Owens CC Nur102 Test 3

Placenta previa

- Abnormal implantation of placenta - Bright bleeding occurs when cervix dilates, resulting in painless, bright red bleeding TABLE 5-4, p. 88

Neonatal herpes

- Can be either localized or disseminated (widespread) - High mortality rate!

A patient who has experienced frequent miscarriages is referred for chromosomal analysis. Which sample should the nurse obtain to conduct karyotyping for the patient? 1 Urine 2 Saliva 3 Muscle 4 Blood

4 Karyotyping is the estimation of the number, size, and forms of chromosomes for detecting chromosomal abnormalities like trisomy. These are the major causes for frequent miscarriage, stillbirths, and other gynecologic disorders. Blood sample is the preferred sample for determining chromosome abnormalities. Nucleated and replicating cells such as white blood cells are extracted from the blood sample and chosen for karyotyping. Urine, saliva, and muscle samples are not used for analyzing chromosome number, because they do not undergo rapid division to form new cells.

The nurse is assessing a neonate with hydrocephaly. What observation reported by the nurse would be consistent with the neonate's condition?

A head circumference greater than chest circumference Hydrocephaly is a condition where fluids accumulate around the neonate's brain. Hydrocephaly is confirmed when the neonate's head circumference is 4.5 cm greater than the chest circumference. If a neonate has a body weight of 7 pounds, it is the normal weight of a newborn and does not indicate any abnormalities. A neonatal heart rate with 120 beats/min indicates that the newborn is healthy. A head-to-heel length of 55 cm is the normal body length of any newborn. This factor does not lead to hydrocephaly.

1, 2 Triple marker screening, which is performed in the first trimester of pregnancy, includes the measurement of two maternal biomarkers: PAPP-A and free β-hCG. High levels of free β-hCG and low levels of PAPP-A in the first trimester indicate that the fetus has Down syndrome, or trisomy 21.Inhibin-A is a placental hormone. Low levels of inhibin-A also indicate the possibility of Down syndrome, but inhibin-A levels are not measured in the triple marker screen; these levels are measured in quad screening. A low level of MSAFP and unconjugated estriol also indicate Down syndrome, but these can be measured only in the second and third trimesters.

A patient in the first trimester of pregnancy undergoes a triple marker screening test. On reviewing the report, the nurse infers that the fetus may have Down syndrome. What clinical findings are noted by the nurse in the test reports? Select all that apply. 1 High levels of beta-human chorionic gonadotropin (β-hCG) 2 Low levels of pregnancy-associated placental protein (PAPP-A) 3 Low levels of inhibin-A in the fetal blood 4 Low levels of maternal serum alpha-fetoprotein (MSAFP) 5 Low levels of unconjugated estriol in the fetal blood

57 The recommended weight gain for an underweight pregnant patient is 0.5 kg per week, according to the pattern of weight gain. Because the patient weighed 55 kg in the third month of pregnancy, the recommended weight gain in the fourth month would be 0.5 kg x 4 = 2 kg. Therefore the possible weight of the patient in the fourth month of pregnancy would be 55 + 2 = 57 kg.

A patient weighs 55 kg in the third month of pregnancy. After reviewing the reports, the nurse finds that the patient was underweight before pregnancy. What would be the recommended weight of the patient in the fourth month of pregnancy according to weight gain pattern? Record your answer using a whole number. ______ kg

2 Placing a small towel under the patient's right hip decreases the direct pressure on the major vessels in the abdomen, which become compressed when the patient lies on her back. Infection control is not an issue at this time. Placing a pillow under her legs may make the patient more comfortable, but won't improve perfusion. Placing the patient on her right side does not allow for proper measurement while maximizing perfusion.

As the pregnancy progresses, the patient experiences shortness of breath when the fundal height is being assessed. What action should the nurse take to minimize the shortness of breath or dizziness as a result of the weight of the growing uterus? 1 Use a new paper tape measure for each visit to decrease infection. 2 Place a small towel under the patient's right hip. 3 Place a pillow under the patient's knees whenever she is on her back. 4 Place the patient on her right side while the measurement is done.

4 The patient must not become pregnant for 3 months after the rubella vaccination because of its potential teratogenic effects. The rubella vaccine is made from duck eggs, so an allergic reaction may occur in the patients with egg allergies. Because the virus is not transmitted through breast milk, the patient may continue to breastfeed even after vaccination. Transient arthralgia (joint pain) and skin rashes are the common adverse effects of the rubella vaccine.

The nurse is preparing to administer rubella vaccine to a postpartum patient. What should the nurse tell the patient? 1 "The vaccine is safe even if you have an egg allergy." 2 "You cannot breastfeed for 5 days after taking the vaccine." 3 "You will not have joint pains or skin rashes after the vaccination." 4 "You should use proper contraception for 3 months after the vaccination."

2, 1, 4, 5, 3 A nitrazine dye test is performed to learn the status of the amniotic membrane in the pregnant patient. Informing the patient and her partner about the testing procedure makes the patient feel comfortable. The cotton-tipped applicator specified for this procedure is soaked in nitrazine dye. Then, the applicator is inserted into the vagina to get the fluid on the applicator. Perineal care is then performed to ensure that there is no risk of infections. Finally, the test result is seen and documented appropriately.

The nurse is preparing to perform a nitrazine pH test on a pregnant patient. Arrange the steps that the student nurse would follow while conducting the test. 1. Soak the cotton-tipped applicator in the nitrazine dye. 2. Inform the patient and the partner about the procedure. 3. Document the test reports of the patient in the patient record. 4. Insert the cotton-tipped applicator deep into the vagina. 5. Perform perennial care in the patient as required.

2 In most cases, the patient can continue to breastfeed. If the affected breast is too sore, the patient can pump the breast gently. Regular emptying of the breast is important to prevent the formation of abscess. Use of a supportive bra suppresses milk production and prevents breast engorgement. Additional supportive measures include ice packs, breast supports, and analgesics. Antibiotic therapy assists in resolving the mastitis within 24 to 48 hours.

The nurse is providing instructions to a postpartum patient who has been diagnosed with mastitis. Which statement made by the patient indicates a need for further teaching? 1 "I need to wear a supportive bra to relieve the discomfort." 2 "I need to stop breastfeeding until this condition resolves." 3 "I can use analgesics to alleviate some of the discomfort." 4 "I need to take antibiotics, and I should begin to feel better in 24 to 48 hours."

1 The indirect Coombs test is a screening tool for Rh incompatibility. If the maternal titer for Rh antibodies is greater than 1:8, amniocentesis for determination of bilirubin in amniotic fluid is indicated to establish the severity of fetal hemolytic anemia. Hemoglobin reveals the oxygen carrying capacity of the blood. hCG is the hormone of pregnancy. Maternal serum alpha-fetoprotein (MSAFP) levels are used as a screening tool for NTDs in pregnancy.

The nurse is reviewing lab values to determine Rh incompatibility between mother and fetus. Which specific lab result should the nurse assess? 1 Indirect Coombs test 2 Hemoglobin level 3 hCG level 4 Maternal serum alpha-fetoprotein (MSAFP

All fours position

benefits and relieves back pain

Best time to take BP

between contractions

Commission

doing the wrong thing

Pregestational DM: Major risk for congenital anomalies to occur from maternal hyperglycemia during when?

during the embryonic period of development

Maintaining placental perfusion is a priority in order to

ensure adequate fetal oxygenation!!! (because the babies oxygenation comes from placenta)

Fetal Attitude

relation of fetal body parts to one another. Most common=General Flexion. Bi-parietal diamer is about 9.25 cm at term.

A woman with____________ requires close medical and nursing care. What would you teach her?

sickle cell disease Teach her to prevent dehydration and activities that cause hypoxia

Genetic Anemias: Sickle Cell Disease What can it clog?

small blood vessels

Effacement

thinning and shortening of the cervix

True labor

uterine contracations resulting in cervical dilation and effacement

What are some Pregnancy-Related Complications?

- Hyperemesis gravidarum - Bleeding disorders - Hypertension - Blood incompatibility between woman & fetus

Heart Disease Manifestations

- Increased levels of clotting factors - Increased risk of thrombosis

Management of GH: Treatment focuses on?

- Maintaining blood flow to the woman's vital organs and to the placenta - Preventing convulsions

Second Stage

"Labor" Cervix dilated completely; 10cm Urge to push or bear down, may feel like they need to have BM The vulva bulges and encircles the fetal head Ends with birth of baby Crowning

Bleeding Disorders of Early Pregnancy: What are some types of INDUCED abortions?

- Therapeutic - Elective

High Reliability Organization

-Exhibit sensitivity to operations -Focused on predicting and eliminating errors -Reluctance to simplify -Deference to expertise -Exhibit a commitment to reliance

Preventive errors

-Failure to provide prophylactic treatment -Inadequate monitoring or follow up of treatment

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? 1 Teach gentle lower extremity exercises to the patient. 2 Suggest that the patient lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the patient. 4 Give tocolytic medications as per the physician's prescription.

1 The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.

Folic Acid Deficiency Anemia: Treatment - Folate deficiency is treated with folic acid supplementation - ____________(over twice the amount of the preventive supplement)* *Dose may be higher for women who have had a previous child with a neural tube defect

1 mg/day

The nurse is teaching a class on childbirth. What does the nurse teach about signs of local anesthetic toxicity? Select all that apply. 1 Tinnitus 2 Metallic taste 3 Slurred speech 4 Long stage II labor 5 Increased use of oxytocin

1, 2, 3 The central nervous system can be affected if a local anesthetic agent is injected accidentally into a blood vessel leading to local anesthetic toxicity . Signs include metallic taste, tinnitus, and slurred speech. Longer stage II labor and increased use of oxytocin are side effects of epidural and spinal anesthesia.

The nurse acts as an advocate for the patient during an informed consent. What care must the nurse take while obtaining an informed consent? Select all that apply. 1 Check for the patient's signature. 2 Ensure that the consent is in English. 3 Obtain a family member's signature. 4 Check for the date on the consent form. 5 Check the anesthetic care provider's signature.

1, 4, 5 The nurse must ensure that the consent form has the correct date. The nurse must ensure that the patient has not been compelled to consent for the procedure. The form must carry the signature of the anesthetic care provider, certifying that the patient has received and expresses understanding of the explanation. The consent form must be written or explained in the patient's primary language. The nurse need not obtain a family member's signature on the document. The patient's signature is important.

With regard to abnormalities of chromosomes, nurses should be aware that: 1 they occur in approximately 10% of newborns. 2 abnormalities of number are a major cause of pregnancy loss. 3 Down syndrome is a result of an abnormal chromosomal structure. 4 unbalanced translocation results in a mild abnormality that the child will outgrow.

2 Aneuploidy is an abnormality of number that also is the leading genetic cause of cognitive impairment. Chromosomal abnormalities occur in less than 1% of newborns. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.

338. The nurse is monitoring a postpartum client who received epidural anesthesia for delivery for the presence of a vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? 1. Changes in vital signs 2. Signs of heavy bruising 3. Complaints of intense pain 4. Complaints of a tearing sensation

1. Changes in vital signs Because the client has had epidural anesthesia and is anesthetized, she cannot feel pain, pressure, or a tearing sensation. Changes in vital signs indicate hypovolemia in an anesthetized postpartum client with vulvar hematoma. Option 2 (heavy bruising) may be seen, but vital sign changes indicate hematoma caused by blood collection in the perineal tissues.

7 cardinal movements that baby has to adapt to through the birth canal during birth (mechanisms of labor)

1. Engagement 2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. .Restitution and external rotation 7. Expulsion (birth)

Once it has been established that the head is at the inlet, two important facts are know:

1. that the lie is longitudinal 2. that the presentation is cephalic -head is harder, smoother, more globular, and easier to move -a groove representing the neck and the shoulders may be felt -head can be moved laterally without the body moving

In the recovery room, if a woman is asked either to raise her legs (knees extended) off the bed or to flex her knees, place her feet flat on the bed, and raise her buttocks well off the bed, most likely she is being tested to see whether she: a. Has recovered from epidural or spinal anesthesia. b. Has hidden bleeding underneath her. c. Has regained some flexibility. d. Is a candidate to go home after 6 hours.

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

What care must the nurse take when implementing aromatherapy for a patient in labor? 1 Apply oil to the skin and massage. 2 Ask the patient to choose the scents. 3 Apply a few drops of oil to the hair. 4 Allow inhalation of warm oil vapors

2 Certain scents can evoke pleasant memories and feelings of love and security. So, it is helpful if the patient is allowed to choose the scents. The oils must never be applied in full strength directly on to the skin. Most oils should be diluted in a vegetable oil base before use. Inhaling vapors from the oil can lead to unpleasant side effects like nausea or headache. Drops of essential oils can be put on a pillow or on a woman's brow or palms or used as an ingredient in creating massage oil. It is not applied to the hair. STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.

List the time span in lunar months, calendar months, weeks, and days that indicates the appropriate length for a normal pregnancy. Record your response as whole numbers separated by commas (ex. 2, 4, 6, 8). _______________

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

Normal FHR

110-160

Latent labor

3-5cm dilation Woman is excited and relatively comfortable

A child born to a couple is diagnosed with cystic fibrosis. After reviewing the genetic reports, the couple is found to be carriers for the disorder. How should the nurse explain this to the couple? This disorder is an: 1 "X-linked recessive inherited disorder." 2 "X-linked dominant inherited disorder." 3 "Autosomal recessive inherited disorder." 4 "Autosomal dominant inherited disorder."

3 Cystic fibrosis is an autosomal recessive disorder. It is inherited and expressed only when the individual carries both the genes for the abnormality. Because both parents are carriers, both of them contributed their recessive genes to the child. It is an autosomal recessive disorder and is not associated with X-linked recessive or dominant inheritance. Autosomal dominant disorders need only one copy of the gene for variation. If the gene for variation is carried on the dominant allele, the individual exhibits the disorder.

339. The nurse is developing a plan of care for a postpartum client with a small vulvar hematoma. The nurse should include which specific action during the first 12 hours after delivery? 1. Assess vital signs every 4 hours. 2. Measure fundal height every 4 hours. 3. Prepare an ice pack for application to the area. 4. Inform the health care provider of assessment findings.

3. Prepare an ice pack for application to the area. A hematoma is a localized collection of blood into the tissues of the reproductive sac after delivery. Vulvar hematoma is the most common. Application of ice reduces swelling caused by hematoma formation in the vulvar area. Options 1, 2, and 4 are not interventions that are specific to the plan of care for a client with a small vulvar hematoma.

Active labor

4-6cm dilation Station=0 (head at ischial spine) Assess FHR ever 30min; 15min if high risk

334. A client in a postpartum unit complains of sudden sharp chest pain and dyspnea. The nurse notes that the client is tachycardic and the respiratory rate is elevated. The nurse suspects a pulmonary embolism. Which should be the initial nursing action? 1. Initiate an intravenous line. 2. Assess the client's blood pressure. 3. Prepare to administer morphine sulfate. 4. Administer oxygen, 8 to 10 L/ minute, by face mask.

4. Administer oxygen, 8 to 10 L/ minute, by face mask. If pulmonary embolism is suspected, oxygen should be administered, 8 to 10 L/ minute, by face mask. Oxygen is used to decrease hypoxia. The client also is kept on bed rest with the head of the bed slightly elevated to reduce dyspnea. Morphine sulfate may be prescribed for the client, but this would not be the initial nursing action. An intravenous line also will be required, and vital signs need to be monitored, but these actions would follow the administration of oxygen.

Folic Acid Deficiency Anemia: To prevent, daily supplement of ...? (give the amount)

400 mcg (0.4 mg)

Transition labor

6-8cm dilation Abrupt change in behavior; increased irritability

Term

>37 weeks

Environmental Hazards During Pregnancy: 3 basic categories A, B, C

A — Can be easily transmitted person to person B — Can be spread via food & water C — Can be spread via manufactured weapons designed to spread disease

What are the leading causes of traumatic death ?

Automobile accidents Homicide Suicide

In a variation of rooming-in, called couplet care, the mother and infant share a room, and the mother shares the care of the infant with: a. The father of the infant. b. Her mother (the infant's grandmother). c. Her eldest daughter (the infant's sister). d. The nurse.

ANS: D In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care.

Upon assessing the CRIES neonatal postoperative pain scale findings, the nurse concludes that the infant is experiencing severe pain. What finding made the nurse conclude this? Incorrect1 The infant wakes up frequently. 2 The infant's skin has a pink complexion. Correct3 The infant requires 40% oxygen support. 4 The infant's Heart rate was 110 beats/min.

According to the CRIES scale, the infant is experiencing severe pain when he or she requires more than 30% oxygen support to maintain normal functioning. The normal heart rate of an infant is 110 beats/min. The heart rate increases when the infant cries. A pink complexion is a normal indication, so a pink complexion does not cause the nurse to conclude that the infant is in severe pain.

Manifestations of GH: Respiratory System

Accumulation of fluid in lungs (pulm. edema)

Sharp End

Active Errors Direct Patient Care

2, 4, 5 The triple marker screen measures the levels of three maternal serum markers: unconjugated estriol, hCG, and MSAFP. Low values of unconjugated estriol, hCG, and MSAFP indicate that the fetus has trisomy 18. The quad screen has an additional serum marker: inhibin-A. A low inhibin-A level indicates the possibility of Down syndrome. NT is not a serum marker protein. Moreover, elevated NT indicates that the fetus has a chromosomal abnormality but does not specifically indicate that the fetus has trisomy 18.

After reviewing the triple marker screen reports of a patient who is in the second trimester of pregnancy, the nurse concludes that the fetus has trisomy 18. What factors in the report led to the nurse's conclusion? Select all that apply. 1 Low level of inhibin-A in the maternal serum 2 Low level of unconjugated estriol in serum 3 Elevated nuchal translucency (NT) in the fetus 4 Low level of maternal human chorionic gonadotrophin (hCG) 5 Low level of maternal serum alpha-fetoprotein (MSAFP)

Episiotomy

An incision in the perineum to facilitate passage of the baby

The student nurse is asked to distinguish cutaneous jaundice from normal skin color of a neonate. What will the student nurse do to differentiate them?

Apply pressure on the forehead with a finger

The primary health care provider (PHP) prescribes ventilator support for a newborn. What finding would the PHP have assessed in the newborn?

Bluish discoloration of the skin

Manifestations of GH: Eyes

Blurred or double vision, spots before eyes - often precede convulsion

Passage

Bony pelvis, Cervix Pelvic floor muscles vagina introitus(external vagina opening)

Review Signs of CHF During Pregnancy

Box 5-5, p. 101

What findings does the nurse expect in a female patient whose genetic report reveals monosomy of the X chromosome with a missing paternal X or Y chromosome? Select all that apply. A Tall stature B High-set ears C Webbing of the neck D High hairline in the back E Lymphedema of the hands

C, E A female patient with monosomy of the X chromosome and missing paternal X or Y chromosome has a genetic makeup of 45,X, which indicates Turner syndrome. Therefore, the nurse expects that the patient will have associated webbing of the neck and lymphedema of the hands. Such patients are generally short in stature and have low-set ears with a low hairline in the back.

What can sickle cell disease can lead to?

Can lead to preterm birth, growth restriction, and fetal demise

2 Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. Splitting of S1 and S2 is more audible. 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. Production of RBCs accelerates during pregnancy.

Cardiovascular system changes occur during pregnancy. Which finding is considered normal for a woman in her second trimester? 1 Less audible heart sounds (S1, S2) 2 Increased pulse rate 3 Increased blood pressure 4 Decreased red blood cell (RBC) production

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?

Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change

Ecotopic pregnancy treatment priority

Control the bleeding

Decreased BP =

Decreased placental perfusion.

4 Fetal kick count is a simple method to determine the presence of complications related to fetal oxygenation and activity level. The fetal kick count during the third trimester of pregnancy is approximately 30 kicks an hour; a count lower than that is an indication of poor health of the fetus. Fetal anomalies may not affect the oxygenation levels of the fetus. The nurse already knows the gestational age of the fetus; therefore the nurse need not refer the woman for ultrasonography to find the gestational age. Fetal position does not affect the activity level of the fetus.

During a prenatal checkup, the patient who is 7 months pregnant reports that she is able to feel about two kicks in an hour. The nurse refers the patient for an ultrasound. What is the primary reason for this referral? To check: 1 For fetal anomalies 2 Gestational age 3 Fetal position 4 For fetal well-being

3 Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention. Although vaginal or vulvar hematomas are a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Although unrepaired lacerations are a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Although retained placental fragments is a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause.

Excessive blood loss after childbirth can have several causes; however, the most common is: 1 vaginal or vulvar hematomas. 2 unrepaired lacerations of the vagina or cervix. 3 failure of the uterine muscle to contract firmly. 4 retained placental fragments.

During assessment, the nurse finds that the heart rate of a neonate is 110 beats/min and respiratory rates vary from 35 to 40 breaths/min. The nurse also finds that the neonate has a pink complexion. What conclusion regarding the Apgar score would the nurse make from these findings? The neonate:

Exhibits normal findings

1, 2, 4 The fetal movements are clearly visible on ultrasound during week 32 of pregnancy as the fetus is developed and active. An increase in the cardiac output around 30% to 50% is seen in week 32, which later declines by about 20% in week 40. Braxton Hicks contractions are irregular, painless contractions, which become definite after week 28 of pregnancy. The uterus is almost the size of a grapefruit in week 12, which increases later because of mechanical pressure of the fetus. Fetal heart tones are detected by ultrasound in week 6, but later can be easily detected by a fetal stethoscope.

Following the complete assessment and review of the medical reports of a pregnant female, the nurse concludes that the female is in week 32 of pregnancy. What findings are consistent with the nurse's conclusion? Select all that apply. 1 Fetal movements are clearly visible. 2 Cardiac output of the patient is increased. 3 Uterus is almost the size of a grapefruit. 4 Braxton Hicks contractions are observed. 5 Fetal heart tone is detected by ultrasound.

Breastfeeding is contraindicated for mothers who are...?

HIV positive

What is the primary prevention of Cytomegalovirus (CMV)

Handwashing!

The nurse is assessing a breastfed newborn 1 hour after birth. The nurse identified that the glucose levels are less than 25 mg/dL and immediately reported it to the primary health care provider (PHP). What medication administration does the nurse expect the PHP to advise?

IV dextrose infusion

Teach woman which foods are high in iron & folic acid (REVIEW p. 103 Box with foods)

Know what foods are high in these

Primips vs. Multips

Labor, particularly the first stage of labor will be MUCH longer for a Primips. Descent is slow and steady in first time mom. It comes much faster after that. Level of pain varies for each woman.

Positive Consequences (Outcomes)

No Harm Uneventful Discharge Culture of Transparency

Stages of Labor First Stage

Onset of contractions; full dilation of the cervix. Longest stage 3 phases: Latent- cervical effacement with minimal dilation and decent. Active and Transition Phases- generally rapid cervical dilation and descent.

The nurse is assessing a preterm baby and observes dark red skin color with harlequin signs on the skin. What does the nurse infer from these findings? The baby has: Hypotension. 2 Polycythemia. 3 Hyperthermia. 4 A neurologic disorder

Polycythemia - Polycythemia is common in preterm infants because of the presence of fetal red blood cells (RBCs) The dark red color skin of the newborn with harlequin signs indicates polycythemia. Polycythemia is common in preterm infants because of the presence of fetal red blood cells (RBCs). The presence of hypotension in the infant is indicated by gray coloration of the skin. The presence of hyperthermia in a newborn is indicated by blue coloration (cyanosis) of the skin. Neurologic disorders are associated with cyanosis but not with polycythemia

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

Postbirth uterine/vaginal discharge (called lochia): 1 is similar to a light menstrual period for the first 6 to 12 hours. 2 is usually greater after cesarean births. 3 will usually decrease with ambulation and breastfeeding. 4 should smell like normal menstrual flow unless an infection is present.

Safety

Protection from harm or injury for patients and providers through both system effectiveness and individual performance.

Manifestations of GH: CNS

Severe, unrelenting HA Hyperactive deep tendon reflexes

Fourth Stage

Stage of recover/bonding Monitor for hemorrhage Palpate uterus

Crew Resource Management

Standardize procedures & communication Decrease errors Increase efficiency

4 If the BPP score is less than 2, regardless of gestational age, delivery can be performed. If the BPP score is 0 to 2 and chronic asphyxia is suspected, then testing time should be extended to 120 minutes. If the BPP score is 8 to 10 and a low risk for chronic asphyxia is suspected, then the test should be repeated at twice-weekly intervals. If the fetal pulmonary test result is negative and the BPP score is 6, then the BPP profile should be repeated in 4 to 6 hours.

The biophysical profile (BPP) testing report of a pregnant patient gives the following information: one episode of fetal breathing movement lasting for 30 seconds in a 30-minute observation; three limb movements of the fetus in 30 minutes; an amniotic fluid index greater than 5; a reactive nonstress test; and a BPP score of 1. The test is performed for 120 minutes. What does the nurse expect the primary health care provider to do? 1 Extend the test time to 120 minutes. 2 Repeat the test twice a week. 3 Repeat the test in 4 to 6 hours. 4 Consider delivery of the fetus.

Lightening

The decent of the fetus into the pelvis

2 The normal baseline fetal heart rate ranges from 110 to 160 beats/min. If the fetal heart rate is more than 160 beats/min, then tachycardia in the fetus is indicated. Ischemia is a condition in which there is a reduced blood supply to the fetal tissues. Baseline heart rate below 110 beats/min indicates bradycardia in fetus. Hypotension indicates a blood pressure level below 120/80 mm Hg, which is a life-threatening condition for the fetus.

The diagnostic test reports of a pregnant patient reveal a baseline fetal heart rate of 175 beats/min. What does this finding indicate to the nurse? 1 Presence of fetal ischemia 2 Fetal tachycardia 3 Fetal bradycardia 4 Hypotension in the fetus

1 A patient who is Rh negative or Rh unsensitized should receive 300 mcg immunoglobulin to prevent complications in the fetus related to Rh incompatibility. Elevated amniotic fluid volume (or polyhydramnios), streptococcal infection, and HIV infection cannot be treated with immunoglobulin. Severe polyhydramnios is treated by aspirating a small amount of amniotic fluid (amniocentesis). If a patient tests positive for group B streptococcal infection, antibiotic therapy is initiated. If the pregnant patient is HIV positive, antiretroviral drugs are administered to prevent transmission of infection from the mother to the child.

The primary health care provider has ordered 300 mcg of immunoglobulin to be delivered intramuscularly to a pregnant patient. What would be the reason for administering this to the patient? The patient: 1 Is Rh negative and unsensitized. 2 Has elevated amniotic fluid volume. 3 Has group B streptococcal infection. 4 Is human immunodeficiency virus (HIV) positive

Molding

The shaping of the fetal head to adapt to the mother's pelvis during labor

Intensity

The strength of the contraction at the peak of a contraction

Newborns are at high risk for injury if appropriate safety precautions are not implemented. Parents should be taught to:

Use a rear-facing carseat

Bloody Show

Vaginal discharge. Cervical secretion, blood-tinged mucus, and the mucous plug that blocked the cervix during pregnancy

Fetal Presentation

What part of the baby is entering the pelvis first 1. cephalic/vertex- head 2. breech-bum 3. shoulder

Crowning

When the largest diameter of the fetal head is past the vulva.

1 The fetal heart strip shows an early deceleration indicating expected head compression during contractions. Documenting this finding is appropriate. Positioning the woman on the left aside, applying oxygen via a face mask, and notifying the health care provider are correct actions for a late deceleration.

When the nurse observes this fetal heart pattern, the most important nursing action is to: 1 document the finding. 2 position mother on left side. 3 apply 10 L of oxygen via face mask. 4 notify the health care provider

The placement of errors may be described as:

active or latent

GI

decrease in gastric motility, absorption of food, emptying time slowed. Nausea/Vomiting at onset of labor not unusual

Musculoskeletal

diaphoresus-sweating fatigue, proteinuria, increased temp, don't point toes in pregnancy= may cause leg cramps. as well as backaches, joint aches. increase in muscle activity

Execution

doing the right thing incorrectly

IOM offers a definition of safety as

freedom from accidental injury; ensuring patient safety

Passenger

movement of fetus, placenta, membranes thru birth canal. -size of fetal head -fetal presentation -fetal lie -fetal attitude -fetal position

Omission

not doing the right thing

OP

occiput posterior

Labor

process of moving fetus, placenta and membranes out of the uterus and through the birth canal

Cardiovascular changes in Maternal Adaptation

-With each contraction, a return of blood from the placenta to the mom's circulation (400 ml goes back) increasing the Cardiac Output. -BP increases during contractions and stabilizes between. -WBC increases - HR increases Preteinureia may occur -Blood glucose decreases -Temp increases

engaged or floating?

-check by attempting to move the head from side to side to see wheter it is outsid the pelvis and free (floating) or in the pelvis and fixed (engaged).

What are some nursing responsibilities regarding tests?

- Preparing the patient properly, offer psychosocial support - concern for fetal well-being - Explaining the reason for the test - Clarifying and interpreting results in collaboration with other health care providers

Nursing Care Focus: Caring for acutely ill woman (pg. 93)

- Quiet, low light, bedrest left side, - Padded siderails, prevent injury and restore oxygenation to mother & fetus, suction equip

Post-Abortion Teaching

- Report increased bleeding - Take temperature every 8 hours for 3 days - Take an oral iron supplement if prescribed - Resume sexual activity as recommended - Return at the recommended time for a checkup & contraception information - Pregnancy can occur before the first menstrual period returns after the abortion procedure

Human Immunodeficiency Virus (HIV) is acquired in one of three ways.. what are they?

- Sexual contact - Parenteral or mucous membrane exposure to infected body fluids - Perinatal exposure

Effects of Diabetes in Pregnancy BOX 5-4 (p. 97): Maternal Effects

- Spontaneous abortion - Gestational hypertension - Preterm labor and PROM (premature rupture of membranes) - Excessive amniotic fluid - Infections - Complications of large size

Danger Signs in Pregnancy NEED TO KNOW

- Sudden gush of fluid from the vagina - Vaginal bleeding - Abdominal pain - Persistent Vomiting - Epigastric pain - Edema of face & hands - Severe, persistent headache - Blurred vision or dizziness - Chills with fever over 38.0° C (100.4° F) - Painful urination or reduced urine output (UTI)

For a woman with B- thalassemia, what would you teach her?

- Teach her to avoid situations where exposure to infections are more likely - Teach her to promptly report any signs of infections

Bleeding Disorders of Early Pregnancy: What are some types of SPONTANEOUS abortions?

- Threatened - Inevitable - Incomplete - Complete - Missed - Recurrent

Human Immunodeficiency Virus (HIV): Infant may be infected how?

- Transplacentally - Through contact with infected maternal secretions at birth - Through breast milk

Anemia * Four types are significant during pregnancy - Two are nutritional: What are they? - Two are genetic disorders: What are they?

- Two are nutritional: Iron deficiency Folic acid deficiency - Two are genetic disorders: Sickle cell disease Thalassemia

Third Stage

Expulsion of placenta 5-7 minutes

With Herpesvirus there are 2 types: - Type 1: Likely to cause ? - Type 2: Likely to cause ?

- Type 1: Likely to cause fever blisters or cold sores - Type 2: Likely to cause genital herpes

Herpesvirus: Infant can be infected in one of two ways: how?

- Virus ascends into the uterus after the membranes rupture - Infant has direct contact with infectious lesions during vaginal delivery

Treatment error

-Performance of operation, procedure or test -In dose or method of administration -Avoidable delay in treatment -Responding to abnormal test

See Box 5-1 on Page 86

S/S of Hypovolemic Shock

Diagnostic error

-Result of a delay in diagnosis, -Failure to employ indicated tests; -Use of outmoded test -Failure to act on results of monitoring or testing

What is the expected delivery date of a patient whose conception is reported on June 20, 2012? 1 March 13, 2013 2 March 27, 2013 3 February 13, 2013 4 February 27, 2013

1 The gestation period of a fetus is 266 days from the date of conception and 280 days from the last menstrual period. Calculating the gestational period after conception from June 20, the expected date of delivery is March 13, 2013. March 27, 2013, is the expected date of delivery if June 20, 2012, is the first day of the last menstrual period. February 13 and 27 are not the expected date of delivery unless the baby is a preterm infant.

4 A first-degree laceration extends through the skin and structures superficial to muscles. A second-degree laceration extends through muscles of the perineal body. A third-degree laceration continues through the anal sphincter muscle. A fourth-degree laceration involves the anterior rectal wall.

A patient sustained a first-degree laceration during childbirth. What physical finding should the nurse infer from this? The laceration: 1 Also involves the anterior rectal wall. 2 Continues through the anal sphincter muscle. 3 Extends through muscles of the perineal body. 4 Extends through the skin and structures superficial to muscles

Nursing Care of the Pregnant Woman With Excessive Bleeding: What are the priorities?

monitoring fetal heart and character of contractions

Presenting Part

The part of the fetus in contact with the cervix

Ectopic Pregnancy: What happens if the tube ruptures?

- May have sudden severe lower abdominal pain - Vaginal bleeding - Signs of hypovolemic shock - Shoulder pain may also be felt

Abruptio placentae

- Normal implantation of placenta - Dark bleeding with pain and enlarging uterus suggest blood is accumulating within the cavity - Abdominal or low back pain TABLE 5-4, p. 88

Best position

laying on her left side

Just Culture

refers to a system's explicit value of reporting errors without punishment

The mother of a circumcised infant reports to the nurse that while she is cleaning her child's penis, he cries out loudly. What question does the nurse ask the patient to understand the reason behind this? 1 "Are you applying A&D ointment while cleaning?" 2 "Are you cleaning the penis with lukewarm water?" 3 "Are you applying fresh petrolatum while cleaning?" 4 "Are you cleaning with prepackaged commercial wipes?"

"Are you cleaning with prepackaged commercial wipes?" Do not use prepackaged commercial baby wipes for cleaning the circumcised site because they can contain alcohol. Alcohol delays healing and also causes discomfort to the infant. The infant cries out loudly because of the discomfort. Washing the penis gently with lukewarm water is recommended to remove urine and feces. Fresh petrolatum is applied to reduce pain after each diaper change. The application of A&D ointment while cleaning is done to prevent the sticking of the penis to the discharge, as well as to increase the infant's comfort.

Effects of Diabetes in Pregnancy BOX 5-4 (p. 97): fetal and neonatal effects

- Congenital abnormalities - Large size - Birth injury - Delayed lung maturation leading to resp. distress syndrome - Perinatal death

Hyperemesis Gravidarum: Treatment

- Correct dehydration and electrolyte or acid-base imbalance - Antiemetic drugs may be prescribed - In extreme cases: TPN (total parental nutrition) may be required or Hospitalization

Treatment of GDM

- Diet - Monitoring blood glucose levels - Ketone monitoring - Insulin administration - Exercise - Fetal assessment *Table 5-7 Review signs of Hypoglycemia/hyperglycemia and corrective measures

When teaching a woman how to take supplements, what would you include?

- Do not take iron supplements at the same time when drinking milk - Do not take antacids with iron - When taking iron, stools will be dark green to black

Hyperemesis Gravidarum: Manifestations

- Excessive nausea and vomiting - Dehydration (skin turgor, mucous membranes, urine output) - Reduced delivery of blood, oxygen, and nutrients to the fetus

Risk Factors for GH

- First pregnancy - Obesity - Family history of GH - Age over 40 years or under 19 years - Multifetal pregnancy - Chronic hypertension - Chronic renal disease - Diabetes mellitus

Management of GH: Drug Therapy may include...

- Magnesium sulfate - Calcium gluconate needs to be available - Antihypertensives

Factors Linked to GDM (Gestational Diabetes)

- Maternal obesity (>90 kg or 198 lb) - Large infant (>4000 g or about 9 lb) - Maternal age older than 25 years - Previous unexplained stillbirth or infant having congenital abnormalities - History of GDM - Family history of DM - Fasting glucose level over 126 mg/dl or postmeal glucose level over 200 mg/dl

A pregnant patient has a sister with a genetic disorder but has never shown symptoms of the disorder herself. The patient's husband has an uncle with the disorder but has likewise never shown symptoms of the disorder himself. Which test is performed to determine the risk of the patient's fetus acquiring this disorder? 1 Carrier screening test 2 Maternal serum screening 3 Predispositional predictive testing 4 Presymptomatic predictive testing

1 A parent may show no symptoms of an autosomal recessive condition but still carry a gene mutation for that condition. A carrier screening test can be performed to rule out the possibility of the fetus being affected by the condition. Maternal serum screening is a blood test that is helpful in detecting the presence of neural tube defects and chromosomal abnormalities such as Down syndrome in the fetus; it is not used to determine if the parent is a carrier of an autosomal recessive condition. Predispositional predictive testing is performed to test for mutations, such as those involving the BRCA1 gene to determine susceptibility for breast cancer; it is not used to determine if the parent is a carrier of an autosomal recessive condition. Presymptomatic predictive testing is done for the mutation analysis for Huntington disease (HD), not to determine if the parent is a carrier of an autosomal recessive condition.

During a genetic counseling session, a patient discloses that her partner's mother has color blindness. The laboratory results show that the patient does not have the genes that are responsible for color blindness. What does the nurse infer from this? The patient's son: 1 Will not demonstrate any color blindness. 2 Will become a carrier for color blindness. 3 Has a 25% chance of having color blindness. 4 Has a 50% chance of having color blindness.

1 Color blindness is an X-linked recessive inheritance. The genes responsible for the disease are carried on the X chromosome. In this scenario, the patient does not have the genes that cause color blindness. However, the patient's partner's mother has color blindness. Because color blindness is an autosomal recessive disorder, this implies that the patient's partner is affected and is color-blind. The patient's son acquires the unaffected X chromosome from the mother and Y chromosome from the father. Therefore this patient's son will not be affected and will not develop color blindness. Males cannot be the carriers for X-linked chromosomal disorders, but they are always expressed in them. A 25% and 50% chance of developing color blindness in the patient's son occurs if the mother is a carrier for the disease.

A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use: 1 counterpressure against the sacrum. 2 pant-blow (breaths and puffs) breathing techniques. 3 effleurage. 4 biofeedback

1 Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain; however, it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support.

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's most appropriate analgesic for pain control is: 1 fentanyl (Sublimaze). 2 promethazine (Phenergan). 3 butorphanol tartrate (Stadol). 4 nalbuphine (Nubain)

1 Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

A patient who is 8 weeks pregnant wants to know when she can feel the fetal movements in the womb. What is the best nursing response? "You will have to wait for another: 1 8 to 12 weeks." 2 6 to 8 weeks." 3 4 to 6 weeks." 4 2 to 4 weeks."

1 Fetal movements are generally observed between 16 to 20 weeks of gestation. As the patient is in the 8th week of gestation, she will be able to notice fetal movements in another 8 to 12 weeks. By this time the arms and legs of the fetus will be completely developed. All the other options, which are below 16 weeks of gestation are incorrect as the arms and legs of the fetus are not well developed. Therefore, the patient cannot feel the fetal movements after 6 to 8 weeks, 4 to 6 weeks, or 2 to 4 weeks from then.

What kind of anesthesia does the nurse expect the primary health care provider to prescribe to a patient who is to have an emergency cesarean birth due to fetal distress? 1 General anesthesia 2 Pudendal nerve block 3 Nitrous oxide with oxygen 4 Local infiltration anesthesia

1 General anesthesia may be necessary if indications necessitate rapid birth (vaginal or emergent cesarean), when there is a pressing need for time and/or primary health care providers to perform a block. Pudendal nerve block is administered late in the second stage of labor. It may be required if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Nitrous oxide mixed with oxygen can be inhaled in 50% or less concentration to provide analgesia during the first and second stages of labor. Local infiltration anesthesia may be used when an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.

The nurse is caring for a patient who is administered local perineal infiltration anesthesia. In what situation does the nurse expect the use of local perineal infiltration anesthesia? When a(n): 1 Episiotomy is required. 2 Forceps birth is expected. 3 Cesarean birth is expected. 4 Vacuum extractor is to be used.

1 Local perineal infiltration anesthesia may be used when an episiotomy is to be performed. It may also be used when lacerations must be sutured after birth in a patient who does not have regional anesthesia. Pudendal nerve block is administered late in the second stage of labor if an episiotomy is to be performed or if forceps or a vacuum extractor is to be used to facilitate birth. Low spinal anesthesia (block) may be used for cesarean birth.

After reviewing the maternal serum screening results of a pregnant patient, the nurse infers that the patient may be carrying a child with Down syndrome. What is the potential finding in the report? 1 Trisomy 2 Triploid 3 Tetralogy 4 Tetraploidy

1 Maternal serum screening is the diagnostic tool used for detecting chromosomal abnormalities in the fetus. It helps detect whether the fetus has an increased risk for Down syndrome or neural tube defects. Deviation in the number of chromosomes and a condition with an extra chromosome is considered a trisomy. Trisomy is an aneuploidic condition in which the chromosome count is observed as 47 (XXX). The incidence of Down syndrome is high in a child having a trisomy. The chromosome count for a female child with triploid condition is 69 (3N). The chromosome count for a female child with tetrasomy is 48 (XXXX). The chromosome count for a female child with tetraploidy condition is 92 (4N). The incidence of Down syndrome is not high in these conditions.

A patient who is pregnant for the first time is anxious about the pain related to labor. Which physiologic factor does the nurse relate that may increase the intensity of pain during childbirth? 1 History of dysmenorrhea 2 Low level of prostaglandin 3 Cramps during menstruation 4 High level of β-endorphin

1 Patients with a history of dysmenorrhea may experience increased pain during childbirth. These patients are known to have high levels of prostaglandin. Low levels of prostaglandin do not increase the intensity of pain during labor. The level of beta (β) endorphins increases during pregnancy and birth. β endorphins are endogenous opioids that reduce pain. Back pain associated with menstruation also increases the likelihood of contraction-related low back pain.

The nurse is assessing a group of pregnant women at a community health center. Which patients would be at highest risk for pregnancy-related complications? The patient: 1 With uncontrolled diabetes mellitus. 2 Who is of African-American descent. 3 Who is between 30 and 33 years old. 4 With history of alcohol consumption.

1 Patients with uncontrolled diabetes are at a higher risk for complications associated with pregnancy. If the pregnant mother develops uncontrolled hyperglycemia, this may produce hyperglycemia in the fetus. This in turn stimulates fetal hyperinsulinemia and islet cell hyperplasia. Hyperinsulinemia prevents fetal lung maturation and places the neonate at an increased risk for respiratory distress. African-American patients have an increased chance of having dizygotic twins. They are not associated with an increased risk for pregnancy-related complications. Patients within the age-group of 30 to 33 years are not at risk for complications associated with pregnancy. Alcohol consumption during pregnancy leads to respiratory complications and fetal alcohol syndrome. However, patients with a history of alcohol consumption do not usually have pregnancy-related complications.

The blood pressure of a pregnant patient becomes low when the patient lies on the back. What would be the best nursing intervention to maintain normal blood pressure in the patient? 1 Position the patient to lie on the left side and rest. 2 Suggest that the patient perform aerobic exercises daily. 3 Have the patient stand up and take a deep breath. 4 Tell the patient to lie straight facing up and take frequent rest periods.

1 Pregnant women often experience hypotension when they lie on their back (in the supine position). The blood that is trying to return to the right atrium is diminished because the uterus is compressing the vena cava. Therefore the nurse should have the patient to lie on either side to rest. This will reduce the uterine pressure on the right atrium and helps in optimal circulation. Aerobic exercise will not be helpful in reducing the pressure caused by uterine compression. Making the patient stand up and take deep breaths will worsen the symptoms of hypotension. Making the patient lie in the supine position will further increase the uterine compression and hypotension.

A patient in the eighteenth week of pregnancy visits a clinic to know about the development of the fetus. The patient says to the nurse, "I am excited, and I want to know what has developed in my child so far." What information should the nurse be able to tell to the patient about the fetus? The fetus has: 1 "Hair on the scalp." 2 "Some sweat glands." 3 "Nasal cartilage." 4 "Sebaceous glands."

1 Scalp hair appears after week 16 of pregnancy, along with eyes, ears, and the nose. However, it is still in the developmental stages and is observed upon gross examination of the fetus. Sweat glands are formed at the twenty-fourth week of pregnancy. Nasal cartilage is observed after 40 weeks of pregnancy. Sebaceous glands are formed after 20 weeks of pregnancy.

Nurses should be aware of the difference experience can make in labor pain, such as: 1 sensory pain for nulliparous women often is greater than for multiparous women during early labor. 2 affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. 3 women with a history of substance abuse experience more pain during labor. 4 multiparous women have more fatigue from labor and therefore experience more pain.

1 Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

The nurse is teaching pain relief techniques to a group of expectant patients. What does the nurse teach the patients about the gate-control theory of pain? 1 Distractions block the nerve pathways. 2 Neuromuscular activity can increase pain. 3 All sensations travel together to the brain. 4 Motor activity during labor intensifies pain

1 The gate-control theory of pain explains the way pain relief techniques work to relieve the pain of labor. Distractions close down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. According to this theory only a limited number of sensations can travel through the sensory nerve pathways to the brain at one time. When the laboring patient engages in motor activity and neuromuscular activity, activity within the spinal cord itself further modifies the transmission of pain. Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

The nurse is assessing a 40-year-old patient who is 12 weeks pregnant. What should the nurse anticipate based on the patient's age? 1 The fetus is at a risk for Down syndrome. 2 The patient is at a risk for sickle cell anemia. 3 The fetus is at a risk for neural tube defects. 4 The patient is at a risk for Huntington's disease (HD).

1 The risk for Down syndrome increases in the fetus as the age of the pregnant mother gets older. Because the patient is older than 35 years of age, the fetus is at an increased risk for having Down syndrome. The development of sickle cell anemia is not related to the age of the mother. It is caused by inheriting the defective genes from the parents. Neural tube defect in the fetus results from insufficient intake of folic acid during pregnancy. HD is an autosomal dominant disorder caused by a mutation on the normal gene and is not related to the age of the patient.

The primary health care provider instructs the nurse to administer warfarin (Coumadin) to a child with venous thrombosis. What precaution should the nurse take to prevent possible severe adverse drug reactions in the child? Administer: 1 The genotype-guided dose of the drug. 2 The drug orally on an empty stomach. 3 A test dosage before the medication. 4 The drug by the intramuscular route.

1 Warfarin (Coumadin) is the drug of choice given to children for the treatment of thromboembolic events. However, for treatment to be effective and to prevent adverse effects, the dosage of warfarin (Coumadin) may have to be customized for each patient based on his or her genotype. This drug does not have to be given on an empty stomach. Warfarin (Coumadin) is not given as a test dose. Some antibiotics may be administered by testing a small dose first to determine hypersensitivity, but not warfarin (Coumadin). This medication is not given by the intramuscular route. It is an anticoagulant, and giving the medication through this route may cause bleeding.

What interventions does the nurse perform for a laboring patient with hypotension and fetal bradycardia? Select all that apply. 1 Notify the primary health care provider or anesthesiologist. 2 Monitor the fetal heart rate (FHR) every 5 minutes. 3 Monitor maternal blood pressure every 10 minutes. 4 Administer oxygen using a non rebreather facemask. 5 Position the patient in Sims' or modified Sims' position.

1, 2, 4 The nurse must immediately notify the primary health care provider, anesthesiologist, or nurse anesthetist. The nurse must administer oxygen by nonrebreather facemask at 10 to 12 L/min or as per health care facility's protocol. The FHR must be monitored every 5 minutes. The patient must be turned to lateral position or a pillow or wedge must be placed under a hip to displace the uterus. Sims' or modified Sims' position may be used when spinal anesthesia is administered. Maternal blood pressure must be monitored every 5 minutes.

The nurse teaches the patient nonpharmacologic pain management methods during a prenatal class. Which methods require practice for best results? Select all that apply. 1 Biofeedback 2 Massage and touch 3 Patterned breathing 4 Controlled relaxation 5 Slow-paced breathing

1, 3, 4 Patterned breathing, controlled relaxation, and biofeedback techniques must be practiced to obtain best results. Patterned breathing and controlled relaxations help to manage pain during labor. Biofeedback is effective when the patient is able to focus and control body responses during labor. The nurse assisting the laboring patient can use methods such as massage and touch and slow-paced breathing successfully without the patient having any prior knowledge about it.

A patient inquires about the use of hypnosis for pain management during a prenatal assessment. What does the nurse teach the patient about this modality? Select all that apply. 1 It gives a better sense of control. 2 It must be performed by a support person. 3 It is a form of deep relaxation or meditation. 4 It is more effective than the use of a placebo. 5 It can cause dizziness, nausea, and headache

1, 3, 5 Hypnosis is a form of deep relaxation, similar to daydreaming or meditation. It enhances relaxation and diminishes fear, anxiety, and perception of pain. It allows the patient to have a greater sense of control over painful contractions. Failure to dehypnotize properly may result in mild dizziness, nausea, and headache. Self-hypnosis must be learnt during childbirth preparation classes. It is not performed by a support person. Although hypnosis is beneficial, studies have not found it to be more effective than the use of a placebo or other interventions for pain management during labor.

What interventions does the nurse perform to provide emotional support to a patient in labor? Select all that apply. 1 Compliment patient efforts during labor. 2 Avoid offering food during labor. 3 Use a calm, confident approach. 4 Discourage activities that distract. 5 Involve the patient in care decisions.

1, 3, 5 The nurse must offer emotional support by complimenting the patient and offering positive reinforcement for efforts during labor. The patient must be involved in decision making regarding own care. The nurse must use a calm and confident approach when assisting the patient during labor. The nurse may offer food and nourishment, if allowed by the primary health care provider. The nurse must encourage participation in distracting activities and nonpharmacologic measures for comfort.

The nurse is teaching a couple about the use of imagery and visualization in managing pain during labor. What is the patient expected to do during this technique? Select all that apply. 1 Imagine breathing in light and energy. 2 Maintain clenched fists to drive out pain. 3 Engage in dance or rhythmic movements. 4 Imagine walking through a restful garden. 5 Envisage breathing out worries and tension.

1, 4, 5 Imagery and visualization are useful techniques in preparation for birth and are often used in combination with relaxation. Imagery involves techniques, such as breathing in light and energy, imagining a walk through a restful garden, or envisaging breathing out worries and tension. Relaxation or reduction of body tension is a technique that involves rhythmic motion that stimulates the mechanoreceptors of the brain. The nurse must recognize the signs of tension, such as clenching of fists when in pain by the laboring patient.

The nurse teaches acupressure methods for pain relief during labor to a couple in the prenatal clinic. What does the nurse teach about acupressure? Select all that apply. 1 Blood circulation is enhanced. 2 Flow of qi (energy) is restored. 3 Lubricants are used over the area. 4 Pressure is applied with the fingers. 5 Pressure is applied with contractions.

1, 4, 5 Pressure is usually applied with the heel of the hand, fist, or pads of the thumbs and fingers. Pressure is applied with contractions initially and then continuously as labor progresses to the transition phase at the end of the first stage of labor. Acupressure is said to promote the circulation of the blood, the harmony of yin and yang, and the secretion of neurotransmitters. Thus acupressure maintains normal body functions and enhances well-being. Acupressure is applied over the skin without using lubricants. In acupuncture, the flow of qi (energy) is restored.

The nurse is assisting a patient in labor. What breathing pattern must the nurse remind the patient to use when the contractions increase in frequency and intensity in the first phase of labor? 1 Slow-paced breathing 2 Modified-paced breathing 3 3:1 pattern-paced breathing 4 4:1 pattern-paced breathing

2 During the first phase of labor, as contractions increase in frequency and intensity, the patient must change breathing patterns to a modified-paced breathing technique. This breathing pattern is shallower and faster than the patient's normal rate of breathing, but should not exceed twice the resting respiratory rate. Slow-paced breathing is performed at approximately half the normal breathing rate and is initiated when the patient can no longer walk or talk through contractions. Patterned-paced breathing is suggested in the second phase of labor. It consists of panting breaths combined with soft blowing breaths at regular intervals. The patterns may vary, the 3:1 pattern is pant, pant, pant, blow and the 4:1 pattern is pant, pant, pant, pant, and blow.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? 1 "Many pregnant women imagine what their baby is like." 2 "A baby in utero does respond to the mother's voice." 3 "You'll need to ask the doctor if the baby can hear yet." 4 "Thinking that your baby hears will help you bond with the baby."

2 Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice. Although stating that many pregnant women imagine what their baby is like is accurate, it is not the most appropriate response. The mother should be instructed that her fetus can hear at 24 weeks and can respond to the sound of her voice. Stating that if the woman thinks that her baby hears will help them bond gives the impression that her baby cannot hear her. It also belittles the mother's interpretation of her fetus's behaviors.

The genetic screening of a newborn is indicative of phenylketonuria. The nurse learns that the couple has no history of genetic disorders in the past three generations. What other tests does the nurse suggest to the couple to determine the reason for the genetic disorder? 1 Sonography of the fetus 2 Genetic test of the couple 3 Chorionic villus sampling 4 Maternal serum screening

2 Genetic testing of the couple may determine whether the parents of the newborn are carriers for the mutation. Phenylketonuria can be seen in the newborn only if both parents are carriers for the disorder. Fetal sonography is a technique of imaging the fetus in the uterus using high-frequency sound waves. Chorionic villus sampling is a prenatal diagnostic technique to determine chromosomal disorders in the fetus. Maternal serum sampling is carried out on the mother through a blood test to screen the high risk of carrying a fetus with neural tube defects or genetic abnormalities.

A genetic test in a patient with hemophilia shows that the patient's partner is not a carrier for hemophilia. The patient is worried and wants to know about the chances of hemophilia in their children. What information should the nurse convey to the patient? The chance of hemophilia in the: 1 "Male offspring is 50%." 2 "Male offspring is 100%." 3 "Female offspring is 50%." 4 "Female offspring is 100%."

2 Hemophilia is an X-linked recessive inheritance disorder carried on the X chromosome. In the scenario, the patient is homozygous to hemophilia because the symptoms are expressed in the patient. The patient's partner is not a carrier for hemophilia. The abnormal trait present on the X chromosome of the mother will be expressed in the male offspring, because males receive X chromosome from the mother. Therefore the chance of having hemophilia in the male offspring is 100%. If the mother is a carrier for hemophilia, then there is a 50% chance of hemophilia in the male offspring. All the female offspring of the patient will be carriers for hemophilia, because the partner does not carry any abnormal X chromosome for hemophilia.

What does the nurse teach the patient about the benefits of breathing techniques in the second stage of labor? 1 Does not interfere with fetal descent 2 Causes increase in abdominal pressure 3 Reduces discomfort during contractions 4 Increases the size of the abdominal cavity

2 In the second stage of labor breathing technique is used to increase abdominal pressure and expel the fetus. In the first stage of labor, breathing helps to promote the relaxation of the abdominal muscles, thereby increasing the size of the abdominal cavity. This lessens the discomfort during contraction caused by the friction between the abdominal wall and the uterus. It also relaxes the muscles of the genital area and does not interfere with fetal descent. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.

Which findings can be observed in the individuals with mosaicism on an autosomal gene? 1 Neural tube defect 2 Down syndrome 3 Congenital heart defect 4 Normal intelligence

2 Mosaicism is a condition in which the individual may have an extra chromosome in some of the cells. This disorder is usually associated with sex chromosome. It is detected to be present on an autosomal gene and results in Down syndrome in the majority of individuals. Neural tube defects are caused by the deficiency of folic acid during pregnancy. Congenital heart defect is a multifactorial inheritance caused by environmental and chromosomal defects. The child will not be born with normal intelligence.

The nurse is assisting a patient who is prepared to use the paced breathing method. What does the nurse remind the patient to do at the beginning of the breathing pattern? 1 Exhale a deep breath. 2 Take a deep relaxing breath. 3 Take 32 breaths per minute. 4 Take three breaths per minute.

2 The patient must remember that all breathing patterns begin with a deep, relaxing "cleansing breath" to "greet the contraction." The patient must then exhale a deep breath to "blow the contraction away." These deep breaths ensure adequate oxygen for the mother and the baby and signal that a contraction is beginning or has ended. The patient must take three to four breaths per minute when performing slow-paced breathing. As contractions increase in frequency and intensity, the patient takes shallow, fast breaths, about 32 to 40 per minute.

What is the duration for which the sperm remains viable in the female reproductive system? 1 2 to 4 days after intercourse 2 3 to 5 days after intercourse 3 4 to 8 days after intercourse 4 5 to 9 days after intercourse

2 The sperm remains viable in the female reproductive system for 3 to 5 days after sexual intercourse. Within this time a sperm fuses with an ova to form a zygote. The sperm is no longer viable after 5 days. Therefore they do not remain viable after 4 to 8, and 5 to 9 days after intercourse.

The nurse is reviewing the diagnostic test results with a pregnant patient and informs the patient that she is going to have twins. Based on which diagnostic test did the nurse make such a conclusion? 1 Human placental lactogen 2 Ultrasound results 3 Cytogenetic testing 4 Amniotic fluid levels

2 Ultrasound scan or fetal ultrasound is the technique used for visualizing the fetus and the internal structures for prenatal analysis. In this technique, high-frequency sound waves produce the image of the fetus without harming the fetal internal organs. Therefore this technique is used to identify the presence of twins in the patient's womb. Human placental lactogen changes the metabolism of the mother and supplies energy to the fetus. Cytogenetic testing helps find the genetic abnormalities and that caused by changes in the chromosomes. Amniotic fluid protects the fetus from injuries. These tests do not help determine the presence of twins in the patient's womb.

Before conducting the ultrasound scan, the nurse instructs the pregnant patient on the procedure. Which statement made by the patient indicates the need for further teaching? 1 "The sound waves are not harmful to the fetus at all." 2 "A needle is inserted in the abdomen during the scan." 3 "The frequency of the sound produced can be adjusted." 4 "Fetal anomalies can be identified by ultrasound scan."

2 Ultrasound testing is performed using high-frequency sound waves to obtain an image of the fetus. This technique is painless and a needle is not inserted in the womb. If the patient asks about the insertion of a needle in ultrasound, it implies that the patient did not understand about the technique and requires further teaching. A needle is used for an amniocentesis. These sound waves do not harm the fetus, and their frequency can be adjusted. This technique helps to identify the fetal abnormalities, because it shows the image of the fetus.

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: 1 uterine contractions occurring every 8 to 10 minutes. 2 a fetal heart rate (FHR) of 180 with absence of variability. 3 the woman needing to void. 4 rupture of the woman's amniotic membranes.

2 An FHR of 180 with absence of variability is non-reassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured.

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include? 1 "Because this is a repeat procedure, you are at the lowest risk for complications." 2 "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." 3 "Because this is your second cesarean birth, you will recover faster." 4 "You will not need preoperative teaching because this is your second cesarean birth."

2 Physiologic and psychological recovery from a cesarean birth is multifactorial and individual to each woman each time. Maternal and fetal risks are associated with every cesarean birth. Preoperative teaching should always be performed regardless of whether the woman has already had this procedure.

The nurse evaluates the blood pressure (BP) of a neonate and suspects a cardiac defect. What recordings of the neonate's BP confirm a cardiac defect? 1 The BP in the lower extremities is 60/40 mm Hg and in the upper extremities is 70/50 mm Hg. 2 The BP in the lower extremities is 50/40 mm Hg and in the upper extremities is 80/70 mm Hg. 3 The BP in the lower extremities is 70/40 mm Hg and in the upper extremities is 60/40 mm Hg. 4 The BP in the lower extremities is 80/40 mm Hg and in the upper extremities is 70/60 mm Hg.

2 The BP in the lower extremities is 50/40 mm Hg and in the upper extremities is 80/70 mm Hg. Systolic BP should be 60 to 80 mm Hg, and diastolic BP should be 40 to 50 mmHg. When the recordings are varied by 20 mm Hg in both the extremities, it implies that the neonate has a cardiac defect, such as coarctation of the aorta. If the BP of the lower extremities is 50/40 mm Hg and that of the upper extremities is 80/70 mm Hg, it indicates that the neonate has a cardiac defect, such as coarctation of the aorta. The same recordings on all the extremities signify that the neonate's heart functions properly. Variations of 10 mm Hg are still considered a normal finding in a neonate.

330. The nurse is monitoring a client in the immediate postpartum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss? 1. A temperature of 100.4 ° F 2. An increase in the pulse rate from 88 to 102 beats/ minute 3. A blood pressure change from 130/ 88 to 124/ 80 mm Hg 4. An increase in the respiratory rate from 18 to 22 breaths/ minute

2. An increase in the pulse rate from 88 to 102 beats/ minute During the fourth stage of labor, the maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. An increasing pulse is an early sign of excessive blood loss because the heart pumps faster to compensate for reduced blood volume. A slight increase in temperature is normal. The blood pressure decreases as the blood volume diminishes, but a decreased blood pressure would not be the earliest sign of hemorrhage. The respiratory rate is slightly increased from normal.

337. A postpartum client is diagnosed with cystitis. The nurse should plan for which priority nursing action in the care of the client? 1. Providing sitz baths 2. Encouraging fluid intake 3. Placing ice on the perineum 4. Monitoring hemoglobin and hematocrit levels

2. Encouraging fluid intake Cystitis is an infection of the bladder. The client should consume 3000 mL of fluids per day if not contraindicated. Sitz baths and ice would be appropriate interventions for perineal discomfort. Hemoglobin and hematocrit levels would be monitored with hemorrhage.

What major side effect does the nurse expect if a patient in labor is administered diazepam (Valium)? 1 Severe nausea and vomiting in the mother 2 Neonatal central nervous system depression 3 Disrupted temperature control in the newborn 4 Magnified pain if administered without analgesic

3 Diazepam (Valium) disrupts thermoregulation in the newborn. Thus the newborn is less able to maintain body temperature. Benzodiazepines, when given with an opioid analgesic, seem to enhance pain relief and reduce nausea and vomiting. Pain is magnified if a barbiturate is given without an analgesic to a patient who is experiencing pain. This is because the normal coping mechanism in the patient may be blunted. Barbiturates should be avoided if birth is anticipated within 12 to 24 hours because it has the potential to cause neonatal central nervous system depression.

The nurse is caring for a patient who is using fentanyl citrate (Sublimaze) through patient-controlled analgesia (PCA) while in labor. What effects of fentanyl citrate does the nurse expect? 1 Provides long duration of action 2 Requires only a single dose 3 Provides quick relief to pain 4 Causes sedation and nausea

3 Fentanyl citrate (Sublimaze) is a potent short-acting opioid agonist analgesic. Therefore it provides quick pain relief. It rapidly crosses the placenta, so it is present in the fetal blood within 1 minute after intravenous maternal administration. It is a short-acting drug, so the patient will require more frequent dosing. It is often administered as a patient controlled analgesic. It has fewer neonatal effects as compared to meperidine, and causes less maternal sedation and nausea.

A couple has been counseled for genetic anomalies. They ask, "What is karyotyping?" The nurse's best response is: 1 "Karyotyping will reveal if the baby's lungs are mature." 2 "Karyotyping will reveal if your baby will develop normally." 3 "Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes." 4 "Karyotyping will detect any physical deformities the baby has.

3 Karyotyping provides genetic information, such as gender and chromosomal structure. The lecithin/sphingomyelin ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

The nurse is caring for a nulliparous patient in labor. How is the experience for a nulliparous patient different from that of a multiparous patient? The patient experiences: 1 Less sensory pain during early labor. 2 Greater sensory pain in the second stage of labor. 3 Greater fatigue due to longer duration of labor. 4 Greater affective pain in the second stage of labor.

3 Parity influences the perception of labor pain. The nulliparous patient often has longer labor and therefore, greater fatigue. Sensory pain for nulliparous women is often greater than that for multiparous women during early labor, because their reproductive tract structures are less supple. Affective pain in the nulliparous patient is greater in the first stage as compared to a multiparous patient. It decreases for both patients during the second stage of labor. During the second stage of labor, the multiparous patient may experience greater sensory pain than the nulliparous patient. This is because tissues of the multiparous patient are more supple and increase the speed of fetal descent, thereby intensifying the pain. Test-Taking Tip: Answer every question because, on the NCLEX exam, you must answer a question before you can move on to the next question.

The nurse is teaching a student nurse about questions that can be asked of the patient before undergoing prenatal testing. The nurse then asked the student to write the set of questions on a piece of paper. Which question written by the student nurse indicates the need for further teaching? 1 "What is the age of your partner?" 2 "Do you smoke or drink regularly?" 3 "Do you believe in Christianity?" 4 "What is your partner's profession?

3 Religion does not play a major role in the fetal development. Therefore it is not required to ask whether the patient follows Christianity. Before conducting prenatal testing, the nurse should assess the socioeconomic status of the patient's family. It helps to know the factors that may affect fetal growth and development. Therefore the nurse should ask questions to obtain the information regarding the socioeconomic status of the patient. The nurse should ask about the partner's age to assess the risk for genetic disorders such as Down syndrome. Asking whether the patient regularly drinks alcohol helps assess the risk for fetal alcohol spectrum disorder. Asking about the profession of the patient's partner provides the clue for the risk for carcinogenesis.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates: 1 the fetus is at risk for Down syndrome. 2 the woman is at high risk for developing preterm labor. 3 lung maturity. 4 meconium is present in the amniotic fluid.

3 The detection of the presence of pulmonary surfactants (surface-active phospholipids) in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. The presence of surface-active phospholipids is not an indication of Down syndrome. This result reveals the fetal lungs are mature and in no way indicates risk for preterm labor. Meconium should not be present in the amniotic fluid.

How many veins and arteries are present between the maternal and the fetal circulatory system by the fifth week of pregnancy? 1 One vein and one artery 2 Two veins and one artery 3 One vein and two arteries 4 Two veins and two arteries

3 The fetal heart starts beating by the end of the fifth week. Two arteries carry blood from the embryo to the chorionic villi, and one vein returns the blood to the embryo. Deoxygenated blood leaves the fetus through the umbilical arteries and enters the placenta, where it is oxygenated. Oxygenated blood leaves the placenta through the umbilical vein, which enters the fetus via the umbilical cord. It is rare for there to be one vein and one artery. Approximately 1% of umbilical cords contain only two vessels: one artery and one vein. This occurrence is sometimes associated with congenital malformations. Therefore the presence of two veins and one artery and two veins and two arteries is inappropriate.

What intervention does the nurse perform to provide a relaxed environment for labor? 1 Stand at the bedside. 2 Encourage rapid birth. 3 Control sensory stimuli. 4 Demonstrate excitement

3 The nurse must assist the patient by providing a quiet and relaxed environment. A relaxed environment for labor is created by controlling sensory stimuli, such as light, noise, and temperature, as per the patient's preferences. The nurse must provide reassurance and comfort by sitting rather than standing at the bedside whenever possible. The nurse must not encourage or hurry the patient for rapid birth. The nurse must maintain a calm and unhurried attitude when caring for the patient. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.

During the second phase of labor the patient initiates pattern-paced breathing. What adverse symptoms must the nurse watch for when the patient initiates this method? 1 Pallor 2 Nausea 3 Dizziness 4 Diaphoresis

3 The nurse must watch for symptoms of hyperventilation and resulting respiratory alkalosis. Symptoms of respiratory alkalosis during pattern-paced breathing include dizziness, light-headedness, tingling of fingers, or circumoral numbness. Pallor, nausea, and diaphoresis are generally observed in the active and transition phases of the first stage of labor. They are physiologic effects of pain.

During the prenatal assessment of a patient, the nurse teaches the patient about nonpharmacologic pain management. What does the nurse tell the patient about this method? 1 It is technical and expensive. 2 It requires intensive training. 3 It provides the patient with a sense of control. 4 It is used only in stage I of labor.

3 The patient makes choices about the nonpharmacologic pain management methods that are best suited. This provides the patient with a sense of control over childbirth. These measures are relatively simple and inexpensive. They do not require intensive training. However, the patient may obtain best results from the practice. It can be used throughout labor.

The student nurse is giving a presentation about milestones in embryonic development. Which information should the student include? 1 At 8 weeks of gestation, primary lung and urethral buds appear. 2 At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. 3 At 20 weeks of gestation, the vernix caseosa and lanugo appear. 4 At 24 weeks of gestation, the skin is smooth, and subcutaneous fat is beginning to collect.

3 Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks.

A patient asks the nurse about the use of transcutaneous electrical nerve stimulation (TENS). What does the nurse teach about TENS? 1 It involves the use of one pair of electrodes. 2 It is kept at low intensity during contractions. 3 It releases continuous low-intensity impulses. 4 It is useful for pain in the second stage of labor.

3 When TENS is applied for pain relief, the electrodes provide continuous low-intensity electrical impulses or stimuli from a battery-operated device. TENS is most useful for lower back pain during the early first stage of labor. TENS involves the placing of two pairs of flat electrodes on either side of the woman's thoracic and sacral spine. During a contraction, the patient increases the stimulation from low to high intensity by turning the control knobs on the device.

During a prenatal assessment a patient asks the nurse about the disadvantages of spinal anesthesia. What does the nurse teach the patient about the potential effect of spinal anesthesia? 1 It reduces maternal consciousness. 2 It increases maternal muscular tension. 3 It increases probability of operative birth. 4 It increases the possibility of fetal hypoxia.

3 When a spinal anesthetic is given, the need for episiotomy, forceps-assisted birth, or vacuum-assisted birth tends to increase because voluntary expulsive efforts are reduced or eliminated. Maternal consciousness is maintained. Fetal hypoxia is absent as maternal blood pressure is maintained within a normal range. There is no muscular tension; excellent muscular relaxation is achieved.

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? 1 Internal version 2 Vaginal delivery 3 Cesarean section 4 External cephalic version

3 Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? 1 Vaginal delivery 2 Vacuum-assisted delivery 3 Cesarean section delivery 4 Forceps-assisted delivery

3 Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down.

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? 1 Propranolol (Inderal) 2 Clindamycin (Cleocin) 3 Morphine (MS Contin) 4 Terbutaline (Brethine)

3 The pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. Because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. Therefore, after cesarean birth, the patient should be given an antibiotic, such as clindamycin (Cleocin), which acts against anaerobic organisms. Propranolol (Inderal), morphine (MS Contin), and terbutaline (Brethine) are not antibiotics and are not administered after childbirth. They are drugs used to treat complications of labor.

A newborn is diagnosed with Klinefelter syndrome. On assessing the family, the nurse finds that the couple feels embarrassed by the child. How should the nurse help the couple in coping with the situation? Select all that apply. The nurse: 1 Suggests giving up the child for adoption. 2 Explains the main reason for the disorder. 3 Directs the family to a genetic counselor. 4 Educates the family about the disorder. 5 Instructs about places to leave the child

3, 4, 5 The nurse explains to the couple and their family members about the cause of the disorder. The disorder is caused by a nondisjunction of sex chromosomes and the child is not responsible for it. Genetic counseling for the family may provide detailed knowledge of the syndrome and the possibility of future children to have the syndrome. This may help the family understand the disorder more effectively. Understanding the symptoms and treatment methods would help the parents and the family members adjust according to the needs of the child. The nurse needs to motivate the family to accept the child and not give the child up for adoption or find places to leave the child. The nurse also explains the child's need for emotional support during growing years and that it is the right of the child to be with parents.

333. The postpartum nurse is assessing a client who delivered a healthy infant by cesarean section for signs and symptoms of superficial venous thrombosis. Which sign would the nurse note if superficial venous thrombosis were present? 1. Paleness of the calf area 2. Coolness of the calf area 3. Enlarged, hardened veins 4. Palpable dorsalis pedis pulses

3. Enlarged, hardened veins Thrombosis of superficial veins usually is accompanied by signs and symptoms of inflammation, including swelling, redness, tenderness, and warmth of the involved extremity. It also may be possible to palpate the enlarged, hard vein. Clients sometimes experience pain when they walk. Palpable dorsalis pedis pulses is a normal finding.

340. On assessment of a postpartum client, the nurse notes that the uterus feels soft and boggy. The nurse should take which initial action? 1. Elevate the client's legs. 2. Document the findings. 3. Massage the fundus until it is firm. 4. Push on the uterus to assist in expressing clots.

3. Massage the fundus until it is firm. If the uterus is not contracted firmly (i.e., it is soft and boggy), the initial intervention is to massage the fundus until it is firm and to express clots that may have accumulated in the uterus. Elevating the client's legs would not assist in managing uterine atony. Documenting the findings is an appropriate action but is not the initial action. Pushing on an uncontracted uterus can invert the uterus and cause massive hemorrhage.

335. The nurse is assessing a client in the fourth stage of labor and notes that the fundus is firm, but that bleeding is excessive. Which should be the initial nursing action? 1. Record the findings. 2. Massage the fundus. 3. Notify the health care provider (HCP). 4. Place the client in Trendelenburg's position.

3. Notify the health care provider (HCP). If bleeding is excessive, the cause may be laceration of the cervix or birth canal. Massaging the fundus if it is firm would not assist in controlling the bleeding. Trendelenburg's position should be avoided because it may interfere with cardiac and respiratory function. Although the nurse would record the findings, the initial nursing action would be to notify the HCP.

331. The nurse is preparing a list of self-care instructions for a postpartum client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. 1. Wear a supportive bra. ** 2. Rest during the acute phase. ** 3. Maintain a fluid intake of at least 3000 mL. ** 4. Continue to breast-feed if the breasts are not too sore. *** 5. Take the prescribed antibiotics until the soreness subsides. 6. Avoid decompression of the breasts by breast-feeding or breast pump.

331. 1, 2, 3, 4 Rationale: Mastitis is an infection of the lactating breast. Client instructions include resting during the acute phase, maintaining a fluid intake of at least 3000 mL/ day (if not contraindicated), and taking analgesics to relieve discomfort. Antibiotics may be prescribed and are taken until the complete prescribed course is finished. They are not stopped when the soreness subsides. Additional supportive measures include the use of moist heat or ice packs and wearing a supportive bra. Continued decompression of the breast by breast-feeding or breast pump is important to empty the breast and prevent the formation of an abscess.

What care must the nurse take when assisting a laboring patient with hydrotherapy? 1 Initiate hydrotherapy in the first stage of labor at 3 cm. 2 Ensure water is warm at 32.5° to 34° C (90.5° to 93.2°F). 3 Check the fetal heart rate (FHR) with internal electrodes. 4 Obtain the approval of the primary health care provider.

4 Agency policy must be consulted to determine if the approval of the laboring woman's primary health care provider is required. The nurse must ensure that all criteria are met in terms of the status of the maternal and fetal unit. Hydrotherapy is usually initiated when the patient is in active labor, at approximately 5 cm. This reduces the risk of a prolonged labor. FHR monitoring is done by Doppler, fetoscope, or wireless external monitor when hydrotherapy is in use. Use of internal electrodes for monitoring FHR is contraindicated in jet hydrotherapy. The temperature of the water should be maintained at 36° to 37° C (96.8° to 98.6° F). Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early.

The nurse is interacting with the parents of a newborn who is diagnosed with Down syndrome. What explanation should the nurse provide to the parents about the genetic disorder? Down syndrome is caused by: 1 A decreased intake of folic acid." 2 An X-linked recessive gene issue." 3 An autosomal recessive gene." 4 The presence of an extra chromosome."

4 Down syndrome is an intellectual disability caused by aneuploidy. Aneuploidy is a condition characterized by the presence or absence of an extra chromosome. Therefore the presence of extra chromosome 21 causes Down syndrome in the newborn. The deficiency of folic acid results in neural tube defects in the newborn. X-linked recessive gene disorder results from the presence of a defective gene on the X-chromosome of a carrier mother. Down syndrome is not caused by inheritance of an autosomal recessive gene. It occurs because of the defect in the chromosomal count in an individual.

The nurse is caring for a patient in the last trimester of pregnancy. What assessments will the patient display related to the effects of fear and anxiety during labor? An increase in: 1 Blood flow. 2 The progression of labor. 3 Contractions. 4 Muscle tension

4 Fear and excessive anxiety leads to increased muscle tension. It causes more catecholamine secretion. This increases the stimuli to the brain from the pelvis due to increased muscle tension and decreased blood flow. Thus fear and anxiety magnifies the perception of pain. Anxiety does not increase uterine contractions, but reduces the effectiveness of the contractions leading to increased discomfort. This slows the progress of labor. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.

1 After birth uterine discharge is commonly called lochia that accumulates in the vagina when the woman is lying down. This comes out as a gush of blood when the woman assumes an upright position. If the lochia has a strong smell, it may indicate an offensive odor; this patient does not report an offensive odor. During the assessment, the nurse does not find any symptoms associated with hemorrhage, such as increased heart rate or low blood pressure. Dyspareunia is associated with coital discomfort.

A patient reports to the nurse that she has bright red discharge 3 days after delivery. The patient tells the nurse that a gush of blood comes out of her vagina upon standing upright. What should the nurse interpret from the assessment? 1 Normal finding after delivery 2 Dyspareunia 3 Infection 4 Hemorrhage

The nurse is providing genetic counseling for a patient with Stickler syndrome. What questions should the nurse ask the patient? 1 "Was your father older than 50 years of age when you were born?" 2 "Was your mother older than 35 years of age when you were born?" 3 "May I ask what the socioeconomic status of your family is?" 4 "Have you ever had any other children with birth defects?"

4 Stickler syndrome is an autosomal dominant inheritance caused by the mutation on the normal gene of the individual. Because the syndrome shows few symptoms, the nurse should assess the family history of the patient. The nurse should also ask about whether the patient has other children and if they have any birth defects as a result of the syndrome. The age of the parent plays a vital role during the diagnosis of Down syndrome. Therefore it is not as important to know about the age of the patient's mother and father. Socioeconomic status is not a cause for genetic abnormalities, so the nurse should not include the question about the socioeconomic status of the patient during counseling.

When caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur? 1 Abdominal wall and thighs 2 Gluteal area and iliac crests 3 Lumbosacral area of the back 4 Lower portion of the abdomen

4 Visceral pain in the first stage of labor occurs in the lower portion of the abdomen. Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates. Pressure and traction on uterine tubes, ovaries, ligaments, nerves, and uterine ischemia also cause visceral pain. Pain that originates in the uterus radiates to the gluteal area, iliac crests, abdominal wall, thighs, lumbosacral area of the back, and lower back. This pain is called referred pain.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 116 beats/min 2 Cervix dilated 2 cm and 50% effaced 3 Score of 8 on the biophysical profile 4 One fetal movement noted in 1 hour of assessment by the mother

4 Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a woman at 42 weeks of gestation. A score of 8 on the BPP is a normal finding in a pregnancy at 42 weeks.

Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. 4 Reposition the woman with her hips higher than her head.

4 The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority

332. The nurse is providing instructions about measures to prevent postpartum mastitis to a client who is breast-feeding her newborn. Which client statement would indicate a need for further instruction? 1. "I should breast-feed every 2 to 3 hours." 2. "I should change the breast pads frequently." 3. "I should wash my hands well before breast- feeding." 4. "I should wash my nipples daily with soap and water."

4. "I should wash my nipples daily with soap and water." Mastitis is inflammation of the breast as a result of infection. It generally is caused by an organism that enters through an injured area of the nipples, such as a crack or blister. Measures to prevent the development of mastitis include changing nursing pads when they are wet and avoiding continuous pressure on the breasts. Soap is drying and could lead to cracking of the nipples, and the client should be instructed to avoid using soap on the nipples. The mother is taught about the importance of hand-washing and that she should breast-feed every 2 to 3 hours.

336. The nurse is preparing to care for four assigned clients. Which client is at highest risk for hemorrhage? 1. A primiparous client who delivered 4 hours ago 2. A multiparous client who delivered 6 hours ago 3. A primiparous client who delivered 6 hours ago and had epidural anesthesia 4. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction

4. A multiparous client who delivered a large baby after oxytocin (Pitocin) induction The causes of postpartum hemorrhage include uterine atony; laceration of the vagina; hematoma development in the cervix, perineum, or labia; and retained placental fragments. Predisposing factors for hemorrhage include a previous history of postpartum hemorrhage, placenta previa, abruptio placentae, overdistention of the uterus from polyhydramnios, multiple gestation, a large neonate, infection, multiparity, dystocia or labor that is prolonged, operative delivery such as a cesarean or forceps delivery, and intrauterine manipulation. The multiparous client who delivered a large fetus after oxytocin induction has more risk factors associated with postpartum hemorrhage than the other clients. In addition, there are no specific data in the client descriptions in options 1, 2, and 3 that present the risk for hemorrhage.

The nurse is taking care of a newborn. The nurse finds out that the infant weighs 1800 g and the mother's HBsAg status is unknown. When should the nurse administer the hepatitis B immune globulin (HGIB) vaccine to the infant? 1 9 hours after the infant is born 2 13 hours after the infant is born 3 14 hours after the infant is born 4 18 hours after the infant is born

9 hours after the infant is born If the mother's HBsAg status is unknown, then the infant's weight is considered to determine the time for the administration of the HBIG vaccine. The infant weighs 1800 g, so the HBIG vaccine is given within 12 hours after the infant's birth. Therefore the HBIG vaccine should be administered 9 hours after birth, not 13, 14, or 18 hours after. If the mother's HBsAg status is known and the baby weighs more than 2000 g, then the HBIG vaccine can be administered within a week of the newborn's birth. In such a situation, the vaccine can be administered at 13, 14, or 18 hours after the birth of the infant.

Characteristic Causes of High-Risk Pregnancies

> Pregnancy itself > A medical condition or injury that complicates the pregnancy > Environmental hazards that affect the mother or fetus > Maternal behaviors/lifestyles that have a negative effect on mother or fetus

39 This patient definitely meets the guidelines for "Care of the Obese Perinatal Patient." The BMI is calculated as follows: 220 lbs = 99 .7 kg; 5' 3'' = 1.60 m; 1.6 squared = 2.56; 99.7 divided by 2.56 = 38.9.

A 35-year-old primiparous patient is being admitted to the labor unit for an elective cesarean birth. The patient states that she has gained more weight during her pregnancy than was recommended by her obstetrician. She is 5 feet 3 inches tall and weighs 220 lbs. The nurse is cognizant that in order to provide safe and optimal care, this patient may meet the criteria for the "Care of the Obese Perinatal Patient" multidisciplinary care plan. This guideline applies to all patients with a body mass index (BMI) of 30 kg/m2 or greater. The nurse must now determine the patient's BMI in order to adopt the guideline. The BMI is calculated by the following formula: BMI = Weight (kg) / Height (m)2. Using a whole number to record your answer, the BMI for this patient is ________.

1 Fetal heart activity begins around 6 weeks, so 4 weeks is too early to detect fetal heart activity, and this is a normal finding. Absence of fetal heart activity at an advanced gestational age may indicate congenital anomalies, impaired growth, or cardiac disorders.

A 4-week pregnant patient is undergoing an ultrasound. The report shows an absence of fetal heart activity. What does the nurse infer about the fetus from the report? 1 Normal finding 2 Congenital abnormality 3 impaired growth 4 Cardiac disorder

4 Transvaginal ultrasound is useful for obese women whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal). An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age.

A 40-year-old woman with a high body mass index is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? 1 Biophysical profile 2 Amniocentesis 3 Maternal serum alpha-fetoprotein (MSAFP) 4 Transvaginal ultrasound

3 The recommended caloric intake for a lactating mother who breastfeeds more than one infant is more than 2700 kcal/day. If a lactating mother of twins takes less than 2200 kcal/day, she may not produce enough milk. An intake of 1800 to 2200 kcal/day is recommended for nonlactating mothers.

A lactating patient who gave birth to twins 1 month earlier approaches the primary health care provider (PHP) for a general checkup. What suggestion does the nurse give to the patient about the recommended calorie intake? 1 Less than 1800 kcal/day 2 Less than 2200 kcal/day 3 More than 2700 kcal/day 4 Should be 1800 to 2200 kcal/day

3 Increased frequency of urination in a postpartum patient is termed postpartal diuresis. Postpartum patients have decreased estrogen and progesterone levels. In addition, removal of increased venous pressure in the lower extremities and loss of the remaining pregnancy-induced increase in blood volume may also cause diuresis. Diuresis helps get rid of excess fluids from the body. The levels of oxytocin are not related to postpartum diuresis. The aldosterone levels drop after childbirth and are not related to postpartum diuresis. hCG tends to disappear after the childbirth and has no role in diuresis.

A lactating postpartum patient reports frequent urination. What could be the reason for increased frequency of urination in the patient? A decrease in the levels of: 1 Estrogen and aldosterone 2 Oxytocin and progesterone 3 Progesterone and estrogen 4 Human chorionic gonadotropin (hCG)

3 In the immediate puerperium, a decrease in the levels of human placental lactogen, estrogens, and cortisol is seen. This results in significantly lowered blood glucose levels. Therefore it is a transitional period for carbohydrate metabolism, making it difficult to interpret the glucose tolerance test. Breastfeeding the baby gradually depletes the mother's energy stores deposited during the pregnancy and does not have a significant influence on the glucose tolerance. Blood, tissue debris, fluids, and retained fragments of membranes are discharged out in the form of lochia, which does not affect the glucose tolerance test. Dietary regulations prevent the mother from consuming additional calories, but this does not influence the glucose tolerance of the woman in her immediate puerperium.

A lactating woman with type 1 diabetes in her immediate puerperium period undergoes a glucose tolerance test. The test results are nonconclusive. What could be the reason for the test to be nonconclusive? 1 Breastfeeding the baby 2 Loss of blood in the form of lochia 3 Decreased levels of maternal hormones 4 Decreased food intake and diet regulations

4 A triple marker test determines the levels of MSAFP along with serum levels of estriol and human chorionic gonadotropin; an elevated level is associated with open neural tube defects. Low levels of MSAFP are associated with Down syndrome. Sickle cell anemia is not detected by the MSAFP. Cardiac defects are not detected with the MSAFP.

A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with: 1 Down syndrome. 2 sickle cell anemia. 3 cardiac defects. 4 open neural tube defects such as spina bifida

1, 4, 5 The nonlactating patient may feel discomfort caused by the accumulation of milk. The nurse advises the patient to use ice packs, fresh cabbage leaves, and a well-fitted supportive bra for relieving discomfort. The nurse should not advise the patient to express milk or perform nipple stimulation because it increases milk production, which worsens pain and discomfort.

A nonbreastfeeding patient reports discomfort in the breast caused by the accumulation of milk. What should the nurse suggest to the patient to relieve the discomfort? Select all that apply. 1 "Use ice packs on the breast." 2 "Express the breast milk." 3 "Perform nipple stimulation." 4 "Apply fresh cabbage leaves on breast." 5 "Use a well-fitted supportive bra."

08/02/2015 According to Nägele's rule, the estimated birth date is calculated by adding 7 days to LMP and counting forward 9 months. Hence, because the patient's LMP is November 25, 2014, the expected birth date would be 25 + 7 days = 32 days (December 2, 2014), plus 9 months, for an EDB of August 2, 2015.

A patient reveals the first day of the last menstrual period (LMP) as November 25, 2014. After an assessment, the nurse confirms that the patient is pregnant. What will be the estimated date of birth (EDB)? Record as 00/00/0000.

2, 3, 5 Vibroacoustic stimulation is often used to stimulate fetal activity if the initial NST result is nonreactive and thus hopefully shortens the time required to complete the test (Greenberg, Druzin, and Gabbe, 2012). A nonreactive test requires further evaluation. The testing period is often extended, usually for an additional 20 minutes, with the expectation that the fetal sleep state will change and the test will become reactive. Care providers sometimes suggest that the woman drink orange juice or be given glucose to increase her blood sugar level and thereby stimulate fetal movements. Although this practice is common, there is no evidence that it increases fetal activity (Greenberg, Druzin, and Gabbe, 2012). A needle biopsy is not part of a NST. The FHR is recorded with a Doppler transducer, and a tocodynamometer is applied to detect uterine contractions or fetal movements. The tracing is observed for signs of fetal activity and a concurrent acceleration of FHR.

A nonstress test (NST) is ordered on a pregnant woman at 37 weeks of gestation. What are the most appropriate teaching points to include when explaining the procedure to the woman? Select all that apply. 1 After 20 minutes, a nonreactive reading indicates the test is complete. 2 Vibroacoustic stimulation may be used during the test. 3 Drinking orange juice before the test is appropriate. 4 A needle biopsy may be needed to stimulate contractions. 5 Two sensors are placed on the abdomen to measure contractions and fetal heart tones.

3 The use of illicit drugs (such as cocaine or methamphetamines) might cause increased variability . Maternal ingestion of narcotics may be the cause of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these are known to cross the placental barrier. Tranquilizer use is a possible cause of decreased variability in the fetal heart rate.

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: 1 narcotics. 2 barbiturates. 3 methamphetamines. 4 tranquilizers.

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A parasite acquired by contact with cat feces or raw meat

1, 3, 5 Any comfort measures useful for the patient should be demonstrated to the patient's partner. The patient's partner may be reminded to take food. The nurse can also offer snacks and fluids to the partner. The nurse can offer to relieve him of the duty of supporting and encouraging the patient in order to get proper rest. The decision regarding the involvement of the partner in the process of labor should be left to the couple. The nurse should respect their decision. The nurse should tell the partner about the changes that may take place in the patient's behavior during labor and childbirth.

A patient has been admitted to the labor room. What are the measures to be taken by the nurse to support the partner of the patient? Select all that apply. 1 Offer snacks and fluids to the partner as required. 2 Do not discuss the psychological change in the patient. 3 Demonstrate the performance of the comfort measures. 4 Guide the partner to make decisions about his involvement. 5 Relieve the person occasionally from the job of supporting the patient.

2 The patient is experiencing uterine contractions that are 3 to 5 minutes apart and last for about 60 seconds (1 minute). The patient also exhibits flushed cheeks. These findings indicate that the patient is in the active phase of the first stage of labor. The nursing assessment in the active stage of labor is to check the patient's appearance and mood every 15 minutes, or 4 times in an hour. The patient's mood and energy levels fluctuate, and therefore the nurse should constantly assess them to ensure effective patient care. The patient's blood pressure should be assessed every 30 minutes. The nurse should assess the patient's body temperature every 4 hours until membrane rupture and thereafter every 2 hours. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A patient in labor exhibits flushed cheeks. The nurse records the uterine contractions in the patient as being 3 to 5 minutes apart and lasting for about 1 minute. What nursing intervention is most effective to assess the patient's status during this phase of labor? 1 Check blood pressure every 2 hours. 2 Note patient's appearance and mood every 15 minutes. 3 Assess the patient's temperature every 2 hours until membranes rupture.

1 Three-dimensional (3D) or four-dimensional (4D) ultrasonography is advisable for women who want to see the fetus. MRI cannot be used in this case because it requires the fetus to be still for a long period of time for a clear image. CT uses ionizing radiation for imaging, which can be harmful to the fetus. Therefore CT is contraindicated for fetal imaging. NT is a specific ultrasonography screening procedure used to test for genetic abnormalities in the fetus.

A patient in the sixth month of pregnancy expresses her wish to see the fetus. What investigation does the nurse suggest for the patient to help her see the fetus? 1 Ultrasonography 2 Magnetic resonance imaging (MRI) 3 Computed tomography (CT) 4 Nuchal translucency (NT)

2 Lochial bleeding is normal and decreases with time. Nonlochial bleeding occurs as a result of the tears in either the cervical or vaginal regions. In normal condition (lochial), the bleeding decreases with time. However, in this patient there is continuous bleeding even 4 weeks after childbirth. Normally, the color of the blood is bright red in the beginning (known as lochia rubra); after that, the color of the blood becomes slightly less pigmented. Therefore the patient has nonlochial discharge evident by the continuous bright red color bleeding. The odor of the lochia is the same as of the menstrual bleeding. The offensive odor of the lochia indicates presence of infection.

A patient reports continuous bleeding 4 weeks after childbirth. Upon assessment, the nurse finds that the bleeding is bright red in color with an offensive odor. What does the nurse suspect as the cause of the bleeding? 1 Lochial; the odor is caused by infection. 2 Nonlochial; the odor is caused by infection. 3 Lochial; the odor is normal in all postpartum patients. 4 Nonlochial; the odor is normal in all postpartum patients.

4 Because the woman has missed her period, it is likely that the woman is 4 to 6 weeks pregnant. A serum pregnancy test helps in the earliest detection of pregnancy. This test can be used to detect pregnancy in women who are 4 weeks pregnant. Therefore the nurse should ask the patient to take the serum pregnancy test. It is performed during weeks 4 to 12 of pregnancy. Hegar sign and Chadwick signs will be observed during weeks 6 to 12 of pregnancy, and pelvic congestion may be the other cause for such signs. Urine pregnancy test gives positive results during weeks 6 to 12 of pregnancy.

A patient reports to the nurse that she had missed her period this month and suspects that she is a pregnant. What would be the most suitable nursing action for this patient? 1 Assess for Hegar sign. 2 Assess for Chadwick sign. 3 Obtain an order for a urine pregnancy test. 4 Obtain an order for a serum pregnancy test.

2, 3 Consumption of alcohol by a lactating mother would affect the health of the infant. Maternal alcohol consumption causes delayed psychomotor development in the infant. Alcohol also inhibits the milk ejection reflex, so the infant may not be able to suck milk. The inability to produce milk is a side effect of smoking. Caffeine intake can lead to a reduced iron concentration in milk and causes the development of anemia in the infant. Caffeine does affect the activity levels of the mother but does not cause insomnia in the infant.

A patient tells the nurse, "I abstained from alcohol throughout my pregnancy, but now that I have delivered my baby, I want to be able to drink alcohol." What should the nurse inform the patient? Select all that apply. 1 "You would not be able to produce sufficient milk for the baby." 2 "Your child may develop psychomotor retardation if you drink." 3 "Your child would not be able to suck milk if you have alcohol." 4 "Your child may become anemic if you drink any form of alcohol." 5 "Your child would not be able sleep properly if you have alcohol."

2, 5 A patient who has had a cesarean birth and has remained in the bed for more than 8 hours is at risk of venous thromboembolism. If a thrombus is suspected, as evidenced by warmth, redness, or tenderness in the leg, the nurse should notify the PHP immediately. Meanwhile, the patient should remain in bed with the affected limb elevated on pillows. Applying heat increases discomfort because the affected limb is already warm. Applying antiinflammatory ointment to the leg at the reddened site would not be useful because the redness is caused by embolism, not inflammation.

A patient who has had a cesarean birth has been on bed rest for 8 hours after surgery and has warmth and redness in the left lower limb. Which interventions taken by the nurse would be most beneficial to the patient? Select all that apply. 1 Advise the patient to apply a hot compress at the reddened site. 2 Inform the primary health care provider (PHP) about the patient's condition immediately. 3 Advise the patient to apply an antiinflammatory ointment at the reddened site. 4 Have the patient sit upright and lower the reddened leg. 5 Have the patient remain in bed with reddened limb elevated on pillows.

1 Diverticulosis is a condition in which the patient develops muscular outpouchings in the colon. Intake of fibrous food reduces the risk for diverticulosis in a pregnant patient. Therefore the nurse should recommend that the patient incorporate the diet containing whole grains, bran, vegetables, and fruits. The intake of citrus fruits and dark green leafy vegetables is recommended for vitamin C deficiency. Shellfish, liver, meats, whole grains, and milk are recommended foods for a zinc deficiency. A diet containing iodized salt, seafood, milk products, and rolls is rich in iodine.

A patient who is 6 months pregnant is diagnosed with diverticulosis. Which diet should the nurse recommend to the patient? 1 Whole grains, bran, vegetables, and fruits 2 Citrus fruits and dark green leafy vegetables 3 Shellfish, liver, meats, whole grains, and milk 4 Iodized salt, seafood, milk products, and rolls

1 Diuretics are the medications that are usually prescribed to a patient with hypertension. These drugs may interfere with the levels of human chorionic gonadotropin (hCG) hormone. This may give a false-negative home pregnancy test result. Analgesics are the group of drugs used for pain relief. These drugs do not affect the hCG levels and therefore do not show a false report in the home pregnancy test. Tranquilizers are the drugs used for reducing anxiety, fear, and tension. The use of a tranquilizer results in a false-positive pregnancy test result because it increases hCG levels. Anticonvulsants are a group of drugs used in treating epileptic seizures; they affect the hCG levels and create a false-positive test result.

A patient who is pregnant used a home pregnancy test that showed a negative result. What will the nurse check for in the medication history of the patient? 1 Diuretics 2 Analgesics 3 Tranquilizers 4 Anticonvulsants

1 If the patient reports severe perineal pain after vaginal delivery, the nurse should apply ice packs in the first 24 hours to reduce edema, pain, and vulvar irritation. Administering fluids and blood compensates for blood loss in the patient, but they do not reduce pain. Postpartum hematologic studies are performed to assess the consequences of blood loss. This intervention does not reduce pain in the patient.

A patient who underwent a vaginal delivery 3 hours earlier reports having severe perineal pain. Which would be the first step taken by the nurse in this situation? 1 Apply ice packs in the perineum. 2 Administer fluids to the patient. 3 Administer blood to the patient. 4 Refer the patient for hematologic tests.

4 Facial pigmentation that occurs during pregnancy and fades away with childbirth is referred to as melasma. This occurs because of increased production of melanotropin during pregnancy. Oral contraceptive use can also cause stimulation of melanotropin production. This may cause melasma to recur. Antibiotics are the drugs used for treating bacterial infection. They do not trigger the recurrence of melasma. Antipsoriatics are used to treat the itchy and scaly patches in psoriasis. Antihistamines, antipsoriatics, and antibiotics do not affect the anterior pituitary gland. Antihistamines are used to relieve itching in mild pruritus and they do not cause pigmentation.

A patient with a dark complexion has brownish pigmentation over the cheeks, the nose, and the forehead. The patient reports that this pigmentation was present during pregnancy, which faded and has recurred now. What relevant drug history does the nurse assess in the patient? 1 Antibiotics 2 Antipsoriatics 3 Antihistamines 4 Contraceptives

2, 3, 4 Persistent headache in postpartum patients need to be evaluated further. However, the stress and physical fatigue of childbirth may cause the patient to experience headaches. Postpartum-onset preeclampsia, characterized by high blood pressure and the presence of proteins in the urine, may also cause headaches. Epidural or spinal anesthesia involves the placement of the needle into the spinal space. This may lead to leakage of cerebrospinal fluid into the extradural space, resulting in a headache. Orthostatic hypotension may cause dizziness, but it does not cause headache. The presence of varices and hemorrhoids may cause discomfort and pain, but these do not cause headache.

A postpartum patient complains of a headache. What could be the reasons for the headache in the patient? Select all that apply. 1 Orthostatic hypotension 2 Stress of childbirth in the patient 3 Postpartum-onset preeclampsia 4 Leakage of the cerebrospinal fluid 5 Presence of varices and hemorrhoids

3, 4, 5 Patients who choose not to breastfeed may experience breast engorgement and related discomfort. The nurse should instruct the patient to wear a well-fitted support bra or use a breast binder to support the breasts, which can relieve discomfort. Applying ice packs with a 15-minutes-on, 45-minutes-off schedule also helps relieve breast engorgement and reduce discomfort. Expressing milk from the breast or performing nipple stimulation may increase milk production and may worsen breast engorgement.

A postpartum patient has chosen not to breastfeed. What instructions should the nurse provide to the patient to prevent discomfort caused by breast engorgement? Select all that apply. 1 Express the milk from both breasts. 2 Perform regular breast stimulation. 3 Wear a well-fitted support bra. 4 Use a breast binder. 5 Apply ice packs on the breasts

1 The patient who has an episiotomy may have constipation due to discomfort during bowel movements. Therefore the nurse should instruct the patient to use stool softeners to help ease the passage of stools. Prenatal vitamins should be continued in all patients regardless of the episiotomy. All patients should take iron supplements to increase their hemoglobin levels. However, they do not ease the discomfort of episiotomy. Analgesics are usually prescribed for patients who underwent a cesarean.

A postpartum patient who has an episiotomy is being discharged to home. Which instruction about medications is most important for the patient? 1 Take stool softeners regularly. 2 Continue prenatal vitamins. 3 Include iron supplements. 4 Take analgesics as prescribed.

4 Because 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. Having the woman's sister as her coach, using Lamaze techniques to reduce pain, and using a birthing room are realistic plans for the birth.

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 is considered unrealistic and requires further discussion with the nurse? 1 "My husband and I have agreed that my sister will be my coach because 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." 2 "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." 3 "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." 4 "We do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage."

4 Trial of labor after cesarean is the method in which the patient who has had a cesarean delivery previously attempts to have a vaginal delivery in the present pregnancy. The patient who has preterm birth risk would generally undergo a cesarean. Women who get pregnant at an older age are at a high risk for having pregnancy complications. These women usually have cesarean delivery. The patient who has a multifetal pregnancy would generally undergo a cesarean.

A pregnant patient asks the nurse about a trial of labor after cesarean. What is the patient's reason for asking about this? The patient is: 1 Having a preterm delivery. 2 In her late 30s. 3 Having multiple fetuses. 4 Attempting a vaginal birth.

4

A pregnant patient asks the nurse, "How can I prevent blockage of the nipples while breastfeeding when my baby is born?" What cleaning instructions should the nurse provide to the patient regarding nipple care? 1 "Use soap." 2 "Apply tincture." 3 "Use alcohol." 4 "Rinse with warm water."

3 Because of their reduced gastrointestinal tract motility and intestinal compression, constipation is a common complaint among pregnant women. Gastrointestinal motility is reduced by changes in progesterone levels, which increases reabsorption of water. This in turn leads to the drying of stools, or constipation. Therefore the nurse should instruct the patient to drink six to eight glasses of water every day. During pregnancy, the nurse should not instruct the patient to take mineral oil or stool softener because they may be harmful to the fetus; these are prescribed only by the primary health care provider. Constipation may result from oral iron supplementation, but the nurse should not instruct the patient to stop taking iron supplementation because iron supplements are essential to prevent anemia.

A pregnant patient complains of constipation. While checking the patient's history, the nurse learns that the patient is taking oral iron supplements. What instruction does the nurse give the patient to relieve constipation? 1 "Drink mineral oil before going to bed." 2 "Take a stool softener before going to bed." 3 "Drink six to eight glasses of water every day." 4 "Discontinue taking iron supplements."

1, 5 Canned sardines and refried beans are rich sources of calcium. Therefore a diet containing these foods should be suggested for patients who do not drink milk. Avocado, cooked pasta, and bread have poor calcium content. These foods are rich sources of folic acid and are suggested to pregnant patients to increase folate levels.

A pregnant patient does not drink milk because of lactose intolerance. Which foods should the nurse instruct the patient to incorporate in her diet to prevent calcium deficiency? Select all that apply. 1 Sardines 2 Avocadoes 3 Cooked pasta 4 Wheat bread 5 Refried beans

4 MRI is a noninvasive technique that causes little pain. Therefore the patient undergoing MRI should be advised to not worry about pain. The patient undergoing MRI should be positioned in a supine position. The lithotomy position is not suitable for this procedure. The patient need not take fluids before the scan to ensure a full bladder because this procedure enables a full pelvic view without a full bladder. The patient should be instructed not to move during the scanning process because it may blur the images obtained.

A pregnant patient is about to undergo magnetic resonance imaging (MRI). What information does the nurse give the patient before the procedure? The patient will: 1 Be positioned in a lithotomy position. 2 Need to take fluids to have a full bladder. 3 Be able to move freely during the procedure. 4 Not have pain during the process

4 Elevated serum phosphorus levels cause leg cramps in pregnant patients. During pregnancy, hormonal changes occur in the body. Elevated estrogen levels cause nasal stuffiness, epistaxis, angiomas, and gingivitis. Elevated progesterone levels cause constipation. Leg cramps (gastrocnemius spasm) are caused when serum calcium levels are low.

A pregnant patient reports severe leg cramps, especially in the reclining posture. The nurse assesses the patient's laboratory reports. Which factor is responsible for the leg cramps in the patient? 1 Elevated estrogen level 2 Elevated progesterone level 3 Elevated serum calcium level 4 Elevated serum phosphorus level

4 Fingernails may regain strength to the prepregnancy state in a few weeks after delivery. Brittle and soft nails are caused by iron deficiency, not potassium deficiency. Carpal tunnel syndrome causes physiologic edema due to compression of the median nerve, but it does not cause brittle and soft nails. Moisture can cause soft and brittle fingers, so moisture should be reduced, not enhanced.

A pregnant patient reports to the nurse, "My nails are soft and brittle, and I am worried about it." What is the nurse's best response to the patient? 1 "You should make sure your nails are well moisturized." 2 "You have low potassium, so take potassium supplements." 3 "Your nails are soft and brittle due to carpal tunnel syndrome." 4 "After delivery your nails should return to normal consistency and strength."

1 A normal fetal kick count is an indication of fetal activity. The patient has undergone nonstress testing, which may have high false-positive rates. Therefore the patient may be scheduled for a contraction stress test. Biophysical profile testing allows detailed assessment of the physical and physiologic characteristics of the fetus. Because the kick count is normal, biophysical profile testing is not needed. Maternal serum analysis is done to determine fetal abnormalities. It is not advised in this case, because the fetal kick count indicates adequate fetal activity. Doppler blood flow analysis is a noninvasive test for analyzing fetal circulation. It cannot be used to assess the fetal heart rate.

A pregnant patient with a normal fetal kick count has come for a regular nonstress testing session. The nurse notices that there are no heart accelerations after 40 minutes of testing. What diagnostic testing will the nurse include in the plan of care? 1 Contraction stress test 2 Biophysical profile test 3 Maternal serum analysis 4 Doppler blood flow test

1, 2, 4 The nurse should instruct the patient to drink cranberry juice and acidophilus milk, because they have antibacterial properties and help prevent recurrence of urinary tract infections. The nurse should advise the patient to drink at least 2 liters of fluids per day to maintain adequate hydration. This also promotes optimal urination and prevents bacterial infection. The nurse should instruct the patient to avoid bubble baths because they can irritate the urethra. The nurse should instruct the patient to avoid using scented toilet paper because it may irritate the genitourinary tissues.

A pregnant patient with a urinary tract infection is being discharged from the hospital after recovery. What preventive measures does the nurse suggest to the patient? Select all that apply. 1 "Drink cranberry juice." 2 "Drink acidophilus milk." 3 "Regularly take bubble baths." 4 "Drink 2 liters of fluids daily." 5 "Use scented toilet paper.

2 The client works in a manufacturing unit and needs to stand for prolonged periods. During pregnancy, the patient should neither stand nor sit for prolonged periods because doing so may adversely affect fetal health. Therefore the nurse instructs the patient to not stand for a prolonged period so as to reduce the risk for preterm labor. Leg cramps result from reduced levels of diffusible serum calcium or an elevation in serum phosphorus levels. Thrombophlebitis can result from sitting with crossed legs for prolonged periods. Carpal tunnel syndrome results from compression of the median nerve that results from the changes in the surrounding tissues; it is not caused by prolonged standing or sitting.

A pregnant patient works as a supervisor in a manufacturing unit. The nurse advises the patient not to stand for prolonged periods, despite the demands of her occupation. Why should the pregnant patient not stand for prolonged periods? To lower the risk for: 1 Leg cramps 2 Preterm labor 3 Thrombophlebitis in the legs 4 Carpal tunnel syndrome

2 A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that can contribute to nausea. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A pregnant woman at 7 weeks of gestation complains to her nurse-midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse-midwife should suggest that the woman: 1 drink warm fluids with each of her meals. 2 eat a high-protein snack before going to bed. 3 keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. 4 schedule three meals and one midafternoon snack a day.

2 A pregnant woman experiencing nausea and vomiting should eat small, frequent meals. She should avoid consuming fluids early in the day or when nauseated. She should reduce her intake of fried foods and other fatty foods and should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

A pregnant woman experiencing nausea and vomiting should: 1 drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. 2 eat small, frequent meals (every 2 to 3 hours). 3 increase her intake of high-fat foods to keep the stomach full and coated. 4 limit fluid intake throughout the day.

4-1-2-0-2 Gravida (the first number) is 4 because this woman is now pregnant and was pregnant 3 times before. Para (the next 4 numbers) represents the outcomes of the pregnancies and is described as: 4T: 1 = term birth at 41 weeks of gestation (son) 4P: 2 = preterm birth at 32 weeks of gestation (stillbirth) and 36 weeks of gestation (daughter) 4A: 0 = abortion: none occurred 4L: 2 = living children: her son and her daughter.

A pregnant woman is the mother of two children. Her first pregnancy ended in a stillbirth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system (#-#-#-#-#) to describe this woman's current obstetric history, the nurse records ____________________________.

4 Sudden discharge of fluid from the vagina before 37 weeks indicates premature rupture of membranes. Severe backache or flank pain is sign of renal calculus (renal stone). Absence of fetal movements during the third trimester indicates intrauterine fetal death. A positive glucose tolerance test indicates gestational diabetes mellitus.

A pregnant woman reports a sudden discharge of fluid from the vagina before 37 weeks' gestation. What does the nurse infer from this observation? This is a sign of: 1 Renal calculus in the patient. 2 Intrauterine fetal death. 3 Gestational diabetes mellitus. 4 Premature rupture of membrane

1 If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also, the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse should be most concerned regarding what this woman consumes during and after tennis matches. Which is the most important? 1 Several glasses of fluid 2 Extra protein sources, such as peanut butter 3 Salty foods to replace lost sodium 4 Easily digested sources of carbohydrate

2 A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy is about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb per week during the second and third trimesters. One pound per week is not the correct guideline during pregnancy. One pound per week during the first two trimesters and two pounds per week thereafter is not the correct guideline for weight gain during pregnancy. A total weight gain of 25 to 35 pounds is correct, but the pattern needs to be explained to the woman.

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response is to tell the woman that her pattern of weight gain should be approximately: 1 a pound a week throughout pregnancy. 2 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. 3 a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. 4 a total of 25 to 35 lbs

4, 3, 1, 5, 2 Amniocentesis is performed to obtain the amniotic fluid, which contains the fetal cells. Amniotic fluid can be collected transabdominally under ultrasonographic visualization. After the amniotic fluid is collected, the fluid should be centrifuged. Centrifugation is done to separate the supernatant fluid and cellular components. Because the supernatant fluid has a lighter weight, it collects in the upper part of the centrifuge tube. This supernatant fluid is collected first and is sent for chemical analysis. Cellular components, which lie in the bottom of the centrifuge tube, are then collected to perform chromosomal analysis.

A primary health care provider is performing a transabdominal amniocentesis procedure in a pregnant patient. Arrange the steps of the amniocentesis procedure in the correct order. 1. Separate the supernatant fluid and cellular components. 2. Collect the cellular components for chromosomal studies. 3. Centrifuge the collected amniotic fluid. 4. Collect the amniotic fluid under ultrasonographic visualization. 5. Collect the supernatant for chemical analysis.

2 Dyspareunia is a condition of painful sexual intercourse, which results in localized dryness and coital discomfort. This is commonly seen in the woman after childbirth and is due to decreased estrogen levels, vaginal dryness, or poor lubrication of the vagina. Therefore it is usually recommended to use a water-soluble lubricant during sexual intercourse. Hemorrhoids are the enlarged veins in the anus or lower rectum that cause itching, discomfort, and bright red bleeding upon defecation. However, these are not known to cause dyspareunia. There are many foldings inside the vagina, known as rugae, which reappear within 3 weeks after childbirth. However, these foldings do not cause dyspareunia. If the woman does not practice good hygiene and health, erythema and edema may persist in the introitus, especially in the area of laceration repair.

A woman complains of dyspareunia during the involution process. What does the nurse suspect to be the cause of dyspareunia? 1 Hemorrhoids 2 Estrogen deficiency 3 Foldings in the vagina 4 Poor hygiene and health

3-1-0-1-0 Using the GPTAL system , this woman's gravidity and parity information is calculated as follows: G: Total number of times the woman has been pregnant (she is pregnant for the third time); T: Number of pregnancies carried to term (she has one stillborn); P: Number of pregnancies that resulted in a preterm birth (she has none); A: Abortions or miscarriages before the period of viability (she has had one); L: Number of children born who are currently living (she has no living children)

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. Record her gravidity and parity using the GTPAL system as x-x-x, etc.

2 An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. Heart palpitations are a normal change related to pregnancy. This is most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: 1 constipation. 2 alteration in the pattern of fetal movement. 3 heart palpitations. 4 edema in the ankles and feet at the end of the day.

2 Discussing the woman's fears allows her to share her concerns with the nurse and is a therapeutic communication tool. Telling the woman not to worry negates her fears and is not therapeutic. Telling the woman that labor is not scary negates her fears and offers a false sense of security. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: 1 "Don't worry about it. You'll do fine." 2 "It's normal to be anxious about labor. Let's discuss what makes you afraid." 3 "Labor is scary to think about, but the actual experience isn't." 4 "You may have an epidural. You won't feel anything."

4 The nonstress test is one of the most widely used techniques to determine fetal well-being and is accomplished by monitoring fetal heart rate in conjunction with fetal activity and movements. An ultrasound is the test that requires a full bladder. An amniocentesis is the test that a pregnant woman should be driven home afterward. A maternal alpha-fetoprotein test is used in conjunction with unconjugated estriol levels, and human chorionic gonadotropin helps to determine Down syndrome.

A woman who is at 36 weeks of gestation is having a nonstress test. Which statement by the woman indicates a correct understanding of the test? 1 "I will need to have a full bladder for the test to be done accurately." 2 "I should have my husband drive me home after the test because I may be nauseous." 3 "This test will help to determine if the baby has Down syndrome or a neural tube defect." 4 "This test will observe for fetal activity and an acceleration of the fetal heart rate to determine the well-being of the baby."

4 After childbirth, the abdominal wall is relaxed, so the abdomen protrudes similarly to the pregnancy state. This condition usually takes 6 weeks to return to a prepregnant state. Reducing fat content in the diet may help reduce weight. However, in postpartum patients, the protruding abdomen results from increased elasticity in the uterus and cannot be reduced by reducing fat in the diet. Vigorous exercise should not be prescribed immediately after delivery, because the patient would still be in a fragile state. Breastfeeding would help utilize the fat deposited during the pregnancy, but it does not reduce a protruding abdomen.

A worried postpartum patient reports to the nurse, "It's been 3 weeks after my delivery, and I am still showing." Which is the best response of the nurse? 1 "Reduce the fat content in your diet; it will help you." 2 "Start a vigorous exercise routine, and you will be fine." 3 "Breastfeeding the child will reduce the protruding abdomen." 4 "Three more weeks and you will most likely be back to an almost prepregnant state."

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? a. The woman leaves the infant on her bed while she takes a shower. b. The woman continues to hold and cuddle her infant after she has fed her. c. The woman reads a magazine while her infant sleeps. d. The woman changes her infant's diaper and then shows the nurse the contents of the diaper.

ANS: A Leaving an infant on a bed unattended is never acceptable for various safety reasons. Holding and cuddling the infant after feeding and reading a magazine while the infant sleeps are appropriate parent-infant interactions. Changing the diaper and then showing the nurse the contents of the diaper is appropriate because the mother is seeking approval from the nurse and notifying the nurse of the infant's elimination patterns.

New parents express concern that, because of the mother's emergency cesarean birth under general anesthesia, they did not have the opportunity to hold and bond with their daughter immediately after her birth. The nurse's response should convey to the parents that: a. Attachment, or bonding, is a process that occurs over time and does not require early contact. b. The time immediately after birth is a critical period for people. c. Early contact is essential for optimum parent-infant relationships. d. They should just be happy that the infant is healthy.

ANS: A Attachment, or bonding, is a process that occurs over time and does not require early contact. The formerly accepted definition of bonding held that the period immediately after birth was a critical time for bonding to occur. Research since has indicated that parent-infant attachment occurs over time. A delay does not inhibit the process. Parent-infant attachment involves activities such as touching, holding, and gazing; it is not exclusively eye contact. A response that conveys that the parents should just be happy that the infant is healthy is inappropriate because it is derogatory and belittling.

Discharge instruction, or teaching the woman what she needs to know to care for herself and her newborn, officially begins: a. At the time of admission to the nurse's unit. b. When the infant is presented to the mother at birth. c. During the first visit with the physician in the unit. d. When the take-home information packet is given to the couple.

ANS: A Discharge planning, the teaching of maternal and newborn care, begins on the woman's admission to the unit, continues throughout her stay, and actually never ends as long as she has contact with medical personnel

The nurse can help a father in his transition to parenthood by: a. Pointing out that the infant turned at the sound of his voice. b. Encouraging him to go home to get some sleep. c. Telling him to tape the infant's diaper a different way. d. Suggesting that he let the infant sleep in the bassinet.

ANS: A Infants respond to the sound of voices. Because attachment involves a reciprocal interchange, observing the interaction between parent and infant is very important. Separation of the parent and infant does not encourage parent-infant attachment. Educating the parent in infant care techniques is important, but the manner in which a diaper is taped is not relevant and does not enhance parent-infant interactions. Parent-infant attachment involves touching, holding, and cuddling. It is appropriate for a father to want to hold the infant as the baby sleeps.

When the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics, this is called: a. Mutuality. c. Claiming. b. Bonding. d. Acquaintance.

ANS: A Mutuality extends the concept of attachment to include this shared set of behaviors. Bonding is the process over time of parents forming an emotional attachment to their infant. Mutuality refers to a shared set of behaviors that is a part of the bonding process. Claiming is the process by which parents identify their new baby in terms of likeness to other family members and their differences and uniqueness. Mutuality refers to a shared set of behaviors that is part of the bonding process. Like mutuality, acquaintance is part of attachment. It describes how parents get to know their baby during the immediate postpartum period through eye contact, touching, and talking.

Which finding could prevent early discharge of a newborn who is now 12 hours old? a. Birth weight of 3000 g b. One meconium stool since birth c. Voided, clear, pale urine three times since birth d. Infant breastfed once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast.

ANS: D Infant breastfed once with some difficulty latching on and sucking and once with some success for about 5 minutes on each breast indicates that the infant is having some difficulty with breastfeeding. The infant needs to complete at least two successful feedings (normal sucking and swallowing) before an early discharge. Birth weight of 3000 g; one meconium stool since birth; and voided, clear, pale urine three times since birth are normal infant findings and would not prevent early discharge.

A hospital has a number of different perineal pads available for use. A nurse is observed soaking several of them and writing down what she sees. This activity indicates that the nurse is trying to: a. Improve the accuracy of blood loss estimation, which usually is a subjective assessment. b. Determine which pad is best. c. Demonstrate that other nurses usually underestimate blood loss. d. Reveal to the nurse supervisor that one of them needs some time off.

ANS: A Saturation of perineal pads is a critical indicator of excessive blood loss, and anything done to aid in assessment is valuable. The nurse is noting the saturation volumes and soaking appearances. It's possible the nurse if trying to determine which pad is best, but it is more likely that the nurse is noting saturation volumes and soaking appearances to improve the accuracy of blood loss estimation. Nurses usually overestimate blood loss, if anything. It is more likely that the nurse is noting saturation volumes and soaking appearances to improve the accuracy of blood loss estimation.

What would prevent early discharge of a postpartum woman? a. Hemoglobin <10 g b. Birth at 38 weeks of gestation c. Voids about 200 to 300 ml per void d. Episiotomy that shows slight redness and edema and is dry and approximated

ANS: A The mother's hemoglobin should be above 10 g for early discharge. The birth of an infant at term is not a criterion that would prevent early discharge. A normal voiding volume is 200 to 300 ml per void and does not indicate that the woman should not be discharged early. A normal episiotomy would show slight redness and edema and would be dry and approximated and would not prevent a woman from being discharged early.

The nurse notes that a Vietnamese woman does not cuddle or interact with her newborn other than to feed him, change his diapers or soiled clothes, and put him to bed. In evaluating the woman's behavior with her infant, the nurse realizes that: a. What appears to be a lack of interest in the newborn is in fact the Vietnamese way of demonstrating intense love by attempting to ward off evil spirits. b. The woman is inexperienced in caring for newborns. c. The woman needs a referral to a social worker for further evaluation of her parenting behaviors once she goes home with the newborn. d. Extra time needs to be planned for assisting the woman in bonding with her newborn.

ANS: A The nurse may observe a Vietnamese woman who gives minimal care to her infant and refuses to cuddle or interact with her infant. The apparent lack of interest in the newborn is this cultural group's attempt to ward off evil spirits and actually reflects an intense love and concern for the infant. It is important to educate the woman in infant care, but it is equally important to acknowledge her cultural beliefs and practices.

While admitting the pregnant woman, the nurse should be aware that postpartum hospital stays that are becoming shorter are primarily the result of the influence of: a. Health maintenance organizations (HMOs) and private insurers. b. Consumer demand. c. Hospitals. d. The federal government.

ANS: A The trend for shortened hospital stays is based largely on efforts to reduce health care costs. Secondarily consumers have demanded less medical intervention and more family-centered experiences. Hospitals are obligated to follow standards of care and federal statutes regarding discharge policies. The Newborns' and Mothers' Health Protection Act provided minimum federal standards for health plan coverage for mothers and their newborns. Under this act couples were allowed to stay in the hospital for longer periods.

The laboratory results for a postpartum woman are as follows: blood type, A; Rh status, positive; rubella titer, 1:8 (EIA 0.8); hematocrit, 30%. How would the nurse best interpret these data? a. Rubella vaccine should be given. b. A blood transfusion is necessary. c. Rh immune globulin is necessary within 72 hours of birth. d. A Kleihauer-Betke test should be performed.

ANS: A This client's rubella titer indicates that she is not immune and that she needs to receive a vaccine. These data do not indicate that the client needs a blood transfusion. Rh immune globulin is indicated only if the client has a negative Rh status and the infant has a positive Rh status. A Kleihauer-Betke test should be performed if a large fetomaternal transfusion is suspected, especially if the mother is Rh negative. The data do not provide any indication for performing this test.

In the United States the en face position is preferred immediately after birth. Nurses can facilitate this process by all of these actions except: a. Washing both the infant's face and the mother's face. b. Placing the infant on the mother's abdomen or breast with their heads on the same plane. c. Dimming the lights. d. Delaying the instillation of prophylactic antibiotic ointment in the infant's eyes.

ANS: A To facilitate the position in which the parent's and infant's faces are approximately 8 inches apart on the same plane, allowing them to make eye contact, the nurse can place the infant at the proper height on the mother's body, dim the light so that the infant's eyes open, and delay putting ointment in the infant's eyes.

What concerns about parenthood are often expressed by visually impaired mothers? Choose all that apply. a. Infant safety b. Transportation c. The ability to care for the infant d. Missing out visually e. Needing extra time for parenting activities to accommodate the visual limitations

ANS: A, B, D, E Concerns expressed by visually impaired mothers include infant safety, extra time needed for parenting activities, transportation, handling other people's reactions, providing proper discipline, and missing out visually. Blind people sense reluctance on the part of others to acknowledge that they have a right to be parents. However, blind parents are fully capable of caring for their infants.

Many first-time parents do not plan on their parents' help immediately after the newborn arrives. What statement by the nurse is the most appropriate when counseling new parents about the involvement of grandparents? a. "You should tell your parents to leave you alone." b. "Grandparents can help you with parenting skills and also help preserve family traditions." c. "Grandparent involvement can be very disruptive to the family." d. "They are getting old. You should let them be involved while they can."

ANS: B "Grandparents can help you with parenting skills and also help preserve family traditions" is the most appropriate response. Intergenerational help may be perceived as interference, but a statement of this sort is not therapeutic to the adaptation of the family. Not only is "Grandparent involvement can be very disruptive to the family" invalid, it also is not an appropriate nursing response. Regardless of age, grandparents can help with parenting skills and preserve family traditions. Talking about the age of the grandparents is not the most appropriate statement, and it does not demonstrate sensitivity on the part of the nurse.

Gestational Hypertension (GH)

High BP during pregnancy - preeclampsia -eclampsia BP > 140/90

A woman gave birth 48 hours ago to a healthy infant girl. She has decided to bottle-feed. During your assessment you notice that both of her breasts are swollen, warm, and tender on palpation. The woman should be advised that this condition can best be treated by: a. Running warm water on her breasts during a shower. b. Applying ice to the breasts for comfort. c. Expressing small amounts of milk from the breasts to relieve pressure. d. Wearing a loose-fitting bra to prevent nipple irritation.

ANS: B Applying ice to the breasts for comfort is appropriate for treating engorgement in a mother who is bottle-feeding. This woman is experiencing engorgement, which can be treated by using ice packs (since she is not breastfeeding) and cabbage leaves. A bottle-feeding mother should avoid any breast stimulation, including pumping or expressing milk. A bottle-feeding mother should wear a well-fitted support bra or breast binder continuously for at least the first 72 hours after giving birth. A loose-fitting bra will not aid lactation suppression. Furthermore, the shifting of the bra against the breasts may stimulate the nipples and thereby stimulate lactation.

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior? a. The parents have difficulty naming the infant. b. The parents hover around the infant, directing attention to and pointing at the infant. c. The parents make no effort to interpret the actions or needs of the infant. d. The parents do not move from fingertip touch to palmar contact and holding.

ANS: B Hovering over the infant and obviously paying attention to the baby are facilitating behaviors. Inhibiting behaviors include difficulty naming the infant, making no effort to interpret the actions or needs of the infant, and not moving from fingertip touch to palmar contact and holding.

Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom might say: a. High-pitched voices irritate newborns. b. Infants can learn to distinguish their mother's voice from others soon after birth. c. All babies in the hospital smell alike. d. A mother's breast milk has no distinctive odor.

ANS: B Infants know the sound of their mother's voice early. Infants respond positively to high-pitched voices. Each infant has a unique odor. Infants quickly learn to distinguish the odor of their mother's breast milk.

When dealing with parents who have some form of sensory impairment, nurses should realize that all of these statements are true except: a. One of the major difficulties visually impaired parents experience is the skepticism of health care professionals. b. Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact. c. The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities. d. Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information.

ANS: B Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. The skepticism, open or hidden, of health care professionals places an additional and unneeded hurdle for the parents. After the parents' capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a child's cry. Sign language is acquired readily by young children.

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to: a. Tell the mother she must pay attention to her infant. b. Show the mother how the infant initiates interaction and pays attention to her. c. Demonstrate for the mother different positions for holding her infant while feeding. d. Arrange for the mother to watch a video on parent-infant interaction.

ANS: B Pointing out the responsiveness of the infant is a positive strategy for facilitating parent-infant attachment. Telling the mother that she must pay attention to her infant may be perceived as derogatory and is not appropriate. Educating the young mother in infant care is important, but pointing out the responsiveness of her baby is a better tool for facilitating mother-infant attachment. Videos are an educational tool that can demonstrate parent-infant attachment, but encouraging the mother to recognize the infant's responsiveness is more appropriate.

With regard to the adaptation of other family members, mainly siblings and grandparents, to the newborn, nurses should be aware that: a. Sibling rivalry cannot be dismissed as overblown psychobabble; negative feelings and behaviors can take a long time to blow over. b. Participation in preparation classes helps both siblings and grandparents. c. In the United States paternal and maternal grandparents consider themselves of equal importance and status. d. Since 1990 the number of grandparents providing permanent care to their grandchildren has been declining.

ANS: B Preparing older siblings and grandparents helps with everyone to adapt. Sibling rivalry should be expected initially, but the negative behaviors associated with it have been overemphasized and stop in a comparatively short time. In the United States, in contrast to other cultures, paternal grandparents frequently consider themselves secondary to maternal grandparents. The number of grandparents providing permanent child care has been rising.

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, would the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? a. Talks and coos to her son b. Seldom makes eye contact with her son c. Cuddles her son close to her d. Tells visitors how well her son is feeding

ANS: B The woman should be encouraged to hold her infant in the en face position and make eye contact with the infant. Normal infant-parent interactions include talking and cooing to her son, cuddling her son close to her, and telling visitors how well her son is feeing.

With regard to rubella and Rh issues, nurses should be aware that: a. Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus. b. Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1 month after vaccination. c. Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant. d. Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

ANS: B Women should understand they must practice contraception for 1 month after being vaccinated. Because the live attenuated rubella virus is not communicable in breast milk, breastfeeding mothers can be vaccinated. Rh immune globulin is administered intramuscularly; it should never be given to an infant. Rh immune globulin suppresses the immune system and therefore might thwart the rubella vaccination

A recently delivered mother and her baby are at the clinic for a 6-week postpartum checkup. The nurse should be concerned that psychosocial outcomes are not being met if the woman: a. Discusses her labor and birth experience excessively. b. Believes that her baby is more attractive and clever than any others. c. Has not given the baby a name. d. Has a partner or family members who react very positively about the baby.

ANS: C If the mother is having difficulty naming her new infant, it may be a signal that she is not adapting well to parenthood. Other red flags include refusal to hold or feed the baby, lack of interaction with the infant, and becoming upset when the baby vomits or needs a diaper change. A new mother who is having difficulty would be unwilling to discuss her labor and birth experience. An appropriate nursing diagnosis might be impaired parenting related to a long, difficult labor or unmet expectations of birth. A mother who is willing to discuss her birth experience is making a healthy personal adjustment. The mother who is not coping well would find her baby unattractive and messy. She may also be overly disappointed in the baby's sex. The client might voice concern that the baby reminds her of a family member whom she does not like. Having a partner and/or other family members react positively is an indication that this new mother has a good support system in place. This support system will help reduce anxiety related to her new role as a mother.

Of the many factors that influence parental responses, nurses should be aware that all of these statements regarding age are true except: a. An adolescent mother's egocentricity and unmet developmental needs interfere with her ability to parent effectively. b. An adolescent mother is likely to use less verbal instruction, be less responsive, and interact less positively than other mothers. c. Adolescent mothers have a higher documented incidence of child abuse. d. Mothers older than 35 often deal with more stress related to work and career issues and decreasing libido.

ANS: C Adolescent mothers are more inclined to have a number of parenting difficulties that benefit from counseling, but a higher incidence of child abuse is not one of them. Midlife mothers have many competencies but are more likely to have to deal with career and sexual issues than are younger mothers.

The nurse hears a primiparous woman talking to her son and telling him that his chin is just like his dad's chin. This woman's statement reflects: a. Mutuality. c. Claiming. b. Synchrony. d. Reciprocity.

ANS: C Claiming refers to the process by which the child is identified in terms of likeness to other family members. Mutuality occurs when the infant's behaviors and characteristics call forth a corresponding set of maternal behaviors and characteristics. Synchrony refers to the "fit" between the infant's cues and the parent's responses. Reciprocity is a type of body movement or behavior that provides the observer with cues.

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

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

With regard to parents' early and extended contact with their infant and the relationships built, nurses should be aware that: a. Immediate contact is essential for the parent-child relationship. b. Skin-to-skin contact is preferable to contact with the body totally wrapped in a blanket. c. Extended contact is especially important for adolescents and low-income women because they are at risk for parenting inadequacies. d. Mothers need to take precedence over their partners and other family matters.

ANS: C Nurses should encourage any activity that optimizes family extended contact. Immediate contact facilitates the attachment process but is not essential; otherwise, adopted infants would not establish the affectionate ties they do. The mode of infant-mother contact does not appear to have any important effect. Mothers and their partners are considered equally important.

The early postpartum period is a time of emotional and physical vulnerability. Many mothers can easily become psychologically overwhelmed by the reality of their new parental responsibilities. Fatigue compounds these issues. Although the baby blues are a common occurrence in the postpartum period, about one-half million women in America experience a more severe syndrome known as postpartum depression (PPD). Which statement regarding PPD is essential for the nurse to be aware of when attempting to formulate a nursing diagnosis? a. PPD symptoms are consistently severe. b. This syndrome affects only new mothers. c. PPD can easily go undetected. d. Only mental health professionals should teach new parents about this condition.

ANS: C PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. PPD symptoms range from mild to severe, with women having both good and bad days. Both mothers and fathers should be screened. PPD in new fathers ranges from 1% to 26%. The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur

If a woman is at risk for thrombus and is not ready to ambulate, nurses might intervene by doing all of these interventions except: a. Putting her in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots. b. Having her flex, extend, and rotate her feet, ankles, and legs. c. Having her sit in a chair. d. Notifying the physician immediately if a positive Homans' sign occurs.

ANS: C Sitting immobile in a chair will not help. Bed exercise and prophylactic footwear might.TED hose and SCD boots are recommended. Bed exercises, such as flexing, extending, and rotating her feet, ankles, and legs, are useful. A positive Homans' sign (calf muscle pain or warmth, redness, or tenderness) requires the physician's immediate attention.

Under the Newborns' and Mothers' Health Protection Act, all health plans are required to allow new mothers and newborns to remain in the hospital for a minimum of _____ hours after a normal vaginal birth and for _____ hours after a cesarean birth. a. 24, 73 c. 48, 96 b. 24, 96 d. 48, 120

ANS: C The specified stays are 48 hours (2 days) for a vaginal birth and 96 hours (4 days) for a cesarean birth. The attending provider and the mother together can decide on an earlier discharge.

A 25-year-old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-pound, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating, "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is: a. Retained placental fragments. c. Uterine atony. b. Unrepaired vaginal lacerations. d. Puerperal infection.

ANS: C This woman gave birth to a macrosomic boy after Pitocin augmentation. The most likely cause of bleeding 4 hours after delivery, combined with these risk factors, is uterine atony. Although retained placental fragments may cause postpartum hemorrhage, this typically would be detected in the first hour after delivery of the placenta and is not the most likely cause of hemorrhage in this woman. Although unrepaired vaginal lacerations may cause bleeding, they typically would occur in the period immediately after birth. Puerperal infection can cause subinvolution and subsequent bleeding, but it typically would be detected 24 hours after delivery.

Excessive blood loss after childbirth can have several causes; the most common is: a. Vaginal or vulvar hematomas. b. Unrepaired lacerations of the vagina or cervix. c. Failure of the uterine muscle to contract firmly. d. Retained placental fragments.

ANS: C Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention. Although vaginal or vulvar hematomas, unpaired lacerations of the vagina or cervix, and retained placental fragments are possible causes of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause.

Nursing activities that promote parent-infant attachment are many and varied. One activity that should not be overlooked is the management of the environment. While providing routine mother-baby care, the nurse should ensure that: a. The baby is able to return to the nursery at night so that the new mother can sleep. b. Routine times for care are established to reassure the parents. c. The father should be encouraged to go home at night to prepare for mother-baby discharge. d. An environment that fosters as much privacy as possible should be created.

ANS: D Care providers need to knock before gaining entry. Nursing care activities should be grouped. Once the baby has demonstrated adjustment to extrauterine life (either in the mother's room or the transitional nursery), all care should be provided in one location. This important principle of family-centered maternity care fosters attachment by giving parents the opportunity to learn about their infant 24 hours a day. One nurse should provide care to both mother and baby in this couplet care or rooming-in model. It is not necessary for the baby to return to the nursery at night. In fact, the mother will sleep better with the infant close by. Care should be individualized to meet the parents' needs, not the routines of the staff. Teaching goals should be developed in collaboration with the parents. The father or other significant other should be permitted to sleep in the room with the mother. The maternity unit should develop policies that allow for the presence of significant others as much as the new mother desires.

Nursing care in the fourth trimester includes an important intervention sometimes referred to as taking the time to mother the mother. Specifically this expression refers to: a. Formally initializing individualized care by confirming the woman's and infant's identification (ID) numbers on their respective wrist bands. ("This is your baby.") b. Teaching the mother to check the identity of any person who comes to remove the baby from the room. ("It's a dangerous world out there.") c. Including other family members in the teaching of self-care and child care. ("We're all in this together.") d. Nurturing the woman by providing encouragement and support as she takes on the many tasks of motherhood.

ANS: D Many professionals believe that the nurse's nurturing and support function is more important than providing physical care and teaching. Matching ID wrist bands is more of a formality, but it is also a get-acquainted procedure. "Mothering the mother" is more a process of encouraging and supporting the woman in her new role. Having the mother check IDs is a security measure for protecting the baby from abduction. Teaching the whole family is just good nursing practice. ANS: D Many professionals believe that the nurse's nurturing and support function is more important than providing physical care and teaching. Matching ID wrist bands is more of a formality, but it is also a get-acquainted procedure. "Mothering the mother" is more a process of encouraging and supporting the woman in her new role. Having the mother check IDs is a security measure for protecting the baby from abduction. Teaching the whole family is just good nursing practice.

A 25-year-old multiparous woman gave birth to an infant boy 1 day ago. Today her husband brings a large container of brown seaweed soup to the hospital. When the nurse enters the room, the husband asks for help with warming the soup so that his wife can eat it. The nurse's most appropriate response is to ask the woman: a. "Didn't you like your lunch?" b. "Does your doctor know that you are planning to eat that?" c. "What is that anyway?" d. "I'll warm the soup in the microwave for you."

ANS: D "I'll warm the soup in the microwave for you" shows cultural sensitivity to the dietary preferences of the woman and is the most appropriate response. Cultural dietary preferences must be respected. Women may request that family members bring favorite or culturally appropriate foods to the hospital. "What is that anyway?" does not show cultural sensitivity.

After giving birth to a healthy infant boy, a primiparous woman, 16, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is risk for impaired parenting related to deficient knowledge of newborn care. In planning for the woman's discharge, what should the nurse be certain to include in the plan of care? a. Tell the woman how to feed and bathe her infant. b. Give the woman written information on bathing her infant. c. Advise the woman that all mothers instinctively know how to care for their infants. d. Provide time for the woman to bathe her infant after she views an infant bath demonstration.

ANS: D Having the mother demonstrate infant care is a valuable method of assessing the client's understanding of her newly acquired knowledge, especially in this age group, because she may inadvertently neglect her child. Although verbalizing how to care for the infant is a form of client education, it is not the most developmentally appropriate teaching for a teenage mother. Although providing written information is useful, it is not the most developmentally appropriate teaching for a teenage mother. Advising the woman that all mothers instinctively know how to care for their infants is an inappropriate statement; it is belittling and false

Because a full bladder prevents the uterus from contracting normally, nurses intervene to help the woman empty her bladder spontaneously as soon as possible. If all else fails, the last thing the nurse might try is: a. Pouring water from a squeeze bottle over the woman's perineum. b. Placing oil of peppermint in a bedpan under the woman. c. Asking the physician to prescribe analgesics. d. Inserting a sterile catheter.

ANS: D Invasive procedures usually are the last to be tried, especially with so many other simple and easy methods available (e.g., water, peppermint vapors, pain pills). Pouring water over the perineum may stimulate voiding. It is easy, noninvasive, and should be tried early. The oil of peppermint releases vapors that may relax the necessary muscles. It is easy, noninvasive, and should be tried early. If the woman is anticipating pain from voiding, pain medications may be helpful. Other nonmedical means could be tried first, but medications still come before insertion of a catheter.

The trend in the United States is for women to remain hospitalized no longer than 1 or 2 days after giving birth for all of the following reasons except: a. A wellness orientation rather than a sick-care model. b. A desire to reduce health care costs. c. Consumer demand for fewer medical interventions and more family-focused experiences. d. Less need for nursing time as a result of more medical and technologic advances and devices available at home that can provide information.

ANS: D Nursing time and care are in demand as much as ever; the nurse just has to do things more quickly. A wellness orientation seems to focus on getting clients out the door sooner. Less hospitalization means lower costs in most cases. People believe the family gives more nurturing care than the institution

After birth a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as: a. Entrainment. c. Synchrony. b. Reciprocity. d. Biorhythmicity.

ANS: D The newborn is in rhythm with the mother. The infant develops a personal biorhythm with the parents' help over time. Entrainment is the movement of newborns in time to the structure of adult speech. Reciprocity is body movement or behavior that gives cues to the person's desires. These take several weeks to develop with a new baby. Synchrony is the fit between the infant's behavioral cues and the parent's responses.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: a. Begin an intravenous (IV) infusion of Ringer's lactate solution. b. Assess the woman's vital signs. c. Call the woman's primary health care provider. d. Massage the woman's fundus.

ANS: D The nurse should assess the uterus for atony. Uterine tone must be established to prevent excessive blood loss. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from impending hemorrhage; assessing vital signs should not be the nurse's first action. The physician would be notified after the nurse completes the assessment of the woman.

A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath TID, and a stool softener. What information is most closely correlated with these orders? a. The woman is a gravida 2, para 2. b. The woman had a vacuum-assisted birth. c. The woman received epidural anesthesia. d. The woman has an episiotomy.

ANS: D These orders are typical interventions for a woman who has had an episiotomy, lacerations, and hemorrhoids. A multiparous classification is not an indication for these orders. A vacuum-assisted birth may be used in conjunction with an episiotomy, which would indicate these interventions. Use of epidural anesthesia has no correlation with these orders

A nurse who administers the incorrect medication because of a failure to check the medication order is involved in an

Active Error

Effect on Fetal circulation

Affected by mom's position, uterine contractions, blood pressure, umbilical cord blood flow. Fetal umbilical cord can become compressed during contractions

1, 2, 4 Carpal tunnel syndrome results from compression of the median nerve caused by changes in the surrounding tissues. Tingling, numbness, and dropping of objects are symptoms of carpal tunnel syndrome. It causes pain and loss of skilled movements. During pregnancy, the sweat glands are more active, and this results in increased sweating. Flatulence with bloating occurs during pregnancy because of reduced gastrointestinal motility caused by hormonal changes.

After assessing a pregnant patient, the nurse finds that the patient has carpal tunnel syndrome. Which symptoms helped the nurse to arrive at this conclusion? Select all that apply. 1 Tingling 2 Numbness 3 Increased sweating 4 Dropping of objects 5 Flatulence and bloating

1, 4 Tachycardia (an increase in the FHR) is the early sign of fetal hypoxemia. Prolonged decelerations in FHR lasting for more than 2 minutes indicates the fetus is hypoxemic. Early decelerations, moderate variability, and occasional variable decelerations in the FHR are common observations during labor. These are normal findings and require no intervention.

After monitoring the fetal heart activity, the nurse concludes that there is impaired fetal oxygenation. What had the nurse observed in the fetal monitor to come to this conclusion? Select all that apply. 1 Increase in the fetal heart rate (FHR) to over 160 beats/min 2 Early decelerations 3 Moderate variability 4 Late decelerations 5 Occasional variable decelerations

2, 3 When performing the ECG of the fetus, the nurse should insert the electrode into the cervix to reach the fetus. Therefore the nurse should check if the cervix is dilated up to 3 cm and if the membranes are ruptured. This allows the nurse to reach the fetus's position. Lactate levels do not affect the ECG testing and thus need not be checked before the test. Umbilical cord compression or decreased frequency of UCs is not the required conditions for performing an ECG on the fetus.

After observing the electronic fetal monitor, a primary health care provider asks the nurse to conduct an electrocardiogram (ECG) of the fetus. What should the nurse assess before obtaining an ECG of the fetus? Select all that apply. 1 Fetal lactate levels 2 Placental membranes 3 Cervical dilation 4 Umbilical cord compression 5 Frequency of uterine contractions

4 In the umbilical cord acid-base stimulation method, arterial values indicate the condition of the newborn. Arterial blood pH of 7.2 to 7.3, carbon dioxide pressure (Pco2) value of 45 to 55 mm Hg, and oxygen pressure (Po2) value of 15 to 25 mm Hg approximately indicates the normal fetal condition. Therefore pH of 7.3, Pco2 of 45 mm Hg, and Po2 of 25 mm Hg represent the normal fetal condition. Arterial blood pH of 7.1, Pco2 of 50 mm Hg, and Po2 of 20 mm Hg indicate that the fetus may have respiratory acidosis. Arterial blood pH of 7.4 is indicative of fetal alkalosis.

After observing the reports of the umbilical cord acid-base determination test, the nurse informs the patient that the newborn's condition is normal. Which value indicates the normal condition of the newborn? 1 Umbilical artery: pH, 7.1; Pco2, 50 mm Hg; Po2, 20 mm Hg 2 Umbilical artery: pH, 7.3; Pco2, 40 mm Hg; Po2, 10 mm Hg 3 Umbilical artery: pH, 7.4; Pco2, 52 mm Hg; Po2, 27 mm Hg 4 Umbilical artery: pH, 7.3; Pco2, 45 mm Hg; Po2, 25 mm Hg

2 The nurse should place the patient in a position that helps the rotation of the fetal occiput from a posterior to an anterior position. Therefore the nurse should encourage the patient to sit in hands-and-knees position, as it increases the pelvic diameter, allowing the head to rotate toward anterior position. The patient should not lie in supine position, as it may cause postural hypotension. Placing a pillow under the patient's hip when lying in supine position helps prevent supine hypotensive syndrome, but does not help in delivering the baby. The nurse should not ask the patient to lie in lateral position on the opposite side of the fetal spine, as it increases counter pressure on the back. Instead, lying in lateral position on the same side of the fetal spine will help the fetus rotate toward the posterior, as the gravity pulls the fetal back forward.

After performing Leopold maneuvers, the nurse finds that the fetus of a pregnant patient is in occiput posterior position. Which suitable action should the nurse employ while caring for the patient? 1 Help the patient to lie in supine position on the bed. 2 Encourage the patient to sit in hands-and-knees position. 3 Place a pillow under the patient's hip when lying in supine position. 4 Ask the patient to lie in lateral position on the opposite side of the fetal spine.

2 Exposure to nicotine from maternal smoking has been reported to increase the fetal S/D ratio. An elevated S/D ratio indicates a poorly perfused placenta. To improve the blood supply to the placenta, the patient should quit smoking as soon as possible. The AFV cannot be assessed through Doppler umbilical blood flow study. Moreover, smoking does not affect amniotic fluid volume. Smoking increases the S/D ratio; it does not decrease it.

After reviewing the Doppler umbilical flow reports of a pregnant patient, the nurse advises the patient to quit smoking immediately. Which finding in the report could be the reason for this instruction? 1 High amniotic fluid volume (AFV) 2 High systolic-to-diastolic (S/D) ratio 3 Low amniotic fluid volume (AFV) 4 Low systolic-to-diastolic (S/D) ratio

4 If the BPP score is 8 to 10, then the test should be repeated weekly or twice weekly. If the BPP score is 0 to 2, then chronic asphyxia may be suspected. In this case the testing time should be extended to 120 minutes. If the BPP score is 4 after 36 weeks' gestation, then clinical conditions exist that may lead to an eminent delivery. If the BPP score is 4 before 32 weeks' gestation, the test should be repeated. If the BPP score is 6 at 36 to 37 weeks' gestation with positive fetal pulmonary testing, then delivery can be performed. If the BPP score is 6 before 36 weeks' gestation with negative pulmonary testing, then BPP can be repeated in 4 to 6 hours, and if oligohydramnios is present, then delivery can be done. The BPP provides an insight into fetal maturity and well-being and as such should be used as a diagnostic tool to plan and evaluate management of care. Findings are related to several factors involving both maternal and fetal characteristics.

After reviewing the biophysical profile (BPP) reports of a pregnant patient close to term, the nurse advises the patient to repeat the test on a weekly basis. What BPP score did the nurse find in the report? 1. 1 2. 4 3. 6 4. 9

2, 4, 5 The laboratory findings may indicate the health condition of the patient. The hemoglobin value is 13 g/dL, which is within the normal range (greater than 11 g/dL). The mean corpuscular hemoglobin value of 30 pg (normal range = 27-31 pg) and the mean corpuscular hemoglobin concentration of 34 g/dL (normal range = 32-36 g/dL) also imply normal findings. The bladder capacity of 1000 mL is less than the normal value (1500 mL). The total serum proteins value of 5.1 g/dL is not within the normal range (5.5-7.5 g/dL). These findings would not indicate that the patient is normal.

After reviewing the laboratory reports of a 5-month pregnant female, the nurse tells the patient that her condition is normal. Which findings enabled the nurse to conclude that the patient is healthy? Select all that apply. 1 The patient's bladder has a capacity of 1000 mL. 2 The hemoglobin value is 13 g/dL in the patient. 3 The total serum proteins value is 5.1 g/dL in the patient. 4 The mean corpuscular hemoglobin value is 30 pg. 5 The mean corpuscular hemoglobin concentration is 34 g/dL.

1 I.V. fluids are administered to increase the amount of fluids and restore the electrolyte balance. As the patient is dehydrated, the PHP advises the nurse to administer I.V. fluids. Administration of I.V. fluids as a medical treatment for the prevention of preterm labor is not indicated unless medical management involves use of therapeutic protocols such as magnesium sulfate. As the patient is at term, preterm labor would not be a factor. Administering fluids may increase the venous pressure, thereby enhancing the blood pressure. Therefore I.V. fluids must not be administered if the patient has hypertension. Other prospective medical management should be initiated if maternal hypertension is noted. I.V. fluids should not be administered to hyperglycemic patients, but rather other prospective medical management should be initiated if maternal hyperglycemia is noted and deemed to be significant.

After reviewing the laboratory reports of a pregnant patient at term, the primary health care provider (PHP) advised the nurse to administer intravenous (I.V.) fluids to the patient. What is the reason for giving such advice? 1 Dehydration 2 Hypertension 3 Maternal hyperglycemic 4 Preterm labor

4 Stable or decreasing fundal height indicates that fetal growth does not correspond to the mother's gestational age. This indicates intrauterine growth restriction of the fetus. Polyhydramnios is a condition in which the amniotic fluid volume is greater than normal. In this condition, fundal height is greater than normal. Multifetal gestation is the presence of more than one child. Maternal malnourishment may affect the growth of the fetus but is not directly associated with fundal height.

After reviewing the obstetric reports of a pregnant patient, the nurse finds that the patient's fundal height has not changed in the last 4 weeks. What condition does the nurse potentially interpret from this finding? 1 Polyhydramnios 2 Multifetal gestation 3 Maternal malnourishment 4 Intrauterine growth restriction (IUGR)

1 An AFI less than 5 cm indicates oligohydramnios. Oligohydramnios is associated with intrauterine growth restriction and congenital anomalies. An AFI of 10 cm or greater indicates that the fetus is normal. AFI values between 5 and 10 cm are considered low normal, indicating a comparatively low risk for congenital anomalies. An AFI greater than 25 cm indicates polyhydramnios. This is associated with neural tube defects and obstruction of the fetal gastrointestinal tract.

After reviewing the reports of a pregnant patient, the nurse infers that there might be a high risk for intrauterine growth restriction (IUGR). What could be the reason for this? The amniotic fluid index (AFI) is: 1 Less than 5 cm. 2 Equal to or more than 10 cm. 3 Between 5 and 10 cm. 4 More than 25 cm

3 Specialized or targeted ultrasound scans are performed only if a patient is suspected of carrying an anatomically or physiologically abnormal fetus. Limited ultrasound examination is used to estimate the amniotic fluid volume. Standard ultrasound scan is used to see the detailed anatomy of the fetus. Ultrasound scan is not used to find genetic abnormalities in the fetus.

After reviewing the standard ultrasound scan reports of a pregnant patient, the nurse advises the patient to undergo a specialized ultrasound scan. What is the nurse's rationale for this suggestion? 1 To estimate the amniotic fluid volume 2 To identify the detailed fetal anatomy 3 To assess for physiologic abnormalities 4 To assess for fetal genetic abnormalities

4 If pH 2 >55 mm Hg (elevated), and base deficit value respiratory acidosis. In this case, the partial pressure carbon dioxide >55 mm Hg is indicative of respiratory acidosis. A pH >7.20 and base deficit value ≥12 mmol/L are all considered normal. Blood glucose level is not a part of this acid-base report.

After reviewing the umbilical cord acid-base report, the nurse confirms that the fetus has respiratory acidosis. Which reading is consistent with the nurse's conclusion? 1 A base deficit value ≥12 mmol/L 2 Blood glucose levels = 120 mg/dL 3 Arterial pH >7.20 4 Partial pressure carbon dioxide >55 mm Hg

Near miss:

An error or commission or omission that could have harmed the pt. but serious harm did not occur. ex- (the pt received a contraindicated drug but did not experience and adverse drug reaction) ex- (a potentially lethal overdose was prescribed but nurse identifies problem prior to administration)

Adverse event:

An event that results in unintended harm to the pt. by an act of commission or omission rather than by the condition of the pt.

4 Uterine contractions that accompany orgasm can stimulate labor and can be problematic if the woman is at risk for or has a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: 1 intercourse should be avoided. 2 intercourse is safe until the third trimester. 3 safer-sex practices should be used once the membranes rupture. 4 intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

2, 1, 4, 5, 3 While performing transvaginal ultrasonography, the nurse should first position the patient in the lithotomy position to ensure the optimal view of pelvic structures. The transducer probe is then covered with a suitable probe cover. Then the probe is lubricated with a water-soluble gel to increase penetration of ultrasonic waves. The probe is then inserted into the patient's vagina. Finally, the position of the probe is adjusted for a better view of the inner pelvic structures.

Arrange the steps the nurse takes while performing transvaginal ultrasonography for a pregnant patient, in the correct order. 1. Cover the transducer probe with a probe cover. 2. Position the pregnant patient in the lithotomy position. 3. Position the probe for proper view of pelvic structures. 4. Lubricate the transducer probe with water-soluble gel. 5. Insert the transducer probe into the patient's vagina.

The nurse administers concentrated oral sucrose through the suckling method to a neonate before performing the heelstick method. Why would the nurse do this?

As a source of comfort to the infant The heelstick method is used to collect blood to estimate various biologic and chemical materials. The nurse administers oral sucrose to a neonate before performing a painful procedure such as the heelstick method to comfort the neonate. It is not necessary to hydrate the neonate before performing the heelstick method. Hydration of a neonate is usually achieved by administering human milk or infant formula. The infant's glucose levels are maintained by infusing dextrose; it is not used to recognize reflexes in infant.

1, 5 Breasts are essentially unchanged for the first 24 hours after birth. Colostrum, or early milk, a clear, yellow fluid, may be expressed from the breasts during the first 24 hours. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used.

As part of postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1-day postpartum. Expected findings include: Select all that apply. 1 little if any change. 2 leakage of milk at let-down. 3 swollen, warm, and tender on palpation. 4 a few blisters and a bruise on each areola. 5 small amount of clear, yellow fluid expressed

The nurse auscultates a neonate in resting position and hears a murmur. What further assessments should the nurse make to know if the infant has any cardiac defects?

Assess BP in all 4 extremities When murmurs are heard, the nurse should check the neonates' BP from all four extremities to rule out congenital heart diseases. Circumference of the head is measured to detect head-related complications, such as microcephaly and hydrocephaly. However, it is unrelated to congenital heart disease. Assessing the body movements would correlate more with the muscular activity of the neonate but not with cardiac activity.

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

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: 1 wear a snug, supportive bra. 2 allow warm water to soothe the breasts during a shower. 3 express milk from breasts occasionally to relieve discomfort. 4 place absorbent pads with plastic liners into her bra to absorb leakage.

1 Biochemical findings such as an L/S ratio of 2:1, an S/A ratio of 60 mg/g, and the presence of PG in amniotic fluid indicate that the fetal lungs are well developed. The gestational age can be predicted only with the help of creatinine and lipid levels in the amniotic fluid. Creatinine levels greater than 2 mg/dL in amniotic fluid indicate that the gestational age is more than 36 weeks. The presence of alpha-fetoprotein (AFP) in the amniotic fluid indicates a neural tube defect in the fetus. The nurse needs to assess AFP levels in the amniotic fluid to determine whether the fetus has an open neural tube defect. A high AFP level in amniotic fluid after 15 weeks' gestation indicates that the fetus has an open neural tube defect.

Biochemical examination of the amniotic fluid of a pregnant patient yields the following results: lecithin-to-sphingomyelin (L/S) ratio, 2:1; surfactant-to-albumin (S/A) ratio, 60 mg/g; and phosphatidylglycerol (PG) present. What conclusions will the nurse draw from this report? 1 The fetal lungs are well developed. 2 The gestational age is 36 weeks. 3 The fetus has a neural tube defect. 4 The fetus has an open neural tube defect.

Exemplars of Safety (system level)

Care coordination Documentation/electronic records Team systems Work processes Communication processes Environmental system Error Reporting/Analysis Regulatory system National quality benchmarks

The mother of a newborn reports that the baby scratches himself with his long nails. What would the nurse suggest to the mother? Select all that apply. 1 Clip the baby's nails every day. 2 Cut the nails while the baby is playing. 3 Cut the nails while the baby is sleeping. 4 Cut the nails while breastfeeding the baby. 5 Cover the baby's hands with loose-fitting mitts

Clip the baby's nails every day, Cut the nails while the baby is sleeping, Cover the baby's hands with loose-fitting mitts Cover the baby's hands with loose-fitting mitts. The nurse suggests that the mother cut the baby's nails when the baby is sleeping. Covering the hands of the baby with loose-fitting mitts would protect the baby from scratching himself. Since the nails do not grow very fast, it is not necessary to cut them daily. The infant's nails should not be cut while playing, because it may disturb the movement of extremities and could cause injuries to the fingers. Cutting the nails while the baby is breastfeeding is also not recommended, because it disturbs the feeding infant.

Health Care Quality

Defined as identifying the gap that occurs between ideal care and actual care delivered.

Types of Errors

Diagnostic Treatment Preventive Communication failure

Human factors

Disjointed supply sources Missing or nonfunctioning supplies or equipment Repetitive travel Interruptions Waiting for systems Difficulty in accessing resources to continue care Breakdown in communication Communication media

1 At approximately six weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign is flexibility of the uterus at the junction of the cervix and uterus and usually can be detected at seven to eight weeks of gestation. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.

During a woman's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse documents this finding as the: 1 Hegar sign. 2 McDonald sign. 3 Chadwick sign. 4 Goodell sign

4 Leopold maneuvers (abdominal palpation) help identify the degree of descent into the pelvis of the presenting part in a pregnant patient. Therefore the nurse should grasp the lower pole of the uterus between the thumb and fingers, pressing in slightly in order to determine whether the fetal head is flexed or extended. Identifying the fetal part that occupies the fundus of the patient helps to identify the fetal position. The fetal head is palpated with the palmar surface of the fingertips using both hands, but not with only the right hand to determine the cephalic prominence. Palpation of the smooth convex contour of the fetal back and irregularities using the palmar surface of one hand is not used to determine the attitude of the fetal head. This maneuver helps identify the feet, hands, and elbows of the fetus.

During an assessment, the nurse is instructed to determine the position of the fetal head in a pregnant patient. What should the nurse do to determine whether the fetal head is flexed or extended? 1 Palpate the fetal head with the palmar surface of the fingertips of the right hand. 2 Identify the fetal part that occupies the fundus in the uterus of the pregnant patient. 3 Palpate the smooth convex contour of the fetal back using the palmar surface of one hand. 4 Grasp the lower pole of the uterus between the thumb and fingers, pressing in slightly.

1 Hypertension is caused by decreased levels of potassium and increased intake of sodium. To prevent the risk for hypertension, the nurse instructs the patient to consume 8 to 10 cups of vegetables and fruits, low fat meats, and dairy products. These foods are rich sources of potassium and also reduce the sodium content in the body. This helps prevent hypertension. Milk is a rich source of calcium and does not prevent hypercalcemia. These food choices do not enhance uric acid excretion and therefore do not prevent hypouricemia. Hypothyroidism is caused by the imbalance of thyroid hormones.

During the assessment of a pregnant patient, the nurse instructs the patient to eat eight to ten servings of vegetables and fruits, three servings of milk products, and incorporate low-fat meats daily. What is the most probable reason for giving such instruction? To prevent: 1 Hypertension 2 Hypercalcemia 3 Hypouricemia 4 Hypothyroidism

2 Estrogen levels increase during pregnancy and result in hyperemia of mucous membranes, which is characterized by nasal stuffiness and nose bleeding. Anemia is caused by low iron levels. High progesterone levels slow gastrointestinal tract motility and digestion, which may cause constipation. Low serum calcium levels cause gastrocnemius spasm.

During the first trimester of pregnancy, a patient reports nasal stuffiness and nose bleeding. What does the nurse identify as the probable reason? 1 Low iron level 2 High estrogen level 3 High progesterone level 4 Low serum calcium level

3 During the first trimester, a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family is an appropriate topic for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester, a woman works on the task of, "I am going to have a baby." Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

During the first trimester, the pregnant woman is most motivated to learn about: 1 fetal development. 2 impact of a new baby on family members. 3 measures to reduce nausea and fatigue so she can feel better. 4 location of childbirth preparation and breastfeeding classes.

Consequences Negative (Outcomes)

Extended Hospitalization Injury Death Cost Liability

REVIEW TABLE 5-1

Fetal Diagnostic tests (pp. 80-81) Focus on: - Ultrasound - Kick count - Alpa-fetoprotein testing (AFP) - Amniocentesis - Non-stress test - Contraction Stress Test

3 Variability in the fetal heart rate can be classified as absent, mild, or moderate variability. This results in hypoxia and metabolic acidemia in the fetus. Central nervous system (CNS) depressants, such as secobarbital (Seconal), cause variability in the fetal heart rate. This medication affects the baseline heart rate in the fetus by less than 5 beats/min. Hydroxyzine (Vistaril), terbutaline (Brethine), and atropine (Sal-Tropine) may result in tachycardia in the fetus. These drugs can increase the baseline fetal heart rate as much as 25 beats/min.

Fetal monitoring of a pregnant patient revealed that the fetal heart rate has minimal variability. Which prescribed drug is most likely responsible for the condition? 1 Hydroxyzine (Vistaril) 2 Terbutaline (Brethine) 3 Secobarbital (Seconal) 4 Atropine (Sal-Tropine)

1 Fetal well-being during labor is measured by the response of the FHR to UCs . In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of this text over an extended period of time ensures your understanding of the mechanics of the examination and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

Fetal well-being during labor is assessed by: 1 the response of the fetal heart rate (FHR) to uterine contractions (UCs). 2 maternal pain control. 3 accelerations in the FHR. 4 an FHR greater than 110 beats/min

3 Smoking and alcohol stimulates the sympathetic nervous system. Thus the heart rate and blood pressure gets increased, which may also affect the fetus. Alcohol and smoking are usually consumed to relieve stress and are not known to induce stress in pregnancy. Hemolytic anemia is a form of anemia that occurs because of hemolysis of red blood cell (RBC). Smoking and alcohol does not cause hemolysis. Bleeding may be caused as a side effect of anticoagulants; it may not be a harmful effect of smoking and alcohol.

Following an assessment, the nurse finds that a pregnant female is alcoholic and a smoker. What advice does the nurse give the patient? "Avoid these behaviors because they can: 1 Elevate stress during the pregnancy." 2 Lead to hemolytic anemia in pregnancy." 3 Elevate blood pressure in pregnancy." 4 Increase the risk for bleeding during delivery."

4 Mean arterial pressure (MAP) depends on the blood pressure. The normal MAP readings in the nonpregnant woman are 86 ± 7.5 mm Hg (78.5-93.5 mm Hg). The MAP reading of 100 mm Hg (greater than normal) implies high blood pressure. The MAP of 80 mm Hg, 86 mm Hg, or 90 mm Hg is considered normal.

Following an assessment, the nurse informs that the patient has high blood pressure. What could have been the mean arterial pressure (MAP) of the patient? 1 80 mm Hg 2 86 mm Hg 3 90 mm Hg 4 100 mm Hg

1, 2, 3 Labor care begins with the onset of progressive, regular contractions. The woman and the nurse can formulate their plan of care before labor or during treatment. Labor care begins when the blood-tinged mucoid vaginal discharge appears. The woman and the nurse can formulate their plan of care before labor or during treatment. Labor care begins when amniotic fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment. Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment. Pain is subjective. The onset of progressive, regular contractions signals the beginning of labor, not the intensity of the pain.

For the labor nurse, care of the expectant mother begins with which situations? Select all that apply. 1 The onset of progressive, regular contractions 2 The bloody, or pink, show 3 The spontaneous rupture of membranes 4 Formulation of the woman's plan of care for labor 5 Moderately painful contractions

What is the leading cause of perinatal infection with high mortality rate

Group B Streptococcus (GBS) Infection - Organism found in woman's rectum, vagina, cervix, throat, or skin - The risk of exposure to the infant is greater if the labor is long or the woman experiences premature rupture of membranes

The nurse gives a newborn an Apgar score of 4. What condition observed in the neonate would be consistent with the score? 1 Clear eyes 2 Acrocyanosis 3 Flexed posture 4 Heart rate of 70 beats/min

Heart rate of 70 beats/min The Apgar score of 4 indicates that the neonate has difficulty adapting to the extrauterine environment. A heart rate of 70 beats/min is not a normal finding and can be consistent with the condition. Observations such as clear eyes, acrocyanosis, and flexed posture in the neonate are normal findings and suggest an Apgar score of 7 to 10. However, these findings are not consistent with the low Apgar score of 4.

4 Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination are positive signs diagnostic of pregnancy . Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) because error can occur in performing the test or, in rare cases, human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today because pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy.

If exhibited by a pregnant woman, what represents a positive sign of pregnancy? 1 Morning sickness 2 Quickening 3 Positive pregnancy test 4 Fetal heartbeat auscultated with Doppler/fetoscope

2 Persistent refusal to talk about the fetus may be a sign of a problem and should be assessed. Viewing the pregnancy with pride is normal. Expressing concern about fainting at the birth is normal. Experiencing pregnancy-like symptoms is called couvade syndrome.

If exhibited by an expectant father, what is a warning sign of ineffective adaptation to his partner's first pregnancy? 1 Views pregnancy with pride as a confirmation of his virility 2 Consistently changes the subject when the topic of the fetus/newborn is raised 3 Expresses concern that he might faint at the birth of his baby 4 Experiences nausea and fatigue, along with his partner, during the first trimester

After assessing an infant's health screening reports, the nurse instructs the mother to stop breastfeeding and switch to a soy-based formula. What findings most likely caused the nurse to recommend this change? 1 Elevated leucine levels in the infant 2 Increased galactose levels in the infant 3 Elevated methionine levels in the infant 4 Increased thyrotropin levels in the infant

Increased galactose levels in the infant Galactosemia is a condition where the galactose levels are elevated in an infant. If this condition is present, the nurse would instruct the mother to stop breastfeeding, because breast milk is contraindicated in infants with galactosemia. Elevated leucine causes maple syrup urine disease in an infant but is not a contraindication for breastfeeding. Elevated methionine causes homocystinuria in infants who are supplemented with thiamine. Elevated thyrotropin, or elevated thyroid-stimulating hormone (TSH), causes congenital hypothyroidism in infants. The parents of infants suffering from congenital hypothyroidism are instructed to get the newborn's bone mass tested regularly.

The nurse is assessing an infant with a body weight of 2500 g. Two days after delivery the blood report of the infant's mother confirms the presence of hepatitis B. What medication does the primary health care provider instruct the nurse to administer to the infant? 1 Intravenous (I.V.) hepatitis B vaccine 2 Intramuscular (IM) hepatitis B vaccine 3 Intravenous (I.V.) hepatitis B immune globulin (HBIG) 4 Intramuscular (IM) hepatitis B immune globulin (HBIG)

Intramuscular (IM) hepatitis B immune globulin (HBIG) A dose of IM HBIG should be given to the infant whose mother's hepatitis B surface antigen's (HBsAg) status is determined to be positive. The vaccine is also given to infants who weigh 2000 g or more before 1 week of age. The hepatitis B vaccine and HBIG are not given through the IV route in infants because of their adverse effects. The IM hepatitis B vaccine is given to infants born to hepatitis B surface antigen (HBsAg)-negative mothers before being discharged from the hospital.

The nurse observes increased bilirubin levels in the laboratory reports of a newborn. Which complication does the nurse expect in the newborn if this condition is poorly monitored? Syndactyly 2 Kernicterus 3 Rectal fistula 4 Down syndrome

Kernicterus Very high levels of bilirubin cause kernicterus. Bilirubin is a yellow pigment that is produced in the body during the normal recycling of old red blood cells (RBCs). High levels of bilirubin in the body can cause the skin to look yellow, a condition known as jaundice. Syndactyly is a condition where two or more digits are fused together. It is not associated with increased bilirubin levels. Rectal fistula is caused by the absence of the anal opening in the newborn. Down syndrome is a chromosome defect and is not associated with increased bilirubin levels.

A flaw in a system, errors occurring at the blunt end

Latent Error

Blunt End

Latent Errors Organizational/System

Changes we begin to see days/weeks before labor

Lightening Bloody show Slight weight loss Backache Braxton hicks contractions

Ectopic Pregnancy Manifestation(s)

Lower abdominal pain, may have light vaginal bleeding

Position of Mother

Mom's position changes can relive fatigue, increase comfort and improve circulation for her and baby, prevent aortacaval compression and decreased BP.

Why isn't rubella given during pregnancy ?

Not given during pregnancy because vaccine is from a live virus

4 MSAFP is a screening tool, not a diagnostic tool. Further diagnostic testing is indicated after an abnormal MSAFP. CVS does provide a rapid result, but it is declining in popularity because of advances in noninvasive screening techniques. MSAFP screening is recommended for all pregnant women. MSAFP, not PUBS, is part of the quad-screen tests for Down syndrome.

Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy, including that: 1 chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. 2 screening for maternal serum alpha-fetoprotein (MSAFP) levels is recommended only for women at risk for neural tube defects. 3 percutaneous umbilical blood sampling (PUBS) is one of the quad-screen tests for Down syndrome. 4 MSAFP is a screening tool only; it identifies candidates for more definitive procedures.

Hydatidiform Mole

Occurs when chorionic villi abnormally increase & develop vesicles

Ectopic Pregnancy

Occurs when the fertilized ovum (zygote) is implanted outside the uterine cavity

Erythroblastosis Fetalis: Define

Occurs when the maternal anti-Rh antibodies cross the placenta and destroy fetal erythrocytes

4 From the assessment, the nurse concludes that development of the fetus is normal at 28 weeks' gestation. According to the standard measurement, fundal height (in centimeters) is approximately equal to the number of weeks of gestation. The patient's bladder should be empty while the nurse measures the fundal height. An excessive increase in fundal height indicates polyhydramnios or multifetal gestation. Vaginal bleeding and abdominal cramping during the first trimester of pregnancy indicate the possibility of an ectopic pregnancy.

On assessing a pregnant patient, the nurse finds that the patient's fundal height is 27 cm at 28 weeks' gestation. What does the nurse conclude from this finding? This measurement indicates: 1 Polyhydramnios. 2 Multifetal gestation. 3 Ectopic pregnancy. 4 Normal development.

1 An early deceleration pattern from head compression is described. No action other than documentation of the finding is required because this is an expected reaction to compression of the fetal head as it passes through the cervix. Repositioning the woman onto her side would be implemented when non-reassuring or ominous changes are noted. Calling the physician would be implemented when non-reassuring or ominous changes are noted. Administering oxygen would be implemented when non-reassuring or ominous changes are noted.

On review of a fetal monitor tracing, the nurse notes that for several contractions the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: 1 describe the finding in the nurse's notes. 2 reposition the woman onto her side. 3 call the physician for instructions. 4 administer oxygen at 8 to 10 L/min with a tight face mask.

4 Homans' sign is an assessment test used to determine whether the patient has VTE. Presence of Homans' sign indicates that the patient may have VTE. Uterine atony can be assessed by palpating the uterine fundus. Hypotensive shock can be assessed by checking the patient's vitals. Mastitis can be assessed by the examining the patient's breasts.

On reviewing the medical reports of a postpartum patient, the nurse finds that the patient has Homans' sign. What does the nurse interpret from this finding? 1 Risk of uterine atony 2 Hypotensive shock 3 Risk of developing mastitis 4 Venous thromboembolism (VTE)

4 The peribottle should be used in a backward direction over the perineum . The flow should never be directed upward into the vagina because debris would be forced upward into the uterus through the still-open cervix. Using soap and warm water to wash is appropriate. Washing from the symphysis pubis back to the episiotomy is appropriate. Changing the perineal pad every 2 to 3 hours is appropriate. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse recognizes the need for additional instruction if the woman: 1 uses soap and warm water to wash the vulva and perineum. 2 washes from the symphysis pubis back to the episiotomy. 3 changes her perineal pad every 2 to 3 hours. 4 uses the peribottle to rinse upward into her vagina.

The nurse is educating the parents of a newborn about the use of the bulb syringe. Which statement from the parents indicates effective learning about the bulb syringe? "It is used in the baby to:

Prevent suffocation and clear airway obstruction The bulb syringe is used to prevent suffocation and clear airway obstruction of newborns, and hence, it prevents aspiration. If the newborn's anal opening prevents defecation, it leads to severe gastrointestinal abnormalities. The bulb syringe is not used to reduce the newborn's temperature during hypothermia. It is also not used to avoid heat loss from the newborn due to evaporation and convection. Heat loss from the newborn is avoided by using warm water for bathing, drying the newborn carefully, and avoiding exposing the newborn to drafts.

The nurse is assessing a neonate who was born on the way to hospital. Which nursing intervention should be performed to prevent apneic spells in the neonate? 1 Provide warmth to the neonate. 2 Provide ventilator support to the neonate. 3 Provide chest compressions to the neonate. 4 Clean the neonate's body with lukewarm water

Provide warmth to the neonate. The neonate born on the way to hospital may become hypothermic, so the nurse should gradually warm the neonate's body to avoid apneic spells (insufficiency breathing). Rapid warming may cause apneic spells. Thus the warming process should be gradual. Ventilator or chest compressions are given when a neonate already has respiratory distress, which is identified by assessing the heart rate. The nurse can use lukewarm water to clear the stains on the neonate's body only after thermal stability is achieved.

Bleeding Incompatibilities:Rh incompatibility can only occur if..?

Rh incompatibility can only occur if the woman is Rh-negative and the fetus is Rh-positive

Ferguson's reflex

Spontaneous, involuntary urge to bear down

3 The normal value of AFI is 10 cm or greater, with the upper limit of normal around 25 cm. An AFI less than 5 cm indicates oligohydramnios. This condition is associated with renal agenesis in the fetus. A high AFI indicates neural tube defects and fetal hydrops. The AFI is not directly related to fetal movement. Fetal activity can be assessed using ultrasonography.

The amniotic fluid index (AFI) of a pregnant patient is 3 cm. What clinical information related to the fetus does the nurse infer from this? 1 Neural tube defect 2 Fetal hydrops 3 Renal defects 4 Low activity level

4 Human chorionic somatotropin decreases the maternal metabolism of glucose and increases the production of fatty acids for metabolic needs. A decrease in the metabolism of glucose and increased fatty acid deposition is caused by the decrease in human chorionic somatotropin. The metabolism of glucose and fatty acid deposition is not affected by the defect in insulin, estrogen, and parathyroid. In pregnant females, insulin is produced to repress the effect of insulin antagonism by placental hormones. A defect in insulin does not lead to the increase of metabolism in glucose. Estrogen is responsible for fatty acid deposition but is not involved in glucose metabolism. Parathyroid hormone controls the metabolism of calcium and magnesium.

The biochemical reports of a pregnant woman show an increase in the metabolism of glucose and increased fatty acid deposition of the body. Which hormone is responsible for these changes in the patient? 1 Insulin 2 Estrogen 3 Parathyroid 4 Human chorionic somatotropin

4 Montevideo units can only be calculated using the internal monitoring of UA. An intrauterine pressure catheter (IUPC) monitors UA internally. Therefore Montevideo units can only be calculated using the IUPC. Spiral electrode monitoring is used for assessing the fetal heart rate (FHR), not UA internally. The tocotransducer monitoring system is used to monitor the UA externally. An ultrasound transducer is also used to monitor the FHR externally.

The charge nurse instructed a group of student nurses about the monitoring of uterine activity (UA) during labor. Which statement by the student nurse is accurate regarding the calculation of Montevideo units? "They can be calculated: 1 Using a spiral electrode monitoring device." 2 Using a tocotransducer monitoring system." 3 Using an ultrasound transducer machine." 4 With an intrauterine pressure catheter (IUPC)."

1, 2, 5 High levels of estrogen during pregnancy increase the production of cervical mucus. Therefore pregnant women have copious white or gray cervical discharge. Increased estrogen levels increase the blood supply to the breasts, thereby causing breast heaviness. The presence of well-defined pink blotches on the palm, referred to as palmar erythema, is also the effect of increased estrogen levels during pregnancy. Milk production is possible only when the baby has been delivered and there is a decreased estrogen level in the body. High levels of estrogen cause laxity of the ligaments of the rib cage, which increases the chest expansion.

The hormonal reports of a pregnant female reveal increased estrogen levels in the body. Which related signs would the nurse find in the patient? Select all that apply. 1 Mucoid discharge from the cervix 2 Heaviness in the patient's breasts 3 Milk discharge from the patient's nipples 4 Decreased chest expansion of the patient 5 Well-defined pink blotches on the palm

3 Hyponatremia is a condition in which the body has low levels of sodium because of excess excretion of sodium. Aldosterone is a hormone that stimulates excess sodium reabsorption from the renal tubules of the kidneys. Therefore the administration of aldosterone is useful for treating hyponatremia. Insulin is the hormone that is used to control blood sugar levels in the body. The hormone oxytocin stimulates uterine contractions and milk ejection from the breasts. Oxytocin is also used to induce labor pain in pregnant women. Serum prolactin prepares the pregnant woman for lactation.

The laboratory reports of a pregnant female reveal severe hyponatremia. Which hormone supplementation helps in normalizing sodium levels in the patient? 1 Insulin 2 Oxytocin 3 Aldosterone 4 Serum prolactin

Duration

The length of one contraction, from the beginning of the increment to the conclusion of the decrement

3 Variable decelerations in the fetal heart rate (FHR) are observed when the umbilical cord is compressed. An amnioinfusion refers to the infusion of isotonic fluid into the uterine cavity when the amniotic fluid levels are decreased. This intervention is usually done for the prevention of umbilical cord compression. Late decelerations are observed when infections or elevated uterine contractions (UCs) are seen in a patient. This condition will be reversed by maintaining an I.V. solution, but aminoinfusion is not administered. Early deceleration in the FHR is a normal sign that does not require any intervention. Prolonged deceleration of the FHR occurs when there is a marked reduction of the fetal oxygen supply.

The nurse administers an amnioinfusion to a pregnant patient according to the primary health care provider's (PHP's) instructions. What is the reason behind the PHP's instructions? 1 Late decelerations 2 Early decelerations 3 Variable decelerations 4 Prolonged decelerations

4 A firm, muscular wall with less adipose tissue would ensure that the patient is able to regain the prepregnancy abdominal tone after delivery. Thus the nurse should advise the patient to do static abdominal exercises during pregnancy. The abdominal tone is not a factor based on which the nurse can determine whether the patient would have a normal vaginal delivery. Patients with weak abdominal muscles, especially those who have multifetal gestation or a large fetus, are at the risk of having diastasis recti abdominis. These abdominal striations usually do not fade away completely. Although the abdominal skin retains its tone, some striae always remain.

The nurse advises a pregnant patient to do static abdominal exercises. How would these exercises benefit the patient? 1 They will lead to a normal vaginal childbirth. 2 The patient will have diastasis recti abdominis. 3 The patient will not have any abdominal striations. 4 They will help the patient to gain proper abdominal tone after delivery.

3 Alcohol has teratogenic effects such as fetal alcohol syndrome. It causes devastating effects and impairs fetal development. Therefore, to prevent these teratogenic effects the nurse should advise the pregnant patient to avoid consuming alcohol. Angiomas (spider nevi) result from an increased concentration of estrogen in the pregnant women. They are not caused by alcohol consumption. Alcohol consumption has no effect on the urinary system. Gastrocnemius spasm results from low levels of diffusible serum calcium or elevation of serum phosphorus.

The nurse advises an alcoholic patient to stop consuming alcohol during pregnancy. What could be the reason for this? To prevent: 1 Angiomas in the fetus 2 Urinary infections in the patient 3 Teratogenic effect in the fetus 4 Gastrocnemius spasm in the patien

3 Lochia rubra and a firm fundus are normal findings in a postpartum patient. Because the assessment findings do not indicate a postpartum complication, the nurse should document the findings and continue to monitor. Because the patient has a firm fundus, she does not have postpartum hemorrhage, so prostaglandins and oxytocin should not be administered. Because the fundus is firm, massage is not needed to help the fundus contract.

The nurse assesses a postpartum patient and finds that the patient has lochia rubra with a firm fundus at the level of the umbilicus. Which is the most important nursing intervention in this situation? 1 Administer prostaglandins. 2 Administer oxytocin. 3 Document the findings and continuing to monitor. 4 Massage the fundus every 15 minutes.

4 Retained placental fragments or infection cause subinvolution of the uterus. Therefore the nurse should assess the patient for any placental fragments in the uterus. Estrogen and progesterone stimulate massive growth of the uterus during pregnancy. In the postpartum stage, the hormone levels are reduced and, therefore, do not affect involution of the uterus. Platelet aggregation causes uterine muscle contraction, but it does not result in involution of the uterus.

The nurse assesses a postpartum patient several hours after delivery and suspects that the uterus is subinvoluted. What could be a potential etiology for this finding? 1 Estrogen levels 2 Progesterone levels 3 Impaired platelet aggregation 4 Retained placental fragments

4 The nurse suspects that the patient may have slow progress in labor after knowing that the patient is worried and stressed, because she had complications in the previous labor. Stress may reduce the progress in the labor by decreasing the levels of catecholamines. This, in turn, reduces the UCs. Family history of diabetes does not affect the labor progression or UCs. Folic acid supplements are necessary for fetal growth and are given early in pregnancy to prevent neural tube defects. They do not affect the birth process. Taking a diet with a high amount of protein may not affect the onset of labor. Moreover, it helps in the fetal growth and development.

The nurse assesses a pregnant patient and finds that the patient has reduced strength of uterine contractions (UCs). Upon further assessment, the nurse suspects that the patient may have slow progress in labor. Which statement made by the patient indicates the reason for slow progress in labor? 1 "I have a family history of diabetes and hypertension." 2 "I stopped taking folic acid supplements a week ago." 3 "I have been on a diet with high amounts of protein for 15 days." 4 "I am worried a lot this time; I had a lot of problems in my last labor."

1, 3, 5 After an assessment, the nurse reports to the PHP that a pregnant patient is in the second stage of labor because the patient has a cervical dilation of 10 cm (fully dilated). The patient has a premature urge to bear down and an urge to defecate. The patient may have flushed cheeks in the active phase of first stage of labor, but it is not a sign of second stage of labor. Brownish discharge of mucus is a sign of latent phase of first stage of labor, but does not appear in the second stage of labor.

The nurse assesses a pregnant patient and reports to the primary health care provider (PHP) that the patient is in the second stage of labor. Which of the patient's signs enabled the nurse to give such a report to the PHP? Select all that apply. 1 Urge to defecate 2 Cheeks appear to be flushing 3 Cervical dilation of 10 cm 4 Brownish discharge of mucus from the vagina 5 Premature urge to bear down

3 If the nurse notes minimal FHR variability, the nurse should reassess the heart rate to determine a pattern. If in 30 minutes the nurse notices moderate variability, the fetus may be in a sleep state. The nurse would further confirm after half an hour and report it as moderate variability, where the heart rate baseline is confirmed as normal (110-160 beats/min). Heart rate variability is a characteristic of the baseline FHR and does not include accelerations or decelerations of the FHR. A fetal baseline heart rate of 180 beats/min is considered severe variability.

The nurse assesses the fetal heart rate (FHR) of a pregnant patient and finds minimal FHR variability. The nurse reassesses the patient 30 minutes later and finds moderate variability. What should the nurse infer? 1 No acceleration 2 Late deceleration 3 Baseline heart rate is 150 beats/min 4 Baseline heart rate is 180 beats/min

1 A nulliparous woman has prominent rugae in introitus along with erythema and edema. Nulliparous women may have mild uterine cramping resulting in fewer or less severe afterpains compared to multiparous woman. Single gestation may cause mild afterpains, but it does not cause prominence of rugae or erythema or edema in the introitus. A multiparous woman usually has more afterpains compared with a nulliparous woman. Rugae are also seen in a multiparous woman, but the rugae are less prominent and flattened. Multiple gestation usually causes severe afterpains.

The nurse assessing a patient finds prominent rugae erythema and edema in the vaginal introitus. The patient reports having mild afterpains. What does the nurse interpret about the patient's clinical status from this assessment? 1 Nulliparous 2 Multiparous 3 Single gestation 4 Multiple gestation

2 A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action is to massage the fundus until firm. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action is to: 1 place her on a bedpan to empty her bladder. 2 massage her fundus. 3 call the physician. 4 administer Methergine, 0.2 mg IM, which has been ordered prn.

113 The BP of the patient is 180/80 mm Hg, which means that the systolic blood pressure is 180 mm Hg and the diastolic blood pressure is 80 mm Hg. The mean arterial pressure of the patient is calculated using this formula: systolic blood pressure + 2(diastolic blood pressure)/3. Thus the mean arterial pressure of the patient would be [180 + 2 (80)/3] = 113 mm Hg.

The nurse examines the blood pressure (BP) of a patient and records it as 180/80 mm Hg. What could be the mean arterial pressure of the patient? Record your answer using a whole number. _______ mm Hg

2 A postpartum patient should be closely monitored for hemorrhage. If the perineal pad soaks in 15 minutes, the patient is hemorrhaging and needs immediate medical attention. Excessive hemorrhaging is not a normal finding after childbirth. Lochial discharge occurs after childbirth but is different from active bleeding. Hypotension may not increase bleeding in the postpartum patient.

The nurse finds that a postpartum patient's perineal pad is soaked after 15 minutes. What should the nurse infer from the finding? 1 Normal finding after childbirth 2 Sign of excessive hemorrhage 3 Presence of lochial discharge 4 Sign of postpartum hypotension

3 The nonstress test is the most widely used technique for prenatal evaluation of the fetus. The results are either nonreactive or reactive. In a nonreactive test, there are less than two qualifying accelerations of the fetal heart rate in a 20-minute period. Absence of fetal heart rate accelerations during the nonstress test indicates that the fetus is sleeping. In a reactive test, there are at least two qualifying accelerations in a 20-minute time period. More than two fetal heart rate accelerations within a 20-minute time period also would be considered a reactive test.

The nurse finds that the nonstress test of a pregnant patient is nonreactive. Which factor in the report might have led the nurse to this finding? 1 No qualifying accelerations in a 20-minute period 2 Two qualifying accelerations in a 20-minute period 3 Less than two qualifying accelerations in a 20-minute period 4 More than two qualifying accelerations in a 20-minute period

1, 3, 4 Impaired urinary elimination occurs as a result of sensory impairment caused by the labor process. Therefore the nurse has to perform interventions that help in emptying the patient's bladder every 2 hours. The nurse should encourage the patient to void every 2 hours to avoid bladder distention. The nurse can use running water to stimulate voiding by asking the patient to keep her hands in the running water. The nurse should palpate the patient's bladder on a frequent basis to detect the inability to void. The nurse should not catheterize the patient immediately for voiding, because it may result in trauma to the bladder. Effleurage helps in reducing pain but does not help stimulate voiding in the patient.

The nurse finds that the pregnant patient has impaired urinary elimination. Which interventions should be performed by the nurse to relieve the patient's problem? Select all that apply. 1 Encourage the patient to urinate every 2 hours. 2 Catheterize the patient immediately for voiding. 3 Palpate patient's bladder superior to symphysis. 4 Ask the patient to place the hand in running water. 5 Provide effleurage massage to the patient frequently.

4 The fetal blood is collected by making a small incision on the fetal scalp, which is visible in the newborn. This might be disturbing to the patient, but the nurse should help the patient understand the purpose of the test. Postpartum hemorrhage or increased risk for cesarean birth is not associated with this procedure. The test has to be conducted only once, and it does not have to be reconducted.

The nurse has a prescription to obtain a blood sample from a patient to determine fetal lactate levels. What information should the nurse provide to the patient before the procedure? 1 "There is an increased risk for postpartum hemorrhage." 2 "There may be a need to reconduct the diagnostic test." 3 "There is an increased risk for requiring a cesarean birth." 4 "There will be a small incision on the scalp of the newborn."

1, 3 Grapes and apricots are some of the fruits that are common in the diets followed in the Middle East. Therefore the nurse should teach the patient to include grapes and apricots in the diet to improve the nutritional status. Peaches, star fruit, and pomegranates are not popular fruits in Middle East. Peaches are the most common fruits for Native American groups. Star fruit is a fruit commonly eaten by people in Chinese communities. Pomegranates are popular in Italian communities.

The nurse instructs a Middle Eastern patient who is pregnant regarding the importance of including a good amount of fruits in the diet to improve folate levels in the body. Which fruits should the nurse recommend to the patient? Select all that apply. 1 Grapes 2 Peaches 3 Apricots 4 Star fruit 5 Pomegranates

2 Varicose veins are observed in pregnant patients usually in the second or third trimesters. Prolonged sitting increases the blood pressure in the legs veins, causing varicose veins. Patients who spend more time sitting (e.g., at a desk job) have a high risk for developing varicose veins. Similarly, wearing tight-fitting pants can also affect the venous return and cause stasis of the blood in the veins. Constipation is another regularly observed complication during pregnancy. Increased intake of fiber and water is helpful to relieve constipation. Supine hypotension is caused when the abdominal contents compress the inferior vena cava in the supine position. This can be relieved by changing the positions when sleeping. Urinary tract infections can be prevented during pregnancy by increasing the intake of water and by emptying bladder regularly.

The nurse instructs a pregnant patient to avoid sitting for a long time and to wear loose-fitting pants. Which pregnancy discomfort is the nurse trying to ease? 1 Constipation 2 Varicose veins 3 Supine hypotension 4 Urinary tract infections

3 During labor, the nurse asks the patient to breathe through the mouth to keep the mouth open to increase both maternal and fetal oxygenation. Nasal congestion is not a complication associated with labor. Opening of the mouth does not increase the pushing capability. Early decelerations are observed by pushing which does not require any intervention.

The nurse instructs a pregnant patient to breathe through the mouth and keep it open while pushing during labor. What is the rationale for this nursing intervention? 1 To avoid nasal congestion in the patient 2 To decrease the efforts required for pushing 3 To facilitate increased oxygen to the fetus 4 To avoid deceleration in the fetal heart rate

2.7 The adequate fluid intake of at least 50 mL/kg/day helps hydrate the fiber and increase the bulk of the stool of the patient. Therefore, because the patient weighs 54 kg, she has to take approximately 54 x 50 = 2700 mL = 2.7 liters of fluid per day in order to hydrate fibrous foods.

The nurse instructs a pregnant patient to include foods that are high in fiber to prevent constipation. The patient weighs 54 kg in the first trimester. What daily fluid intake should the nurse recommend to the patient to promote adequate bowel elimination? Record your answer to the nearest tenth. ______ liters per day

1 Brie, Camembert, and the soft Mexican cheeses are made with unpasteurized milk. Listeriosis is a disease caused by the infection of the bacteria Listeria, which is present in unpasteurized milk. This disease increases the risk for miscarriage, premature birth, and stillbirth in pregnant patients. Thus the nurse instructs the patient to stay away from those products that cause listeriosis. Brie, Camembert, and the soft Mexican cheeses are not associated with physiologic anemia, diverticulosis, and PKU. Pregnant patients with physiologic anemia are instructed to eat iron-rich foods. Pregnant patients are advised to eat fiber-rich food to prevent diverticulosis flare-ups. Pregnant patients with PKU should not use the artificial sweetener aspartame.

The nurse instructs a pregnant patient to stay away from Brie, Camembert, and the soft Mexican cheeses. What would be the possible clinical reason for giving such advice to the patient? 1 Possibility of listeriosis developing 2 Physiologic anemia 3 Sigmoid diverticulosis 4 Phenylketonuria (PKU)

3 A diet containing nuts, legumes, cocoa, and whole grains is suggested for a pregnant patient to improve the levels of magnesium. Magnesium is essential for energy metabolism, tissue growth, and muscle action. Thus the most appropriate reason for adding these in the diet is to eliminate the risk for magnesium deficiency. Nuts, legumes, cocoa, and whole grains are not rich sources of zinc, vitamin A, or vitamin D. Food sources high in zinc are liver, shellfish, meat, whole grains, and milk. Food sources containing vitamin A are dark green leafy vegetables, liver, fruits, fortified margarine, and butter. Foods rich in vitamin D are fortified milk, cereals, oily fish, butter, and liver.

The nurse instructs the patient to eat nuts, legumes, cocoa, and whole grains during the second trimester of pregnancy. What is the rationale for this instruction? The patient has: 1 A diet that is low in zinc. 2 A low intake of vitamin A. 3 A low intake of magnesium. 4 Decreased vitamin D intake.

2 Vascular spider-like rashes are tiny, star-shaped or branched, slightly raised, and pulsating end-arterioles usually found on the neck, thorax, face, and arms during pregnancy. These spider-like rashes usually disappear after pregnancy. The appearance of vascular spider-like rashes is common during the 2 to 5 months of pregnancy and is not a result of a food allergy. Folic acid supplementation is given in pregnancy to reduce birth defects. Folic acid does not cause vascular or skin changes. Vascular spider-like rashes are not caused by elevated estrogen levels.

The nurse is assessing a 3-month pregnant patient who is given folic acid supplement. The patient is worried because of the appearance of reddish spider-like rashes on the face and neck. What does the nurse tell the patient about these rashes? 1 "This is a side effect of folic acid." 2 "This disappears after pregnancy." 3 "This is caused by a food allergy." 4 "This is caused by decreased estrogen."

4 Carpal tunnel syndrome is characterized by paresthesia and pain in the hand radiating to the elbow. Smoking and alcohol consumption impairs the microcirculation and worsens the symptoms of the syndrome. Smoking does not worsen the signs of supine hypotensive syndrome, osteoporosis, and gestational diabetes. If the patient had supine hypotensive syndrome, then the nurse would have suggested the patient to lie on the lateral position. If the patient had osteoporosis, then the nurse would have suggested the intake of calcium supplements. Gestational diabetes is a common condition in pregnant women and it disappears after childbirth.

The nurse is assessing a 5-month pregnant female and learns that the patient smokes. The nurse instructs the patient to quit smoking. What could be the possible reason for giving this instruction? The patient: 1 Has supine hypotensive syndrome. 2 Is at risk for developing osteoporosis. 3 Is found to have gestational diabetes. 4 Has carpal tunnel syndrome in the right hand.

2 During an unplanned pregnancy, some partners find it difficult to accept the impending changes in life plans and lifestyles, but over time they adapt to the reality of pregnancy. Because the patient's partner is not mentally prepared for the baby, it is not advisable to ask the partner to play with children, develop a new hobby, or visit an orphanage.

The nurse is assessing a patient who has an unplanned pregnancy. The patient says to the nurse, "My partner is not happy that I'm pregnant." What should be a relevant response by the nurse? "Your partner should: 1 Be advised to play with children." 2 Be given adequate time to adapt to the idea of having a baby." 3 Be encouraged to develop a new hobby." 4 Visit an orphanage a for few days."

3 An increase in the arterial pressure increases the velocity of blood flow to the uterus. Therefore low arterial pressure decreases the uterine blood flow velocity and thereby decreases the blood supply to the fetus. Supine position of the mother decreases the intervillous blood flow. Therefore lateral position is preferred for sleeping. The blood flow would be the highest in this position, compared with the supine and prone positions. Estrogen has a vasodilator effect. Therefore reduced estrogen levels would decrease the velocity of the uterine blood flow. Contraction of the uterine muscles reduces the blood flow, whereas relaxation of the uterine muscles increases the blood flow.

The nurse is assessing a patient who is pregnant and has diabetes. The Doppler ultrasound examination shows that there is a decrease in the uterine blood flow velocity. Which is the reason for reduced uterine blood flow in the patient? 1 Reduced estrogen levels 2 Lying in the lateral position 3 Low arterial blood pressure 4 Relaxation of the uterine muscles

1 Pica refers to the practice of consuming nonfood substances, such as clay and dirt. Consumption of soil and pulverized pottery causes high levels of lead in the mother and the child because of lead contamination of the soil. Anemia is usually caused by a lack of red blood cells (RBCs). An anemic patient may possibly be at risk for pica and may develop cravings for metallic items but will not show excessive amounts of lead in the body. Malnutrition in the mother leads to several severe risks like premature labor, miscarriage, or lack of nutrition in the child. Preeclampsia is the condition for high blood pressure and excess of protein in the urine of a pregnant woman. Preeclampsia may be caused by an imbalanced diet, but it does not show unusually high levels of lead in the body.

The nurse is assessing a patient who recently delivered a child. The laboratory reports of both the mother and the child show high amounts of lead in the blood. What clinical condition observed in the mother during pregnancy could be the reason for the abnormal levels of lead? 1 Pica 2 Anemia 3 Malnutrition 4 Preeclampsia

1 A pregnant patient usually has nausea and vomiting during the first trimester. The nurse should ensure proper nutrition by prescribing an appropriate diet plan. Ideally, the patient should gain 2 kg body weight by the end of the first trimester. Thus the patient should weigh 59 kg (57 + 2) by the end of her first trimester. Excess weight gain (62 kg) is not a good sign in pregnancy and could lead to complications such as gestational hypertension and gestational diabetes. Sleep disturbances and constipation are commonly observed in the second trimester of pregnancy. These problems are not associated with maternal weight gain or impaired nutrition.

The nurse is assessing a patient who weighs 57 kg in the first month of pregnancy. The nurse plans a diet regimen to provide adequate nutrition to the patient. Which assessment finding at the end of the third month would indicate that the diet prescribed was effective? The patient: 1 Weighs 59 kg. 2 Weighs 62 kg. 3 Has good-quality sleep. 4 Has regular bowel moments.

1, 4 Couvade syndrome is a condition in which men experience pregnancy-like symptoms, such as nausea, weight gain, and other physical symptoms. During this condition some emotional and physiologic changes are observed in the men. Couvade syndrome does not have any impact on the skin or throat. Therefore the patient will not have skin rashes, sore throat, or persistent cough.

The nurse is assessing a patient with couvade syndrome. What symptoms is the nurse likely to find? Select all that apply. 1 Nausea 2 Skin rashes 3 Sore throat 4 Weight gain 5 Persistent cough

4 Postpartum headaches are common and may be caused by various conditions. During delivery, an epidural or special anesthesia may be administered. Placement of the spinal needle during spinal anesthesia may cause leakage of cerebrospinal fluid into extradural space, which can lead to headaches. Nonlactating women do not necessarily have headaches; they may have reduction in milk production causing a decline in the prolactin levels, which has no effect on headaches. Gestational hypertension causes increased flow of blood and increases heart rate, but it does not aggravate headaches. Sleep deprivation is common in postpartum women, it causes mild headaches.

The nurse is assessing a postpartum patient who reports having a severe headache. What could be the reason for headache in the patient? 1 Problems with lactation 2 Inability to sleep properly 3 Maternal gestational hypertension 4 Administration of spinal anesthesia to the patient

3 Some pregnant women tend to have nonfood cravings, such as for clay and ice. This condition is referred as pica. This condition is a manifestation of iron deficiency. Iron deficiency can be determined by reduced hemoglobin levels in the blood. Therefore the most likely reason for referring the patient for a blood test is to check for the patient's hemoglobin levels. Alterations in sodium, WBC, and human chorionic gonadotropin levels are not known to be associated with nonfood cravings. Sodium levels are usually checked to assess the filtration ability of the kidney. WBC count is generally increased during pregnancy to around 15,000 cells/mm3 of blood. An increase of WBC count of more than 15,000 cells/mm3 would be suggestive of infection. Increasing levels of hCG in the blood early in pregnancy causes nausea and vomiting.

The nurse is assessing a pregnant female in the second trimester. The patient informs the nurse that she feels like eating clay. The nurse refers the patient for a blood test. What could be the reason for this referral? To check for: 1 Sodium levels in the blood 2 The white blood cell (WBC) count 3 Hemoglobin levels in the blood 4 Human chorionic gonadotropin (hCG) levels

2 An increase in the pulse rate is seen in between 14 and 20 weeks of gestation in a pregnant female. Ballottement is a sign of passive movements in the fetus, which is generally observed between weeks 16 and 18 of pregnancy. The fetus can be visualized by radiographic images during week 16 of pregnancy. Human chorionic gonadotropin (hCG) levels in the urine decline after 60 days of pregnancy (week 12), which results in a negative urine pregnancy test. Therefore the probable age of the fetus is 16 weeks. In week 6 of pregnancy, the fetus is not visualized by radiography. In weeks 26 and 36, signs of ballottement and increased pulse are not seen, but fetal movements are observed.

The nurse is assessing a pregnant female who has signs of ballottement and increased pulse rate. The nurse is able to visualize the fetus by radiography images, but the laboratory reports show a negative urine pregnancy report. What is the most probable age of the fetus? 1 6 weeks 2 16 weeks 3 26 weeks 4 36 weeks

3 Maternal hypertension can cause serious adverse effects on the fetus. A blood pressure reading of 150/90 mm Hg indicates that the mother is hypertensive. To assess the effect of maternal hypertension on the fetus, the nurse should refer the patient for a Doppler blood flow analysis. It is a noninvasive ultrasonic technique used to study fetal blood flow. NT is a technique used to assess genetic abnormalities in the fetus. CVS is a prenatal test used to diagnose structural defects in the fetus. PUBS is used to assess the fetal circulation.

The nurse is assessing a pregnant patient and finds that her blood pressure is 150/90 mm Hg. What procedure does the nurse recommend for this patient? 1 Nuchal translucency (NT) test 2 Chorionic villus sampling (CVS) 3 Doppler blood flow analysis 4 Percutaneous umbilical blood sampling (PUBS)

3 n a pregnant patient the normal range of uterine contractions (UCs) during labor are noted to be 2 to 5 in every 10 minutes. Each one contraction lasts from 45 to 80 seconds. Therefore, when the nurse reports the contraction period as 2 minutes, 15 seconds (135 seconds) in 10 minutes of time, the nurse should have observed 135 ÷ 45 = 3 contractions.

The nurse is assessing a pregnant patient during labor and reports the normal duration of the contraction period as 2 minutes, 15 seconds in a span of 10 minutes. What would be the number of contractions observed in this span of 10 minutes? Record your answer using a whole number._______

2 The patient has flushed cheeks, UCs of 65 seconds with a frequency of 4 minutes, and pink to bloody mucus. These symptoms are observed during the active phase of labor. The symptoms of the patient do not correlate with the latent, transition, or active pushing phases (second stage) of labor. In the latent phase of labor, the UCs are 30 to 45 seconds with a frequency of 5 to 30 minutes, and the mucus is pale pink. In the transition phase, the UCs are 45 to 90 seconds with a frequency of 2 to 3 minutes, and the mucus appears bloody. In the active pushing phase of the second stage of labor, the UCs are 90 seconds with a frequency of 2 to 2.5 minutes.

The nurse is assessing a pregnant patient in the last week of gestation. The nurse observes that the patient has flushed cheeks, uterine contractions (UCs) of 65 seconds with a frequency of 4 minutes, and pink to bloody mucus. What stage of labor should the nurse infer that the patient is in based on these observations? 1 Latent phase 2 Active phase 3 Transition phase 4 Active pushing phase

3, 4, 5 A tocotransducer is an external device that is used for assessment of uterine activity (UA). This instrument would report duration and frequency of the uterine contractions (UCs). The spiral electrode can monitor accelerations of the fetal heart rate. These systems do not report the intensity of UCs. Strength of UCs can be assessed using an intrauterine pressure catheter (IUPC). Neither a tocotransducer nor a spiral electrode is used to determine the lactate level; it is obtained by the fetal scalp sampling method.

The nurse is assessing a pregnant patient through a tocotransducer placed externally and a spiral electrode placed internally. What information would the nurse obtain by this arrangement? Select all that apply. 1 Lactate levels in the fetal blood 2 Strength of uterine contractions 3 Duration of uterine contractions 4 Frequency of uterine contractions 5 Accelerations of fetal heart rate

2 If a pregnant patient has less than the recommended fluid intake, her urine could be of a dark color. Therefore the nurse should advise the patient to increase her fluid intake to help dilute her urine. Bubble baths are usually not recommended in pregnant women because they may irritate the urethra. The pregnant patient is advised to take dry carbohydrates to prevent vomiting during the first trimester of pregnancy, but a dry carbohydrate diet has no effect on the patient's urination patterns. Regular back rubs can ease back pain in the pregnant patient, but they have no effect in diluting the urine.

The nurse is assessing a pregnant patient who complains of painful urination. The patient says, "My urine is dark in color." What will the nurse tell the patient to do? 1 "Take bubble baths regularly." 2 "Increase your fluid intake." 3 "Include dry carbohydrates in your diet." 4 "Get regular back rubs."

4 In early pregnancy, the kidneys have increased capacity to excrete water. Therefore the patient may feel thirsty because of increased loss of water. A low-fiber diet may cause constipation in pregnant females. Fiber does not interfere with the water levels in the body. Consumption of fatty foods in proper amounts is necessary in pregnancy, and fatty foods usually do not cause excess thirst. Sodium ions trigger fluid retention in the body and do not cause thirst.

The nurse is caring for a 3-month pregnant woman who reports, "I always feel very thirsty." What does the nurse infer from the patient's statement? The patient: 1 Consumes less fiber in the diet. 2 Takes high amounts of fat in the diet. 3 Has high sodium content in the blood. 4 Has increased loss of water from the body.

1 Hegar sign is the softening and compressibility of the lower uterine segment that is seen during weeks 6 to 12 of the gestation period. The fetal heartbeat is detected using ultrasound stethoscope between 8 and 17 weeks. A decrease in the partial pressure of carbon dioxide by 5 mm Hg is seen at week 10 of gestation. Therefore it is most likely that the fetus is in the tenth week of gestation. Fetal heartbeat can be detected by fetal stethoscope after week 17 of pregnancy. Therefore, at weeks 20, 30, and 35 of gestation, Doppler ultrasound stethoscope is not required. Hegar sign is not seen in weeks 20, 30, or 35.

The nurse is assessing a pregnant patient who has a positive Hegar sign. The fetal heartbeat is evident by Doppler ultrasound stethoscope, and there is about 5 mm Hg decrease of carbon dioxide partial pressure. The nurse suspects the patient is in which week of gestation? 1 Week 10 2 Week 20 3 Week 30 4 Week 35

4 Terbutaline (Brethine) is administered during pregnancy, especially during elective cesarean birth. Terbutaline (Brethine) is known to improve the Apgar score of the fetus to more than 5 and the pH value of the cord to 7.2. Terbutaline (Brethine) has no effect on placental integrity or function. Terbutaline (Brethine) does not cause fetal heart rate (FHR) acceleration. The fetal scalp stimulators are used to improve the accelerations.

The nurse is assessing a pregnant patient who has been given terbutaline (Brethine). What is the desired outcome from the administration of the drug? 1 Increased fetal accelerations 2 Reduced placental abruption 3 An Apgar score less than 2 4 A cord blood ph result of 7.2

2 Patients who have undergone bariatric surgery are at a high risk for impaired nutrition, so the nurse should regularly monitor the patient's nutritional status. The client's family history is considered to rule out the risk for congenital anomalies in the fetus, which is not necessary in this case. Blood glucose levels are monitored if the patient is at high risk for developing gestational diabetes during the first or last trimester. Blood pressure levels are usually monitored in the pregnant patient during regular visits to assess the risk for gestational hypertension.

The nurse is assessing a pregnant patient who has undergone bariatric surgery in the past. What will the nurse primarily check in the patient's health records? 1 Family history 2 Nutritional status 3 Blood glucose levels 4 Blood pressure

2 If the area of saturated pad is less than 2.5 cm, it indicates that the patient had scanty bleeding. If it is less than 10 cm, then the patient had light bleeding. If the pad is saturated within 2 hours, the patient had heavy bleeding. If it is 10 cm or more, the patient had moderate bleeding.

The nurse is assessing blood loss in a postpartum patient by observing the perineal pad. The nurse finds that 1.5 cm of the pad is saturated. What patient clinical observation should the nurse infer from this finding? 1 Light bleeding 2 Scanty bleeding 3 Heavy bleeding 4 Moderate bleeding

1 Transvaginal ultrasound is performed to determine the cervical length of a pregnant patient. When the cervical length is found to be short, the patient is at risk for preterm labor, and patients at risk for preterm labor are advised to avoid air travel. To prevent supine hypotension, the pregnant patient should be instructed on maintaining side-lying or semisitting postures. Avoiding air travel does not prevent supine hypotension. Peripartum hemorrhage occurs during delivery and cannot be prevented by avoiding air travel. Gestational hypertension is a pregnancy complication that is not affected by air travel.

The nurse is assessing the transvaginal ultrasound report of a pregnant patient. After assessment, the nurse instructs the patient to avoid air travel. What is the reason for giving this instruction? To prevent: 1 Preterm labor in the client 2 Supine hypotension 3 Peripartum hemorrhage 4 Gestational hypertension

2, 3, 5 The nurse helps the pregnant patient during labor. This includes teaching the patient relaxation techniques. The nurse teaches the patient to keep the mouth open during exhalation to allow air to easily leave the lungs. Placing the patient in a semi-Fowler or lateral position is helpful during labor. Therefore the nurse should instruct the patient to maintain a lateral or semi-Fowler position with a lateral tilt. Asking the patient to cough frequently would increase intraabdominal pressure of the patient and would make the patient uncomfortable. Having the patient lie down in a supine position during labor may cause orthostatic hypotension. Therefore the nurse should instruct the patient to lie down in a position other than supine.

The nurse is assisting a pregnant patient in labor. What instructions should the nurse give to the patient to promote comfort? Select all that apply. 1 "You should cough frequently." 2 "Breathe with your mouth open." 3 "Lie down in the lateral position." 4 "Lie in the supine position in bed." 5 "Lie in the semi-Fowler position."

3 To reduce breast irritation, the nurse advises the patient to wear breast shells. This will increase comfort during breastfeeding. Application of ice packs between feedings reduces breast engorgement. Hydrogel pads can be applied if the patient has sore nipples between feedings. Cold cabbage leaves applied to the breasts for 15 to 20 minutes between feedings can reduce breast engorgement by reducing tissue swelling and facilitating the flow of milk.

The nurse is caring for a 2-day postpartum patient who is breastfeeding. The patient reports breast irritation. Which intervention would be beneficial to the patient? 1 Apply ice packs to the breasts between feedings. 2 Place hydrogel pads to the breasts between feedings. 3 Tell the patient to wear breast shells. 4 Apply cold cabbage leaves to the breasts between the feedings.

3 A patient who complains of abdominal discomfort and gas pains should be encouraged to use a rocking chair because it stimulates the passage of flatus and relieves discomfort. The patient should not be encouraged to drink coffee because the caffeine present in it intensifies the pain by increasing bowel movements. Analgesic medication does not relieve gas, but the administration of antigas or antiflatulent medications may help relieve gas. Offering soups and beverages may cause more discomfort and gas in the patient.

The nurse is caring for a 24-hour-postpartum patient who had a cesarean birth with general anesthesia. The patient complains of abdominal discomfort and gas pains. What would be the most suitable nursing intervention in this situation? 1 Encourage the patient to drink coffee. 2 Administer analgesic medications to patient. 3 Encourage the patient to use a rocking chair. 4 Offer soups and beverages to the patient

2 The patient with a history of spinal surgery should not undergo epidural anesthesia. The patient with a history of appendectomy, uterine surgery, or pelvic floor problems can undergo epidural anesthesia.

The nurse works in a maternity unit. Which patient condition in her history would be a contraindication for epidural anesthesia during labor? 1 Appendectomy 2 Spinal surgery 3 Uterine surgery 4 Pelvic floor problems

2 Some patients often wish to breastfeed after the ejection of the milk. The patient cannot be given instruction to breastfeed 1 hour after birth. The patient may require rest, but breastfeeding should be encouraged only after the milk ejection. Some patients prefer to breastfeed during the infant's reactive state, but patients of a Hispanic background may not choose to do this, as it may not fall within their cultural belief system. The nurse should always respect the cultural beliefs of the patient.

The nurse is caring for a Hispanic patient who has given birth to a baby. When does the nurse expect the patient to start breastfeeding? 1 First hour after birth 2 When the milk comes 3 When the infant cries 4 After the patient has rested

2, 3, 5 The parents may be worried about the newborn's dusky appearance. Therefore the nurse should properly explain to the parents that the baby may initially appear dusky. The color may become normal once the circulation is established. Siblings may be encouraged to hold the newborn to promote bonding between them. The infant's head is molded due to the narrowness of the birth canal and the pelvic structures. This is to be explained to the parents. Southeast Asian patients consider the head to be the sacred part of the human body and should not be touched. Hence, the nurse should avoid placing hand on the infant's head. The Southeast Asian population considers any praise of the infant as harmful, as they believe the jealous spirits will take away the baby.

The nurse is caring for a Southeast Asian patient who gave birth to a child. What interventions can the nurse perform to promote bonding between the newborn and the family? Select all that apply. 1 Placing the hand on the infant's head 2 Encouraging the sibling to hold the baby 3 Explaining the molding of the infant's head 4 Praising the infant's appearance and health 5 Explaining the dusky appearance of the infant

4 To facilitate father-infant bonding, the nurse should include the father while giving instructions about newborn care. If the nurse asks the father to change the baby's diaper, the father may be anxious and may not be willing to do it. Instead, the nurse should show the father how to change the diapers and then ask the latter to return demonstrate the process. Asking the father why he is anxious or reassuring him that it will take time to get used to the newborn may not improve father-child bonding or reduce his fear about handling the newborn

The nurse is caring for a family who has a newborn. The father appears to be very anxious and nervous when the newborn's mother asks him to bring the baby. Which nursing intervention is most beneficial in promoting father-infant bonding? 1 Hand the father the newborn and instruct him to change the diaper. 2 Ask the father why he is so anxious and nervous. 3 Tell the father that he will get used to the newborn in time. 4 Provide education about newborn care when the father is present.

1, 2, 4 Engorgement in a breastfeeding woman requires careful management to preserve the milk supply while managing the increased blood flow to the breasts. Taking warm showers can increase milk flow. Frequent feedings will permit the breasts to empty fully and establish the supply-demand cycle that is appropriate for the infant. Cold cabbage leaves work well to reduce pain and swelling and should be applied every 4 hours. Binding the breasts is not appropriate because it decreases the milk supply. To ease the discomfort associated with sore nipples, the mother may apply topical preparations such as purified lanolin or hydrogel pads.

The nurse is caring for a lactating patient with a body temperature of 102° F (38.9° C). The nurse finds that the patient's breasts are engorged, swollen, hard, and red. Which interventions related to patient care would be helpful in managing breast engorgement? Select all that apply. 1 Taking warm showers before breastfeeding 2 Nursing the baby frequently 3 Using a tight supportive bra or a breast binder 4 Applying cold cabbage leaves to the breasts 5 Avoiding use of lanolin or hydrogel pads

1 It is important that the nurse explain the procedure to the patient. Because the patient does not speak English, it is advisable to call an interpreter. This helps the patient understand the test procedures without any confusion. Nonverbal communication is not useful in this case, because it may cause the patient to become confused. Explaining the medical examination procedure may include complex terms and words. Limiting those words may not help clarify to the patient who does not speak English. Finally, the patient may not feel comfortable in the presence of additional hospital staff.

The nurse is caring for a non-English-speaking pregnant patient. What nursing interventions would help explain the procedure of vaginal examination to the patient? 1 Call a service for an interpreter. 2 Try to communicate nonverbally. 3 Limit the use of medical terminologies. 4 Ask for the assistance of the hospital staff

4 Swollen and tender breasts are caused by distention in the breast. Breast distention is caused by the congestion of veins and lymphatics in the breast, making them tender and warm to the touch. A decline in the prolactin levels occurs when a patient does not breastfeed, resulting in the lapse of milk production. The accumulation of milk does not aggravate the tenderness of the breasts; instead, it makes them fuller in appearance. Engorgement of the breast occurs while feeding, and it reduces with frequent feeding and proper care.

The nurse is caring for a nonbreastfeeding postpartum patient. The patient reports having swollen and tender breasts. What does the nurse anticipate as the reason for these symptoms? 1 Decline in the prolactin levels 2 Accumulation of milk in the breast 3 Engorgement of the breast tissues 4 Congestion of veins in the breast

3 If a patient with excessive postpartum hemorrhage shows signs such as grayish, cool, and clammy skin, the patient is at risk of developing hypovolemic shock. If the patient has foul-smelling lochia, then the patient might be at risk of infection. Every patient experiences pain after giving birth; however, a change in skin color does not result from pain. If the patient has not voided urine within 8 hours after birth, then the patient might be at risk of impaired urinary elimination.

The nurse is caring for a patient with excessive postpartum hemorrhage. The nurse observes that the patient's skin has turned grayish. What does the nurse infer from this finding? 1 Risk of infection 2 Evidence of severe pain 3 Potential risk of hypovolemic shock 4 Potential risk of impaired urinary elimination

4 The hands-and-knees position is suitable for patients with back pain and for patients experiencing back labor, because it reduces stress on the back. The lateral position can be used when the patient is receiving a back rub, but this position does not offer relief from back pain. An upright position may not have a significant effect on back pain. Therefore this position is not planned for childbirth. The semirecumbent position does not support the back, so back pain may not be relieved.

The patient reports severe lower back pain during labor. Which position does the nurse plan for the patient during childbirth? 1 Lateral position 2 Upright position 3 Semirecumbent position 4 Hands-and-knees position

2 Lochia serosa is a pink or brown fluid containing old blood, serum, leukocytes, and tissue debris. The lochia serosa starts 3 to 4 days after childbirth. Lochia alba is a yellow to white fluid containing leukocytes, serum, epithelial cells, bacteria, and decidua. It starts 10 days after childbirth in most women. In the case of a vaginal tear, the patient would have bright red bleeding for more than 2 hours after delivery. Lochia rubra, a bright red fluid containing small clots, starts from the end of the childbirth and disappears within 2 hours.

The nurse is caring for a postpartum patient and finds that the patient has brown vaginal discharge. What is the cause of the discharge? 1 Lochia alba 2 Lochia serosa 3 Lochia rubra 4 Vaginal or cervical tear

4 The psychosocial assessment includes evaluating adaptation to parenthood, as evidenced by the parents' reactions to the baby and interactions with the new baby. Good attachment behaviors include seeking eye contact with the baby and talking to the baby during caretaking activities; the nurse should investigate the behaviors when these are not observed. Changing diapers, positioning baby comfortably, and maintaining eye-to-eye contact are appropriate behaviors that increase parent-infant attachment.

The nurse is caring for a postpartum patient who gave birth recently. The nurse is evaluating the parent's behavior toward the new baby. Which parent-infant behaviors should the nurse investigate further? 1 Change the baby's diapers when needed. 2 Position the baby comfortably. 3 Demonstrate eye-to-eye contact with the baby. 4 Complete the child care activities silently, without looking at the baby.

3 Vaginal deliveries cause the pelvic muscles and ligaments to stretch and weaken. Kegel exercises help strengthen the pelvic floor muscles and thereby can prevent uterine complications, such as prolapse. The physical activity of climbing stairs may delay the process of healing from an episiotomy, so it is usually avoided. However, avoiding stairs does not prevent uterine prolapse. A diet high in protein is necessary to build muscle strength, but it cannot prevent uterine prolapse. Because the patient has already undergone delivery, sleeping in prone position does not cause any harm.

The nurse is caring for a postpartum patient who had a normal vaginal delivery. The nurse tells the patient, "This will help you prevent uterine prolapse in later stages of life." Which instruction from the primary health care provider (PHP) is the nurse most likely explaining to the patient? 1 "Avoid climbing of the stairs." 2 "Maintain a high-protein diet." 3 "Do Kegel exercises every day." 4 "Avoid sleeping in the prone position."

3 Patients with episiotomy may have soreness and back pain. To relieve soreness and back pain, the nurse should advise the patient to place an ice pack on the affected area. This provides comfort and reduces the inflammation and pain. A sitz bath helps relieve lower back pain and discomfort, so the patient should be encouraged to use sitz baths at a temperature of 38° to 40° C (100° to 104° F) at least twice a day to prevent edema. Not cleaning the perineal area may cause infection, so the nurse should advise the patient to clean her perineum frequently. Drinking plenty of water and eating foods such as fresh fruit and vegetables that contain fibers can relieve constipation or hemorrhoids but does not help reduce soreness.

The nurse is caring for a postpartum patient who has an episiotomy wound. The nurse finds that the patient has soreness at the incision site and lower back pain. What does the nurse tell the patient? 1 Avoid using sitz baths. 2 Avoid cleaning the perineal area frequently. 3 Place a covered ice pack on the affected area. 4 Drink plenty of water and eat foods containing fiber

4 Orthostatic hypotension develops as a result of splanchnic engorgement after birth, which causes dizziness immediately upon standing upright. Decreased blood pressure results from hypovolemia due to hemorrhage. Manifestations of endometritis include pain, fever, and abdominal tenderness, along with continued flow of lochia serosa or alba up to 3 to 4 weeks. Manifestations of hemorrhoids include itching, discomfort, and bright red bleeding upon defecation. Puerperal sepsis manifests by an increase in the maternal temperature up to 38° C (100.4° F) 24 hours after childbirth. This increased temperature persists or recurs for about 2 days.

The nurse is caring for a postpartum patient who reports dizziness upon standing. What does the nurse believe to be the most likely cause for this occurrence? 1 Endometritis 2 Hemorrhoids 3 Puerperal sepsis 4 Orthostatic hypotension

2 The infant should be dried to prevent cold stress due to rapid loss of heat and then covered with a warm blanket. The Apgar score is to be recorded at 1 and 5 minutes after the birth of the infant. Recording it after 30 minutes may lead to failure in assessing the fetal signs. The cord should be cut at 2.5 cm above the placement of the clamp. A newborn may be very slippery to hold, and the mother may not be able to hold the baby due to fatigue. The infant can be given to the mother only after complete drying.

The nurse is caring for a pregnant patient during labor. What should the nurse do immediately after the child's birth? 1 Ask the mother to hold the infant. 2 Dry the infant and place in warm blanket. 3 Record the Apgar scores after 30 minutes. 4 Cut the umbilical cord 3.5 cm above the clamp.

4 Paresthesia is an abnormal sensation that is perceived as a burning and tingling in the skin. This is caused by edema that compresses the nerves. Edema in carpal ligament of the wrist causes carpal tunnel syndrome, which is characterized by paresthesia. Sciatica is a burning pain that is felt in the back, buttocks, and leg when the sciatic nerve is irritated. Neuralgia is a stabbing, burning pain that occurs along a damaged nerve. Acroesthesia is the numbness and tingling of the hands caused by stoop-shouldered stance.

The nurse is caring for a pregnant patient who is in the third trimester. The patient reports a burning sensation starting from the hands to the elbow. On further evaluation, the nurse finds compression in the carpal ligament of the wrist. What finding does the nurse infer from examining the patient? 1 Sciatica 2 Neuralgia 3 Acroesthesia 4 Paresthesia

1 The patient's perineum should be cleaned frequently to prevent the risk for infection. This helps maintain proper hygiene and provides comfort to the patient. The nurse can clean the patient's teeth with an ice-cold wet washcloth, which helps prevent a feeling of thirst and dryness of the mouth. Using a warm cloth may not be helpful. The patient is offered a cool cloth for wiping her face, which helps prevent diaphoresis. Warm water should be poured on the patient's back to provide relaxation and accelerate labor. Using a warm washcloth for a face wash and placing cool water on the patient's back will not help in providing comfort.

The nurse is caring for a pregnant patient. What interventions should the nurse follow to ensure proper hygiene in the patient? 1 Clean the perineum of the patient frequently. 2 Clean the patient's teeth with a warm wet cloth. 3 Offer a warm washcloth to the patient for a face wash. 4 Allow cool water to flow on the patient's back for 5 minutes.

3 Estrogen and progesterone play a vital role in the development of the uterus during pregnancy. They are responsible for the growth of the uterus and may cause hypertrophy and hyperplasia of the uterine muscle cells. A decrease in estrogen and progesterone results in decreased growth of the uterus, which might even lead to miscarriage. Low estrogen and progesterone may not cause increased UCs. Moreover, the pituitary hormone oxytocin is primarily responsible for UCs during labor. Low levels of estrogen and progesterone lead to abnormally low growth of the uterus. Estrogen and progesterone also increase the blood circulation in the mother. Low levels of these hormones would decrease blood circulation.

The nurse is caring for a pregnant woman who has low levels of estrogen and progesterone. What does the nurse expect may occur as a result of the low hormone levels? 1 Massive growth of the uterus during pregnancy 2 Increased uterine contractions (UCs) during labor 3 Decreased growth of the uterus during pregnancy 4 Increased blood circulation to the uterus during pregnancy

1, 2, 3, 5 Dried beans, seeds, peanut butter, and eggs provide protein. A bagel is an example of a whole grain food, not protein.

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein-containing foods? Select all that apply. 1 Dried beans 2 Seeds 3 Peanut butter 4 Bagel 5 Eggs

4 Every pregnant patient should be taught about safety measures to prevent motor vehicle accidents. Automobile accidents may lead to placental separation, causing fetal death. This condition is called abruptio placentae. Preterm birth and ectopic pregnancy are not associated with automobile accidents. Thrombophlebitis is commonly observed in pregnant patients because the heavy abdominal contents compress the blood vessels. Pregnant patients are usually taught certain exercises to prevent thrombophlebitis.

The nurse is explaining to a pregnant patient about prevention of motor vehicle accidents. What risk is most associated with motor vehicle accidents in pregnant patients? 1 Preterm birth 2 Thrombophlebitis 3 Ectopic pregnancy 4 Abruptio placentae

4 Kegel exercises strengthen and increase the elasticity of the pubococcygeus muscle, which is the main perineal muscle. They improve vaginal tone and also help prevent stress incontinence and hemorrhoids. Kegel exercises do not prevent urine retention, relieve lower back pain, or tone abdominal muscles.

The nurse is helping prepare a patient for discharge after childbirth. During a teaching session, the nurse instructs the patient to do Kegel exercises. What is the purpose of these exercises? 1 To prevent urine retention 2 To provide relief of lower back pain 3 To tone the abdominal muscles 4 To strengthen the perineal muscles

2 During the postpartum period, maternal blood pressure, pulse, and respiration should be checked every 15 minutes during the first hour. A rising pulse is an early sign of excessive blood loss because the heart pumps faster to increase the supply of blood. A body temperature of 100.4º F is a normal finding. A respiratory rate of 22 breaths/min indicates that the patient has no internal bleeding. A blood pressure of 120/80 mm Hg does not indicate that the patient has hemorrhage.

The nurse is monitoring a postpartum patient for signs of hemorrhage. Which observation would indicate excessive blood loss? 1 A body temperature of 100.4º F 2 An increase in pulse from 88 to 102 beats/min 3 An increase in respiratory rate from 18 to 22 breaths/min 4 A blood pressure change from 130/88 to 120/80 mm Hg

1 An abdominal examination is part of a physical assessment. For abdominal examination, the patient lies on her back, and the weight of her abdominal contents compresses the vena cava and aorta, which results in supine hypotension. Therefore, during a physical assessment the nurse should place a small wedge under the patient's right hip to prevent supine hypotension. A back massage is helpful for promoting sleep, not for preventing supine hypotension. The nurse should instruct the patient to empty her bladder for fundal assessment, but emptying the bladder does not prevent supine hypotension. Intake of warm milk promotes sleep, but it does not prevent supine hypotension during a physical assessment.

The nurse is performing a physical assessment of a pregnant patient. What precaution will the nurse take to prevent supine hypotension in the patient? 1 Place a small wedge under the patient's right hip. 2 Give a back massage to the patient before assessment. 3 Instruct the patient to empty her bladder before assessment. 4 Instruct the patient to drink warm milk before assessment.

2 Leg cramps during pregnancy result from an imbalance in the calcium levels in the body. Thus the nurse would include a food rich in calcium in the diet. Because the patient is a vegetarian, this can be accomplished by incorporating turnip greens in the diet. Turnip greens are turnip leaves that are rich in calcium. Even though sardines have high calcium content, the patient is a vegetarian and this is considered a meat source. Milk is the richest source of calcium. Hispanic people do not consume milk directly but use it as an additive in coffee. Having too much coffee also affects the pregnant patient's health adversely, so it should not be included. Melon fruit is rich in vitamin A but is not a good source of calcium; therefore the nurse should not suggest it to increase calcium in the patient's diet.

The nurse is preparing a diet chart for a Hispanic pregnant patient who is a vegetarian. The patient complains of leg cramps. What does the nurse ensure to include in the patient's diet? 1 Melon fruit 2 Turnip greens 3 Whole or 2% milk 4 Canned sardines

3 Rubella vaccine is made from duck eggs; therefore women who are allergic to duck eggs can develop a hypersensitivity reaction to the vaccine. As a result, the patient might develop rashes on her skin. The PHP would prescribe adrenaline to combat hypersensitivity reactions. Oxytocin is injected to increase the tone of the uterine muscles but not to combat hypersensitivity. Rh immune globulin suppresses the immune system, which would worsen the condition; therefore this medication is unlikely to be prescribed. Magnesium sulfate is used for preeclampsia and is not used to minimize hypersensitivity reactions caused by rubella vaccine.

The nurse is preparing to administer rubella vaccine to a patient during the postpartum period. At the follow-up visit, the patient reports to the nurse that she has rashes on her skin. What does the nurse expect the primary health care provider (PHP) to prescribe in this situation? 1 Oxytocin (Pitocin) 2 Rh immune globulin 3 Adrenaline (Epinephrine) 4 Magnesium sulfate

4 A diet rich in vitamin B12 and folic acid is essential for proper neural development of the fetus during pregnancy. Asparagus, fortified cereals, and green leafy vegetables are rich sources of folic acid, and eggs are rich in vitamin B12. Therefore a diet containing these foods is most advisable for the patient to ensure proper neural development of the fetus. Nuts, beans and legumes, cocoa, meats, and whole grains are rich sources of magnesium. Iodized salt, milk and milk products, yeast breads, and rolls contain iodine. Citrus fruits, broccoli, melons, strawberries, and tomatoes are rich sources of vitamin C. Magnesium, iodine, and vitamin C do not affect the neural development of the fetus.

The nurse is providing dietary education to a patient who is 4 months pregnant. Which diet should the nurse suggest to the patient for proper neural development of the fetus? 1 Nuts, beans and legumes, cocoa, meats, and whole grains 2 Iodized salt, milk and milk products, yeast breads, and rolls 3 Citrus fruits, broccoli, melons, strawberries, and tomatoes 4 Asparagus, eggs, fortified cereals, and green leafy vegetables

2 Meconium is normally stored in the infant's intestines until after birth, but sometimes (in cases of fetal distress and hypoxia) it is expelled into the amniotic fluid before birth. The amniotic fluid is then said to be meconium stained. Fewer than three contractions in 10 minutes or late decelerations occurring with 50% or more of contractions constitute positive CST results. Positive CST results are associated with meconium-stained amniotic fluid. Negative CST results indicate that the fetus is normal. Suspicious or unsatisfactory CST results are not associated with any other fetal conditions.

The nurse is reviewing the contraction stress test (CST) reports of a pregnant patient. The nurse expects the fetus to have meconium-stained amniotic fluid. What would be the reason for that conclusion? 1 Negative CST results 2 Positive CST results 3 Suspicious CST results 4 Unsatisfactory CST results

3 The pregnant patient has a family history of diabetes and may be at a high risk for developing gestational diabetes. Because the initial 1-hour glucose tolerance test results are normal, the patient should be advised to repeat the test again at 28 weeks of pregnancy. The patient has normal blood sugar levels and is therefore unlikely to have renal complications. The patient does not need to undergo a renal function test. The laboratory reports do not indicate that the patient has any nutritional deficiencies and does not indicate a need for the patient to increase her food intake. A 3-hour glucose test is conducted only for pregnant patients whose 1-hour glucose tolerance test is positive.

The nurse is reviewing the lab reports of a patient who is 10 weeks pregnant and has a family history of diabetes mellitus. The nurse finds that the patient's 1-hour glucose tolerance test is normal. What does the nurse advise the patient? 1 "Undergo a renal function test." 2 "Increase food intake." 3 "Repeat the test at 28 weeks." 4 "Undergo a 3-hour glucose test."

4, 3, 2, 1 At conception the uterus has a small size and is in the shape of an upside-down pear. At week 7 of gestation the size of the uterus increases and the uterus takes the shape of a large hen's egg. At week 10 of gestation the uterus turns into a size of an orange. The uterus takes the shape of a grapefruit by week 12 of gestation.

The nurse is teaching a group of nursing students about the changes in shape, size, and position of the uterus during pregnancy. Arrange the shapes and sizes of the uterus during pregnancy in an ascending order. 1. Grapefruit-shaped uterus 2. Orange fruit-shaped uterus 3. Large hen's egg-shaped uterus 4. Upside-down pear-shaped uterus

4 An elevated level of oxytocin increases UCs during labor. A reduced hemoglobin level leads to a decreased oxygen supply to the fetus but is not a complication associated with an elevated oxytocin level. Oxytocin has no effect on the blood glucose levels. A family history of diabetes may increase the risk for gestational diabetes in the patient. Conditions such as hypertension in the patient may lower the blood supply to the placenta but are not associated with oxytocin levels.

The nurse is teaching a group of nursing students regarding fetal oxygenation. The nurse questions a student, "What happens when oxytocin levels are elevated in the patient?" What would be the most appropriate answer given by the nursing student related to the patient's condition? 1 "Hemoglobin levels will decrease." 2 "Blood glucose levels will increase." 3 "Placenta lowers the blood supply." 4 "Uterine contractions (UCs) will increase."

3 Anemia is caused by decreased hemoglobin levels in the blood, which, in turn, is caused by decreased iron intake. Iron supplements are usually given to treat iron deficiency anemia. Tea, coffee, and milk decrease iron absorption, which reduces the efficiency of iron supplements. Therefore the nurse teaches the anemic patient to stop drinking tea, coffee, and milk with the iron supplement. Tea, coffee, and milk do not affect the plasma levels of caffeine, the hematopoiesis process, or cause RBC destruction.

The nurse is teaching a patient with anemia when and how to take the prescribed iron supplements. The nurse provides a list of beverages for the patient to stay away from while taking the iron supplement. What is the rationale for this? 1 They can affect the process of hematopoiesis. 2 They increase red blood cell (RBC) destruction. 3 They can decrease iron supplement absorption. 4 They can increase the plasma levels of caffeine.

2 Intake of dry carbohydrate is recommended in pregnant patient's diet to suppress the vomiting observed during early pregnancy. Sometimes pregnancy symptoms are also experienced by the male partner. This is called couvade syndrome. Vena cava syndrome (supine hypotension) and carpal tunnel syndrome are not affected by intake of dry carbohydrate. Brachial plexus traction syndrome is manifested as drooping of the shoulder, which eventually disappears after childbirth. A dry carbohydrate diet has no effect on brachial plexus traction syndrome.

The nurse is teaching a pregnant patient who complains of vomiting about the use of dry carbohydrate in the morning. The patient asks the nurse, "My husband has similar problems. Will it be useful for my husband as well?" What can the nurse interpret from this? The husband has: 1 Vena cava syndrome. 2 Couvade syndrome. 3 Carpal tunnel syndrome. 4 Brachial plexus traction syndrome.

4 Sudden appearances of sweat on the upper lip, shaking of the extremities, and vomiting indicate the onset of the second stage of labor. Irregular and mild to moderate uterine contractions (UCs) indicate the onset of the latent phase of the first stage labor. Postural hypotension is characterized by a sudden fall in the blood pressure while changing the position. Respiratory depression is characterized by a decreased rate of respiration.

The student nurse finds that the patient who is in labor has sweat on the upper lip, is shivering in the extremities, and is vomiting. What would the student nurse interpret from these observations? The patient has symptoms of: 1 Postural hypotension. 2 Respiratory depression. 3 Onset of the first stage of labor. 4 Onset of the second stage of labor.

3 Some patients decrease their food intake during pregnancy for fear of weight gain. This may affect fetal development. Therefore the nurse should teach the patient to maintain adequate nutrition. When the patient delivers the baby and begins to breastfeed, this will aid postpartum weight loss. However, most of the weight is lost after the child's birth due to reduction of fat. There is no evidence that reduced consumption of carbohydrates may cause fetal obesity. Fetal obesity can happen as a result of maternal obesity. Lack of proper nutrition causes ketonuria, which may lead to preterm delivery, not a delay in the delivery. Ketonuria happens because the body breaks down fats for energy because of the lack of carbohydrates. Carbohydrates and proteins are essential for fetal development. Therefore the nurse should suggest the patient eat a balanced diet, rather than increasing the intake of protein.

The nurse notices that a pregnant patient is worried about gaining weight and has stayed away from eating foods high in carbohydrates. What should the nurse do to ensure adequate nutrition? 1 Inform the patient that lack of proper nutrition may delay the newborn's delivery date. 2 Suggest the patient increase her protein intake to compensate for the carbohydrate levels. 3 Inform the patient that breastfeeding aids in losing the weight gained during pregnancy. 4 Inform the patient that a decreased intake of carbohydrates during pregnancy causes fetal obesity.

2 Caffeine intake leads to reduced absorption of iron into the milk. In turn this reduces the concentration of iron in the milk, which may cause anemia in the newborn. Iron supplements are usually prescribed to prevent anemia in the mother. Iron does not cause anemia in the newborn. Folate supplements help prevent spina bifida (SB) in the newborn. Folate does not cause anemia in the newborn. Excess fluids help maintain the blood volume in the mother and enhance the formation of milk. Excess fluids do not cause anemia in the newborn.

The nurse notices that the hemoglobin levels of an infant who is breastfed have reduced drastically since birth. What is the probable reason for the infant to have anemia? 1 The infant's mother is still taking folic acid and B vitamins. 2 The infant's mother is consuming large amounts of caffeine. 3 The infant's mother continues to take oral iron supplements. 4 The infant's mother drinks large amounts of water and juices.

4 A BMI of 34.2 kg/m2 indicates that the patient is obese. Obese patients are more likely to develop preeclampsia as compared with their counterparts who have normal weight. Hypervitaminosis, severe hypotension, and lower extremity edema are not associated with preeclampsia. Deficiency of vitamin B6 is associated with preeclampsia. Hypertension during pregnancy, which is also referred to as gestational hypertension, is associated with preeclampsia. Small amounts of lower-extremity edema are normal in pregnant patients.

The nurse observes a patient had preeclampsia during the second trimester of her pregnancy. Which is the most likely reason for preeclampsia in this patient? 1 Hypervitaminosis 2 Severe hypotension 3 Lower extremity edema 4 Body mass index (BMI) of 34.2 kg/m2

2 Vitamin D plays a key role in the absorption and metabolism of calcium. A severe deficiency of vitamin D leads to tetany, neonatal hypocalcemia, and hypoplasia of tooth enamel. Thus the patient is most likely to have the risk for tetany. Goiter, ketonuria, and macrosomia are not related to vitamin D deficiency. Goiters occur because of an iodine deficiency. Ketonuria is the presence of ketones in urine and happens in patients with diabetes mellitus. Macrosomia is a risk that can happen with obese women during pregnancy.

The nurse observes that a patient has a decreased vitamin D level during a prenatal visit. Which associated risk should the nurse suspect to observe in the patient? 1 Goiter 2 Tetany 3 Ketonuria 4 Macrosomia

2 Severe itching in the pregnant woman is a condition called pruritus gravidarum. It is the result of intrahepatic cholestasis (accumulation of bile in the liver) caused by placental steroids. Hence, the hepatic function was affected in the patient. Itching is not indicative of renal, pulmonary, or gastrointestinal function. Glucosuria and proteinuria indicate that the renal function is affected. Nasal stuffiness, sinus stuffiness, and epistaxis indicate that the upper respiratory function is impaired. Pyrosis or heartburn indicates that the gastrointestinal function is impaired.

The nurse observes that a patient has severe itching during pregnancy. Which function in the patient is affected? 1 Renal function 2 Hepatic function 3 Respiratory function 4 Gastrointestinal function

2 The blood glucose level of 180 mg/dL indicates that the patient has high blood glucose levels. Therefore the patient has to be administered an electrolyte solution without glucose to prevent the risk of fetal hyperglycemia and hyperinsulinism. Hence, the nurse would expect the PHP to prescribe Ringer's lactate solution to the patient, as it does not increase blood sugar levels. Lidocaine (Nervocaine) is an anesthetic preparation, which may be given during emergency. Hydromorphone (Dilaudid) is an opioid preparation and is not used in treating blood glucose levels in the body. IV solution containing a small amount of dextrose is administered to increase the fatty acid metabolism when the patient has ketosis. It is not useful to treat hyperglycemia.

The nurse observes that a pregnant patient has a blood glucose level of 180 mg/dL in early labor. Which medication order does the nurse expect to receive from the primary health care provider (PHP)? 1 Lidocaine (Nervocaine) to the patient 2 Ringer's lactate solution to the patient 3 Hydromorphone (Dilaudid) to the patient 4 Intravenous (IV) solution containing a small amount of dextrose

4 Oligohydramnios is a condition that may cause umbilical cord compression and results in variable decelerations in the FHR. Usually lactated Ringer's or normal saline solution can be administered into the umbilical cord to increase the amniotic fluid volume and normalize fetal heart activity. Terbutaline (Brethine) is a uterine relaxant. It is mostly used to reduce uterine tachysystole. The nurse can administer phenylephrine (Endal) if other measures are unsuccessful in improving maternal hypotension. Oxytocin (Pitocin) is a uterine stimulant to induce labor. It is not used to reduce the umbilical cord compression.

The nurse observes variable decelerations in fetal heart rate (FHR) while assessing a pregnant patient with oligohydramnios. What medication should be immediately given to the patient? 1 Oxytocin (Pitocin) 2 Terbutaline (Brethine) 3 Phenylephrine (Endal) 4 Lactated Ringer's solution

4 Leopold maneuvers (abdominal palpation) help identify the degree of descent into the pelvis of the presenting part in a pregnant patient. The head feels round, firm, freely movable, and palpable by ballottement when the fetus has a cephalic or breech presentation. Based on the descent of the presenting part, it may be difficult to infer the fetal position, as the presenting part can be head or buttock. The cephalic prominence on the same side as the back shows that the fetal head is extended and the face is the presenting part. This maneuver is not related to identification of fetal position. If the head is presenting to the true pelvis and is not engaged, then it determines the attitude of fetal head whether flexed or extended. It does not indicate the fetal position.

The nurse palpates the abdomen of a pregnant patient and reports that the fetus lies in longitudinal position with cephalic presentation. Which observation enabled the nurse to report about the fetal position? 1 The presenting part has deeply descended in the pelvis. 2 The cephalic prominence is on the same side as the back. 3 The head is presenting to the true pelvis and is not engaged. 4 The head feels round, firm, freely movable, and palpable by ballottement

2 The patient may have severe fatigue after labor due to depletion of energy. In order to restore the energy levels, the nurse gives a specific time for the patient to rest and sleep by restricting the visitors. Severe pain, inefficiency in the birth process, and a problem of irregular urination are not the reason for the nurse to limit visitors. The nurse would administer analgesics or anesthesia on an order if the patient experienced acute pain. The nurse would provide comfort measures if the patient was ineffective in the birth process. The nurse would palpate the patient's bladder if irregular urination were a concern.

The nurse restricts the visitors of a pregnant patient and gives a specific time for the patient to rest and sleep after the labor. What maternal patient experience could be the probable reason for this nursing action? 1 Severe pain during labor 2 Severe fatigue during labor 3 Ineffective birth process 4 Problem of irregular urination

2 The nurse suggests the patient prevent conception because the patient was using isotretinoin (Accutane) for the treatment of acne. It is because isotretinoin (Accutane) is teratogenic and associated with fetal malformations. Sucralose (Splenda), saccharin (Sweet'N Low), and aspartame (NutraSweet) are artificial sweeteners, which have no profound effect on pregnancy. However, aspartame (NutraSweet) contains phenylalanine, which is to be avoided in pregnant patients with phenylketonuria (PKU).

The nurse reviews the medical history of a patient and instructs the patient to prevent conception. Which finding led the nurse to make such a decision? The patient is using: 1 Sucralose (Splenda). 2 Isotretinoin (Accutane). 3 Saccharin (Sweet'N Low). 4 Aspartame (NutraSweet).

2 The nurse suggests the patient avoid pregnancy because the patient is using isotretinoin (Accutane) for the treatment of acne. This medication is teratogenic and is associated with fetal malformations. Proteinuria and increased blood glucose levels are the common conditions during pregnancy, although they disappear after childbirth. Promethazine (Phenergan) therapy can cause only false-negative results for pregnancy tests. This drug is not a contraindication for pregnancy.

The nurse reviews the medical records of a patient and suggests the patient avoid becoming pregnant. Why does the nurse suggest so? The patient: 1 Has excess proteins in the urine. 2 Is using isotretinoin (Accutane). 3 Has increased blood sugar levels. 4 Is taking promethazine (Phenergan).

1 Doppler blood flow analysis allows the examiner to study the blood flow noninvasively in the fetus and placenta. It is a helpful tool in the management of high risk pregnancies because of intrauterine growth restriction (IUGR), diabetes mellitus, multiple fetuses, or preterm labor. Because of the potential risk of inducing labor and causing fetal distress, a CST is not performed on a woman whose fetus is preterm. Indications for an amniocentesis include diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and the diagnosis of fetal hemolytic disease, not IUGR. Fetal kick count monitoring is performed to monitor the fetus in pregnancies complicated by conditions that may affect fetal oxygenation. Although this may be a useful tool at some point later in this woman's pregnancy, it is not used to diagnose IUGR.

The nurse sees a woman for the first time when she is 30 weeks pregnant. The woman has smoked throughout the pregnancy, and fundal height measurements now are suggestive of growth restriction in the fetus. In addition to ultrasound to measure fetal size, what tool is useful in confirming the diagnosis? 1 Doppler blood flow analysis 2 Contraction stress test (CST) 3 Amniocentesis 4 Daily fetal movement counts

A patient with a history of gonorrheal infection has just delivered a baby. What immediate intervention should the nurse provide to the newborn to ensure safety? 1 Place the newborn in incubator. 2 Administer ophthalmic solution. 3 Perform a heelstick puncture test. 4 Provide ventilator support to the newborn.

The nurse should administer erythromycin ophthalmic solution to the newborn within 2 hours of birth to prevent ophthalmia neonatorum caused by gonorrheal infection. Incubation is preferred when a neonate has hypothermia in order to regulate the body temperature. Heelstick puncture is performed to detect abnormalities in blood levels only if the neonate has any infection. Ventilator support is provided if the neonate's heart rate is below 100 beats/min. However, the heart rate is not decreased due to gonorrheal infection.

2, 4, 1, 3 Sucralose (Splenda) is 600 times sweeter than sugar. Acesulfame K (Sunett) is 200 times sweeter than sugar. Saccharin (Sweet'N Low) is 300 times sweeter than sugar. Aspartame (NutraSweet) is 180 times sweeter than sugar. Therefore the descending order of sweetness of the artificial sweeteners is sucralose (Splenda), saccharin (Sweet'N Low), acesulfame K (Sunett), and aspartame (NutraSweet).

The nurse teaches a group of students about the use of artificial sweeteners during pregnancy. Arrange the artificial sweeteners in a descending order according to their sweetness as compared to sugar. 1. Acesulfame K (Sunett) 2. Sucralose (Splenda) 3. Aspartame (NutraSweet) 4. Saccharin (Sweet'N Low)

1 If 15 mL of fetal blood is detected in the maternal circulation of an Rh-negative woman, as indicated by Kleihauer-Betke test, then 300 mcg (1 vial) of Rh immune globulin is usually sufficient to prevent maternal sensitization. A dose of 400 mcg of intramuscular Rh immune globulin may result in an overdosage. A dose of 100 mcg or 200 mcg of intramuscular Rh immune globulin is not sufficient to prevent maternal sensitization.

The nurse tells the primary health care provider (PHP) that there is 15 mL of fetal blood in maternal circulation, as detected by Kleihauer-Betke test, in an Rh-negative patient. What does the nurse expect the PHP to prescribe to this patient? 1 300 mcg of intramuscular Rh immune globulin 2 400 mcg of intramuscular Rh immune globulin 3 100 mcg of intramuscular Rh immune globulin 4 200 mcg of intramuscular Rh immune globulin

2 The intensity of afterpains depends on the lactating status of the patient, the number of times a patient has been pregnant, and the type of gestation whether single or multiple. Breastfeeding stimulates uterine contractions (UCs), which increase afterpains. First-time mothers may have only mild uterine cramping, so nulliparous women may have mild afterpains compared with the multiparous women. An overdistended uterus caused by multiple gestation and polyhydramnios makes the afterpains more noticeable. Therefore a patient who is lactating, is multiparous, and had multiple gestation would have more afterpains. If a patient is lactating but is nulliparous and had single gestation, the intensity of afterpains would be less. A patient who is nonlactating, is nulliparous, and has oligohydramnios may have less afterpains. The patient who had multiple gestation but is nonlactating and nulliparous may have less intense afterpains.

The postpartum patient reports to the nurse, "I am having intolerable pain after the delivery." Which conditions would cause the patient's afterpains? 1 Lactating, nulliparous, single gestation 2 Lactating, multiparous, multiple gestation 3 Nonlactating, nulliparous, oligohydramnios 4 Nonlactating, nulliparous, multiple gestation

3 When the membranes rupture, there is a possible risk of infection, as the microorganisms can ascend form the vagina to the uterus. Ruptured membranes can be assessed by monitoring the body temperature and vaginal discharge every 2 hours. The assessment is not used for knowing the onset of labor because it does not indicate the progress of labor. The fetal status is not known by the assessment of the temperature and vaginal show; it may be known by another procedure called Leopold maneuvers. This measure is not done to prevent fetal hypertension, because the maternal body temperature and vaginal discharge does not indicate fetal blood pressure.

The primary health care provider (PHP) advised the nurse to assess the maternal temperature and vaginal discharge of a pregnant patient every 2 hours. What is the reason behind this advice? 1 To evaluate fetal status 2 To know the onset of labor 3 To assess for potential risk for infection 4 To prevent fetal hypertension

4, 5 After receiving the first dose of Varivax, the patient must take the second dose 4 to 8 weeks later. The patient must use contraception for 1 month after being vaccinated to avoid pregnancy because the vaccine has teratogenic effects. Mothers who receive the varicella vaccine can continue to breastfeed because the vaccine is not transmitted to the fetus through breast milk. Postpartum women usually have low immunity, so one dose is not sufficient. Stopping of all medications is not necessary and can endanger the patient.

The primary health care provider (PHP) has asked the nurse to administer varicella vaccine (Varivax) to a postpartum patient on the day of discharge from the hospital. What instruction does the nurse give the patient before administering the vaccine? Select all that apply. 1 "Stop breastfeeding after receiving the vaccine." 2 "You need not return to the hospital because one dose is enough for you." 3 "Stop taking all medications after returning home." 4 "You must return for a second dose in 4 to 8 weeks." 5 "Use contraception for 1 month to avoid pregnancy."

2 Oxytocin (Pitocin) is administered immediately after birth to retain a firm and well-contracted uterus. A patient with vaginal delivery may need oxytocin (Pitocin) because the uterine muscles are stretched to a larger extent. Therefore oxytocin (Pitocin) is administered to induce contraction. Thyroiditis, or the inflammation of the thyroid gland, causes anemia and postpartum hemorrhage, but it does not affect elasticity of the uterus. A patient who had a cesarean delivery may not need oxytocin (Pitocin), because the uterus is not as stretched compared with that of a patient who had a vaginal delivery. Gestational diabetes does not decrease oxytocin levels, so the patient may not need an oxytocin supplement.

The primary health care provider (PHP) instructed the nurse to administer oxytocin (Pitocin) to the patient immediately after birth. What could be the patient's clinical status for the PHP's instruction? 1 Thyroiditis 2 Postvaginal delivery 3 Delivery by cesarean section 4 Gestational diabetes

2 The presence of bilirubin in the amniotic fluid indicates the possibility of hemolytic anemia in the fetus. The degree of hemolytic anemia can be determined by using Doppler blood flow analysis. The presence of the placental hormone inhibin-A in the quad screen indicates Down syndrome. The amniotic fluid index values are used to detect Potter syndrome. Fetal hydrops is caused by polyhydramnios, which can be assessed by ultrasound scanning.

The primary health care provider advises a pregnant woman to undergo a Doppler blood flow analysis after reviewing the amniocentesis reports. What clinical condition in the fetus could be the reason for this referral? 1 Down syndrome 2 Hemolytic anemia 3 Potter syndrome 4 Fetal hydrops

3 It is necessary to monitor the FHR in the pregnant patient who is given general anesthesia. General anesthesia usually causes minimal variability or no change in the FHR. Tachycardia is caused by fetal hypoxemia, whereas bradycardia is caused from a structural defect in the fetal heart. Moderate variability in the FHR indicates normal fetal activity.

The primary health care provider has administered general anesthesia to a patient who is scheduled for an elective cesarean section. What changes should the nurse observe in the fetal heart rate (FHR) after the administration of general anesthesia? 1 Decrease 2 Increase 3 Minimal variability 4 Moderate variability

1 Terbutaline (Brethine) is usually prescribed to postpone labor, because the drug reduces the frequency of uterine contractions. Terbutaline (Brethine) can also increase the fetal heart rate (FHR). Terbutaline (Brethine) does not decrease the heart rate, nor does it cause any accelerations or decelerations in the FHR. Heart block or viral infections can decrease the FHR and may result in bradycardia. There may be accelerations in the FHR during a vaginal examination. A parasympathetic response may cause decelerations in heart rate. Terbutaline is a sympathomimetic drug and thus does not cause decelerations in FHR.

The primary health care provider has administered terbutaline (Brethine) to a pregnant patient to postpone preterm labor. What changes would the nurse observe in the fetal heart monitor after this drug was administered? 1 Increase in fetal heart rate 2 Decrease in fetal heart rate 3 Accelerations in heart rate 4 Decelerations in heart rate

88 116 + 2(74)/3; 116 + 148/3; 264/3 = 88

To provide optimal prenatal care, a blood pressure (BP) reading should be obtained at each prenatal visit. The nurse should ensure that the same arm is used for each reading, utilize the appropriate sized cuff, and have the woman resting in a seated position with her arm supported. Calculating the mean arterial pressure (MAP) (the mean of the blood pressure in the arterial circulation) can increase the value of the diagnostic findings. MAP readings for a pregnant woman at term are 90 + 5.8 mm Hg. The nurse has just obtained a BP reading of 116/74 mm Hg on a 38-week multiparous patient. The nurse is aware that the provider would like to review the MAP readings on all of her patients. The formula is Systolic + 2 (Diastolic)/3. The nurse calculates the MAP for this patient. Record your answer using a whole number.___mm Hg

Infections: Acronym TORCH is used to describe infections that can be devastating to the fetus or newborn What is T.O.R.C.H

Toxoplasmosis Other infections Rubella Cytomegalovirus Herpes

Hepatitis B: T/F Transmitted by body fluids including breast milk; can also cross the placenta

True

4 Puerperal sepsis is a condition in which a woman's genital tract becomes infected due to low immunity caused by long labor, severe bleeding, or dehydration. Therefore the nurse should assess the patient for puerperal sepsis if the temperature of the woman after childbirth is raised to 100.4° F. Blood pressure is routinely assessed in postpartum patients to detect hemorrhage. A rapid pulse rate indicates the presence of hypovolemia as a result of hemorrhage. The respiratory rate is measured because hypoventilation can occur after a high subarachnoid block or epidural narcotic following a cesarean birth.

Twenty-four hours after childbirth, a patient developed a high temperature of 100.4° F. Which monitoring action is most important for the nurse? 1 Pulse rate 2 Blood pressure 3 Respiratory rate 4 Assess for puerperal sepsis

1, 3, 4 Vaginal examinations should be performed when the woman is admitted to the hospital or birthing center at the start of labor. When the woman perceives perineal pressure or the urge to bear down is an appropriate time to perform a vaginal examination. After rupture of membranes (ROM), a vaginal examination should be performed. The nurse must be aware that there is an increased risk of prolapsed cord immediately after ROM. An accelerated FHR is a positive sign; variable decelerations, however, merit a vaginal examination. Examinations are never done by the nurse if vaginal bleeding is present because the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.

Under which circumstances should a vaginal examination be performed by the nurse? Select all that apply. 1 An admission to the hospital at the start of labor 2 When accelerations of the fetal heart rate (FHR) are noted 3 On maternal perception of perineal pressure or the urge to bear down 4 When membranes rupture 5 When bright, red bleeding is observed

Iron Deficiency Anemia: *Prevention - Iron supplements - ____________may enhance absorption - Do not take iron with milk or antacids (calcium impairs absorption)

Vitamin C

CHF Treatment: - Priority care is limiting physical activity - Drug therapy - Prolonged bedrest = greater risk of clot formation - May include beta-adrenergic blockers, anticoagulants, diuretics - __________cannot be used - may cause birth defects - ___________ - safe for pregnancy for clot prevention

Warfarin cannot be used Heparin can be used

3 In postpartum women, the colostrum transforms to mature milk within approximately 72 to 96 hours after birth. This mature milk is slightly bluish in color. Thus, based on the finding, the nurse would infer that the patient is expressing mature milk. There are no secretions from the nipples in cases of breast abscess. Colostrum is clear, yellow fluid, which is commonly secreted immediately after birth. Fibrocystic changes in the breast are characterized by nodular lumps in the breast, which are always palpable in the same location.

What does the nurse infer about the patient's condition from the finding of slightly bluish-colored milk expressed from the breasts of a postnatal patient? 1 The patient may have a breast abscess. 2 The patient may be expressing colostrum. 3 The patient may be expressing mature milk. 4 The patient may have fibrocystic changes in the breast.

4 Suppression of lactation is recommended in cases of neonatal death. To suppress lactation, the nurse should advise the patient to wear a breast binder continuously for the first 72 hours after delivery. Running warm water over the breast stimulates lactation. Mild analgesics can be administered to reduce breast engorgement, but they are not used to suppress lactation. Administration of oral or intravenous fluids may stimulate lactation.

What intervention does the nurse perform to suppress lactation in a patient who had a stillbirth? 1 Run warm water over the patient's breasts. 2 Administer strong analgesics. 3 Administer oral and intravenous fluids. 4 Advise the patient to wear a breast binder for the first 72 hours after giving birth.

Leopold's first maneuver

What is the presenting part? look for the head in the pelvis (90% of the time it's there)

1, 2, 5 Morning sickness is seen in most women during the first trimester. Hot foods have strong odors, which may stimulate the chemoreceptor trigger zone and cause nausea. Therefore the nurse should advise the patient to ingest the food when it is not too hot. The patient is usually taught to have smaller, more frequent meals every 2 to 3 hours because it prevents stomach distention. Starch reduces the concentration of gastric acid, which aids in preventing nausea. Therefore the nurse should teach the patient to incorporate foods that contain higher quantities of starch. Usually patients are instructed to include higher amounts of fluids during pregnancy to prevent dehydration caused by nausea. Fried foods and foods rich in fats tend to produce more acids that can aggravate nausea and contribute to reflux.

What measures should the nurse instruct a pregnant patient to take to relieve the symptoms of morning sickness during the first trimester? Select all that apply. 1 Consume food when it is not hot. 2 Eat food in smaller portions. 3 Include smaller amounts of fluids. 4 Include foods that are high in fats. 5 Include food high in starch content.

2 The L/S ratio indicates fetal lung maturity. AFP is assessed to check for the presence of neural defects. Presence of creatinine in the amniotic fluid indicates that the patient's gestational age is more than 36 weeks. The antibody titer is used to determine Rh incompatibility in the fetus.

What parameter does the nurse check in the amniocentesis report of a pregnant patient to assess fetal lung growth? 1 Alfa-fetoprotein (AFP) levels 2 Lecithin-to-sphingomyelin (L/S) ratio 3 Creatinine levels in the blood 4 Antibody titer in the blood

3 When the nurse is assessing a patient's socioeconomic status, the nurse should determine whether the patient has health insurance. Lack of health insurance may mean the patient does not have a job to pay for insurance or the income to pay for it privately. This may affect the patient's prenatal care if she cannot afford services. When the nurse asks about the family's medical history, this falls under the patient's personal history. The nurse asks about the community in which the patient lives when assessing the patient's environment. Medications can affect the fetus in a pregnant patient. Therefore the nurse should ask about the medications taken by the patient when assessing the patient's health status.

What question does the nurse ask while assessing the socioeconomic status of a pregnant patient? 1 "What prescription medications do you take?" 2 "Do you have any factories around your house?" 3 "Do you have any medical or dental insurance?" 4 "Are there any diseases that run in your family?"

4 Before the ultrasonic recording, the nurse should first locate the site on the abdomen where the maximal intensity of the fetal heart rate can be assessed. This should be done to find where the ultrasound transducer head can be placed. The apical heart rate of the patient need not be assessed before this procedure, because this procedure does not interfere with the cardiac activity of the pregnant patient. After finding the site of application, the nurse can apply conductive gel on the transducer and on the abdomen of the patient.

What should be the first step taken by the nurse when assessing fetal heart activity using an ultrasound transducer? 1 Auscultate the apical heart rate of the pregnant patient. 2 Apply some conductive gel on the maternal abdomen. 3 Apply some conductive gel on the ultrasound transducer. 4 Locate the maximal intensity area of the fetal heart rate.

2 Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.

What statement by a woman who just gave birth indicates that she knows what to expect about her menstrual activity after childbirth? 1 "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." 2 "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." 3 "I will not have a menstrual cycle for 6 months after childbirth." 4 "My first menstrual cycle will be heavier than normal and then will be light for several months after."

4 The levels of steroid hormones such as progesterone and estrogen suddenly drop after childbirth. This leads to reduced renal function, which persists for 1 month after delivery. This leads to decreased urine output in the patient. Lactation may result in lactosuria. The patient exhibits signs such as fever and pain during urination if the patient has a urinary tract infection. Pregnancy-induced hypotonia results in decreased tone of the muscles supporting the pelvic structures. This poor muscular tone is detected during pregnancy and requires about 6 weeks to revert to the nonpregnant state.

What would the nurse assume is the cause of reduced urine output in a postpartum patient on the second day after delivery with no other abnormal signs or symptoms? 1 Lactation 2 Urinary tract infection 3 Pregnancy-induced hypotonia 4 Low levels of progesterone and estrogen

2 Edema usually refers to the abnormal accumulation of fluid in the interstitium. In the past it was believed to be caused by an excess of sodium. However, a moderate amount of edema is considered normal. This happens because of higher estrogen levels. Vitamin B deficiency causes neural tube defects. Taking in too many calories does not cause edema; it causes weight gain. Glucose is the basic source for energy, deficiency of which causes hypoglycemia and reduces stamina. However, it does not cause edema.

When assessing a pregnant woman in the second trimester, the nurse finds the patient to be healthy, but the patient reports mild edema. What should the nurse infer from this finding? 1 The patient has a vitamin B deficiency. 2 This is a normal finding; it results from estrogen. 3 The patient is consuming too many calories. 4 The nurse should check the blood glucose

4 Fetal scalp and vibroacoustic stimulation are two stimulating methods that are used to determine the fetal scalp blood pH. They are performed only when the fetal baseline heart rate is within the normal range. These techniques are not suggested if there is fetal bradycardia. These stimulation methods are related to neither the patient's weight nor uterine contractions.

When does the nurse use the fetal scalp stimulation technique to assess the fetal scalp pH? 1 If the patient's contractions have increased 2 If there is maternal weight loss in the last trimester 3 If fetal bradycardia is present 4 When the fetal heart rate (FHR) is within the baseline

3 The findings indicate a full bladder, which pushes the uterus up and to the right or left of midline. The recommended action is to empty the bladder. If the bladder remains distended, uterine atony could occur, resulting in a profuse flow. A firm fundus should not be massaged because massage could overstimulate the fundus and cause it to relax. Methergine is not indicated in this case because it is an oxytocic and the fundus is already firm. This is not an expected finding, and emptying the bladder is required. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience.

When palpating the fundus of a woman 18 hours after birth, the nurse notes that it is firm, 2 fingerbreadths above the umbilicus, and deviated to the left of midline. The nurse should: 1 massage the fundus. 2 administer Methergine, 0.2 mg PO, that has been ordered prn. 3 assist the woman to empty her bladder. 4 recognize this as an expected finding during the first 24 hours following birth.

1 The assessment includes palpation; duration, frequency, intensity, and resting tone. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: 1 the examiner's hand should be placed over the fundus before, during, and after contractions. 2 the frequency and duration of contractions are measured in seconds for consistency. 3 contraction intensity is given a judgment number of 1 to 7 by the nurse and patient together. 4 the resting tone between contractions is described as either placid or turbulent.

3 An ultrasound transducer is used to assess the FHR by an external mode of electronic fetal monitoring. It does not require membrane rupture and cervical dilation. A tocotransducer can be used to assess the uterine activity (UA) in a pregnant patient whose cervix is not sufficiently dilated, but it does not assess the FHR. Spiral electrode is used as an internal mode of electronic fetal monitoring to assess the FHR. It can be used only when the membranes are ruptured and the cervix is dilated during the intrapartum period. IUPC is used to assess uterine activity in internal mode. It can be used only when the membranes are ruptured and the cervix is dilated during the intrapartum period.

Which device can be used as a noninvasive way to assess the fetal heart rate (FHR) in a patient whose membranes are not ruptured? 1 Tocotransducer 2 Spiral electrode 3 Ultrasound transducer 4 Intrauterine pressure catheter (IUPC)

3 33% Hct; 11 g/dL Hgb represents the lowest acceptable value during the first and the third trimesters. 38% Hct; 14 g/dL Hgb is within normal limits in the nonpregnant woman. 35% Hct; 13 g/dL Hgb is within normal limits for a nonpregnant woman. 32% Hct; 10.5 g/dL Hgb represents the lowest acceptable value for the second trimester when the hemodilution effect of blood volume expansion is at its peak.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent the lowest acceptable values for a woman in the third trimester of pregnancy? 1 38% Hct; 14 g/dL Hgb 2 35% Hct; 13 g/dL Hgb 3 33% Hct; 11 g/dL Hgb 4 32% Hct; 10.5 g/dL Hgb

3 The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Administration of Methergine can help prevent postpartum hemorrhage. Voiding frequently can help the uterus contract, thus preventing postpartum hemorrhage. Rest and nutrition are helpful for enhancing healing and preventing hemorrhage. Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.

Which measure is least effective in preventing postpartum hemorrhage? 1 Administering Methergine, 0.2 mg every 6 hours for four doses, as ordered 2 Encouraging the woman to void every 2 hours 3 Massaging the fundus every hour for the first 24 hours following birth 4 Teaching the woman the importance of rest and nutrition to enhance healing

2, 3, 5 A nulliparous patient has rigid perineal tissue making it susceptible to injury. Fetal breech presentation exerts undue pressure on the tissues, increasing the risk of injuries. Forceps delivery also increases the risk of injury due to undue stretch of the perineum. Multiparous patients have stretchable perineal tissues, which are less likely to get injured during childbirth. Fetal vertex presentation causes the least amount of tissue damage.

Which patients are more susceptible to soft-tissue damage with vaginal deliveries? Select all that apply. 1 Multiparous patients 2 Nulliparous patients 3 Patients needing forceps delivery 4 Patients with fetal vertex presentation 5 Patients with fetal breech presentatio

1, 2, 3 Assessment of physiologic parameters such as AFV, FBMs, and limb and head movements of the fetus by ultrasonography gives a reliable picture of fetal well-being. Abnormalities in the amniotic fluid volume are frequently associated with fetal disorders. Fetal breathing and limb and head movements reflect the status of the central nervous system. Daily fetal movement count is the most common method used to assess fetal activity. Ultrasound is not used to assess the daily fetal movement count. The fluid volume in the nape of the fetal neck is measured to assess structural abnormalities in the fetus.

Which physiologic parameters does the nurse check in the ultrasound report to assess fetal well-being? Select all that apply. 1 Amniotic fluid volume (AFV) 2 Fetal breathing movements (FBMs) 3 Fetal limb and head movements 4 Daily count of fetal movements 5 Fluid volume in the nape of the fetal neck

3 A high pulse rate of 129 beats per minute in a postpartum patient immediately after childbirth may be indicative of hypovolemia caused by blood loss during labor. This is an abnormal assessment finding postdelivery. Labor may cause dehydration, and this may result in a slight increase in body temperature of up to 38° C. This is a normal finding associated with labor. Blood pressure may be slightly altered after childbirth. A blood pressure of 126/80 mm Hg would be a normal finding in this patient. The respiratory rate increases during labor and then slowly comes back to normal after labor. Normal respiratory rate is 12 to 14 breaths per minute. Thus, 15 breaths per minute is a normal finding.

Which postpartum patient finding would the nurse consider abnormal when assessing the patient's vital signs immediately after childbirth? 1 Temperature 38° C 2 Blood pressure 126/80 mm Hg 3 Pulse rate 129 beats per minute 4 Respiratory rate 15 breaths per minute

1, 2, 4 Angiomas, gingivitis, and nose bleeding occur in the pregnant patient because of an increase in estrogen levels. Angiomas (spider nevi) appear on the neck, thorax, face, and arms during the second or third trimester of pregnancy. Estrogen increases vascularity and proliferation of the connective tissue. This results in gingivitis. Estrogen causes hyperemia of the mucous membranes. This results in nose bleeding. Constipation during pregnancy results from an increase in progesterone (not estrogen) levels. Gastrocnemius spasm during pregnancy is caused by a reduced level of diffusible serum calcium or an elevation of serum phosphorus.

Which signs and symptoms in a pregnant patient would the nurse attribute to elevated levels of estrogen? Select all that apply. 1 Angiomas 2 Gingivitis 3 Constipation 4 Nose bleeding 5 Gastrocnemius spasm

A, B, C Pelvic muscles support the pelvic organs such as the uterus, rectum, and bladder. Relaxation or weakness of this pelvic muscular support may lead to prolapse of these organs in the future. The small intestine is not a pelvic organ. Inguinal vessels are not held in place by pelvic muscular support.

Which structures may be affected due to the relaxation of pelvic muscular support that occurs after childbirth? Select all that apply. A Uterus B Rectum C Bladder D Small intestine E Inguinal vessels

1, 2, 3, 5 Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg), but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? Select all that apply. 1 Underweight women should gain 12.5 to 18 kg. 2 Overweight women should gain at least 7 to 11.5 kg. 3 Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. 4 In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. 5 Normal weight women should gain 11.5 to 16 kg.

3 The NT ultrasound screening technique is used to measure fluid in the nape of the fetal neck between 10 and 14 weeks' gestation. Fluid volume greater than 3 mm is considered abnormal. NT is used mostly to identify possible fetal genetic abnormalities. AFV, fetal body movements, and fetal heart activity are measured to assess fetal well-being.

Which test does the nurse recommend for the patient to help assess fetal genetic abnormalities? 1 Amniotic fluid volume (AFV) 2 Fetal body movements 3 Nuchal translucency (NT) 4 Fetal heart activity

2 In many instances, a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. A urine analysis should be performed on admission to labor and delivery. This test is used to identify the presence of glucose and protein. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.

Which test is performed to determine if membranes are ruptured? 1 Urine analysis 2 Fern test 3 Leopold maneuvers 4 Artificial rupture of membranes (AROM

1 Applying a covered ice pack to the perineum from front to back during first 24 hours decreases edema and increases comfort. Using two or more perineal pads would be helpful in absorbing the heavy menstrual flow but will not reduce the pain or promote perineal healing. Sitz baths and Kegel exercises are important measures to provide pain relief and comfort to the patient with a fourth-degree laceration. Therefore the nurse should not advise the patient to avoid taking sitz baths and performing perineal (Kegel) exercises.

While assessing a postpartum patient, the nurse finds that the patient has a fourth-degree laceration. What immediate interventions should the nurse perform while caring for the patient? 1 Apply an ice pack to limit edema during the first 12 to 24 hours. 2 Instruct the patient to use two or more perineal pads. 3 Teach the patient to avoid taking sitz baths. 4 Remind the patient to avoid doing perineal (Kegel) exercises.

4 While assessing the fetal heart rate (FHR) with a fetoscope, the nurse palpates the abdomen of the fetus to evaluate uterine contractions (UCs). This is done to detect any changes in the FHR during and after UCs. FHR decelerations are not identified by palpating the abdomen. It is assessed using the electronic fetal monitoring system. Pain perception is a subjective assessment. Moreover, the pressure from the fetoscope is very minimal and does not cause pain.

While assessing a pregnant patient using a fetoscope, the nurse also palpates the abdomen of the patient. What is the purpose of palpating the abdomen of the patient? 1 Detection of fetal heart rate deceleration 2 Evaluation of the severity of the pain caused by active labor 3 Assessment of pain from pressure applied by the fetoscope 4 Assessment of changes in fetal heart rate during and after contraction

3 W-shaped waves in the FHR monitor are indicative of variable decelerations in the FHR. Variable decelerations are seen when the umbilical cord is compressed at the time of labor. Placental abruption and dilated cervical layers do not cause variable decelerations but may cause late decelerations. Similarly, increased rate of uterine contractions may also cause late decelerations in FHR.

While assessing a pregnant patient who is in labor, the nurse observes W-shaped waves on the fetal heart rate (FHR) monitor. What would the nurse infer from this observation? 1 Placental abruption 2 Dilated cervical layers 3 Umbilical cord compression 4 Elevated uterine contractions

2 During pregnancy, gastrointestinal motility is reduced by changes in hormone levels. This increases bacterial action and results in gas production, which results in flatulence, bloating, and belching. Therefore, to improve digestion and prevent gas production, the nurse should advise the patient to chew foods slowly and thoroughly. Drinking acidophilus milk prevents urinary tract infection but does not help reduce flatulence. The patient should avoid consuming fatty food because it increases flatulence and belching. The patient should not increase fluid intake before bedtime because it may cause frequent urination.

While assessing a pregnant patient, the nurse finds that the patient has increased flatulence, bloating, and belching. Which intervention should the nurse suggest to reduce this discomfort? 1 "Drink acidophilus milk regularly." 2 "Chew foods slowly and thoroughly." 3 "Increase consumption of fatty food." 4 "Increase fluid intake before bedtime."

3 A multiparous patient feels an urge to defecate in the second stage of labor due to rectal pressure by the deeply descending presenting part in the pelvis. Rectal pressure may occur even in the absence of stool in the anorectal area. This often means that the patient is about to give birth to the child. Therefore the nurse has to perform vaginal examination of the patient to assess cervical dilation and station. The patient does not really defecate, so providing a bedpan is not necessary. Placing an enema in the rectum of the patient is not a suitable intervention, as it is done to increase peristalsis. Running water is used to stimulate voiding for the patient if there is a risk of urinary elimination. However, it is unrelated to the patient's urge of defecation.

While caring for a multiparous patient in the second stage of labor, the patient reports the urge to defecate. What is the best nursing intervention? 1 Provide a bedpan to the patient to defecate. 2 Place an enema in the rectum of the patient. 3 Assess cervical dilation and station of the patient. 4 Use running water to stimulate defection for the patient.

1 Estrogen causes fluid accumulation and after childbirth a woman's estrogen levels decrease, leading to postpartal diuresis. Postpartal diuresis results in profuse sweating and an increase in urinary output. The hormone prolactin plays a role in milk production, but not in fluid retention so a decrease in prolactin does not cause fluid loss, diuresis, and sweating. Progesterone helps in the formation of the uterine endometrium and prevents uterine contractions. An increase in progesterone levels may cause uterine atony, but not postpartal diuresis that manifests as increased urinary output and profuse sweating. Human chorionic gonadotropin (hCG) levels decrease rapidly after delivery, but this does not cause diaphoresis. Therefore, an increase in hCG levels would not cause sweating or increased urinary output in this client.

While caring for a postpartum patient, the nurse determines that the client has increased urinary output and profuse nighttime sweating. What could cause these symptoms? 1 Decreased estrogen levels 2 Decreased prolactin levels 3 Increased progesterone levels 4 Increased human chorionic gonadotropin level

1 The fundus descends gradually from the time of childbirth and returns to its normal nonpregnant state. By the sixth day after childbirth, it can be located halfway between the umbilicus and the symphysis pubis. The fundus rises to approximately 1 cm above the umbilicus within 12 hours of childbirth. Within 24 hours, the fundus descends 1 to 2 cm, and the size of the uterus is the same as during 20 weeks' gestation. By the sixth week, the uterus returns to its normal, nonpregnant state.

While examining the postpartum patient, the nurse finds that her fundus is located halfway between the umbilicus and the symphysis pubis. When would the nurse suspect was about the time of the patient's delivery? 1 6 days ago 2 12 hours ago 3 24 hours ago 4 6 weeks ago

2 Variable decelerations in the FHR are usually caused by umbilical cord compression. The knee-to-chest position is useful for relieving cord compression, and thus the nurse should ask the patient to move into this position. Prolonged decelerations in the FHR are not affected by the mother's position. If the nurse finds late decelerations in the FHR, the nurse should ask the mother to lie in the lateral position. Early decelerations in the FHR are a normal finding, and no nursing intervention is required.

While monitoring the fetal heart rate (FHR), the nurse instructs the patient to change positions and lie in the knee-to-chest position. What is the reason for the nurse to give this instruction to the patient? 1 Late decelerations in the FHR 2 Variable decelerations in the FHR 3 Early decelerations in the FHR 4 Prolonged decelerations in the FHR

2 Lack of response after 3 minutes of FAST indicates that the fetus has low activity levels. In this situation, to accurately assess fetal activity, the nurse should recommend a BPP of the fetus. Amniocentesis helps detect genetic abnormalities in the fetus. Fetal activity cannot be determined using this technique. In cordocentesis, the umbilical blood is tested for Rh incompatibility and hemolytic anemia in the fetus. Coombs' test is used to determine the presence of antibody incompatibilities in the fetus and the mother.

While performing the fetal acoustic stimulation test (FAST) in a patient, the nurse observes that there is no fetal response even after 3 minutes of testing. Which test does the nurse suggest? 1 Amniocentesis 2 Biophysical profile (BPP) 3 Cordocentesis 4 Coombs' test

1 In pregnant woman, the tubular reabsorption of glucose is impaired causing glucosuria to occur. This urine glucose level can vary from 0 to 20 mg/dL in a pregnant female. Although glucosuria is a normal finding in pregnancy, the possibility of diabetes should be considered. Decrease in fat absorption does not affect the glucose reabsorption in the kidneys but may lead to malnutrition. A decreased rate of metabolism does not affect glomerular filtration process. β-cells of the islets of Langerhans help in the production of insulin; they are not involved in the glucose absorption by the kidneys.

While reviewing the laboratory reports of a pregnant female, the nurse finds that the patient's urine glucose levels fluctuate. What does the nurse infer from the assessment? The patient has: 1 A normal pregnancy. 2 Decreased fat absorption. 3 Decreased glucose metabolism. 4 Sensitive pancreatic β-cells.

3, 4 A floating fetus is seen in cases of elevated amniotic fluid volume, or polyhydramnios. Polyhydramnios is associated with neural tube defects and gastrointestinal obstruction. Renal agenesis and severe intrauterine growth restriction are associated with oligohydramnios, or low amniotic fluid volume. A low amount of fluid may not result in a floating fetus in the scanned image. The amniotic fluid level is unrelated to cardiac disease in the fetus.

While reviewing the ultrasound reports of a patient, the nurse notices a floating fetus in the scanned image. What potential fetal risks should the nurse interpret from this finding? Select all that apply: 1 Renal agenesis 2 Growth restriction 3 Neural tube defects 4 Gastrointestinal obstruction 5 Cardiac disease.

3 Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large infant or multiple infants overdistend the uterus. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

With regard to afterbirth pains, nurses should be aware that these pains are: 1 caused by mild, continual contractions for the duration of the postpartum period. 2 more common in first-time mothers. 3 more noticeable in births in which the uterus was overdistended. 4 alleviated somewhat when the mother breastfeeds.

1 Prescription and OTC drugs can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that: 1 prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. 2 the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. 3 killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. 4 no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

3 Excess fluid loss can occur through perspiration and urinary output as well as through other means. Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Bladder tone usually is restored 5 to 7 days after childbirth. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all exams is not realistic, but scoring an 85% may be a better goal.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: 1 kidney function returns to normal a few days after birth. 2 diastasis recti abdominis is a common condition that alters the voiding reflex. 3 fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. 4 with adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

2 Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: 1 spina bifida. 2 intrauterine growth restriction. 3 diabetes mellitus. 4 Down syndrome.

Sitting or squatting poisition

abdominal muscles work in greater harmony with uterine contractions

Sentinel event:

an unexpected occurrence involving death or serious physical or psychologic injury, or the risk thereof.

Erythroblastosis Fetalis: Requires RhoGAM to be given when?

at 28 weeks and within 72 hours of delivery to the mother

Valsalva maneuver is holding breath while pushing

avoid this if possible, because it increases intrathoracic pressure, which reduces venous return, and increases venous pressure. CO and BP slows and fetal hypoxia may occur.

Hepatitis B: Upon delivery, the neonate should receive a single dose of hepatitis B immune globulin, followed by the hepatitis B vaccine.. when?

birth, 1—2 months, then 6-18 months

Risks to Supine position

blood flow can be compromised, resulting in hypotension. Upright positions benefit Cardiac Output.

Health care errors

commission omission execution

Following circumcision of a newborn, the nurse provides instructions to his or her parents regarding postcircumcision care. The nurse should tell the parents to: 1 apply topical anesthetics with each diaper change. 2 expect a yellowish exudate to cover the glans after the first 24 hours. 3 change the diaper every 2 hours and cleanse the site with soap and water or baby wipes. 4 apply constant pressure to the site if bleeding occurs and call the physician

expect a yellowish exudate to cover the glans after the first 24 hours Parents should be taught that a yellow exudate will develop over the glans and should not be removed. Topical anesthetics are applied before the circumcision. Infant-comforting techniques are generally sufficient following the procedure. The diaper is changed frequently, but the site is cleansed with warm water only because soap and baby wipes can cause pain/burning and irritation at the site. Intermittent pressure is applied if bleeding occurs.

caput succedaneum

generalized edematous are of the scalp resulting from pressure of the presenting part against cervix- "cone head" disappears after 3-4 days.

3 Regular and strong UCs may occur in the transition phase of labor. Absence of uterine contractions means that the labor has not started. Mild UCs can be observed during early labor. Mild to moderate UCs can be observed during the latent and active phases of labor.

he nurse is examining a newly admitted patient who is 39 weeks pregnant and notes that the patient is in the transition phase of labor. Which symptoms does the nurse note to reach this conclusion? 1 No evidence of uterine contractions (UCs) 2 Mild uterine contractions (UCs) 3 Strong uterine contractions (UCs) 4 Moderate uterine contractions (UCs)

Interrelated Concepts to safety

health care quality communication collaboration care coordination

Genetic Anemias: Thalassemia: Genetic trait causes abnormality in one of two chains of ..?

hemoglobin

Braxton Hicks contractions

irregular, intermittent contractions

Communication failure

lack of communication or clarification

LOA

left occiput anterior (most common)

Fontanels

membrane filled spaces where sutures intersect. Anterior and posterior fontanels are most important. Anterior is diamond shaped and closes by 18 months. Posterior is triangular and closes 6-8 weeks after delivery.

Size of fetal head

molding, and the softenning of fontanels to allow for flexibility through the birthing canal

3 Emotional lability, rapid and unpredictable changes in mood, is related to hormone changes and anxiety during pregnancy. Stating that the woman's behavior is normal is correct but does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This statement is judgmental and not appropriate.

n expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response is: 1 "This is normal behavior and should begin to subside by the second trimester." 2 "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." 3 "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." 4 "You seem impatient with her. Perhaps this is precipitating her behavior."

Factors affecting HR

occur as responses to labor: fetal movement, vaginal exams, fundal pressure uterine contractions, abdominal palpations, fetal head compression

When placing a newborn under a radiant heat warmer to stabilize the temperature after birth, the nurse should: 1 place the thermistor probe on the left side of the chest. 2 cover the probe with a nonreflective material. 3 recheck the temperature by periodically taking a rectal temperature. 4 prewarm the radiant heat warmer and place the undressed newborn under it.

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

Station

relationship of presenting fetal part to a line measureing the degree of descent. 0 station is the maternal ischial spine, + stations are below that, - are above it. 4+, 5+ indicate fetal head is engaged.

Fetal Position

relationship of the reference point on the presenting part (occiput, sacrum, mentum/chin, or sinciput to the 4 quadrants of mom's pelvis) ROP, LOP, LSP, ROA...etc.

Complications or Risks: Placenta Previa Hemorrhage increases as...?

term approaches

Hormones (estrogen, progesterone, & prolactin) and insulinase (enzyme) produced by..?

the placenta 2 effects: - Increased resistance of cells to insulin - Increased speed of insulin breakdown* *Mother normally compensates by secreting extra insulin

Fetal Lie

vertical/longitudinal- parallel to maternal spine transverse/horizontal- fetal spine is at right angle diangnal to maternal spine. Birth cannot happen in transverse lie. Oblique is least common and can most often transfer with change in position to longitudinal

Secondary Power

voluntary process of actually bearing down or pushing with each contraction to expel the fetus and placenta. The vulva bulges and encircles the fetal head just prior to birth.

Exemplars of Safety (point of care)

•Prevention of decubitus ulcers •Medication administration •Fall prevention •Invasive procedures •Diagnostic workup •Recognition of/action on adverse events •Communication