OB/Peds E: 1, 2, 3, 4 MOD 4

2. Pregnancy is a hypercoagulable state, where the mother's blood clots more readily. Is this statement true or false?

ANS: T This is because of an increase in factors that favor coagulation and a decrease in factors that inhibit coagulation. Fibrinogen increases by 50% and factors VII, VIII, IX, and X also rise.

1. While providing education to a primiparous woman regarding the normal changes of pregnancy, it is important for the nurse to explain that the uterus undergoes irregular contractions. These are known as _____________ contractions.

ANS: Braxton Hicks Irregular painless contractions occur throughout pregnancy, although many women do not notice them until the third trimester. Women who are unsure, who have 5 or 6 regular contractions within one hour, or who demonstrate other signs of labor should contact their provider.

1. Inquiring about past pregnancies is an important part of the nursing assessment. Women who have had a previous cesarean birth may request a trial of labor and a ______ delivery.

ANS: VBAC Although vaginal birth after cesarean is less common, it may be chosen for a variety of reasons. The nurse should be aware of the need for increased support of the woman in labor, and for complications that may occur.

3. In order to prevent neural tube defects, updated recommendations include an intake of 0.4 mg to 0.8 mg of ___________________ each day from one month prior to conception until 8 to 10 weeks of pregnancy.

ANS: folic acid Pregnant women should take 0.6 mg of folic acid daily for the duration of their pregnancy. Women who have given birth to an infant with a neural tube defect previously should take 4 mg of folic acid in the 4 weeks prior to pregnancy and throughout the first trimester.

2. During pregnancy many women become increasingly concerned about their ability to protect and provide for the fetus. This concern is often manifested as _____________.

ANS: narcissism Narcissism is an undue preoccupation with one's self and introversion (concentration on one's self and one's body). Selecting the right foods and clothing may be more important than ever before, out of concern for the growing fetus.

20. A woman at 40 weeks of gestation should be instructed to go to a hospital or birth center for evaluation when she experiences a. A trickle of fluid from the vagina b. Thick pink or dark red vaginal mucus c. Irregular contractions for 1 hour d. Fetal movement

ANS: A Feedback A A trickle of fluid from the vagina may indicate rupture of the membranes requiring evaluation for infection or cord compression. B Bloody show may occur before the onset of true labor. It does not require professional assessment unless the bleeding is pronounced. C This is a sign of false labor and does not require further assessment. D The lack of fetal movement needs further assessment.

25. Which comment by a woman in her first trimester indicates ambivalent feelings? a. "I wanted to become pregnant, but I'm scared about being a mother." b. "I haven't felt well since this pregnancy began." c. "I'm concerned about the amount of weight I've gained." d. "My body is changing so quickly."

ANS: A Feedback A Ambivalence refers to conflicting feelings. B This does not reflect conflicting feelings. C By expressing concerns over a normal occurrence, the woman is trying to confirm the pregnancy. D The woman is trying to confirm the pregnancy when she expresses concerns over normal pregnancy changes. She is not expressing conflicting feelings.

18. Prenatal testing for the human immunodeficiency virus (HIV) is recommended for which women? a. All women, regardless of risk factors b. A woman who has had more than one sexual partner c. A woman who has had a sexually transmitted infection d. A woman who is monogamous with her partner

ANS: A Feedback A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated. B All women should be tested for HIV, although this patient is at increased risk of contracting the disease. C Regardless of past sexual history, all women should have an HIV test completed prenatally. D Although this patient is apparently monogamous, an HIV test is still recommended.

12. What occurrence is associated with cervical dilation and effacement? a. Bloody show b. False labor c. Lightening d. Bladder distention

ANS: A Feedback A As the cervix begins to soften, dilate, and efface, expulsion of the mucous plug that sealed the cervix during pregnancy occurs. This causes rupture of small cervical capillaries. B Cervical dilation and effacement do not occur with false labor. C Lightening is the descent of the fetus toward the pelvic inlet before labor. D Bladder distention occurs when the bladder is not empted frequently. It may slow down the decent of the fetus during labor.

1. A pregnant woman's mother is worried that her daughter is not "big enough" at 20 weeks. The nurse palpates and measures the fundal height at 20 cm, which is even with the woman's umbilicus. What should the nurse report to the woman and her mother? a. "The body of the uterus is at the belly button level, just where it should be at this time." b. "You're right. We'll inform the practitioner immediately." c. "When you come for next month's appointment, we'll check you again to make sure that the baby is growing." d. "Lightening has occurred, so the fundal height is lower than expected."

ANS: A Feedback A At 20 weeks, the fundus is usually located at the umbilical level. Because the uterus grows in a predictable pattern, obstetric nurses should know that the uterus of 20 weeks of gestation is located at the level of the umbilicus. B This is incorrect information. At 20 weeks the uterus should be at the umbilical level. C By avoiding the direction question, this might increase the anxiety of both the mother and grandmother. D The descent of the fetal head (lightening) occurs in late pregnancy.

22. A gravida patient at 32 weeks of gestation reports that she has severe lower back pain. The nurse's assessment should include a. Observation of posture and body mechanics b. Palpation of the lumbar spine c. Exercise pattern and duration d. Ability to sleep for at least 6 hours uninterrupted

ANS: A Feedback A Correct posture and body mechanics can reduce lower back pain caused by increasing lordosis. B Pregnancy should not cause alterations in the spine. Any assessment for malformation should be done early in the pregnancy. C Certain exercises can help relieve back pain. D Rest is important for well-being, but the main concern with back pain is to assess posture and body mechanics.

3. Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet? a. Engagement b. Extension c. Internal rotation d. External rotation

ANS: A Feedback A Engagement occurs when the presenting part fully enters the pelvic inlet. B Extension occurs when the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck stops under the symphysis. This causes the fetal head to extend. C Internal rotation occurs when the fetus enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform to the longest diameter of the maternal pelvis. D External rotation occurs after the birth of the head. The head then turns to the side so the shoulders can internally rotate and are positioned with their transverse diameter in the anteroposterior diameter of the pelvic outlet.

19. What is an essential part of nursing care for the laboring woman? a. Helping the woman manage the pain. b. Eliminating the pain associated with labor. c. Sharing personal experiences regarding labor and delivery to decrease her anxiety. d. Feeling comfortable with the predictable nature of intrapartal care.

ANS: A Feedback A Helping a woman manage the pain is an essential part of nursing care, because pain is an expected part of normal labor and cannot be fully relieved. B Labor pain cannot be fully relieved. C Decreasing anxiety is important, but managing pain is a top priority. D The labor nurse should always be assessing for unpredictable occurrences.

17. A patient notices that the doctor writes "positive Chadwick's sign" on her chart. She asks the nurse what this means. The nurse's best response is a. "It refers to the bluish color of the cervix in pregnancy." b. "It means the cervix is softening." c. "The doctor was able to flex the uterus against the cervix." d. "That refers to a positive sign of pregnancy."

ANS: A Feedback A Increased vascularity of the pelvic organs during pregnancy results in the bluish color of the cervix, vagina, and labia, called Chadwick's sign. B Softening of the cervix is Goodell's sign. C The softening of the lower segment of the uterus (Hegar's sign) can allow the uterus to be flexed against the cervix. D Chadwick's sign is a probable indication of pregnancy.

16. Leopold's maneuvers are used by practitioners to determine a. The best location to assess the fetal heart rate (FHR) b. Cervical dilation and effacement c. Whether the fetus is in the posterior position d. The status of the membranes

ANS: A Feedback A Leopold's maneuvers are often performed before assessing the FHR. These maneuvers help identify the best location to obtain the FHR. B Dilation and effacement are best determined by vaginal examination. C Assessment of fetal position is more accurate with vaginal examination. D A Nitrazine or ferning test can be performed to determine the status of the fetal membranes.

34. The nurse notes that a woman who has given birth 1 hour ago is touching her infant with the fingertips and talking to him softly in high-pitched tones. On the basis of this observation, the nurse should a. Document this evidence of normal early maternal-infant attachment behavior. b. Observe for other signs that the mother may not be accepting of the infant. c. Request a social service consult for psychosocial support. d. Determine whether the mother is too fatigued to interact normally with her infant.

ANS: A Feedback A Normal early maternal-infant behaviors are tentative and include fingertip touch, eye contact, and using a high-pitched voice when talking to the infant. B These are signs of normal attachment behavior; no other assessment is necessary at this point. C There is no indication at this point that social service consult is necessary. The signs are of normal attachment behavior. D The mother may be fatigued but is interacting with the infant in an expected manner.

6. Perinatal nurses are legally responsible for a. Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes b. Greeting the patient on arrival, assessing her, and starting an IV line c. Applying the external fetal monitor and notifying the care provider d. Making sure the woman is comfortable

ANS: A Feedback A Nurses who care for women during childbirth are legally responsible for correctly interpreting FHR patterns, initiating appropriate nursing interventions based on those patterns, and documenting the outcomes of those interventions. B These activities should be performed when any patient arrives to the maternity unit. The nurse is not the only one legally responsible for performing these functions. C This is a nursing function that is part of the standard of care for all obstetrical patients. This falls within the RN scope of practice. D Everyone caring for the pregnant woman should ensure that both she and her support partner are comfortable.

24. The nurse auscultates the fetal heart rate (FHR) and determines a rate of 152. Which nursing intervention is appropriate? a. Inform the mother that the rate is normal. b. Reassess the FHR in 5 minutes because the rate is too high. c. Report the FHR to the physician or nurse-midwife immediately. d. Tell the mother that she is going to have a boy because the heart rate is fast.

ANS: A Feedback A The FHR is within the normal range, so no other action is indicated at this time. B The FHR is within the expected range; reassessment should occur, but not in 5 minutes. C The FHR is within the expected range; no further action is necessary at this point. D The sex of the baby cannot be determined by the FHR.

13. The fetal heart rate baseline increases 15 beats per minute after vibroacoustic stimulation. The best interpretation of this is that the fetus is showing a. A reassuring response b. Progressive acidosis c. Parasympathetic stimulation d. A worsening hypoxia

ANS: A Feedback A The fetus with adequate reserve for the stress of labor will usually respond to vibroacoustic stimulation with a temporary increase in the fetal heart rate (FHR) over baseline of 15 bpm for 15 seconds or more. B An increase in the FHR after stimulation is reassuring. C An increase in the FHR after stimulation is a reassuring pattern and does not indicate problems with the parasympathetic nervous system. D An increase in the FHR with stimulation does not indicate hypoxia.

36. To adequately care for a laboring woman, the nurse should know that the _____ stage of labor varies the most in length. a. First b. Second c. Third d. Fourth

ANS: A Feedback A The first stage of labor is considered to last from the onset of regular uterine contractions to full dilation of the cervix. The first stage is much longer than the second and third stages combined. In a first pregnancy, the first stage of labor can take up to 20 hours. B The second stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. The average length is 20 minutes for a multiparous woman and 50 minutes for a nulliparous woman. C The third stage of labor lasts from the birth of the fetus until the placenta is delivered. This stage may be as short as 3 minutes or as long as 1 hour. D The fourth stage of labor, recovery, lasts about 2 hours after delivery of the placenta.

20. The multiple marker screen is used to assess the fetus for which condition? a. Down syndrome b. Diaphragmatic hernia c. Congenital cardiac abnormality d. Anencephaly

ANS: A Feedback A The maternal serum level of alpha-fetoprotein is used to screen for Trisomy 18 or 21, neural tube defects, and other chromosomal anomalies. B The quadruple marker test does not detect this fetal anomaly. Additional testing, such as ultrasonography would be required to diagnose diaphragmatic hernia. C Congenital cardiac abnormality would most likely be identified during an ultrasound examination. D The quadruple marker test would not detect anencephaly.

10. In which situation is a baseline fetal heart rate of 160 to 170 beats per minute be considered a normal finding? a. The fetus is at 28 weeks of gestation. b. The mother has been given an epidural block. c. The mother has a history of fast labors. d. The mother has mild preeclampsia but is not in labor.

ANS: A Feedback A The normal preterm fetus may have a baseline rate slightly higher than the term fetus because of an immature parasympathetic nervous system that does not yet exert a slowing effect on the fetal heart rate (FHR). B Any change in the FHR with an epidural is not considered an expected outcome. C Fast labors should not alter the FHR normally. D Preeclampsia should not cause a normal elevation of the FHR.

5. The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is a. Over the uterine fundus b. On the fetal scalp c. Inside uterus d. Over the mother's lower abdomen

ANS: A Feedback A The tocotransducer monitors uterine activity and should be placed over the fundus, where the most intensive uterine contractions occur. B The tocotransducer monitors uterine contractions. C The tocotransducer is for external use. D The most intensive uterine contractions occur at the fundus; this is the best placement area.

13. To be aware of potential risks to the laboring woman, the nurse understands that a breech presentation is associated with a. Umbilical cord compression b. More rapid labor c. A high risk of infection d. Maternal perineal trauma

ANS: A Feedback A The umbilical cord can be compressed between the fetal body and the maternal pelvis when the body has been born but the head remains within the pelvis. B Breech presentation is not associated with a more rapid labor. C There is no higher risk of infection with a breech birth. D There is no higher risk for perineal trauma with a breech birth.

25. A laboring woman is lying in the supine position. The most appropriate nursing action is to a. Ask her to turn to one side. b. Elevate her feet and legs. c. Take her blood pressure. d. Determine if fetal tachycardia is present.

ANS: A Feedback A The woman's supine position may cause the heavy uterus to compress her inferior vena cava, reducing blood return to her heart and reducing placental blood flow. This problem is relieved by having her turn onto her side. B Elevating her legs will not relieve the pressure from the inferior vena cava. C This position may produce hypotension in the woman, but the action should be to prevent this from happening, not to assess for the problem. D If the woman is allowed to stay in the supine position and blood flow to the placental is reduced significantly, fetal tachycardia may occur. The most appropriate nursing action is to prevent this from occurring by turning the woman to her side.

2. Which maternal condition is considered a contraindication for the application of internal monitoring devices? a. Unruptured membranes b. Cervix is dilated to 4 cm c. External monitors are currently being used d. Fetus has a known heart defect

ANS: A Feedback A To apply internal monitoring devices, the membranes must be ruptured. B Cervical dilation of 4 cm permits the insertion of fetal scalp electrodes and intrauterine catheter. C The external monitor can be discontinued after the internal ones are applied. D A compromised fetus should be monitored with the most accurate monitoring devices.

2. A pregnant woman reports that she works in a long-term care setting and is concerned about the impending flu season. She asks about receiving the flu vaccine. As the nurse, you are aware that some immunizations are safe to administer during pregnancy, whereas others are not. Which vaccines could this patient receive? Select all that apply. a. Tetanus b. Hepatitis A and B c. Measles, mumps, rubella (MMR) d. Influenza e. Varicella

ANS: A, B, D Feedback Correct Inactivated vaccines such as those for tetanus, hepatitis A, hepatitis B, and influenza are safe to administer for women who have a risk for contracting or developing the disease. Incorrect Immunizations with live virus vaccines such as MMR, varicella (chickenpox), or smallpox are contraindicated during pregnancy because of the possible teratogenic effects on the fetus.

1. The nurse who elects to practice in the area of obstetrics often hears discussion regarding the "four Ps." These are the four major factors that interact during normal childbirth. What are the "four Ps"? a. Powers b. Passage c. Position d. Passenger e. Psyche

ANS: A, B, D, E Feedback Correct Powers: the two powers of labor are uterine contractions and pushing efforts. During the first stage of labor through full cervical dilation, uterine contractions are the primary force moving the fetus through the maternal pelvis. At some point after full dilation, the woman adds her voluntary pushing efforts to propel the fetus through the pelvis. Passage: the passage for birth of the fetus consists of the maternal pelvis and its soft tissues. The bony pelvis is more important to the successful outcome of labor, because bones and joints do not yield as readily to the forces of labor. Passenger: this is the fetus plus the membranes and placenta. Fetal lie, attitude, presentation, and position are all factors that affect the fetus as passenger. Psyche: the psyche is a crucial part of childbirth. Marked anxiety, fear, or fatigue decreases the woman's ability to cope. Incorrect Position is not one of the "four Ps."

1. In some Middle Eastern and African cultures, female genital mutilation is a prerequisite for marriage. Women who now live in North America need care from nurses who are knowledgeable about the procedure and comfortable with the abnormal appearance of her genitalia. When caring for this woman, the nurse can formulate a diagnosis with the understanding that the woman may be at risk for (select all that apply) a. Obstructed labor b. Increased signs of pain response c. Laceration d. Hemorrhage e. Infection

ANS: A, C, D, E Feedback Correct The woman is at risk for all of these complications. Female genital mutilation, cutting, or circumcision involves removal of some or all of the external female genitalia. The labia majora are often stitched together over the vaginal and urethral opening as part of this practice. Enlargement of the vaginal opening may be performed before or during the birth. Incorrect The woman is unlikely to give any verbal or nonverbal signs of pain. This lack of response does not indicate lack of pain. In fact, pelvic examinations are likely to be very painful because the introitus is so small and inelastic scar tissue makes the area especially sensitive. A pediatric speculum may be necessary, and the patient should be made as comfortable as possible.

3. During pregnancy there are a number of changes that occur as a direct result of the presence of the fetus. Which of these adaptations meet this criteria? Select all that apply. a. Leukorrhea b. Development of the operculum c. Quickening d. Ballottement e. Lightening

ANS: A, C, E Feedback Correct Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Quickening is the first recognition of fetal movements or "feeling life." Quickening is often described as a flutter and is felt earlier in multiparous women than in primiparas. Lightening occurs when the fetus begins to descent into the pelvis. This occurs two weeks before labor in the nullipara and at the start of labor in the multipara. Incorrect Mucous fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy. Passive movement of the unengaged fetus is referred to asballottement.

27. During the active phase of labor, the FHR of a low-risk patient should be assessed every a. 15 minutes b. 30 minutes c. 45 minutes d. 1 hour

ANS: B Feedback A 15-minute assessments are appropriate for a fetus at high risk. B For the fetus at low risk for complications, guidelines for frequency of assessments are at least every 30 minutes during the active phase of labor. C 45-minute assessments during the active phase of labor is not frequent enough to monitor for complications. D 1-hour assessments during the active phase of labor are not frequent enough to monitor for complications.

13. A woman's last menstrual period was June 10. Her estimated date of delivery (EDD) is a. April 7 b. March 17 c. March 27 d. April 17

ANS: B Feedback A April 7 would be subtracting 2 months instead of 3 months and then subtracting 3 days instead of adding 7 days. B To determine the EDD, the nurse uses the first day of the last menstrual period (June 10), subtracts 3 months (March 10), and adds 7 days (March 17). C March is the correct month, but instead of adding 7 days, 17 days were added. D April 17 is subtracting 2 months instead of 3 months.

27. Mimicry refers to observing and copying the behaviors of other mothers. An example might be a. Babysitting for a neighbor's children b. Wearing maternity clothes before they are needed c. Daydreaming about the newborn d. Imagining oneself as a good mother

ANS: B Feedback A Babysitting other children is a form of role playing where the woman practices the expected role of motherhood. B Wearing maternity clothes before they are needed helps the expectant mother "feel" what it's like to be obviously pregnant. C Daydreaming is a type of fantasy where the woman "tries on" a variety of behaviors in preparation for motherhood. D Imagining herself as a good mother is the woman's effort to look for a good role fit. She observes behavior of other mothers and compares them with her own expectations.

7. To adequately teach patients about the process of labor, the nurse knows that which event is the best indicator of true labor? a. Bloody show b. Cervical dilation and effacement c. Fetal descent into the pelvic inlet d. Uterine contractions every 7 minutes

ANS: B Feedback A Bloody show can occur before true labor. B The conclusive distinction between true and false labor is that contractions of true labor cause progressive change in the cervix. C Fetal descent can occur before true labor. D False labor may have contractions that occur this frequently, but it is usually inconsistent.

9. A number of cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman during pregnancy? a. Cardiac output rises by 25% b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

ANS: B Feedback A Cardiac output increases by 50% with half of this rise occurring in the first 8 weeks gestation. B The pulse increases about 15 to 20 beats/min, which persists to term. C In the first trimester, blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester, both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. D Production of RBCs accelerates during pregnancy.

14. The primary difference between the labor of a nullipara and that of a multipara is the a. Amount of cervical dilation b. Total duration of labor c. Level of pain experienced d. Sequence of labor mechanisms

ANS: B Feedback A Cervical dilation is the same for all labors. B Multiparas usually labor more quickly than nulliparas, making the total duration of their labor shorter. C Level of pain is individual to the woman, not to the number of labors she has experienced. D The sequence of labor mechanisms is the same with all labors.

6. Which statement related to changes in the breasts during pregnancy is the most accurate? a. During the early weeks of pregnancy there is decreased sensitivity. b. Nipples and areolae become more pigmented. c. Montgomery tubercles are no longer visible around the nipples. d. Venous congestion of the breasts is more visible in the multiparous woman.

ANS: B Feedback A Fullness, heightened sensitivity, tingling and heaviness of the breasts occur in the early weeks of gestation in response to increased levels of estrogen and progesterone. B Nipples and areolae become more pigmented, and the nipples become more erectile and may express colostrum. C Montgomery tubercles may be seen around the nipples. These sebaceous glands may have a protective role in that they keep the nipples lubricated for breastfeeding. D Venous congestion in the breasts is more obvious in primigravidas.

15. A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is a. "It is due to an increase in gastric motility." b. "It may be due to changes in hormones." c. "It is related to an increase in glucose levels." d. "It is caused by a decrease in gastric secretions."

ANS: B Feedback A Gastric motility decreases during pregnancy. B Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. C Glucose levels decrease in the first trimester. D Gastric secretions do decrease, but this is not the main cause of nausea and vomiting.

30. A 25-year-old primigravida is in the first stage of labor. She and her husband have been holding hands and breathing together through each contraction. Suddenly the woman pushes her husband's hand away and shouts, "Don't touch me!" This behavior is most likely a. Normal and related to hyperventilation b. Common during the transition phase of labor c. A sign that she needs analgesia d. Indicative of abnormal labor

ANS: B Feedback A Hyperventilation will produce signs of respiratory alkalosis. B The transition phase of labor is often associated with an abrupt change in behavior, including increased anxiety and irritability. C If she is in the transitional phase of labor, analgesia may not be appropriate if the birth is near. D This change of behavior is an expected occurrence during the transition phase.

8. Why is continuous electronic fetal monitoring usually used when oxytocin is administered? a. The mother may become hypotensive. b. Uteroplacental exchange may be compromised. c. Maternal fluid volume deficit may occur. d. Fetal chemoreceptors are stimulated.

ANS: B Feedback A Hypotension is not a common side effect of oxytocin. B The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This response reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, depleting fetal oxygen reserves. C All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. D Oxytocin affects the uterine muscles.

10. Physiologic anemia often occurs during pregnancy as a result of a. Inadequate intake of iron b. Dilution of hemoglobin concentration c. The fetus establishing iron stores d. Decreased production of erythrocytes

ANS: B Feedback A Inadequate intake of iron may lead to true anemia. B When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman will have physiologic anemia, which is the result of dilution of hemoglobin concentration rather than inadequate hemoglobin. C If the woman does not take an adequate amount of iron, true anemia may occur when the fetus pulls stored iron from the maternal system. D There is an increased production of erythrocytes during pregnancy.

2. Which statement is the best rationale for assessing maternal vital signs between contractions? a. During a contraction, assessing fetal heart rates is the priority. b. Maternal circulating blood volume increases temporarily during contractions. c. Maternal blood flow to the heart is reduced during contractions. d. Vital signs taken during contractions are not accurate.

ANS: B Feedback A It is important to monitor fetal response to contractions, but the question is concerned with the maternal vital signs. B During uterine contractions, blood flow to the placenta temporarily stops, causing a relative increase in the mother's blood volume, which in turn temporarily increases blood pressure and slows pulse. C Maternal blood flow is increased during a contraction. D Vital signs are altered by contractions but are considered accurate for that period of time.

4. Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria b. Glycosuria c. Bacteria in the urine d. Ketones in the urine

ANS: B Feedback A The presence of protein could indicate kidney disease or preeclampsia. B Small amounts of glucose may indicate "physiologic spilling." C Urinary tract infections are associated with bacteria in the urine. D An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

7. Which is the most appropriate method of intrapartum fetal monitoring when a woman has a history of hypertension during pregnancy? a. Continuous auscultation with a fetoscope b. Continuous electronic fetal monitoring c. Intermittent assessment with a Doppler transducer d. Intermittent electronic fetal monitoring for 15 minutes each hour

ANS: B Feedback A It is not practical to provide continuous auscultation with a fetoscope. B Maternal hypertension may reduce placental blood flow through vasospasm of the spiral arteries. Reduced placental perfusion is best assessed with continuous electronic fetal monitoring to identify patterns associated with this condition. C This fetus needs continuous monitoring because it is at high risk for complications. D This fetus needs continuous monitoring because it is at high risk for complications.

32. The nurse who practices in a prenatal clinic understands that a major concern of lower socioeconomic groups is to a. Maintain group health insurance on their families. b. Meet health needs as they occur. c. Practice preventive health care. d. Maintain an optimistic view of life.

ANS: B Feedback A Lower socioeconomic groups usually do not have group health insurances. B Because of economic uncertainty, lower socioeconomic groups place more emphasis on meeting the needs of the present rather than on future goals. C They may value health care, but cannot afford preventive health care. D They may struggle for basic needs and often do not see a way to improve their situation. It is difficult to maintain optimism.

15. Which maternal factor may inhibit fetal descent and require further nursing interventions? a. Decreased peristalsis b. A full bladder c. Reduction in internal uterine size d. Rupture of membranes

ANS: B Feedback A Peristalsis does not influence fetal descent. B A full bladder may inhibit fetal descent because it occupies space in the pelvis needed by the fetal presenting part. C Contractions will reduce the internal uterine size in order to assist fetal descent. D Rupture of membranes will assist in the fetal descent.

35. Early pregnancy classes offered in the first and second trimesters cover a. Phases and stages of labor b. Coping with common discomforts of pregnancy c. Methods of pain relief d. Predelivery and postdelivery care of the patient having a cesarean delivery

ANS: B Feedback A Phases and stages of labor are taught in childbirth preparation classes. B Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead. C Pain control is part of childbirth preparation classes. D This is taught in cesarean birth preparation classes.

8. The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to a. Compensate for decreased renal plasma flow. b. Provide adequate perfusion of the placenta. c. Eliminate metabolic wastes of the mother. d. Prevent maternal and fetal dehydration.

ANS: B Feedback A Renal plasma flow increases during pregnancy. B The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. C Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume. D This is not the primary reason for the increase in volume.

21. Which complaint by a patient at 35 weeks of gestation requires additional assessment? a. Shortness of breath when climbing stairs b. Abdominal pain c. Ankle edema in the afternoon d. Backache with prolonged standing

ANS: B Feedback A Shortness of breath is an expected finding by 35 weeks. B Abdominal pain may indicate preterm labor or placental abruption. C Ankle edema in the afternoon is a normal finding at this stage of pregnancy. D Backaches while standing is a normal finding during the later stages of pregnancy.

32. If a woman's fundus is soft 30 minutes after birth, the nurse's first response should be to a. Take the blood pressure. b. Massage the fundus. c. Notify the physician or nurse-midwife. d. Place the woman in Trendelenburg position.

ANS: B Feedback A The blood pressure is an important assessment to determine the extent of blood loss, but it is not the top priority. B The nurse's first response should be to massage the fundus to stimulate contraction of the uterus to compress open blood vessels at the placental site, limiting blood loss. C Notification should occur after all nursing measures have been attempted with no favorable results. D Trendelenburg position is contraindicated for this woman at this point. This position does not allow for appropriate vaginal drainage of lochia. The lochia remaining in the uterus would clot and produce further bleeding.

5. It is important for the nurse providing care during labor to be aware that pregnant women can usually tolerate the normal blood loss associated with childbirth because they have a. A higher hematocrit b. Increased blood volume c. A lower fibrinogen level d. Increased leukocytes

ANS: B Feedback A The hematocrit decreases with pregnancy due to the high fluid volume. B Women have a significant increase in blood volume during pregnancy. After delivery, the additional circulating volume is no longer necessary. C Fibrinogen levels increase with pregnancy. D Leukocyte levels increase during labor, but that is not the reason for the toleration of blood loss.

11. To teach and support the woman in labor, the nurse explains that the strongest part of a labor contraction is the a. Increment b. Acme c. Decrement d. Interval

ANS: B Feedback A The increment is the beginning of the contractions until it reaches the peak. B The acme is the peak or period of greatest strength during the middle of a contraction cycle. C The decrement occurs after the peak until the contraction ends. D The interval is the period between the end of the contraction and the beginning of the next.

10. A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Second stage d. Third stage

ANS: B Feedback A The latent phase is from the beginning of true labor until 3 cm of cervical dilation. B The active phase of labor is characterized by cervical dilation of 4 to 7 cm. C The second stage of labor begins when the cervix is completely dilated until the birth of the baby. D The third stage of labor is from the birth of the baby until the expulsion of the placenta.

30. Which situation best describes a man "trying on" fathering behaviors? a. Spending more time with his siblings b. Coaching a Little League baseball team c. Reading books on newborn care d. Exhibiting physical symptoms related to pregnancy

ANS: B Feedback A The man normally will seek closer ties with his father. B Interacting with children and assuming the behavior and role of a father best describes a man "trying on" being a father. C Men do not normally read information that is provided in advance. The nurse should be prepared to present the information after the baby is born, when it is more relevant. D This is called couvade.

1. The nurse sees a pattern on the fetal monitor that looks similar to early decelerations, but the deceleration begins near the acme of the contraction and continues well beyond the end of the contraction. Which nursing action indicates the proper evaluation of this situation? a. Continue to monitor these early decelerations, which occur as the fetal head is compressed during a contraction. b. This deceleration pattern is associated with uteroplacental insufficiency, so the nurse acts quickly to improve placental blood flow and fetal oxygen supply. c. This pattern reflects variable decelerations. No interventions are necessary at this time. d. Document this reassuring fetal heart rate pattern, but decrease the rate of the intravenous fluid.

ANS: B Feedback A These are late decelerations, not early; therefore interventions are necessary. B This is a description of a late deceleration. Oxygen should be given via snug facemask. Position the woman on her left side to increase placental blood flow. C Variable decelerations are caused by cord compression. A vaginal examination should be performed to identify this potential emergency. D This is not a reassuring pattern, so the intravenous rate should be increased to increase the mother's blood volume.

22. A woman who is gravida 3 para 2 enters the intrapartum unit. The most important nursing assessments are a. Contraction pattern, amount of discomfort, and pregnancy history b. Fetal heart rate, maternal vital signs, and the woman's nearness to birth c. Identification of ruptured membranes, the woman's gravida and para, and her support person d. Last food intake, when labor began, and cultural practices the couple desires

ANS: B Feedback A This is an important nursing assessment, but does not take priority if the birth is imminent. B All options describe relevant intrapartum nursing assessments, but the focus assessment has priority. If the maternal and fetal conditions are normal and birth is not imminent, other assessments can be performed in an unhurried manner. C This is an assessment that can occur later in the admission process if time permits. D This part of the assessment can occur later in the admission process if time permits.

6. To assess the duration of labor contractions, the nurse determines the time a. From the beginning of one contraction to the beginning of the next b. From the beginning to the end of each contraction c. Of the strongest intensity of each contraction d. Of uterine relaxation between two contractions

ANS: B Feedback A This is the frequency of the contractions. B Duration of labor contractions is the average length of contractions from beginning to end. C This is the strength or intensity of the contractions. D This is the interval of the contraction phase.

35. When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the likely position of the fetus? a. ROA b. LSP c. RSA d. LOA

ANS: C Feedback Fetal position is denoted with a three-letter abbreviation. The first letter indicates the presenting part in either the right or left side of the maternal pelvis. The second letter indicates the anatomic presenting part of the fetus. The third letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis. Palpation of a round, firm fetal part in the fundal portion of the uterus would be the fetal head, indicating that the fetus is in a breech position with the sacrum as the presenting part in the maternal pelvis. Palpation of the fetal spine along the mother's right side denotes the location of the presenting part in the mother's pelvis. The ability to palpate the fetal spine indicates that the fetus is anteriorly positioned in the maternal pelvis. This fetus is positioned anteriorly in the right side of the maternal pelvis with the sacrum as the presenting part. RS/A/ is the correct three-letter abbreviation to indicate this fetal position.

21. Which patient at term should go to the hospital or birth center the soonest after labor begins? a. Gravida 2 para 1 who lives 10 minutes away b. Gravida 1 para 0 who lives 40 minutes away c. Gravida 3 para 2 whose longest previous labor was 4 hours d. Gravida 2 para 1 whose first labor lasted 16 hours

ANS: C Feedback A A gravida 2 is expected to have a longer labor than the gravida 3. The fact that she lives close to the hospital allows her to stay home for a longer period of time. B A gravida 1 is expected to have the longest labor. C Multiparous women usually have shorter labors than do nulliparous women. The woman described in option c is multiparous with a history of rapid labors, increasing the likelihood that her infant might be born in uncontrolled circumstances. D The gravida 2 is expected to have a longer labor than the gravida 3, especially since her first labor was 16 hours.

4. How does the available staff influence the selection of either continuous electronic or intermittent auscultation as the fetal-monitoring method? a. There must be a 1:1 nurse-to-patient ratio regardless of the method used. b. Staffing patterns do not influence fetal monitoring choices. c. Use of intermittent auscultation requires a lower nurse-to-patient ratio. d. More nurses are needed when electronic fetal monitoring is used because of increased medical interventions.

ANS: C Feedback A A one-to-one ratio is needed during the second stage of labor or if a high-risk condition exists, regardless of the monitoring method used. B Staffing patterns do plan a role in maintaining safe monitoring practice of the labor patient. C Intermittent auscultation is more staff-intensive. D Less nursing time is needed with electronic monitoring, giving the nurse more time for teaching and supporting the laboring woman.

12. A woman is currently pregnant; she has a 5-year-old son and a 3-year-old daughter. She had one other pregnancy that terminated at 8 weeks. Her gravida and para are a. Gravida 3 para 2 b. Gravida 4 para 3 c. Gravida 4 para 2 d. Gravida 3 para 3

ANS: C Feedback A Because she is currently pregnant, she is classified as a gravida 4; the pregnancy that was terminated at 8 weeks is classified as an abortion. B Gravida 4 is correct, but she is a para 2. The pregnancy that was terminated at 8 weeks is classified as an abortion. C She has had four pregnancies, including the current one (gravida 4). She had two pregnancies that terminated after 20 weeks (para 2). The pregnancy that terminated at 8 weeks is classified as an abortion. D Since she is currently pregnant, she is classified as a gravida 4, not a 3. The para is correct.

2. The woman in labor should be encouraged to use the Valsalva maneuver (holding one's breath and tightening abdominal muscles) for pushing during the second stage. Is this statement true or false?

ANS: F The woman should actually be discouraged from using the Valsalva maneuver. This activity increases intrathoracic pressure, reduces venous return, and increases venous pressure. During the Valsalva maneuver, fetal hypoxia may occur. The process is reversed when the woman takes a breath.

28. Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. The fetal head is felt at 0 station during vaginal examination. b. Bloody mucus discharge increases. c. The vulva bulges and encircles the fetal head. d. The membranes rupture during a contraction.

ANS: C Feedback A Birth of the head occurs when the station is +4. A 0 station indicates engagement. B Bloody show occurs throughout the labor process and is not an indication of an imminent birth. C A bulging vulva that encircles the fetal head describes crowning, which occurs shortly before birth. D Rupture of membranes can occur at any time during the labor process and does not indicate an imminent birth.

34. As a nurse in labor and delivery, you are caring for a Muslim woman during the active phase of labor. You note that when you touch her, she quickly draws away. You should a. Continue to touch her as much as you need to while providing care. b. Assume that she doesn't like you and decrease your time with. c. Limit touching to a minimum, as this may not be acceptable in her culture. d. Ask the charge nurse to reassign you to another patient.

ANS: C Feedback A By continuing to touch her, the nurse is showing disrespect for her cultural beliefs. B A Muslim's response to touch does not reflect like or dislike. C Touching is an important component of communication in various cultures, but if the patient appears to find it offensive, the nurse should respect her cultural beliefs and limit touching her. D This reaction may be offensive to the patient.

31. A 36-year-old divorcee with a successful modeling career finds out that her 18-year-old married daughter is expecting her first child. What is a major factor in determining how the woman will respond to becoming a grandmother? a. Her career b. Being divorced c. Her age d. Age of the daughter

ANS: C Feedback A Career responsibilities may have demands that make the grandparents not as accessible, but it is not a major factor in determining the woman's response to becoming a grandmother. B Being divorced is not a major factor that determines adaptation of grandparents. C Age is a major factor in determining the emotional response of prospective grandparents. Young grandparents may not be happy with the stereotype of grandparents as being old. D The age of the daughter is not a major factor that determines adaptation of grandparents. The age of the grandparent is a major factor.

7. Alterations in hormonal balance and mechanical stretching are responsible for several changes in the integumentary system during pregnancy. Stretch marks often occur on the abdomen and breasts. These are referred to as a. Chloasma b. Linea nigra c. Striae gravidarum d. Angiomas

ANS: C Feedback A Chloasma is a facial melasma also known as the "mask of pregnancy." This condition is manifested by a blotchy, hyperpigmentation of the skin over the cheeks, nose and forehead especially in dark complexioned women. B Linea nigra is a pigmented line extending from the symphysis pubis to the top of the fundus in the midline. C Striae gravidarum or stretch marks appear in 50% to 90% of pregnant women during the second half of pregnancy. They most often occur on the breasts and abdomen. This integumentary alteration is the result of separation within the underlying connective (collagen) tissue. D Angiomas and other changes also may appear.

8. Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis? a. Descent b. Engagement c. Flexion d. Station

ANS: C Feedback A Descent is the moving of the fetus through the birth canal. B Engagement occurs when the largest diameter of the fetal presenting part has passed the pelvic inlet. C Flexion of the fetal head allows the smallest head diameters pass through the pelvis. D The station is the relationship of the fetal presenting part to the level of the ischial spines.

14. A woman in her first trimester of pregnancy can expect to visit her physician every 4 weeks so that a. She develops trust in the health care team. b. Her questions about labor can be answered. c. The condition of the expectant mother and fetus can be monitored. d. Problems can be eliminated.

ANS: C Feedback A Developing a trusting relationship should be established during these visits, but that is not the primary reason. B Most women do not have questions concerning labor until the last trimester of the pregnancy. C This routine allows monitoring of maternal health and fetal growth and ensures that problems will be identified early. D All problems cannot be eliminated because of prenatal visits, but they can be identified.

16. One of the most effective methods for preventing venous stasis is to a. Wear elastic stockings in the afternoons. b. Sleep with the foot of the bed elevated. c. Rest often with the feet elevated. d. Sit with the legs crossed.

ANS: C Feedback A Elastic stockings should be applied before lowering the legs in the morning. B Elevating the legs at night may cause pressure on the diaphragm and increase breathing problems. C Elevating the feet and legs improves venous return and prevents venous stasis. D Sitting with the legs crossed will decrease circulation in the legs and increase venous stasis.

24. Centering pregnancy is an example of an alternative model of prenatal care. Which statement accurately applies to the centering model of care? a. Group sessions begin with the first prenatal visit. b. At each visit blood pressure, weight, and urine dipsticks are obtained by the nurse. c. Eight to 12 women are placed in gestational-age cohort groups. d. Outcomes are similar to traditional prenatal care.

ANS: C Feedback A Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Prior to group sessions, the patient has an individual assessment, physical examination, and history. B At the beginning of each group meeting, patients measure their own BP, weight, and urine dips and enter these in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. C Gestational age cohorts comprise the groups, with approximately 8 to 12 women in each group. This group remains intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. D Results evaluating this approach have been very promising. In a recent study of adolescent patients, there was a decrease in LBW infants and an increase in breastfeeding rates.

5. Which suggestion is appropriate for the pregnant woman who is experiencing nausea and vomiting? a. Eat only three meals a day so the stomach is empty between meals. b. Drink plenty of fluids with each meal. c. Eat dry crackers or toast before arising in the morning. d. Drink coffee or orange juice immediately on arising in the morning.

ANS: C Feedback A Instruct the woman to eat five to six small meals rather than three full meals per day. Nausea is more intense when the stomach is empty. B Fluids should be taken separately from meals. Fluids overstretch the stomach and may precipitate vomiting. C This will assist with the symptoms of morning sickness. It is also important for the woman to arise slowly. D Coffee and orange juice stimulate acid formation in the stomach. It is best to suggest eating dry carbohydrates when rising in the morning.

33. What comment by a new mother exhibits understanding of her toddler's response to a new sibling? a. "I can't believe he is sucking his thumb again." b. "He is being difficult, and I don't have time to deal with him." c. "My husband is going to stay with the baby so I can take our son to the park tomorrow." d. "When we brought the baby home, we made our son stop sleeping in the crib."

ANS: C Feedback A It is normal for a child to regress when a new sibling is introduced into the home. B The toddler may have feelings of jealousy and resentment toward the new baby taking the attention from him. Frequent reassurance of parental love and affection are important. C It is important for a mother to seek time alone with her toddler to reassure him that he is loved. D Changes in sleeping arrangements should be made several weeks before the birth so that the child does not feel displaced by the new baby.

9. What results from the adaptation of the fetus to the size and shape of the pelvis? a. Lightening b. Lie c. Molding d. Presentation

ANS: C Feedback A Lightening is the descent of the fetus toward the pelvic inlet before labor. B Lie is the relationship of the long axis of the fetus to the long axis of the mother. C The sutures and fontanels allow the bones of the fetal head to move slightly, changing the shape of the fetal head so it can adapt to the size and shape of the pelvis. D Presentation is the fetal part that first enters the pelvic inlet.

29. During labor, a vaginal examination should be performed only when necessary because of the risk of a. Fetal injury b. Discomfort c. Infection d. Perineal trauma

ANS: C Feedback A Properly performed vaginal examinations should not cause fetal injury. B Vaginal examinations may be uncomfortable for some women in labor, but that is not the main reason for limiting them. C Vaginal examinations increase the risk of infection by carrying vaginal microorganisms upward toward the uterus. D A properly performed vaginal examination should not cause perineal trauma.

14. When a nonreassuring pattern of the fetal heart rate is noted and the mother is lying on her left side, what nursing action is indicated? a. Lower the head of the bed. b. Place the mother in a Trendelenburg position. c. Change her position to the right side. d. Place a wedge under the left hip.

ANS: C Feedback A Repositioning to the opposite side is the first intervention. If unsuccessful with improving the FHR pattern, further changes in position can be attempted. B The Trendelenburg position is not appropriate for early interventions. If unsuccessful with improving the FHR pattern with other types of position changes, Trendelenburg may be the choice. C Repositioning on the opposite side may relieve compression on the umbilical cord and improve blood flow to the placenta. D The woman is already on her left side, so a wedge on that side is not an appropriate choice.

33. The nurse thoroughly dries the infant immediately after birth primarily to a. Stimulate crying and lung expansion. b. Remove maternal blood from the skin surface. c. Reduce heat loss from evaporation. d. Increase blood supply to the hands and feet.

ANS: C Feedback A Rubbing the infant does stimulate crying, but it is not the main reason for drying the infant. B Drying the infant after birth does not remove all of the maternal blood. C Infants are wet with amniotic fluid and blood at birth, which accelerates evaporative heat loss. D The main purpose of drying the infant is to prevent heat loss.

19. To relieve a leg cramp, the patient should be instructed to a. Massage the affected muscle. b. Stretch and point the toe. c. Dorsiflex the foot. d. Apply a warm pack.

ANS: C Feedback A Since she is prone to blood clots in the legs, massaging the affected leg muscle is contraindicated. B Pointing the toes will contract the muscle and not relieve the pain. C Dorsiflexion of the foot stretches the leg muscle and relieves the painful muscle contraction. D Warm packs can be used to relax the muscle, but more immediate relief is necessary, such as dorsiflexion of the foot.

31. At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink, but the hands and feet are blue. What is the Apgar score for this infant? a. 7 b. 8 c. 9 d. 10

ANS: C Feedback A The baby received 2 points for each of the categories except color. Since the infant's hands and feet were blue this category is given a grade of 1. B The baby received 2 points for each of the categories except color. Since the infant's hands and feet were blue this category is given a grade of 1. C The Apgar score is 9 because 1 point is deducted from the total score of 10 for the infant's blue hands and feet. D The infant had 1 point deducted because of the blue color of the hands and feet.

3. Which method of assessing the fetal heart rate requires the use of a gel? a. Fetoscope b. Tocodynamometer c. Doppler d. Scalp electrode

ANS: C Feedback A The fetoscope does not require the use of gel because ultrasonic transmission is not used. B Tocodynamometer does not require the use of gel. This device monitors uterine contractions. C Doppler is the only listed method involving ultrasonic transmission of fetal heart rates; it requires use of a gel. D The scalp electrode is attached to the fetal scalp; gel is not necessary.

1. The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products a. Continues except when placental functions are reduced b. Increases as blood pressure decreases c. Diminishes as the spiral arteries are compressed d. Is not significantly affected

ANS: C Feedback A The maternal blood supply to the placenta gradually stops with contractions. B The exchange of oxygen and waste products decreases. C During labor contractions, the maternal blood supply to the placenta gradually stops as the spiral arteries supplying the intervillous space are compressed by the contracting uterine muscle. D The exchange of oxygen and waste products is affected by contractions.

9. The nurse-midwife is concerned that a woman's uterine activity is too intense and that her obesity is preventing accurate assessment of the actual intrauterine pressure. On the basis of this information, the nurse should obtain a(n) a. Tocotransducer b. Scalp electrode c. Intrauterine pressure catheter d. Doppler transducer

ANS: C Feedback A The tocotransducer measures the uterine pressure externally; this not be accurate with obesity. B A scalp electrode measurers the fetal heart rate (FHR). C An intrauterine pressure catheter can measure actual intrauterine pressure. D A Doppler auscultates the FHR.

1. Pelvic congestion during pregnancy may lead to heightened sexual interest and increased orgasmic experiences. Is this statement true or false?

ANS: T Increased vascularity, edema, and connective tissue changes during pregnancy make the tissues of the vulva and perineum more pliable. This can lead to an increased interest in sexual activity and ease of orgasm.

15. The nurse notes a pattern of late decelerations on the fetal monitor. The most appropriate action is to a. Continue observation of this reassuring pattern. b. Notify the physician or nurse-midwife. c. Give the woman oxygen by face mask. d. Place the woman in a Trendelenburg position.

ANS: C Feedback A This is not a reassuring pattern; interventions are needed. B Nursing interventions should be initiated before notifying the health care provider. C Late decelerations are associated with reduced placental perfusion. Giving the laboring woman oxygen increases the oxygen saturation in her blood, making more oxygen available to the fetus. D The Trendelenburg position will not increase the placental perfusion.

26. A patient who is 7 months pregnant states, "I'm worried that something will happen to my baby." The nurse's best response is a. "There is nothing to worry about." b. "The doctor is taking good care of you and your baby." c. "Tell me about your concerns." d. "Your baby is doing fine."

ANS: C Feedback A This statement is belittling the patient's concerns. B This statement is belittling the patient's concerns by telling her she should not worry. C Encouraging the client to discuss her feelings is the best approach. Women during their third trimester need reassurance that such fears are not unusual in pregnancy. D This statement disregards the patient's feelings and treats them as unimportant.

18. Which assessment finding could indicate hemorrhage in the postpartum patient? a. Firm fundus at the midline b. Saturation of two perineal pads in 4 hours c. Elevated blood pressure d. Elevated pulse rate

ANS: D Feedback A A firm fundus indicates that the uterus is contracting and compressing the open blood vessels at the placental site. B Saturation of one pad within the first hour is the maximum normal amount of lochial flow. Two pads within 4 hours is within normal limits. C If the blood volume were diminishing, the blood pressure would decrease. D An increasing pulse rate is an early sign of excessive blood loss.

26. What finding should the nurse recognize as being associated with fetal compromise? a. Active fetal movements b. Contractions lasting 90 seconds c. FHR in the 140s d. Meconium-stained amniotic fluid

ANS: D Feedback A Active fetal movement is an expected occurrence. B The fetus should be able to tolerate contractions lasting 90 seconds if the resting phase is sufficient to allow for a return of adequate blood flow. C Expected FHR range is from 120 to 160. D When fetal oxygen is compromised, relaxation of the rectal sphincter allows passage of meconium into the amniotic fluid.

11. While assessing her patient, what does the nurse interpret as a positive sign of pregnancy? a. Fetal movement felt by the woman b. Amenorrhea c. Breast changes d. Visualization of fetus by ultrasound

ANS: D Feedback A Fetal movement is a presumptive sign of pregnancy. B Amenorrhea is a presumptive sign of pregnancy. C Breast changes are a presumptive sign of pregnancy. D The only positive signs of pregnancy are auscultation of fetal heart tones, visualization of the fetus by ultrasound, and fetal movement felt by the examiner.

16. Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by a. Maintaining normal maternal temperature b. Preventing normal maternal hypoglycemia c. Increasing the oxygen-carrying capacity of the maternal blood d. Expanding maternal blood volume

ANS: D Feedback A Increasing fluid volume may alter the maternal temperature only if she is dehydrated. B Most intravenous fluids for laboring women are isotonic and do not add extra glucose. C Oxygen-carrying capacity is increased by adding more red blood cells. D Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension.

2. While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

ANS: D Feedback A Pressures are significantly higher when the patient is standing. This option causes an increase in systolic and diastolic pressures. B The arm should be supported at the same level of the heart. C The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension. D Blood pressure is affected by positions during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension.

17. Which comfort measure should the nurse use to assist the laboring woman to relax? a. Keep the room lights lit so that the patient and her coach can see everything. b. Offer warm, wet cloths to use on the patient's face and neck. c. Palpate her filling bladder every 15 minutes. d. Recommend frequent position changes.

ANS: D Feedback A Soft, indirect lighting is more soothing than irritating bright lights. B Women in labor become hot and perspire. Cool cloths are much better C A full bladder intensifies labor pain. The bladder should be emptied every 2 hours. D Frequent maternal position changes reduce the discomfort from constant pressure and promote fetal descent.

4. To adequately care for patients, the nurse understands that labor contractions facilitate cervical dilation by a. Contracting the lower uterine segment b. Enlarging the internal size of the uterus c. Promoting blood flow to the cervix d. Pulling the cervix over the fetus and amniotic sac

ANS: D Feedback A The contractions are stronger at the fundus. B The internal size becomes smaller with the contractions; this helps to push the fetus down. C Blood flow decreases to the uterus during a contraction. D Effective uterine contractions pull the cervix upward at the same time that the fetus and amniotic sac are pushed downward.

1. Occasionally a woman arrives at the intrapartum unit ready to give birth. Bearing down, grunting, or stating something like "the baby's coming" should direct the nurse to advise the client, "Do not push, pant, and blow until the physician arrives." Is this statement true or false?

ANS: F The nurse's priority is to prevent or reduce injury to mother and infant if delivery is imminent. The emergency delivery kit should be obtained and preparation made for immediate delivery. An abbreviated assessment should be completed in order to obtain the mother's name, that of the support partner, and her care provider. Estimated date of delivery, allergies, and prenatal care are also important information. If time allows, maternal vital signs should be done, as well as a fetal assessment. After delivery, the priority is to maintain the infant's airway and temperature.

3. A pregnant woman has come to the emergency department with complaints of nasal congestion and epistaxis. What is the correct interpretation of these symptoms by the practitioner? a. These conditions are abnormal. Refer the patient to an ear, nose, and throat specialist. b. Nasal stuffiness and nosebleeds are caused by a decrease in progesterone. c. Estrogen relaxes the smooth muscles in the respiratory tract, so congestion and epistaxis are within normal limits. d. Estrogen causes increased blood supply to the mucous membranes and can result in congestion and nosebleeds.

ANS: D Feedback A The patient should be reassured that these symptoms are within normal limits. No referral is needed at this time. B Progesterone is responsible for the heightened awareness of the need to breathe in pregnancy. Progesterone levels increase during pregnancy. C Progesterone affects relaxation of the smooth muscles in the respiratory tract. D As capillaries become engorged, the upper respiratory tract is affected by the subsequent edema and hyperemia, which causes these conditions, seen commonly during pregnancy.

37. A pregnant woman is at 38 weeks of gestation. She wants to know if any signs indicate "labor is getting closer to starting." The nurse informs the woman that which of the following is a sign that labor may begin soon? a. Weight gain of 1.5 to 2 kg (3 to 4 lb) b. Increase in fundal height c. Urinary retention d. Surge of energy

ANS: D Feedback A The woman may lose 0.5 to 1.5 kg, the result of water loss caused by electrolyte shifts, which in turn are caused by changes in the estrogen and progesterone levels. B When the fetus descends into the true pelvis (called lightening), the fundal height may decrease. C Urinary frequency may return before labor. D Women speak of having a burst of energy before labor.

23. A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be a. Admitted and prepared for a cesarean birth b. Admitted for extended observation c. Discharged home with a sedative d. Discharged home to await the onset of true labor

ANS: D Feedback A These are all indications of false labor without fetal distress. There is no indication that a cesarean birth is indicated. B These are all indications of false labor; there is no indication that further assessment or observations are indicated. C The patient will probably be discharged, but there is no indication that a sedative is needed. D The situation describes a woman with normal assessments who is probably in false labor and will probably not deliver rapidly once true labor begins.

29. The maternal task that begins in the first trimester and continues throughout the neonatal period is called a. Seeking safe passage for herself and her baby b. Securing acceptance of the baby by others c. Learning to give of herself d. Developing attachment with the baby

ANS: D Feedback A This is a task that ends with delivery. During this task the woman seeks health care and cultural practices. B This process continues throughout pregnancy as the woman reworks relationships. C This task occurs during pregnancy as the woman allows her body to give space to the fetus. She continues with giving to others in the form of food or presents. D Developing attachment (strong ties of affection) to the unborn baby begins in early pregnancy when the woman accepts that she is pregnant. By the second trimester, the baby becomes real and feelings of love and attachment surge.

23. A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? a. "My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK." b. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." c. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." d. "We do not want the fetal monitor used during labor, since it will interfere with movement and doing effleurage."

ANS: D Feedback A This is an acceptable request for a laboring woman. B Using breathing techniques to alleviate pain is a realistic part of a birth plan. C Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation. D Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low risk pregnancy and as long as labor is progressing normally. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative.

11. When the deceleration pattern of the fetal heart rate mirrors the uterine contraction, which nursing action is indicated? a. Administer oxygen by nasal cannula. b. Reposition the woman. c. Apply a fetal scalp electrode. d. Record this reassuring pattern.

ANS: D Feedback A This is an early deceleration; it is reassuring. B This is an early deceleration; it is reassuring. C This is an early deceleration; it is reassuring. D The periodic pattern described is early deceleration that is not associated with fetal compromise and requires no intervention.

12. When the mother's membranes rupture during active labor, the fetal heart rate should be observed for the occurrence of which periodic pattern? a. Increase in baseline variability b. Nonperiodic accelerations c. Early decelerations d. Variable decelerations

ANS: D Feedback A This is not an expected occurrence after the rupture of membranes. B Accelerations are considered reassuring; they are not a concern after rupture of membranes. C Early declarations are considered reassuring; they are not a concern after rupture of membranes. D When the membranes rupture, amniotic fluid may carry the umbilical cord to a position where it will be compressed between the maternal pelvis and the fetal presenting part, resulting in a variable deceleration pattern.

28. A step in maternal role attainment that relates to the woman giving up certain aspects of her previous life is termed a. Looking for a fit b. Roleplaying c. Fantasy d. Grief work

ANS: D Feedback A This is when the woman observes the behaviors of mothers and compares them with her own expectations. B Roleplaying involves searching for opportunities to provide care for infants in the presence of another person. C Fantasies allow the woman to try on a variety of behaviors. This usually deals with how the child will look and the characteristics of the child. D The woman experiences sadness as she realizes that she must give up certain aspects of her previous self and that she can never go back.