea or by a local peritoneal reaction to the expelling of the follicular contents and body temperature increases about 0.3°C to 0.6°C (0.5°F to 1°F) 24 to 48 hours after the time of ovulation.

Which statement made by the pregnant adolescent would indicate to the nurse that she understood her increased risk of physiologic complications during pregnancy? 1. "It's no big deal that I started prenatal care in my seventh month." 2. "My anemia and eating mostly fast food are not important." 3. "I need to take good care of myself so my baby doesn't come early." 4. "Smoking and using crack cocaine won't harm my baby."

Answer: 3 Explanation: 3. In the adolescent age group, prenatal care is the critical factor that most influences pregnancy outcome.

The labor and delivery nurse is preparing a prenatal class about facilitating the progress of labor. Which of the following frequent responses to pain should the nurse indicate is most likely to impede progress in labor? 1. Increased pulse 2. Elevated blood pressure 3. Muscle tension 4. Increased respirations

Answer: 3 Explanation: 3. It is important for the woman to relax each part of her body. Be alert for signs of muscle tension and tightening. Dissociative relaxation, controlled muscle relaxation, and specified breathing patterns are used to promote birth as a normal process.

The nurse has been asked by a community organization to give a presentation on prevention of teen pregnancy. Which statement indicates appropriate steps toward reduction of the local teen pregnancy rate? 1. Abstinence-only education will be offered in the school and clinics. 2. Classes on how to parent will be mandatory in high school. 3. A low-cost reproductive health clinic will be planned. 4. Parents will be encouraged to avoid discussing sexual activity.

Answer: 3 Explanation: 3. Key strategies for prevention of unintended teen pregnancy and sexual health promotion include the provision of services that ensure accessible and high-quality reproductive health care; sex education programs that provide developmentally appropriate, evidence-based curricula; and youth development strategies to enhance life skills. A low-cost reproductive health clinic would be able to provide these services.

The nurse is analyzing several fetal heart rate patterns. The pattern that would be of most concern to the nurse would be which of the following? 1. Moderate variability 2. Early decelerations 3. Late decelerations 4. Accelerations

Answer: 3 Explanation: 3. Late decelerations are caused by uteroplacental insufficiency. The late deceleration pattern is considered a nonreassuring sign.

The labor and delivery nurse is assigned to four clients in early labor. Which electronic fetal monitoring finding would require immediate intervention? 1. Early decelerations with each contraction 2. Variable decelerations that recover to the baseline 3. Late decelerations with minimal variability 4. Accelerations

Answer: 3 Explanation: 3. Late decelerations are considered a nonreassuring fetal heart rate (FHR) pattern, and therefore require immediate intervention.

The client presents to the labor and delivery unit stating that her water broke 2 hours ago. Barring any abnormalities, how often would the nurse expect to take the client's temperature? 1. Every hour 2. Every 2 hours 3. Every 4 hours 4. Every shift

Answer: 3 Explanation: 3. Maternal temperature is taken every 4 hours unless it is above 37.5°C. If elevated, it is taken every hour.

After noting meconium-stained amniotic fluid and fetal heart rate decelerations, the physician diagnoses a depressed fetus. The appropriate nursing action at this time would be to do what? 1. Increase the mother's oxygen rate. 2. Turn the mother to the left lateral position. 3. Prepare the mother for a higher-risk delivery. 4. Increase the intravenous infusion rate.

Answer: 3 Explanation: 3. Meconium-stained fluid and heart rate decelerations are indications that delivery is considered higher-risk.

The pregnant 16-year-old is seeing the nurse during a prenatal visit. Based on the client's developmental level, which statement would the nurse expect the client to make? 1. "My friends and I all wear totally different styles of clothing." 2. "Having a baby will change my college plans." 3. "I drink alcohol at parties most weekends." 4. "My mom is my best friend."

Answer: 3 Explanation: 3. Middle adolescence (15-17) is a time of experimentation, including drinking alcohol, using other drugs, and sex.

Which statement by a pregnant client to the nurse would indicate that the client understood the nurse's teaching? 1. "Because of their birth relationship, fraternal twins are more similar to each other than if they had been born singly." 2. "Identical twins can be the same or different sex." 3. "Congenital abnormalities are more prevalent in identical twins." 4. "Identical twins occur more frequently than fraternal twins."

Answer: 3 Explanation: 3. Monozygotic twinning is considered a random event and occurs in approximately 3 to 4 per 1000 live births. Congenital anomalies are more prevalent and both twins may have the same malformation.

The nurse is creating a poster for pregnant mothers. Which description of fetal development should the nurse include? 1. Four primary germ layers form from the blastocyst. 2. After fertilization, the cells only become larger for several weeks. 3. Most organs are formed by 8 weeks after fertilization. 4. The embryonic stage is from fertilization until 5 months.

Answer: 3 Explanation: 3. Most organs are formed during the embryonic stage, which lasts from the 15th day after fertilization until the end of the 8th week after conception.

The client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make? 1. "You shouldn't work so much at this point in pregnancy." 2. "What you are describing is not commonly experienced in the last weeks." 3. "Your body may be telling you it is going into labor soon." 4. "If the bladder pressure continues, come in to the clinic tomorrow."

Answer: 3 Explanation: 3. One of the premonitory signs of labor is lightening: The fetus begins to settle into the pelvic inlet (engagement). With fetal descent, the uterus moves downward, and the fundus no longer presses on the diaphragm, which eases breathing.

The nurse is creating a handout on reproduction for teen clients. Which piece of information should the nurse include in this handout? 1. The fertilized ovum is called a gamete. 2. Prior to fertilization, the sperm are zygotes. 3. Ova survive 12-24 hours in the fallopian tube if not fertilized. 4. Sperm survive in the female reproductive tract up to a week.

Answer: 3 Explanation: 3. Ova are considered fertile for about 12 to 24 hours after ovulation.

34) A client has experienced a stillbirth. Which statement by the nurse would be appropriate? 1. "You are young. You can try again." 2. "At least you have your other children." 3. "I'm sure you had many dreams and hopes for the future." 4. "It's a blessing in disguise."

Answer: 3 Explanation: 3. Perinatal loss is unique in that the parents have not had experiences with the child that was to be, and attachment is based mostly upon hopes and dreams for the future relationship. Page Ref: 945

A young adolescent is transferred to the labor and delivery unit from the emergency department. The client is in active labor, but did not know she was pregnant. What is the most important nursing action? 1. Determine who might be the father of the baby for paternity testing. 2. Ask the client what kind of birthing experience she would like to have. 3. Assess blood pressure and check for proteinuria. 4. Obtain a Social Services referral to discuss adoption.

Answer: 3 Explanation: 3. Preeclampsia is more common among adolescents than in young adults, and is potentially life-threatening to both mother and fetus. This assessment is the highest priority.

The nurse is preparing educational materials at a family planning clinic. The client who is an appropriate candidate for using emergency contraception would be one who reports which of the following? 1. Forgetting to start her pill pack yesterday 2. Unprotected intercourse during her menses 3. That a condom broke yesterday in the middle of her cycle 4. Increased dysmenorrhea since IUC insertion

Answer: 3 Explanation: 3. Research indicates that oral hormonal EC taken as soon as possible within 72 hours, but up to 5 days, can reduce the risk of pregnancy after a single act of unprotected intercourse by at least 74%.

The client who was raped is extremely upset when a pregnancy test confirms that she is pregnant, and requests information regarding pregnancy termination. Which statement is best for the nurse to include? 1. "Abortion is morally wrong, and should not be undertaken." 2. "Hypertension is a risk with any abortion." 3. "Surgical abortion in the first trimester is technically easier and safer than abortion in the second trimester." 4. "The most accurate method to determine gestational age are the results of a pregnancy test."

Answer: 3 Explanation: 3. Second-trimester abortion (greater than 13 weeks' gestation up to 24 weeks or as per state law) may be done medically or surgically.

A nurse teaching a sex education class is asked by a male student, "What exactly happens when my body gets aroused?" The nurse's reply includes which statement? 1. "The vas deferens thickens and expands." 2. "The sympathetic nerves of the penis are stimulated." 3. "The penis elongates, thickens, and stiffens." 4. "The prepuce of the penis elongates."

Answer: 3 Explanation: 3. Sexual stimulation causes the penis to elongate, thicken, and stiffen, a process called erection. The penis becomes erect when its blood vessels become engorged.

The physician has prescribed the medication clomiphene citrate (Clomid) for a client with infertility. What should the nurse's instructions to the woman include? 1. "Have intercourse every day of 1 week, starting 5 days after completion of medication." 2. "This medication is administered intravenously." 3. "Contact the doctor if visual disturbances occur." 4. "A contraindication is kidney disease."

Answer: 3 Explanation: 3. Side effects of clomiphene citrate include visual symptoms such as spots and flashes.

35) A client has delivered a stillborn infant at 28 weeks' gestation. Which nursing action is appropriate? 1. Discuss funeral options for the baby. 2. Encourage the couple to try to get pregnant again soon. 3. Ask the couple whether or not they would like to hold the baby. 4. Advise the couple that the baby's death was probably for the best.

Answer: 3 Explanation: 3. Some parents will hold their infant for a short time before returning him or her to the nurse, whereas others will wish to spend a great deal of time with their infant. Allow the infant to remain with the parents for as long as they desire. Page Ref: 959

A client who wishes to have an unmedicated birth is in the transition stage. She is very uncomfortable and turns frequently in the bed. Her partner has stepped out momentarily. How can the nurse be most helpful? 1. Talk to the client the entire time. 2. Turn on the television to distract the client. 3. Stand next to the bed with hands on the railing next to the client. 4. Sit silently in the room away from the bed.

Answer: 3 Explanation: 3. Standing next to the bed is supportive without being irritating. The laboring woman fears being alone during labor. The woman's anxiety may be decreased when the nurse remains with her.

An expectant father has been at the bedside of his laboring partner for more than 12 hours. An appropriate nursing intervention would be to do which of the following? 1. Insist that he leave the room for at least the next hour. 2. Tell him he is not being as effective as he was, and that he needs to let someone else take over. 3. Offer to remain with his partner while he takes a break. 4. Suggest that the client's mother might be of more help.

Answer: 3 Explanation: 3. Support persons frequently are reluctant to leave the laboring woman to take care of their own needs. The laboring woman often fears being alone during labor. Even though there is a support person available, the woman's anxiety may be decreased when the nurse remains with her while he takes a break.

A laboring client asks the nurse, "Why does the physician want to use an intrauterine pressure catheter (IUPC) during my labor?" The nurse would accurately explain that the best rationale for using an IUPC is which of the following? 1. The IUPC can be used throughout the birth process. 2. A tocodynamometer is invasive. 3. The IUPC provides more accurate data than does the tocodynamometer. 4. The tocodynamometer can be used only after the cervix is dilated 2 cm.

Answer: 3 Explanation: 3. The IUPC has several benefits over an external tocotransducer or palpation. Because the IUPC is inserted directly into the uterus, it provides near-exact pressure measurements for contraction intensity and uterine resting tone. The increased sensitivity of the IUPC allows for very accurate timing of uterine contractions (UCs).

A client asks the nurse, "Can you explain to us how to use the basal body temperature method to detect ovulation and prevent pregnancy?" What response by the nurse is best? 1. "Take your temperature every evening at the same time and keep a record for a period of several weeks. A noticeable drop in temperature indicates that ovulation has occurred." 2. "Take your temperature every day at the same time and keep a record of the findings. A noticeable rise in temperature indicates ovulation." 3. "Take your temperature each day, immediately upon awakening, and keep a record of each finding. A noticeable rise in temperature indicates that ovulation is about to occur." 4. "This is an unscientific and unproven method of determining ovulation, and is not recognized as a means of birth control."

Answer: 3 Explanation: 3. The basal body temperature method is used to detect ovulation by an increase in the basal temperature during the menstrual cycle. It requires that the woman take her temperature every morning upon awakening (before any activity) and record the findings on a temperature graph, and is based on the fact that the temperature almost always rises and remains elevated after ovulation because of the production of progesterone, a thermogenic (heat-producing) hormone.

The student nurse is to perform Leopold maneuvers on a laboring client. Which assessment requires intervention by the staff nurse? 1. The client is assisted into supine position, and the position of the fetus is assessed. 2. The upper portion of the uterus is palpated, then the middle section. 3. After determining where the back is located, the cervix is assessed. 4. Following voiding, the client's abdomen is palpated from top to bottom.

Answer: 3 Explanation: 3. The cervical exam is not part of Leopold maneuvers. Abdominal palpation is the only technique used for Leopold maneuvers.

The nurse is providing instructions for a woman who has just had intrauterine contraception inserted. What is essential for the nurse to teach the client? 1. To palpate her lower abdomen each month to check the patency of the device 2. To remain on bed rest for 24 hours after insertion of the device 3. To report any pain during intercourse to the physician 4. To insert spermicidal jelly within 4 hours of every sexual encounter

Answer: 3 Explanation: 3. The client should report any pain during intercourse to the physician. This can be due to an infection.

The nurse has just palpated contractions and compares the consistency to that of the forehead to estimate the firmness of the fundus. What would the intensity of these contractions be identified as? 1. Mild 2. Moderate 3. Strong 4. Weak

Answer: 3 Explanation: 3. The consistency of strong contractions is similar to that of the forehead.

When the nurse is teaching a woman about the use of a diaphragm, it is important to instruct her that the diaphragm should be rechecked for correct size how often? 1. Every five years routinely 2. When weight gain or loss beyond five pounds has occurred 3. After each birth 4. Only after significant weight loss

Answer: 3 Explanation: 3. The diaphragm should be rechecked for correct size after each childbirth and whenever a woman has gained or lost 10 pounds or more.

A school nurse teaching a health class to adolescent boys explains that spermatozoa become motile and fertile during the 2-10 days they are stored in which part of the male body? 1. Prostate gland 2. Vas deferens 3. Epididymis 4. Urethra

Answer: 3 Explanation: 3. The epididymis provides a reservoir where spermatozoa can survive for a long period and the spermatozoa usually remain in the epididymis for 2 to 10 days.

The nurse in the clinic instructs a client using the natural method of contraception to begin counting the first day of her cycle as which day? 1. The day her menstrual period ceases 2. The first day after her menstrual period ceases 3. The first day of her menstrual period 4. The day of ovulation

Answer: 3 Explanation: 3. The first day of menstruation is the first day of the cycle.

The nurse has completed a presentation on reproduction. Which statement indicates that the teaching has been successful? 1. "A male is born with all the sperm he will ever produce." 2. "Females create new ova throughout their reproductive life." 3. "Ova separate into two unequally sized cells." 4. "Each primary spermatocyte divides into four haploid cells."

Answer: 3 Explanation: 3. The first meiotic division produces two cells of unequal size with different amounts of cytoplasm but with the same number of chromosomes.

The nurse is aware that labor and birth will most likely proceed normally when the fetus is in what position? 1. Right-acromion-dorsal-anterior 2. Right-sacrum-transverse 3. Occiput anterior 4. Posterior position

Answer: 3 Explanation: 3. The most common fetal position is occiput anterior. When this position occurs, labor and birth are likely to proceed normally.

16) What is the most significant cause of neonatal morbidity and mortality? 1. Amenorrhea 2. Posttraumatic stress disorder 3. Prematurity 4. Endometriosis

Answer: 3 Explanation: 3. The most significant cause of neonatal morbidity and mortality is prematurity and its associated complications such as respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage.

The nurse educator describes the uterus and ovaries as being held in place in the pelvic cavity by what structures? 1. Muscles 2. Tendons 3. Ligaments 4. Peritoneum

Answer: 3 Explanation: 3. The ovaries and uterus are held in place in the pelvic cavity by a number of ligaments.

A client is admitted to the labor and delivery unit with contractions that are regular, are 2 minutes apart, and last 60 seconds. She reports that her labor began about 6 hours ago, and she had bloody show earlier that morning. A vaginal exam reveals a vertex presenting, with the cervix 100% effaced and 8 cm dilated. The client asks what part of labor she is in. The nurse should inform the client that she is in what phase of labor? 1. Latent phase 2. Active phase 3. Transition phase 4. Fourth stage

Answer: 3 Explanation: 3. The transition phase begins with 8 cm of dilatation, and is characterized by contractions that are closer and more intense.

A client is admitted to the labor and delivery unit with contractions that are 2 minutes apart, lasting 60 seconds. She reports that she had bloody show earlier that morning. A vaginal exam reveals that her cervix is 100 percent effaced and 8 cm dilated. The nurse knows that the client is in which phase of labor? 1. Active 2. Latent 3. Transition 4. Fourth

Answer: 3 Explanation: 3. The transition phase begins with 8 cm to 10 cm of dilatation, and contractions become more frequent, are longer in duration, and increase in intensity.

A prenatal client asks the nurse how the baby can possibly come out through her vagina, because a vagina is not nearly as big as a baby. How does the nurse best answer this client's question? 1. "The vagina usually tears as it stretches during childbirth." 2. "The vagina is designed to allow a baby come through." 3. "The vagina changes due to pregnancy allow the vagina to stretch more." 4. "The vagina dilates and effaces in labor so the baby can get out."

Answer: 3 Explanation: 3. The walls of the vagina are covered with ridges, or rugae, crisscrossing each other. These rugae allow the vaginal tissues to stretch enough for the fetus to pass through during childbirth.

19) The nurse educator is describing the different kinds of abruptio placentae to a group of students, explaining that in a complete abruptio placentae, which of the following occurs? 1. Separation begins at the periphery of the placenta. 2. The placenta separates centrally and blood is trapped between the placenta and the uterine wall. 3. There is massive vaginal bleeding in the presence of almost total separation. 4. Blood passes between the fetal membranes and the uterine wall, and escapes vaginally.

Answer: 3 Explanation: 3. There is massive vaginal bleeding in the presence of almost total separation describes a complete separation of the placenta.

The nurse is admitting a client to the labor and delivery unit. Which aspect of the client's history requires notifying the physician? 1. Blood pressure 120/88 2. Father a carrier of sickle-cell trait 3. Dark red vaginal bleeding 4. History of domestic abuse

Answer: 3 Explanation: 3. Third-trimester bleeding is caused by either placenta previa or abruptio placentae. Dark red bleeding usually indicates abruptio placentae, which is life-threatening to both mother and fetus.

Several adolescent female students are waiting to be seen by the school sexual health clinic nurse. Which student should the nurse see first? 1. 14-year-old whose 17-year-old sister is pregnant 2. 15-year-old who reports using condoms regularly 3. 16-year-old who had chlamydia treated 2 weeks ago 4. 17-year-old with a history of child abuse

Answer: 3 Explanation: 3. This client is the top priority. Teenagers 15 to 19 years old have a high incidence of STIs. The incidence of chlamydial infection is increased in this age group. The presence of such infections during a pregnancy greatly increases the risk to the fetus.

A woman comes into the emergency department stating she was raped the day before, and requests emergency contraception. She states that she is in the middle of her cycle. The nurse knows which of the following about the client? 1. This client has waited too long before coming to the emergency department. 2. The client will have to wait 10 days before she can have emergency contraception. 3. The client can receive emergency contraception up to 72 hours to 5 days after the intercourse. 4. The client will have to wait and see whether she misses a period.

Answer: 3 Explanation: 3. This client is within the 72-hour to 5-day timeframe, and is able to receive the medicine.

A couple is seeking advice regarding what they can do to increase the chances of becoming pregnant. What recommendation can the nurse give to the couple? 1. The couple could use vaginal lubricants during intercourse. 2. The couple should delay having intercourse until the day of ovulation. 3. The woman should refrain from douching. 4. The woman should be on top during intercourse.

Answer: 3 Explanation: 3. This is the correct answer, as douching can alter sperm mobility.

The nurse educator is discussing human chromosomes with her students, and knows that the teaching has been effective when a student makes which statement? 1. "All humans have 48 chromosomes and 2 sex chromosomes." 2. "Human chromosomes are shaped like a 'Y'." 3. "Humans have 46 chromosomes, 2 of which are the sex chromosomes." 4. "Only certain body cells contain the chromosomes."

Answer: 3 Explanation: 3. This is the correct answer. There are 22 pairs of similar cells and 2 sex chromosomes.

The nurse is instructing a client in the use of combined oral contraceptives. The nurse knows that additional teaching is required when the client makes which statement about the risks of taking combined oral contraceptives? 1. "They will lower my risk for breast cancer." 2. "They will increase my risk for cervical cancer." 3. "They will lower my risk for ovarian cancer." 4. "They will increase my risk for uterine cancer."

Answer: 3 Explanation: 3. This is true. There is a reduction in the incidence of ovarian cancer.

The nurse is talking with the parents of a pregnant 15-year-old. Which statement by one of the parents is expected? 1. "We're very happy for her. It will be easier to focus on education with a new baby." 2. "I'm not going to get involved. She understands how her health insurance works." 3. "Her father told her to stop dating that boy. Now look at the trouble she's gotten into." 4. "An abortion is the best choice for her. She can deal with our Catholic priest later."

Answer: 3 Explanation: 3. This statement indicates anger, which is to be expected when a parent finds out about a teen daughter's pregnancy.

A client who wants to use the vaginal sponge method of contraception shows that she understands the appropriate usage when she makes which statement? 1. "I need to use a lubricant prior to insertion." 2. "I need to add spermicidal cream prior to intercourse." 3. "I need to moisten it with water prior to use." 4. "I need to leave it in no longer than 6 hours."

Answer: 3 Explanation: 3. To activate the spermicide in the vaginal sponge, it must be moistened thoroughly with water.

During the initial prenatal visit, the pregnant teenager states that she does not know how she got pregnant. The nurse can help to educate her regarding anatomy by doing what? 1. Allowing her to witness a pelvic exam on another teenager 2. Encouraging her to ask her mother about the physiology of pregnancy 3. Including anatomic models and drawings in the teaching session 4. Discussing the process of fetal development with the client

Answer: 3 Explanation: 3. To teach the client about anatomy and physiology, use simple explanations and lots of audiovisuals.

At 1 minute after birth, the infant has a heart rate of 100 beats per minute, and is crying vigorously. The limbs are flexed, the trunk is pink, and the feet and hands are cyanotic. The infant cries easily when the soles of the feet are stimulated. How would the nurse document this infant's Apgar score? 1. 7 2. 8 3. 9 4. 10

Answer: 3 Explanation: 3. Two points each are scored in each of the categories of heart rate, respiratory effort, muscle tone, and reflex irritability. One point is scored in the category of skin color. The total Apgar would be 9.

3) A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for? 1. Gestational diabetes 2. Placenta previa 3. Abruptio placentae 4. Placenta accreta

Answer: 3 Explanation: 3. Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension.

33) A woman has been in labor for 16 hours. Her cervix is dilated to 3 cm and is 80% effaced. The fetal presenting part is not engaged. The nurse would suspect which of the following? 1. Breech malpresentation 2. Fetal demise 3. Cephalopelvic disproportion (CPD) 4. Abruptio placentae

Answer: 3 Explanation: 3. Cephalopelvic disproportion (CPD) prevents the presenting part from becoming engaged. Page Ref: 598

22) A client dilated to 5 cm has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her BP? 1. Epinephrine 2. Terbutaline 3. Ephedrine 4. Epifoam

Answer: 3 Explanation: 3. Ephedrine is the medication of choice to increase maternal blood pressure.

29) The client with a normal pregnancy had an emergency cesarean birth under general anesthesia 2 hours ago. The client now has a respiratory rate of 30, pale blue nail beds, a pulse rate of 110, and a temperature of 102.6°F, and is complaining of chest pain. The nurse understands that the client most likely is experiencing which of the following? 1. Pulmonary embolus 2. Pneumococcal pneumonia 3. Pneumonitis 4. Gastroesophageal reflux disease

Answer: 3 Explanation: 3. Even when food and fluids have been withheld, the gastric juice produced during fasting is highly acidic and can produce chemical pneumonitis if aspirated. This pneumonitis is known as Mendelson syndrome. The signs and symptoms are chest pain, respiratory distress, cyanosis, fever, and tachycardia. Women undergoing emergency cesarean births appear to be at considerable risk for adverse events.

34) Which of the following is a major side effect of butorphanol tartrate (Stadol)? 1. Blurred vision 2. Agitation 3. Feelings of dysphoria 4. Drowsiness

Answer: 3 Explanation: 3. Feelings of dysphoria are a major side effect of Stardol.

26) The nurse is providing preoperative teaching to a client for whom a cesarean birth under general anesthesia is scheduled for the next day. Which statement by the client indicates that she requires additional information? 1. "General anesthesia can be accomplished with inhaled gases." 2. "General anesthesia usually involves administering medication into my IV." 3. "General anesthesia will provide good pain relief after the birth." 4. "General anesthesia takes effect faster than an epidural."

Answer: 3 Explanation: 3. General anesthesia provides no pain relief after birth, as regional anesthesia does.

11) A client in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of which of the following? 1. A nonstress test 2. A vibroacoustic stimulation test 3. An ultrasound 4. A contraction stress test

Answer: 3 Explanation: 3. Indirect diagnosis is made by localizing the placenta via tests that require no vaginal examination. The most commonly employed diagnostic test is the transabdominal

7) Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do? 1. Remove the epidural catheter and apply a Band-Aid to the injection site. 2. Offer the client a cool cloth and let her know the itching is temporary. 3. Recognize that this is a common side effect, and follow protocol for administration of Benadryl. 4. Call the anesthesia care provider to re-dose the epidural catheter.

Answer: 3 Explanation: 3. Itching is a side effect of the medication used for an epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus.

20) The client vaginally delivers an infant that weighs 4750 g. Moderate shoulder dystocia occurred during the birth. During the initial assessment of this infant, what should the nurse look for? 1. Bell's palsy 2. Bradycardia 3. Erb palsy 4. Petechiae

Answer: 3 Explanation: 3. Macrosomic newborns should be inspected for cephalhematoma, Erb palsy, and fractured clavicles.

12) After nalbuphine hydrochloride (Nubain) is administered, labor progresses rapidly, and the baby is born less than 1 hour later. The baby shows signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn? 1. Fentanyl (Sublimaze) 2. Butorphanol tartrate (Stadol) 3. Naloxone (Narcan) 4. Pentobarbital (Nembutal)

Answer: 3 Explanation: 3. Narcan is useful for respiratory depression caused by nalbuphine (Nubain). Respiratory depression in the mother or fetus/newborn can be improved by the administration of naloxone (Narcan), which is a specific antagonist for this agent.

18) If the physician indicates a shoulder dystocia during the delivery of a macrosomic fetus, how would the nurse assist? 1. Call a second physician to assist. 2. Prepare for an immediate cesarean delivery. 3. Assist the woman into McRoberts maneuver. 4. Utilize fundal pressure to push the fetus out.

Answer: 3 Explanation: 3. The McRoberts maneuver is thought to change the maternal pelvic angle and therefore reduce the force needed to extract the shoulders, thereby decreasing the incidence of brachial plexus stretching and clavicular fracture. Page Ref: 610

4) The nurse is caring for a client at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the client needs additional teaching? 1. "If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured." 2. "If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again." 3. "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy." 4. "If I have aminocentesis, I might rupture the membranes again."

Answer: 3 Explanation: 3. There is no evidence that bed rest in a subsequent pregnancy decreases the risk for PPROM.

The labor and birth nurse is admitting a client. The nurse's assessment includes asking the client whom she would like to have present for the labor and birth, and what the client would prefer to wear. The client's partner asks the nurse the reason for these questions. What would the nurse's best response be? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "These questions are asked of all women. It's no big deal." 2. "I'd prefer that your partner ask me all the questions, not you." 3. "A client's preferences for her birth are important for me to understand." 4. "Many women have beliefs about childbearing that affect these choices." 5. "I'm gathering information that the nurses will use after the birth."

Answer: 3, 4 Explanation: 3. The nurse incorporates the family's expectations into the plan of care to be culturally appropriate and to facilitate the birth. 4. The nurse incorporates the family's expectations into the plan of care to be culturally appropriate and to facilitate the birth.

37) Lacerations of the cervix or vagina may be present when bright red vaginal bleeding persists in the presence of a well-contracted uterus. The incidence of lacerations is higher among which of the following childbearing women? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Over the age of 35 2. Have not had epidural block 3. Have had an episiotomy 4. Have had a forceps-assisted or vacuum-assisted birth 5. Nulliparous

Answer: 3, 4 Explanation: 3. The incidence of lacerations is higher among childbearing women who undergo an episiotomy. 4. The incidence of lacerations is higher among childbearing women who undergo forceps-assisted or vacuum-assisted birth. Page Ref: 619

5) A woman is scheduled to have an external version for a breech presentation. The nurse carefully reviews the client's chart for contraindications to this procedure, including which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Station -2 2. 38 weeks' gestation 3. Abnormal fetal heart rate and tracing 4. Previous cesarean section 5. Rupture of membranes

Answer: 3, 4, 5 Explanation: 3. An abnormal fetal heart rate or tracing would be a contraindication to performing a version. A nonreassuring FHR pattern might indicate that the fetus is already stressed and other action needs to be taken. 4. A previous cesarean is a contraindication for version. 5. Rupture of membranes is a contraindication for version because of insufficient amniotic fluid. Page Ref: 623, 624

The OB-GYN nurse is assessing a pregnant client, and recognizes genetic amniocentesis will be indicated. The nurse makes this conclusion because the indications for genetic amniocentesis include which of the following? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Maternal age under 35 2. Fetus with no abnormalities on ultrasound 3. One child with a chromosome abnormality 4. A family history of neural tube defects 5. Both parents with an abnormal chromosome

Answer: 3, 4, 5 Explanation: 3. Couples who have had a child with trisomy 21, 18, or 13 have approximately a 1% risk or their age-related risk, whichever is higher, of a future child having a chromosome abnormality. 4. Family history of neural tube defects is an indication for genetic amniocentesis. 5. If both parents carry an autosomal recessive disease, they have a 25% chance with each pregnancy that the fetus will be affected.

Which couples may benefit from prenatal diagnosis? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Couples including women under the age of 35 2. Couples with an unbalanced translocation 3. Couples with a family history of known or suspected single-gene disorder 4. Couples including women with a teratogenic risk secondary to an exposure or maternal health condition 5. Family history of birth defects and/or intellectual disability

Answer: 3, 4, 5 Explanation: 3. Couples with a family history of known or suspected single-gene disorder (e.g., cystic fibrosis, hemophilia A or B, Duchenne muscular dystrophy) may benefit from prenatal diagnosis. 4. Women with a teratogenic risk secondary to an exposure or maternal health condition (e.g., diabetes, seizure disorder) may benefit from prenatal diagnosis. 5. Family history of birth defects and/or intellectual disability (mental retardation) (e.g., neural tube defects, congenital heart disease, cleft lip and/or palate) may benefit from prenatal diagnosis.

An abbreviated systematic physical assessment of the newborn is performed by the nurse in the birthing area to detect any abnormalities. Normal findings would include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Skin color: Body blue with pinkish extremities 2. Umbilical cord: two veins and one artery 3. Respiration rate of 30-60 irregular 4. Temperature of above 36.5°C (97.8°F) 5. Sole creases that involve the heel

Answer: 3, 4, 5 Explanation: 3. Normal findings would include a respiration rate of 30-60 irregular. 4. Normal findings would include temperature of above 36.5°C (97.8°F). 5. Normal findings would include sole creases that involve the heel.

The nurse has given a community presentation on adolescent pregnancy. Which statements indicate that further teaching is necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Low educational achievement is major risk factor for adolescent pregnancy." 2. "Teens who are on a low economic trajectory are more likely to become pregnant." 3. "When a teen plans to attend college, abortion is less likely." 4. "In the United States, the adolescent birth rate is higher among white teens." 5. "Teens from low-income households are less likely to become pregnant."

Answer: 3, 4, 5 Explanation: 3. Teens with future goals (i.e., college or job) tend to use birth control more consistently compared with other teens; if they become pregnant, they are also more likely to have abortions. 4. In the United States, the adolescent birth rate is higher among African American and Hispanic teens than among white teens. 5. Poverty is a major risk factor for adolescent pregnancy. As many as 85% of births to unmarried teens occur to those from poor or low-income families.

A nurse working with couples undergoing genetic testing recognizes which of the following as nursing responsibilities? Note: Credit will be given only if all correct and no incorrect choices are selected. Select all that apply. 1. Allowing the family to interact with the genetic counselor without interference 2. Giving information about support groups when asked 3. Identifying families at risk for genetic problems 4. Aiding families in coping with the crisis 5. Ensuring continuity of nursing care to the family

Answer: 3, 4, 5 Explanation: 3. The nurse has a responsibility to identify families at risk for genetic problems. 4. The nurse should aid families in coping. 5. The nurse needs to ensure continuity of care to the family.

22) True postterm pregnancies are frequently associated with placental changes that cause a decrease in the uterine-placental-fetal circulation. Complications related to alternations in placenta functioning include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increased fetal oxygenation 2. Increased placental blood supply 3. Reduced nutritional supply 4. Macrosomia 5. Risk of shoulder dystocia

Answer: 3, 4, 5 Explanation: 3. Reduced nutritional supply is a complication related to alternations in placenta functioning. 4. Macrosomia is a complication related to alternations in placenta functioning. 5. Risk of shoulder dystocia is a complication related to alternations in placenta functioning. Page Ref: 600

The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. Woman at 7 cm, fetus in general flexion 2. Woman at 3 cm, fetus in longitudinal lie 3. Woman at 4 cm, fetus with transverse lie 4. Woman at 6 cm, fetus at -2 station, mild contractions 5. Woman at 5 cm, fetal presenting part is right shoulder

Answer: 3, 4, 5 Explanation: 3. A transverse lie occurs when the cephalocaudal axis of the fetal spine is at a right angle to the woman's spine and is associated with a shoulder presentation and can lead to complications in the later stages of labor. 4. Station refers to the relationship of the presenting part to an imaginary line drawn between the ischial spines of the maternal pelvis. If the presenting part is higher than the ischial spines, a negative number is assigned, noting centimeters above zero station. A -2 station is high in the pelvis. Contractions should be strong to cause fetal descent. Mild contractions will not move the baby down or open the cervix. This client is experiencing a problem between the maternal pelvis and the presenting part. 5. When the fetal shoulder is the presenting part, the fetus is in a transverse lie and the acromion process of the scapula is the landmark. This type of presentation occurs less than 1% of the time. This client is experiencing a problem between the maternal pelvis and the presenting part.

The nurse is explaining the difference between meiosis and mitosis. Which statements would be best? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Meiosis is the division of a cell into two exact copies of the original cell. 2. Mitosis is splitting one cell into two, each with half the chromosomes of the original cell. 3. Meiosis is a type of cell division by which gametes, or the sperm and ova, reproduce. 4. Mitosis occurs in only a few cells of the body. 5. Meiotic division leads to cells that halve the original genetic material.

Answer: 3, 5 Explanation: 3. Meiosis is a special type of cell division by which diploid cells give rise to gametes (sperm and ova). 5. Meiosis creates two cells that contain half the genetic material of the parent cell.

28) Five clients are in active labor in the labor unit. Which women should the nurse monitor carefully for the potential of uterine rupture? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Age 15, in active labor 2. Age 22, with eclampsia 3. Age 25, last delivery by cesarean section 4. Age 32, first baby died during labor 5. Age 27, last delivery 11 months ago

Answer: 3, 5 Explanation: 3. A woman who has had a previous cesarean section is at risk for uterine rupture. 5. A woman who does not have at least 18 months between deliveries is at greater risk for uterine rupture. Page Ref: 617

16) The nurse is explaining induction of labor to a client. The client asks what the indications for labor induction are. Which of the following should the nurse include when answering the client? 1. Suspected placenta previa 2. Breech presentation 3. Prolapsed umbilical cord 4. Hypertension

Answer: 4 Explanation: 4. A client with hypertension is appropriate for labor induction.

37) In the operating room, a client is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the client is draped for surgery? 1. Maternal temperature 2. Maternal urine output 3. Vaginal exam 4. Fetal heart tones

Answer: 4 Explanation: 4. Ascertain fetal heart rate (FHR) before surgery and during preparation because fetal hypoxia can result from aortocaval compression. Page Ref: 644

21) The nurse is completing discharge teaching for a client who delivered 2 days ago. Which statement by the client indicates that further information is required? 1. "Because I have a midline episiotomy, I should keep my perineum clean." 2. "I can use an ice pack to relieve some the pain from the episiotomy." 3. "I can take ibuprofen (Motrin) when my perineum starts to hurt." 4. "The tear I have through my rectum is unrelated to my episiotomy."

Answer: 4 Explanation: 4. This statement is incorrect. The major disadvantage is that a tear of the midline incision may extend through the anal sphincter and rectum. Page Ref: 636

18) The client is having fetal heart rate decelerations. An amnioinfusion has been ordered for the client to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is which of the following? 1. Early decelerations 2. Moderate decelerations 3. Late decelerations 4. Variable decelerations

Answer: 4 Explanation: 4. When cord compression is suspected, amnioinfusion (AI) may be considered. AI helps to prevent the possibility of variable decelerations by increasing the volume of amniotic fluid. Page Ref: 635

The midwife performs a vaginal exam and determines that the fetal head is at a -2 station. What does this indicate to the nurse about the birth? 1. The birth is imminent. 2. The birth is likely to occur in 1-2 hours. 3. The birth will occur later in the shift. 4. The birth is difficult to predict.

Answer: 4 Explanation: 4. A -2 station means that the fetus is 2 cm above the ischial spines. The ischial spines as a landmark have been designated as zero station. If the presenting part is higher than the ischial spines, a negative number is assigned, noting centimeters above zero station. With the fetus's head that high in the pelvis, it is difficult to predict when birth will occur.

40) The client has delivered a 4200 g fetus. The physician performed a midline episiotomy, which extended into a third-degree laceration. The client asks the nurse where she tore. Which response is best? 1. "The episiotomy extended and tore through your rectal mucosa." 2. "The episiotomy extended and tore up near your vaginal mucous membrane." 3. "The episiotomy extended and tore into the muscle layer." 4. "The episiotomy extended and tore through your anal sphincter."

Answer: 4 Explanation: 4. A third degree laceration includes the anal sphincter. Page Ref: 619

The couple at 12 weeks' gestation has been told that their fetus has sickle cell disease. Which statement by the couple indicates that they are adequately coping? 1. "We knew we were both carriers of sickle cell. We shouldn't have tried to have a baby." 2. "If we had been healthier when we conceived, our baby wouldn't have this disease now." 3. "Taking vitamins before we got pregnant would have prevented this from happening." 4. "The doctor told us there was a 25% chance that our baby would have sickle disease."

Answer: 4 Explanation: 4. A true statement indicates coping. When both parents are carriers of an autosomal recessive disease, there is a 25% risk for each pregnancy that the fetus will be affected.

The nurse explains to a preconception class that if only a small volume of sperm is discharged into the vagina, an insufficient quantity of enzymes might be released when they encounter the ovum. In that case, pregnancy would probably not result, because of which of the following? 1. Peristalsis of the fallopian tube would decrease, making it difficult for the ovum to enter the uterus. 2. The block to polyspermy (cortical reaction) would not occur. 3. The fertilized ovum would be unable to implant in the uterus. 4. Sperm would be unable to penetrate the zona pellucida of the ovum.

Answer: 4 Explanation: 4. About a thousand acrosomes must rupture to clear enough hyaluronic acid for even a single sperm to penetrate the ovum's zona pellucida successfully. If only a small amount of sperm were released, there most likely would be an insufficient quantity of acrosomes to penetrate the zona pellucida of the ovum and allow fertilization.

23) A 15-year-old client has delivered a 22-week stillborn fetus. What does the nurse understand? 1. Grieving a fetal loss manifests with very similar behaviors regardless of the age of the client. 2. Teens tend to withhold emotions and need older adults with the same type of loss to help process the experience. 3. Most teens have had a great deal of contact with death and loss and have an established method of coping. 4. Assisting the client might be difficult because of her mistrust of authority figures.

Answer: 4 Explanation: 4. Adolescents rely heavily on peer support and have a natural mistrust of authority figures, which can make assisting them more difficult. Page Ref: 947

10) After inserting prostaglandin gel for cervical ripening, what should the nurse do? 1. Apply an internal fetal monitor. 2. Insert an indwelling catheter. 3. Withhold oral intake and start intravenous fluids. 4. Place the client in a supine position with a right hip wedge.

Answer: 4 Explanation: 4. After the gel, intravaginal insert, or tablet is inserted, the woman is instructed to remain lying down with a rolled blanket or hip wedge under her right hip to tip the uterus slightly to the left for the first 30 to 60 minutes to maintain the cervical ripening agent in place. Page Ref: 627

The nurse teaching a client describes the effect of a vasectomy on fertilization by saying a man who has had a vasectomy becomes functionally sterile because of which of the following? 1. "Sperm are no longer being produced." 2. "Sperm are no longer motile and fertile." 3. "Sperm sit in the testes where they are formed." 4. "Sperm cannot reach the outside of the body."

Answer: 4 Explanation: 4. Although sperm continue to be produced for the next several years, they can no longer reach the outside of the body.

A newborn has been diagnosed with a disorder that occurs through an autosomal recessive inheritance pattern. The parents ask the nurse, "Which of us passed on the gene that caused the disorder?" Which answer should the nurse tell them? 1. The female 2. The male 3. Neither 4. Both

Answer: 4 Explanation: 4. An affected individual can have clinically normal parents, but both parents are generally carriers of the abnormal gene.

The nurse is preparing to assess a laboring client who has just arrived in the labor and birth unit. Which statement by the client indicates that additional education is needed? 1. "You are going to do a vaginal exam to see how dilated my cervix is." 2. "The reason for a pelvic exam is to determine how low in the pelvis my baby is." 3. "When you check my cervix, you will find out how thinned out it is." 4. "After you assess my pelvis, you will be able to tell when I will deliver."

Answer: 4 Explanation: 4. An experienced labor and birth nurse can estimate the time of delivery based on the cervix, fetal position, station, and contraction pattern. However, during a pelvic exam, no information is obtained about contractions. The nurse will not have enough information following the cervical exam to estimate time of birth.

A client scheduled a laparoscopy. After the procedure, what does the nurse instruct the client to do? 1. Stay on bed rest for 48 hours. 2. Expect to have shoulder and arm pain. 3. Purchase a rectal tube to relieve the gas. 4. Lie on her back to relieve the gas pain after the procedure.

Answer: 4 Explanation: 4. Assuming a supine position may help relieve residual shoulder and chest discomfort caused by any remaining gas.

As compared with admission considerations for an adult woman in labor, the nurse's priority for an adolescent in labor would be which of the following? 1. Cultural background 2. Plans for keeping the infant 3. Support persons 4. Developmental level

Answer: 4 Explanation: 4. Because her cognitive development is incomplete, the younger adolescent may have fewer problem-solving capabilities. The very young woman needs someone to rely on at all times during labor. She may be more childlike and dependent than older teens.

The nurse is teaching a pregnant 14-year-old client who is at 10 weeks' gestation about the expected body changes that will occur during pregnancy. Which client statement indicates that additional information is needed? 1. "My breasts are going to get even bigger than they've gotten over the past couple of years." 2. "My belly will gradually get more round, especially from the middle of pregnancy on." 3. "I will feel my baby move in about 16 weeks." 4. "My diet can stay the same even though I'm pregnant."

Answer: 4 Explanation: 4. Because the adolescent is at risk for anemia, she will need education regarding the importance of iron in her diet.

The nurse is caring for a laboring client. A cervical exam indicates 8 cm dilation. The client is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important? 1. Leave the client alone so she can rest. 2. Ask the family to take a coffee-and-snack break. 3. Encourage the client to have an epidural for pain. 4. Reassure the client that she will not be left alone.

Answer: 4 Explanation: 4. Because the client is in the transitional phase of the first stage of labor, she will not want to be left alone; staying with the client and reassuring her that she will not be alone are the highest priorities at this time.

The nurse teaching the phases of the menstrual cycle should include the fact that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and extensive vascular changes occur in which phase? 1. Menstrual phase 2. Proliferative phase 3. Secretory phase 4. Ischemic phase

Answer: 4 Explanation: 4. In the ischemic phase, the corpus luteum begins to degenerate, and as a result, both estrogen and progesterone levels fall. Small blood vessels rupture, and the spiral arteries constrict and retract, causing a deficiency of blood in the endometrium, which becomes pale.

The client has stated that she wants to avoid an epidural and would like an unmedicated birth. Which nursing action is most important for this client? 1. Encourage the client to vocalize during contractions. 2. Perform vaginal exams only between contractions. 3. Provide a CD of soft music with sounds of nature. 4. Offer to teach the partner how to massage tense muscles.

Answer: 4 Explanation: 4. Massage is helpful for many clients, especially during latent and active labor. Massage can increase relaxation and therefore decrease tension and pain.

A woman is in labor. The fetus is in vertex position. When the client's membranes rupture, the nurse sees that the amniotic fluid is meconium-stained. What should the nurse do immediately? 1. Change the client's position in bed. 2. Notify the physician that birth is imminent. 3. Administer oxygen at 2 liters per minute. 4. Begin continuous fetal heart rate monitoring.

Answer: 4 Explanation: 4. Meconium-stained amniotic fluid is an abnormal fetal finding, and is an indication for continuous fetal monitoring.

27) The client is carrying monochorionic-monoamniotic twins. The nurse teaches the client what this is, and the implications of this finding. The nurse knows that teaching is successful when the client states which of the following? 1. "My babies came from two eggs." 2. "About two thirds of twins have this amniotic sac formation." 3. "My use of a fertility drug led to this issue." 4. "My babies have a lower chance of surviving to term than fraternal twins do."

Answer: 4 Explanation: 4. Monochorionic-monoamniotic twins are both in one amniotic sac. There is an increased risk of umbilical cords becoming tangled or knotted and a higher incidence of fetal demise.

The nurse is working at a clinic for pregnant teens. What issues related to development will the nurse expect to encounter in most of the pregnant clients? 1. Peer pressure to stop using alcohol once pregnancy is diagnosed 2. Contraception failure that resulted in this pregnancy 3. The father of the baby's being emotionally supportive to the client 4. Feelings of not living up to parents' expectations

Answer: 4 Explanation: 4. Pregnant teens face risk factors based on the developmental tasks of adolescence. One of these is developing an identity. If the adolescent feels she has not lived up to parental expectations by becoming pregnant, she could adopt a negative identity.

The client has read that the placenta produces hormones that are vital to the function of the fetus. It is evident that that the client understands the function of the placenta when she states that which hormone is primarily responsible for the maintenance of pregnancy past the 11th week? 1. Human chorionic gonadotropin (hCG) 2. Human placental lactogen (hPL) 3. Estrogen 4. Progesterone

Answer: 4 Explanation: 4. Progesterone is a hormone essential for pregnancy. After the 11th week, the placenta produces enough progesterone and estrogen to maintain pregnancy.

The nurse is presenting a community education session on female hormones. Which statement from a participant indicates the need for further information? 1. "Estrogen is what causes females to look female." 2. "The presence of some hormones causes other to be secreted." 3. "Progesterone is present at the end of the menstrual cycle." 4. "Prostaglandin is responsible for achieving conception."

Answer: 4 Explanation: 4. Prostaglandin is not related to conception. Prostaglandin production increases during follicular maturation and has basic regulatory functions in cells.

26) Intervention to reduce preterm birth can be divided into primary prevention and secondary prevention. What does secondary prevention include? 1. Diagnosis and treatment of infections 2. Cervical cerclage 3. Progesterone administration 4. Antibiotic treatment and tocolysis

Answer: 4 Explanation: 4. Secondary prevention strategies are antibiotic treatment and tocolysis.

The nurse has just palpated a laboring woman's contractions. The uterus cannot be indented during a contraction. What would the intensity of these contractions best be characterized as? 1. Weak 2. Mild 3. Moderate 4. Strong

Answer: 4 Explanation: 4. Strong intensity exists when the uterine wall cannot be indented.

The nurse developing a care plan for a pregnant teen knows that what plan is best suited to pregnant teens? 1. Assess menstrual history and the presence of any food allergies. 2. Inquire about family relationships and location of the home. 3. Ask what her body image is, then correct her misconceptions. 4. Determine whether there are substance abuse issues.

Answer: 4 Explanation: 4. Substance abuse issues are important to assess during pregnancy of teens.

The nurse working in an adolescent prenatal clinic knows which of the following about the clients who are 15-17 years old? 1. They are more at ease with their individuality. 2. They see authority as resting with parents. 3. They are able to solve problems and make decisions. 4. They seek independence and identify with their peer group.

Answer: 4 Explanation: 4. Teens who are in middle adolescence (15-17 years old) seek independence and identify with their peer group.

The nurse teaching a class on the reproductive system is discussing what happens at puberty. Which statement does the nurse make? 1. Boys and girls go through puberty at the same time. 2. Most girls develop breasts and start their menses at about the same time. 3. The nocturnal emissions that adolescent boys have contain a large number of sperm. 4. The onset and progress of puberty varies widely from person to person.

Answer: 4 Explanation: 4. The age at onset and progress of puberty vary widely, physical changes overlap, and the sequence of events can vary from person to person.

When comparing the anterior and posterior fontanelles of a newborn, the nurse knows that both are what? 1. Both are approximately the same size 2. Both close within 12 months of birth 3. Both are used in labor to identify station 4. Both allow for assessing the status of the newborn after birth

Answer: 4 Explanation: 4. The anterior and posterior fontanelles are clinically useful in identifying the position of the fetal head in the pelvis and in assessing the status of the newborn after birth.

During the fourth stage of labor, the client's assessment includes a BP of 110/60, pulse 90, and the fundus is firm midline and halfway between the symphysis pubis and the umbilicus. What is the priority action of the nurse? 1. Turn the client onto her left side. 2. Place the bed in Trendelenburg position. 3. Massage the fundus. 4. Continue to monitor.

Answer: 4 Explanation: 4. The client's assessment data are normal for the fourth stage of labor, so monitoring is the only action necessary. During the fourth stage of labor, the mother experiences a moderate drop in both systolic and diastolic blood pressure, increased pulse pressure, and moderate tachycardia.

During a maternal assessment, the nurse determines the fetus to be in a left occiput anterior (LOA) position. Auscultation of the fetal heart rate should begin in what quadrant? 1. Right upper quadrant 2. Left upper quadrant 3. Right lower quadrant 4. Left lower quadrant

Answer: 4 Explanation: 4. The fetal heart rate (FHR) is heard most clearly at the fetal back. Thus, in a cephalic presentation, the FHR is best heard in the lower quadrant of the maternal abdomen.

While caring for a client in labor, the nurse notices during a vaginal exam that the fetus's head has rotated internally. What would the nurse expect the next set of cardinal movements for a fetus in a vertex presentation to be? 1. Flexion, extension, restitution, external rotation, and expulsion 2. Expulsion, external rotation, and restitution 3. Restitution, flexion, external rotation, and expulsion 4. Extension, restitution, external rotation, and expulsion

Answer: 4 Explanation: 4. The fetus changes position in the following order: descent, flexion, internal rotation, extension, restitution, external rotation, and expulsion.

What is the function of the scrotum? 1. Produce testosterone, the primary male sex hormone 2. Deposit sperm in the female vagina during sexual intercourse so that fertilization of the ovum can occur 3. Provide a reservoir where spermatozoa can survive for a long period 4. Protect the testes and the sperm by maintaining a temperature lower than that of the body

Answer: 4 Explanation: 4. The function of the scrotum is to protect the testes and the sperm by maintaining a temperature lower than that of the body.

The nurse is preparing a handout for female adolescents on the menstrual cycle. What phase of the cycle occurs if fertilization does not take place? 1. Menstrual 2. Proliferative 3. Secretory 4. Ischemic

Answer: 4 Explanation: 4. The ischemic phase occurs if fertilization does not occur.

20) A client has just delivered her third child, who was stillborn and had obvious severe defects. Which statement by the nurse is most helpful? 1. "Thank goodness you have other children." 2. "I am so happy that your other children are healthy." 3. "These things happen. They are the will of God." 4. "It is all right for you to cry. I will stay here with you."

Answer: 4 Explanation: 4. The nurse needs to let the client know that crying is a normal reaction to the loss event, and that the nurse will stay with her to offer support and understanding. Page Ref: 964

12) The nurse is caring for a couple who are in the labor/delivery room immediately after the delivery of a stillborn baby with visible defects. Which of the following actions by the nurse is appropriate? 1. Discourage the parents from naming the baby. 2. Advise the parents that the baby's defects would be too upsetting for them to see. 3. Transport the baby to the morgue as soon as possible. 4. Offer the parents the choice to see and hold the baby.

Answer: 4 Explanation: 4. The nurse should offer the couple the opportunity to see and hold the infant, and reassure the couple that any decision they make for themselves is the right one. Page Ref: 959

The nurse explains to the client that the obstetric conjugate measurement is important because of which reason? 1. This measurement determines the tilt of the pelvis. 2. This measurement determines the shape of the inlet. 3. The fetus passes under it during birth. 4. The size of this diameter determines whether the fetus can move down into the birth canal so that engagement can occur.

Answer: 4 Explanation: 4. The obstetric conjugate extends from the middle of the sacral promontory to an area approximately 1 cm below the pubic crest. The fetus passes through the obstetric conjugate, and the size of this diameter determines whether the fetus can move down into the birth canal in order for engagement to occur.

The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. Which information should the nurse include? 1. The hormone human chorionic gonadotropin stimulates ovulation. 2. Irregular menstrual cycles have varying lengths of the luteal phase. 3. The ovum leaves its follicle during the follicular phase. 4. There are two phases of the ovarian cycle: luteal and follicular.

Answer: 4 Explanation: 4. The ovarian cycle has two phases: the follicular phase (days 1 to 14) and the luteal phase (days 15 to 28 in a 28-day cycle).

38) After delivery, it is determined that there is a placenta accreta. Which intervention should the nurse anticipate? 1. 2 L oxygen by mask 2. Intravenous antibiotics 3. Intravenous oxytocin 4. Hysterectomy

Answer: 4 Explanation: 4. The primary complication of placenta accreta is maternal hemorrhage and failure of the placenta to separate following birth of the infant. An abdominal hysterectomy may be the necessary treatment, depending on the amount and depth of involvement. Page Ref: 619

During the initial visit with the nurse at the fertility clinic, the client asks what effect cigarette smoking has on the ability to conceive. What is the nurse's best response? 1. "Smoking has no effect." 2. "Only if you smoke more than one pack a day will you experience difficulty." 3. "After your first semen analysis, we will determine whether there will be any difficulty." 4. "Smoking can affect the quantity of sperm."

Answer: 4 Explanation: 4. The quantity and quality of male sperm are affected by cigarette smoking.

Why is it important for the nurse to assess the bladder regularly and encourage the laboring client to void frequently? 1. A full bladder impedes oxygen flow to the fetus. 2. Frequent voiding prevents bruising of the bladder. 3. Frequent voiding encourages sphincter control. 4. A full bladder can impede fetal descent.

Answer: 4 Explanation: 4. The woman should be encouraged to void because a full bladder can interfere with fetal descent. If the woman is unable to void, catheterization may be necessary.

A nurse counsels a couple on sex-linked disorders. Both the man and the woman are carriers of the disorder. They ask the nurse how this disorder will affect any children they might have. What is the nurse's best response? 1. "If you have a daughter, she will not be affected." 2. "Your son will be affected because the father has the disorder." 3. "There is a 25% chance that your son will have the disorder because the mother has the disorder." 4. "There is a 50% chance that your son will be a carrier only."

Answer: 4 Explanation: 4. There is a 50% chance that a carrier mother will pass the normal gene to each of her sons, who will be unaffected.

The charge nurse has received the shift change report. Which client requires immediate intervention? 1. Woman at 6 cm undergoing induction of labor, strong contractions every 3 minutes 2. Woman at 4 cm whose fetus is in a longitudinal lie with a cephalic presentation 3. Woman at 10 cm and fetus at +2 station experiencing a strong expulsion urge 4. Woman at 3 cm screaming in fear because her mother died during childbirth

Answer: 4 Explanation: 4. This client is most likely fearful that she will die during labor because her mother died during childbirth. This client requires education and a great deal of support, and is therefore the top priority.

The nurse in the clinic is seeing four clients. Which one is the best candidate for receiving an IUC? 1. An unmarried, 22-year-old college graduate 2. A married 24-year-old who has never been pregnant 3. An unmarried 25-year-old with a history of chlamydia 4. A married 26-year-old who has two children

Answer: 4 Explanation: 4. This client is the best candidate, as she is in a stable relationship, and has children.

The nurse working with a client describes cellular multiplication and how the zygote moves through the fallopian tube, a movement that takes place via what process? 1. A squeezing motion 2. Pushing from another ovum that has not been fertilized 3. Hormone action 4. A very weak fluid current in the fallopian tube resulting from the beating action of ciliated epithelium

Answer: 4 Explanation: 4. This is correct. There is a very weak fluid current in the fallopian tube resulting from the beating action of the ciliated epithelium that lines the tube.

A nurse working in an infertility clinic should include which information in her discussions with the clients? 1. It is important to know the statistics surrounding couples who never learn why they are infertile. 2. Couples should understand the legal controversy concerning therapeutic insemination. 3. Couples should seek marriage counseling before undergoing fertility treatments. 4. Couples should discuss therapeutic insemination and in vitro fertilization as alternatives.

Answer: 4 Explanation: 4. This is the correct answer. This information should be presented to clients so that they are aware of all the alternatives and can make an informed decision.

Recommendations for parents to help their teens avoid pregnancy include which of the following? 1. Parents need to encourage frequent and steady dating. 2. Parents need to let their children set their own goals for the future. 3. Parents need to have their children taught about sex by school programs and community resources. 4. Parents should be clear about their own sexual attitudes and values.

Answer: 4 Explanation: 4. This is true. Parents should be clear about their own sexual attitudes and values in order to communicate clearly with children.

A client has been diagnosed with fallopian tube obstruction and told that her best option for becoming pregnant is with in vitro fertilization. The client asks the nurse about the procedure. What is the nurse's best explanation of this procedure? 1. "In vitro fertilization (IVF) occurs over a full menstrual cycle." 2. "In IVF, a woman's ovaries are stimulated by a combination of egg and sperm donations." 3. "After ovarian stimulation, you will be inseminated with your partner's sperm." 4. "The oocytes are aspirated from the ovaries and fertilized in the laboratory."

Answer: 4 Explanation: 4. This is true. The oocytes are aspirated from the client's ovaries and fertilized in the laboratory.

A female client who is 36 years old, weighs 200 pounds, is monogamous, and does not smoke desires birth control. The nurse understands that which contraceptive method is inappropriate for this client? 1. Intrauterine device 2. Vaginal sponge 3. Combined oral contraceptives 4. Transdermal hormonal contraception

Answer: 4 Explanation: 4. Transdermal hormonal contraception is contraindicated because of the client's obesity.

The nurse is orienting a new graduate nurse to the labor and birth unit. Which statement indicates that teaching has been effective? 1. "When a client arrives in labor, a urine specimen is obtained by catheter to check for protein and ketones." 2. "When a client arrives in labor, she will be positioned supine to facilitate a normal blood pressure." 3. "When a client arrives in labor, her prenatal record is reviewed for indications of domestic abuse." 4. "When a client arrives in labor, a vaginal exam is performed unless birth appears to be imminent."

Answer: 4 Explanation: 4. Unless delivery seems imminent because the client is bearing down or contractions are very close and strong, the vaginal exam is performed after the vital signs are obtained.

After several hours of labor, the electronic fetal monitor (EFM) shows repetitive variable decelerations in the fetal heart rate. The nurse would interpret the decelerations to be consistent with which of the following? 1. Breech presentation 2. Uteroplacental insufficiency 3. Compression of the fetal head 4. Umbilical cord compression

Answer: 4 Explanation: 4. Variable decelerations occur when there is umbilical cord compression.

A couple asks the nurse what is the safest method of sterilization. What should the nurse reply? 1. "Laparotomy tubal ligation." 2. "Laparoscopy tubal ligation." 3. "Minilaparotomy." 4. "Vasectomy."

Answer: 4 Explanation: 4. Vasectomy (male sterilization) is a relatively minor procedure.

6) The nurse admits into the labor area a client who is in preterm labor. What assessment finding would constitute a diagnosis of preterm labor? 1. Cervical effacement of 30% or more 2. Cervical change of 0.5 cm per hour 3. 2 contractions in 30 minutes 4. 8 contractions in 1 hour

Answer: 4 Explanation: 4. 8 contractions in a 60 minute period does define a diagnosis of preterm labor.

10) Toward the end of the first stage of labor, a pudendal block is administered transvaginally. What will the nurse anticipate the client's care will include? 1. Monitoring for hypotension every 15 minutes 2. Monitoring FHR every 15 minutes 3. Monitoring for bladder distention 4. No additional assessments

Answer: 4 Explanation: 4. Because a pudendal block is done using a local anesthetic, there is no need for additional monitoring of the mother or the fetus.

25) The nurse is caring for a client in active labor. The membranes spontaneously rupture, with a large amount of clear amniotic fluid. Which nursing action is most important to undertake at this time? 1. Assess the odor of the amniotic fluid. 2. Perform Leopold maneuvers. 3. Obtain an order for pain medication. 4. Complete a sterile vaginal exam.

Answer: 4 Explanation: 4. Checking the cervix will determine whether the cord prolapsed when the membranes ruptured. The nurse would assess for prolapsed cord via vaginal examination. Page Ref: 615

6) A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse suggest? 1. That a mild analgesic be administered 2. An epidural 3. A local anesthetic block 4. Nonpharmacologic methods of pain reliefs.

Answer: 4 Explanation: 4. For this pattern of labor, nonpharmacologic methods of pain relief should be suggested. These can include back rubs, providing encouragement, and clean linens.

23) The nurse examines the client's placenta and finds that the umbilical cord is inserted at the placental margin. The client comments that the placenta and cord look different than they did for her first two births. The nurse should explain that this variation in placenta and cord is called what? 1. Placenta accreta 2. Circumvallate placenta 3. Succenturiate placenta 4. Battledore placenta

Answer: 4 Explanation: 4. In battledore placenta, the umbilical cord is inserted at or near the placental margin. Page Ref: 612

13) The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed? 1. "An epidural can be continuous or can be given in one dose." 2. "A spinal is usually used for a cesarean birth." 3. "Pudendal blocks are effective when a vacuum is needed." 4. "Local anesthetics provide good labor pain relief."

Answer: 4 Explanation: 4. Local anesthetics are not used for labor pain relief. They are used prior to episiotomy and for laceration repair.

12) The client is at 42 weeks' gestation. Which order should the nurse question? 1. Obtain biophysical profile today. 2. Begin nonstress test now. 3. Schedule labor induction for tomorrow. 4. Have the client return to the clinic in 1 week.

Answer: 4 Explanation: 4. Many practitioners use twice-weekly testing providing the amniotic fluid level is normal. One week is too long a period between assessments.

8) A client has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands which of the following? 1. In order to respect her wishes, no medication will be given. 2. Pain relief will allow a more enjoyable birth experience. 3. The use of medications allows the client to rest and be less fatigued. 4. Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

Answer: 4 Explanation: 4. The nurse can explain to the couple that, although pharmacologic agents do affect the fetus, so do the pain and stress experienced by the laboring mother. If the woman's pain and anxiety are more than she can cope with, the adverse physiologic effects on the fetus may be as great as would occur with the administration of a small amount of an analgesic agent. Once the effects are explained, however, it is still the client's choice whether to receive medication.

15) Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which position? 1. On her right side in the center of the bed with her back curved 2. Lying prone with a pillow under her chest 3. On her left side with the bottom leg straight and the top leg slightly flexed 4. Sitting on the edge of the bed

Answer: 4 Explanation: 4. The woman is positioned on her left or right side, at the edge of the bed with the assistance of the nurse, with her legs slightly flexed, or she is asked to sit on the edge of the bed.

14) The multiparous client at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold maneuvers indicate the fetus is in a transverse lie with a shoulder presentation. Which physician order is most important? 1. Artificially rupture membranes. 2. Apply internal fetal scalp electrode. 3. Monitor maternal blood pressure every 15 minutes. 4. Alert surgical team of urgent cesarean.

Answer: 4 Explanation: 4. This is the highest priority because vaginal birth is impossible with a transverse lie. Labor should not be allowed to continue, and a cesarean birth is done quickly. Page Ref: 609

32) The mother of a client who has experienced a term stillbirth arrives at the hospital and goes to the nurses' desk. The mother asks what she should say to her daughter in this difficult time. What is the nurse's best response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Use clichés; your daughter will find the repetition comforting." 2. "Remind her that she is young and can have more children." 3. "Keep talking about other things to keep her mind off the loss." 4. "Express your sadness, and sit silently with her if she doesn't respond." 5. "Encourage her to talk about the baby whenever she wants to."

Answer: 4, 5 Explanation: 4. Silence is commonly what is needed most, and simply saying "I'm sorry for your loss" might help to facilitate communication. 5. Talking is a way for the client experiencing grief and begin to come to terms with what has happened, and is important for resolution of grief. Intuitive grievers will need to talk about the event.

During the initial intrapartal assessment of a client in early labor, the nurse performs a vaginal examination. The client's partner asks why this pelvic exam needs to be done. The nurse should explain that the purpose of the vaginal exam is to obtain information about which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Uterine contraction pattern 2. Fetal position 3. Presence of the mucous plug 4. Cervical dilation and effacement 5. Presenting part

Answer: 4, 5 Explanation: 4. The vaginal examination of a laboring client obtains information about the station of the presenting part and the dilation and effacement of the cervix. 5. The vaginal examination of a laboring client obtains information about the fetal presenting part.

A woman who is 40 weeks pregnant calls the labor suite to ask whether she should be evaluated. Which statements by the client indicate she is likely in labor? Note: Credit will be given only for all correct choices and no incorrect choices. Select all that apply. 1. "The contractions are 5-20 minutes apart." 2. "I had pink discharge on the toilet paper." 3. "I have had cramping for the past 3-4 hours." 4. "The contractions start in my back and then go to my abdomen and are very intense." 5. "The contractions hurt more when I walk."

Answer: 4, 5 Explanation: 4. This is a sign of true labor. The contractions increase in duration and intensity and begin in the back and radiate around to the abdomen. 5. It is a sign of true labor when the client is unable to walk during the contraction.

27) A cesarean section is ordered for a pregnant client. Because the client is to receive general anesthesia, what is the primary danger with which the nurse is concerned? 1. Fetal depression 2. Vomiting 3. Maternal depression 4. Uterine relaxation

Explanation: 1. A primary danger of general anesthesia is fetal depression. The depression in the fetus is directly proportional to the depth and duration of the anesthesia.

9) The nurse has received end-of-shift reports in the high-risk maternity unit. Which client should the nurse see first? 1. The client at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement 2. The client at 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations 3. The client at 35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push 4. The client at 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Explanation: 1. Assessment of the woman with placenta previa must be ongoing to prevent or treat complications that are potentially lethal to the mother and fetus. Painless, bright red vaginal bleeding is the best diagnostic sign of placenta previa. This client is the highest priority.

20) A client had an epidural inserted 2 hours ago. It is functioning well, the client is stable, and labor is progressing. Which parts of the nurse's assessment have the highest priority? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assess blood pressure every hour. 2. Assess the pulse rate every hour. 3. Palpate the bladder. 4. Auscultate the lungs. 5. Assess the reflexes.

Explanation: 1. Blood pressure should be monitored every 1 to 2 minutes for the first 10 minutes and then every 5 to 15 minutes until the block wears off because hypotension is the most common side effect of epidural anesthesia. 3. Nursing care following an epidural block includes frequent assessment of the bladder to avoid bladder distention. Catheterization may be necessary, because most women are unable to void.

29) Slowly removing some amniotic fluid is a treatment for hydramnios. What consequence can occur with the withdrawal of fluid? 1. Preterm labor 2. Prolapsed cord 3. Preeclampsia 4. Placenta previa

Explanation: 2. A needle or a fetal scalp electrode is used to make a small puncture in the amniotic sac. There is a risk that the force of the fluid could make a larger hole in the amniotic sac, thus increasing the risk of a prolapsed cord.

5) A client was admitted to the labor area at 5 cm with ruptured membranes about 14 hours ago. What assessment data would be most beneficial for the nurse to collect? 1. Blood pressure 2. Temperature 3. Pulse 4. Respiration

Explanation: 2. Rupture of membranes places the mother at risk for infection. The temperature is the primary and often the first indication of a problem.

10) In succenturiate placenta, one or more accessory lobes of fetal villi have developed on the placenta, with vascular connections of fetal origin. What is the gravest maternal danger? 1. Cord prolapse 2. Postpartum hemorrhage 3. Paroxysmal hypertension 4. Brachial plexus injury

Explanation: 2. The gravest maternal danger is postpartum hemorrhage if this minor lobe is severed from the placenta and remains in the uterus. Page Ref: 612

18) A laboring client has received an order for epidural anesthesia. In order to prevent the most common complication associated with this procedure, what would the nurse expect to do? 1. Observe fetal heart rate variability 2. Hydrate the vascular system with 500-1000 mL of intravenous fluids 3. Place the client in the semi-Fowler's position 4. Teach the client appropriate breathing techniques

Explanation: 2. The risk of hypotension can be minimized by hydrating the vascular system with 500 to 1000 mL of IV solution before the procedure and changing the woman's position and/or increasing the IV rate afterward.