Promoting Health Across the Lifespan UNIT IV

A nurse is assessing a client who has urosepsis. Which of the following findings should the nurse expect? Decreased heart rate Decreased urinary output Increased blood pressure Increased motility

Decreased heart rate The nurse should expect the client to exhibit manifestations of shock, which includes tachycardia. ✅Decreased urinary output MY ANSWER The nurse should expect the client to exhibit manifestations of shock, which includes a decrease in urinary output and an increase in urine specific gravity. Increased blood pressure The nurse should expect the client to exhibit manifestations of shock, which includes hypotension. Increased motility The nurse should expect the client to exhibit manifestations of shock, which includes a decrease in motility.

A nurse is teaching a client who has a urinary tract infection and a prescription for ciprofloxacin. Which of the following instructions should the nurse include in the teaching? "Limit the amount of fluids you drink while taking this medication." "Try to spend one hour each day outside in the sunshine." "Take this medication with milk to reduce your risk of stomach irritation." "You should not take an antacid within 2 hours of taking ciprofloxacin."

"Limit the amount of fluids you drink while taking this medication." The nurse should instruct the client to increase fluid intake to as much as 3 L per day while taking this medication to avoid crystallization in the kidneys. "Try to spend one hour each day outside in the sunshine." Ciprofloxacin increases the client's skin sensitivity to the sun. The nurse should instruct the client to avoid spending time in the sun and to apply sunscreen and wear protective clothing when outdoors. "Take this medication with milk to reduce your risk of stomach irritation." The nurse should advise the client to avoid taking this medication with milk. The calcium in milk decreases the absorption of this medication. ✅"You should not take an antacid within 2 hours of taking ciprofloxacin." Antacids should not be taken within a 2 hr timeframe of taking ciprofloxacin. These types of products can interfere with the absorption of the medication.

55. The nurse is working with a pregnant woman who states that she is a vegan. Which of the following actions by the nurse is appropriate? 1. Advise the mother that she must eat some animal protein during her pregnancy. 2. Refer the woman to a nutritionist for diet counseling. 3. Remind the mother that cashews and coconut are excellent sources of calcium. 4. Congratulate the woman on agreeing to eat eggs and milk.

1. Although it is not easy, it is possible to consume enough protein to sustain a pregnancy on a vegan diet. ✅2. This action is essential. Women's protein demands increase during pregnancy. Registered dietitians are qualified to evaluate a pregnant woman's total protein and essential amino acid intake. 3. This response is incorrect. Cashews and coconut are not excellent sources of calcium. 4. This response is incorrect. Vegans eat no animal protein. TEST-TAKING TIP: Nurses do receive nutrition education during their nursing programs. They are not, however, experts in the field. It is very important for nurses to know the limits of their knowledge. Because protein, as well as calcium intake, is essential for a healthy pregnancy, it is important for the nurse to refer the client to the expert in the field. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

60. A client on the obstetric unit is receiving IV medications per physician's orders. On rounds the nurse notes that the client's IV has infiltrated. Which of the following actions should the nurse perform first? 1. Determine whether the infusion is a vesicant. 2. Stop the infusion and remove the catheter. 3. Document the occurrence in the medical record. 4. Elevate the extremity and monitor the site.

1. Although this action is very important, the infusion should first be discontinued. If the fluid is a vesicant, the physician should then be notified. ✅2. The first thing the nurse should do is to discontinue the infusion. 3. The nurse should document the occurrence after the important interventions have been performed. 4. After discontinuing the infusion, the arm should be elevated and, if appropriate, warm soaks applied. TEST-TAKING TIP: Although most IV fluids administered in the obstetric area do not harm the tissues if they should extravasate, some, like some antibiotics, can adversely affect the vessels and surrounding tissues. The nurse must be knowledgeable about the actions he or she should take if an infiltration should occur. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

76. The mother of a neonate with Down syndrome wishes to breastfeed. Which of the following considerations should the nurse make in relation to the mother's wishes? 1. The mother should be encouraged to feed expressed breast milk via a bottle. 2. Down syndrome babies consume more calories than unaffected neonates. 3. Because of the weight of the neonatal head, the side-lying position must be used. 4. The baby will likely have a weak suck due to congenitally poor muscle tone.

1. If a mother wishes to breastfeed, the nurse should assist her to do so. 2. Down syndrome babies require the same number of calories as do other babies. 3. The mother can breastfeed the Down baby in any position—side-lying, cradle, cross- cradle, or football—as long as she provides the jaw support that the baby needs. Mothers of Down babies often find that the football hold works best. ✅4. Down syndrome babies are hypotonic. They often have a weak suck at birth. TEST-TAKING TIP: Simply because a baby has a congenital defect does not mean that the baby will be unable to breastfeed. The nurse should assess each situation individually and provide assistance when needed. If additional help is required, a lactation consultant should be requested. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

49. A 1-week-postpartum client calls her obstetrician's office and states, "I am a breastfeeding mother and my nipples are cracked and bleeding." Which of the following comments by the nurse is appropriate at this time? 1. "You will need to be seen by the doctor today." 2. "The blood will make the baby very sick. You should pump and dump your milk for at least 1 week." 3. "You are very high risk for infection. You should cleanse your nipples with dilute hydrogen peroxide twice every day." 4. "Lanolin cream applied after each feeding will help you to heal."

1. It is unnecessary for the woman to be seen by the obstetrician for cracked nipples. 2. There is no need to pump and dump. The blood will not injure the baby. 3. Hydrogen peroxide should not be applied to the nipples. ✅4. Lanolin cream applied after each feeding is an excellent therapy for cracked nipples. TEST-TAKING TIP: The nurse should also ask the client about the baby's latch, making sure that the baby's mouth is wide, lips are flanged, and tongue is below the breast and lying on the baby's gums MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

77. A neonate in the nursery whose mother had no prenatal care has been diagnosed with macrosomia. For which of the following signs/symptoms should the nurse carefully monitor this baby? 1. Jaundice. 2. Jitters. 3. Blepharitis. 4. Strabismus.

1. Macrosomic babies are no more at high risk for jaundice than babies of average weight. ✅2. Macrosomic babies are at high risk for jitters. 3. Macrosomic babies are no more at high risk for blepharitis, inflammation of the eyelash follicles, than babies of average weight. 4. All babies are born with a pseudostrabismus. The muscles of the eyes usually mature by 6 months when the strabismus ceases. TEST-TAKING TIP: To answer this question correctly, the test taker must fully understand the physiology of pregnancy and the pathophysiology of a major cause of macrosomia—namely, maternal gestational diabetes. The high glucose levels in the maternal bloodstream easily cross the placenta, resulting in high glucose levels in the fetus. The babies metabolize the glucose, resulting in a proportionate increase in body weight. When the babies deliver, their bodies continue to excrete high levels of insulin but the high levels of glucose are no longer available. Hypoglycemia and jitters (a symptom of hypoglycemia) result. Because the mother in this scenario had had no prenatal care, it is very possible that she had undiagnosed gestational diabetes. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

63. A couple has decided not to circumcise their son. Based on this decision, which of the following instructions should the nurse include in the parent teaching? 1. The couple should check their son's temperature every evening because he will be at high risk for urinary tract infections. 2. The couple should fully retract the foreskin to assess for the presence of exudate every morning. 3. The pediatrician will observe the baby void during each well-baby examination to assess for a phimosis. 4. The prepuce should be cleansed with soap and water every day during the baby's sponge bath.

1. The incidence of UTIs is slightly higher in boys who have not been circumcised, but there is no need to check the baby's daily temperature. 2. The prepuce should not be fully drawn back during the newborn period because of the potential for inducing pain and scarring. 3. The pediatrician will not have to evaluate the baby. Phimosis, or a tightened prepuce, may be present at birth or may develop subsequent to an infection. The mother, therefore, should be advised to watch that the baby's urine flows freely when he voids. ✅4. This response is correct. The baby's prepuce should be cleansed with soap and water during the daily bath. The mother should not force the foreskin to retract, but if it does naturally loosen from the glans, she and, in later years, the boy should gently clean underneath. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

37. It is noted that a baby admitted to the nursery has translucent skin with visible veins. Because of this finding, the nurse should monitor this baby carefully for which of the following? 1. Polycythemia. 2. Hypothermia. 3. Hyperglycemia. 4. Polyuria.

1. The nurse would not expect the baby to be polycythemic. ✅2. The nurse should watch the baby who has transparent skin with visible veins for hypothermia. 3. The nurse would expect the baby to be hypoglycemic rather than hyperglycemic. 4. The nurse would not expect the baby to have polyuria. TEST-TAKING TIP: Translucent skin with visible veins, a sign of prematurity, indicates that the subcutaneous fat has yet to be deposited. Because subcutaneous fat is an insulating substance, the baby is at high risk for hypothermia. CHAPTER 12 COMPREHENSIVE EXAMINATION

100. The umbilical cord is being clamped by the obstetrician. Which of the following physiological changes is taking place at this time? 1. The baby's blood bypasses the pulmonary system. 2. The baby's oxygen level begins to drop. 3. Bacteria begin to invade the baby's bowel. 4. Bilirubin rises in the baby's bloodstream.

1. This is an incorrect answer. The blood bypasses the pulmonary system during fetal circulation. ✅2. This is a correct answer. When the cord is clamped, the blood is no longer being oxygenated through the placenta. The baby's oxygen levels, therefore, begin to drop. 3. Bacteria will not colonize the bowel until the baby has been in the extrauterine environment and has eaten. 4. Bilirubin levels usually begin to rise on day 2. TEST-TAKING TIP: If the test taker remembers the role of the umbilical cord, the answer becomes very clear. The change in the blood gases—drop in oxygen levels with a concomitant rise in carbon dioxide levels—is one of the important triggers that stimulates babies to breathe. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

91. A client asks the nurse, "Could you explain how the baby's blood and my blood separate at delivery?" Which of the following responses is appropriate for the nurse to make? 1. "When the placenta is born, the circulatory systems separate." 2. "When the doctor clamps the cord, the blood stops mixing." 3. "The separation happens after the baby takes the first breath. The baby's oxygen no longer has to come from you." 4. "The blood actually never mixes. Your blood supply and the baby's blood supply are completely separate."

1. This response is incorrect. The maternal and fetal circulatory systems are independent throughout pregnancy. 2. This response is incorrect. The maternal and fetal circulatory systems are independent throughout pregnancy. 3. This response is incorrect. The maternal and fetal circulatory systems are independent throughout pregnancy. ✅4. This response is correct. The maternal and fetal circulatory systems are independent throughout pregnancy. TEST-TAKING TIP: The fetal circulation and maternal circulation are independent of each other. Oxygen and nutrients enter into the fetal system across cell membranes in the placenta. Similarly, waste products from the fetus are eliminated through the maternal system across the same cell membranes. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

19. In 2000, the perinatal mortality rate in one county was 16. The nurse interprets that information as which of the following? 1. 16 babies died between 28 and 40 weeks' gestation per 1,000 full-term pregnancies. 2. 16 babies died between 28 weeks' gestation and 28 days of age per 1,000 live births. 3. 16 babies died between birth and 1 month of life per 1,000 full-term pregnancies. 4. 16 babies died between 1 month of life and 1 year of life per 1,000 live births.

1. This statement is incorrect. A perinatal mortality rate of 16 means that 16 babies died between 28 weeks' gestation and 28 days of age per 1,000 live births. ✅2. This statement is correct. A perinatal mortality rate of 16 means that 16 babies died between 28 weeks' gestation and 28 days of age per 1,000 live births. 3. This statement is incorrect. A perinatal mortality rate of 16 means that 16 babies died between 28 weeks' gestation and 28 days of age per 1,000 live births. 4. This statement is incorrect. A perinatal mortality rate of 16 means that 16 babies died between 28 weeks' gestation and 28 days of age per 1,000 live births. TEST-TAKING TIP: The perinatal period is defined as the time period between 28 weeks' gestation and 4 weeks (or 28 days) after delivery. The best way to remember that definition is to remember that the prefix "peri" means "around" and the word "natal" refers to "birth." The perinatal period, therefore, is the time period around the birth CHAPTER 12 COMPREHENSIVE EXAMINATION

A nurse is caring for a client who tells the nurse they want to quit smoking. The nurse provides the client with information about smoking cessation and other ways to improve their health. Which of the following nursing roles is the nurse demonstrating? (Select all that apply.) Advocate Collaborator Change manager Health promotor Nurse educator

Advocate is incorrect. The role of advocate is to provide a voice for clients who are unable to do so for themselves. This client is asking for health information and does not require an advocate. Collaborator is incorrect. Collaboration in health care refers to the respectful communication and sharing of ideas, policy, practices, and research with peers and interprofessional team members. The nurse does not need to collaborate with other team members to provide the client with the requested health information. Change manager is incorrect. A change manager is a nurse manager or leader who has the goal of improving staff workflow and client outcomes through change. ✅Health promotor is correct. The nurse is serving as a health promotor by providing the client with information about smoking cessation and health improvement. The concept of educating clients to promote health is a priority to support individuals taking care and control of their own physical and mental health. ✅Nurse educator is correct. The nurse is serving as a nurse educator by providing educational information to the client regarding smoking cessation and other health information. Providing information on selected topics such as such as smoking cessation empowers the client and helps the client improve their overall health and quality of life.

A nurse has accepted a position at a hospital in the state where they live. The nurse should identify that which of the following regulates the nurse's actions when they begin working? American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements The state Nurse Practice Act The National Student Nurses Association (NSNA) The National League for Nursing

American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements The ANA Code of Ethics for Nurses with Interpretive Statements guides all nurses regarding professionalism, regardless of where they live. It demonstrates the ability to provide quality care responsibly and ethically. Code of Ethics for Nurses with Interpretive Statements also outlines behaviors and practices nurses should abide by. ✅The state Nurse Practice Act Upon licensure, a nurse will follow the Nurse Practice Act for the state in which they choose to practice. This document states the rules and regulations surrounding the practice of nursing set forth by each state's board of nursing. The National Student Nurses Association (NSNA) The NSNA was created for nursing students and provides a platform for students to gather information, connect with other students, and learn about scholarship and leadership opportunities. The National League for Nursing The National League for Nursing is a governing organization that sets standards and monitors and regulates nursing practice and nursing education that applies to all nurses. This organization does not provide standards for each individual state.

A nurse is caring for a client who has respiratory acidosis. Which of the following medications should the nurse prepare to administer? Antiemetic Hypoglycemic Antidiarrheal Bronchodilator

Antiemetic The nurse should administer an antiemetic medication to clients who have metabolic alkalosis as a result of prolonged vomiting. Hypoglycemic The nurse should administer a hypoglycemic medication, specifically, insulin, to clients who have metabolic acidosis as a result of diabetic ketoacidosis. Antidiarrheal The nurse should administer an antidiarrheal medication to clients who have metabolic acidosis as a result of prolonged diarrhea. ✅Bronchodilator Clients who have respiratory acidosis require interventions that improve oxygenation and ventilation and help maintain airway patency. The nurse should prepare to administer oxygen, a bronchodilator, and possibly a mucolytic and an anti-inflammatory medication. RN Acid-Base Imbalances Case Study Test

A nurse is preparing to administer a medication to a client. The nurse is unfamiliar with the medication. Which of the following actions should the nurse take before administering this medication? Ask the client about the purpose of the medication. Discuss the need for the medication with the client's family. Consult with the pharmacist about the medication. Research the medication on a .com website.

Ask the client about the purpose of the medication. The nurse is responsible for knowing about the medication's actions, therapeutic effects, dosage, contraindications, interactions, and adverse effects. The client is not a reliable source of that information. Discuss the need for the medication with the client's family. The nurse is responsible for knowing about the medication's actions, therapeutic effects, dosage, contraindications, interactions, and adverse effects. The client's family is not a reliable source of that information and this action can breach client confidentiality. ✅Consult with the pharmacist about the medication. The pharmacist is a reliable source of information about medications. The nurse should consult with the pharmacist or another reliable source of information, such as a pharmacopeia, to learn about the medication's actions, therapeutic effects, dosage, contraindications, interactions, and adverse effects prior to administering the medication in order to provide safe care. Research the medication on a .com website. The nurse is responsible for knowing about the medication's actions, therapeutic effects, dosage, contraindications, interactions, and adverse effects. A .com website is a commercial website and is not a reliable source of that information.

A nurse is reviewing historical nursing data and how it has impacted nursing care. The nurse should identify that which of the following nursing pioneers is credited with first using evidence-based practice in caring for clients? Clara Barton Dorthea Dix Eddie Bernice Johnson Florence Nightingale

Clara Barton Clara Barton is credited with the founding of the American Red Cross, as well as a center for locating missing soldiers. Dorthea Dix Dorthea Dix is credited with advocating for mental health reform and indigenous rights. Eddie Bernice Johnson Eddie Bernice Johnson is credited with being the first registered nurse elected to Congress as a Texas state senator. Florence Nightingale Florence Nightingale is credited with first using evidence-based practice. She collected data and was able to connect the unclean conditions to wound infections during the Crimean War. She reported that overall cleanliness and handwashing reduced the infection rates. RN Nursing Foundations Assessment

32. A nurse is reading a research study that states, "There is a strong negative correlation between the independent and dependent variables (r = −0.85)." The nurse interprets the statement as which of the following? 1. The dependent variable caused a change in the independent variable. 2. The independent and dependent variables are significantly different. 3. As values of the independent variable go up, values of the dependent variable go down. 4. When the confidence interval is computed, the negative value will change to positive.

Correlational statistics never indicate cause and effect relationships. 2. There is no indication of a significant relationship—designated by a P value—in the scenario. ✅3. This statement is accurate. In a negative correlation, as the values of one variable rise, the values of the other variable drop. 4. This statement is meaningless. TEST-TAKING TIP: The test taker must be very careful when interpreting correlational statistics. Correlations merely communicate whether variables covary. Correlations should never be interpreted as cause and effect relationships. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

A nurse is assessing a client who is receiving an infusion of cefotaxime IV. The client has a raised rash on his chest and has begun to wheeze. Which of the following actions should the nurse take? Discontinue the client's IV catheter. Place the head of the client's bed flat. Prepare to administer naloxone to the client. Administer high flow oxygen to the client.

Discontinue the client's IV catheter. The nurse should not discontinue the IV of a client who is having an anaphylactic reaction. Manifestations of an anaphylactic reaction include hypotension, which could make it difficult for the nurse to insert a new IV. An IV access is required to infuse fluids and medications required to provide cardiopulmonary support. The nurse should discontinue the medication, and change the IV tubing and solution. Place the head of the client's bed flat. If the client has hypotension, the nurse should elevate the head of the client's bed to 10° to improve ventilation. If the client's blood pressure is within the expected reference range, the nurse should elevate the head of the client's bed to 45° to improve ventilation. Prepare to administer naloxone to the client. The nurse should prepare to administer epinephrine to a client who is having an anaphylactic reaction. The nurse should administer naloxone to a client who has opioid toxicity. ✅Administer high flow oxygen to the client. MY ANSWER The nurse should assess the client's airway and administer 90% oxygen using a high flow non-rebreather mask to improve oxygenation. The nurse should call the rapid response team to provide immediate medical attention, and should have emergency intubation and tracheotomy equipment ready.

A nurse is talking with a client who arrived at the clinic over an hour ago and states, "Doesn't anyone care that I am sick? Why do I have to wait so long?" The nurse listens to the client and notifies the provider, relaying the needs of the client. In which of the following roles is the nurse performing? Educator Case manager Advocate Leader

Educator An educator supplies information for someone that has a desire or need to learn that information. Case manager A case manager coordinates the interprofessional team to work toward achieving mutual goals for the client. In this role, the nurse works with the client, their family, and the health care team, usually when a client needs a variety of services. ✅Advocate A client advocate acts on behalf of the needs of the client. In this example, the nurse is voicing the concerns for the client when their needs are not being met. Leader A leader takes the initiative to act for a group of people to coordinate efforts for a common goal.

A nurse is promoting independence at mealtime for a client who has vision impairment. Which of the following interventions should the nurse implement? Hand the client a fork with a piece of food placed on it. Place the client's napkin in his lap. Reference to the face of a clock to indicate where the food is placed on the plate. Move the water jug before placing the food tray on the bedside table.

Hand the client a fork with a piece of food placed on it. The nurse should describe where the utensils are located and allow the client to independently select and use the utensil of his choice when eating. Place the client's napkin in his lap. The nurse should promote independence by offering to place the napkin or a towel on the client's chest to catch any food that might spill while eating. ✅Reference to the face of a clock to indicate where the food is placed on the plate. MY ANSWER The nurse should promote independence by orienting the client to the position of the food on the plate by referencing to the numbers on the face of a clock. Move the water jug before placing the food tray on the bedside table. The nurse should promote independence by allowing the client to place the water jug on the bedside table and maintaining the location because a water jug is an important object for meeting hydration needs

A nurse is developing a plan of care for a client who has cystitis. Which of the following interventions should the nurse include in the plan? Insert an indwelling urinary catheter. Monitor the client for bradycardia. Check the client's stools for occult blood. Provide the client with warm sitz baths

Insert an indwelling urinary catheter. Catheters should be inserted only when necessary and discontinued as soon as possible. The use of indwelling urinary catheters can lead to an increased risk of developing urosepsis in a client who has cystitis. Monitor the client for bradycardia. The nurse should monitor the client for manifestations of infection, such as tachycardia and tachypnea. Check the client's stools for occult blood. The nurse should monitor the client's urine for the presence of blood. ✅Provide the client with warm sitz baths. Providing the client with warm sitz baths can relieve some of the discomfort associated with cystitis.

A nurse is caring for a client who asks about healthy choices to lose weight. The nurse shares information from Healthy People 2030 to address the client's questions. Which of the following describes the Healthy People initiative? It is a program for health care practitioners to get healthy. It is a social media platform for nurses. It is a set of objectives for improving the health of American lives. It is a rehabilitation program for clients who have substance use disorders

It is a program for health care practitioners to get healthy. Healthy People 2030 is an initiative based upon past data to improve the health of Americans, not just health care practitioners. Cities and communities can use the Healthy People 2030 goals and adapt them to address health issues in their area. It is a social media platform for nurses. Healthy People 2030 is not a social media platform for nurses. It is a set of initiatives based upon past data to improve upon the health of Americans. ✅It is a set of objectives for improving the health of American lives. Healthy People 2030 is a campaign developed by the U.S. Office of Disease Prevention and Health Promotion. It is science based upon past data providing objectives to improve upon the health of Americans. It is a rehabilitation program for clients who have substance use disorders. Healthy People 2030 is an initiative based upon past data to improve the health of Americans, not just those who have substance use disorders. Cities and communities can use the Healthy People 2030 goals and adapt them to address health issues in their area

Older Adults-Therapeutic communication

MYTH Old age begins at 65 years of age. REALITY Defining 65 years of age as old age happened arbitrarily when 65 years of age was set for Social Security payments in the 1930s, based on the labor market and the economy of that time. MYTH REALITY MYTH REALITY MYTH REALITY MYTH REALITY TABLE 23-1 Myths and Realities About Older Adults CHAPTER 23-The Aging Adult

A nurse is explaining to a newly licensed nurse that caring for clients involves lifelong learning by the nurse. The nurse should include which of the following as examples of learning opportunities for nurses? (Select all that apply) Nursing blogs or opinions Online continuing education journal articles Nursing skill refresher opportunities Continuing education presentations Participating in healthcare research

Nursing blogs or opinions is incorrect. Options for obtaining lifelong learning are varied and include evidence-based or research focused articles, skills courses, and conference offerings. In order to provide continuing education credit, the offering must be accredited by a state board of nursing or the American Nurses Credentialing Center (ANCC). Nursing blogs or opinion pieces do not contain the rigor required to meet continuing education accreditation and may not be evidence- or research-based. ✅Online continuing education journal articles is correct. Online continuing education journal articles provide the nurse with an option for lifelong learning. This allows the nurse to improve their skills, resulting in improved client care. The availability of continuing education for reading the article and successfully completing the post-test or activity indicates the article itself meets the rigor required to meet accreditation standards by either a state board of nursing or some other accrediting agency. ✅Nursing skill refresher opportunities is correct. Nursing skill refresher opportunities provide the nurse with an option for lifelong learning. This allows the nurse to improve their skills, resulting in improved client care. Specialized courses such as skill refresher courses and some college courses provide credits for continuing education demonstrating they meet the rigor required to meet accreditation standards and promote lifelong learning. ✅Continuing education presentations is correct. Continuing education presentations provide the nurse with an option for lifelong learning. This allows the nurse to improve or maintain competency, resulting in improved client care. Presentations that offer credit for continuing education meets accreditation standards and promote lifelong learning. ✅Participating in healthcare research is correct. Health care research provides the nurse with an option for lifelong learning. This allows the nurse to improve nursing practice by generating evidence for nurses to use in the care of their clients. Participation in research demonstrates a dedication to the profession and to advancing learning.

nurse is planning care for a client who is having difficulty swallowing food at mealtime. Which of the following interventions should the nurse include in the plan of care? Place the client in semi-Fowler's position while eating. Allow the client to rest for 15 min before meals. Tilt the client's head backwards when he swallows. Provide oral hygiene before a meal

Place the client in semi-Fowler's position while eating. The client should sit upright in a high-Fowler's position to decrease the risk of aspiration while eating. Allow the client to rest for 15 min before meals. The client should rest 30 min or more before a meal because swallowing is less difficult when well-rested. Tilt the client's head backwards when he swallows. The client should tilt his head forward when swallowing to decrease the risk of choking or aspiration. ✅Provide oral hygiene before a meal. The client should receive oral hygiene before a meal to stimulate and ease swallowing of food, which decreases the risk of aspiration.

A nurse is assessing a client who is postoperative following abdominal surgery and discovers the client has bowel protruding from the incision. Which of the following actions should the nurse take? Place the head of the client's bed in the flat position. Reinsert the protruding bowel. Cover the wound with a nonadherent dressing. Straighten the client's legs.

Place the head of the client's bed in the flat position. The nurse should raise the head of the client's bed to reduce the strain on the client's incision and prevent further evisceration. Reinsert the protruding bowel. Reinserting the protruding bowel can result in injury to the client. ✅Cover the wound with a nonadherent dressing. MY ANSWER The nurse should cover the wound with a nonadherent dressing moistened with warm sterile normal saline to protect the wound from infection and further injury. Straighten the client's legs. The nurse should bend the client's knees to reduce the strain on the client's incision and prevent further evisceration.

A nurse is describing to another nurse how to use social media in client care. Which of the following examples should the nurse include as an acceptable use of social media? Posting a comment on social media about facility staffing shortages Accepting a social media friend request from a client Reviewing the use of a fitness application with a client Sharing client information with a coworker in a private social media message

Posting a comment on social media about facility staffing shortages The nurse should not post disparaging remarks about their employer on social media. Comments should be positive and respectful. Accepting a social media friend request from a client A nurse should not accept a friend request from a client on social media. Establishing an online relationship with a client can make it difficult to distinguish between a personal and a professional relationship. ✅Reviewing the use of a fitness application with a client Reviewing the use of a fitness application with a client is an acceptable use of social media. This can lead to an improvement in client outcomes and a healthier lifestyle. Sharing client information with a coworker in a private social media message Sharing any client related information on social media, even through a private message, is a violation of the American Nurses Association Code of Ethics with Interpretive Statements.

44. Please indicate the frequency and duration of the contraction pattern shown below. Q__________ min × __________ sec

Q 3 min × 60 sec. TEST-TAKING TIP: Frequency (always measured in minutes [min]) is defined as the time period from the beginning of one contraction to the beginning of the next contraction. Duration (always measured in seconds [sec]) is defined as the time period from the beginning of one contraction to the end of the same contraction. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

A nurse is assessing a client who has acute alcohol intoxication. The nurse should identify that the client is at risk for which of the following acid-base imbalances? A.Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

Respiratory acidosis Common causes of respiratory acidosis include electrolyte imbalances, inadequate chest expansion, respiratory depression, and airway obstruction. Respiratory alkalosis Common causes of respiratory alkalosis include mechanical ventilation, aspirin toxicity, shock, anxiety, and hyperventilation. ✅Metabolic acidosis Common causes of metabolic acidosis include alcohol or ethanol intoxication, diabetic ketoacidosis, hypoxia, kidney failure, diarrhea, and pancreatitis. Metabolic alkalosis Common causes of metabolic alkalosis include total parenteral nutrition, blood transfusions, nasogastric suctioning, thiazide diuretics, and hypercortisolism. RN Acid-Base Imbalances Case Study Test

A nurse is caring for a client who has a high fever and is hyperventilating. His ABG results are pH 7.51, PaCO2 28 mm Hg, and HCO3- 24 mEq/L. The nurse should identify that the client has which of the following acid-base imbalances? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory acidosis Respiratory acidosis results from inadequate excretion of carbon dioxide, resulting in an increase in carbon dioxide and corresponding increase in the hydrogen ion level of the blood, causing the pH to decrease. A common cause of this acid-base imbalance is respiratory depression. ✅Respiratory alkalosis Because the client is breathing rapidly, he is exhaling excessive amounts of carbon dioxide. This loss of carbon dioxide decreases the hydrogen ion level of the blood, causing the pH to increase and resulting in respiratory alkalosis. Metabolic acidosis Metabolic acidosis results from a metabolic disturbance, such as diabetic ketoacidosis, seizures, or starvation, not a respiratory problem. Metabolic alkalosis Metabolic alkalosis results from a metabolic disturbance, such as prolonged vomiting, excessive antacid use, or hyperaldosteronism, not a respiratory problem. RN Acid-Base Imbalances Case Study Test

A nurse in a long-term care facility took a picture of a client and posted it on the internet. This action by the nurse is an example of which of the following? Serving as an advocate for the client Violating the code of ethics for nurses Participating in the Healthy People 2030 program Demonstrating collaboration

Serving as an advocate for the client When serving as a client advocate, the nurse uses their own voice to speak up for the needs of the client when the client is unable to do so on their own. Posting a picture of a client on the internet is not an example of client advocacy. ✅Violating the code of ethics for nurses Posting a client's picture on the internet is a violation of the client's right to privacy, which is included in the code of ethics for nurses. Provision 3 of the American Nurses Association Code of Ethics for Nurses with Interpretive Statements states that the nurse should promote, advocate for, and protect the rights, health, and safety of the client. Participating in the Healthy People 2030 program Healthy People 2030 is a national program that offers updated incentives every 10 years to assist Americans in achieving optimal health. Demonstrating collaboration Collaboration in health care refers to the respectful communication and sharing of ideas, policy, practices, and research with peers and interprofessional team members in order to provide quality professional care. RN Nursing Foundations Assessment

A nurse who completed their shift realized they forgot to take a client's vital signs as frequently as prescribed. Which of the following actions should the nurse take to uphold the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements? Take the client's vital signs now and document them as being completed 8 hr earlier. Document vital signs that are the same as those obtained earlier. Make a reminder note to be more diligent when returning the next day. Report this omission to the charge nurse and the nurse on the next shift.

Take the client's vital signs now and document them as being completed 8 hr earlier. Providing false documentation is a violation of The Code of Ethics for Nurses with Interpretive Statements, which demonstrate the ability to provide quality care responsibly and ethically. The Code of Ethics for Nurses with Interpretive Statements also outlines behaviors and practices nurses should abide by, including maintaining human dignity and protecting client rights to privacy and confidentiality. Document vital signs that are the same as those obtained earlier. Providing false documentation is a violation of The Code of Ethics for Nurses with Interpretive Statements, which demonstrates the ability to provide quality care responsibly and ethically. The Code of Ethics for Nurses with Interpretive Statements also outlines behaviors and practices nurses should abide by, including maintaining human dignity and protecting client rights to privacy and confidentiality. Make a reminder note to be more diligent when returning the next day. Not taking the vital signs as prescribed is a violation of The Code of Ethics for Nurses with Interpretive Statements, which demonstrates the ability to provide quality care responsibly and ethically. The Code of Ethics for Nurses with Interpretive Statements also outlines behaviors and practices nurses should abide by, including maintaining human dignity and protecting client rights to privacy and confidentiality. Report this omission to the charge nurse and the nurse on the next shift. ✅The nurse should be ethically responsible as indicated in The Code of Ethics for Nurses with Interpretive Statements and report the omission. The Code of Ethics for Nurses with Interpretive Statements requires nurses to provide quality care responsibly and ethically.

A nurse is reviewing the Institute of Medicine (IOM) Future of Nursing report to better understand proposed educational requirements of nurses. Which of the following organizations is responsible for publishing this report? The American Nurses Association The National Academy of Medicine State Board of Nursing American Association of Colleges of Nursing

The American Nurses Association The American Nurses Association strives to enhance the nursing profession through a variety of initiatives, but it is not responsible for the IOM Future of Nursing report. ✅The National Academy of Medicine The National Academy of Medicine, formerly known as the Institute of Medicine, and the Robert Woods Johnson Foundation published the IOM Future of Nursing report in 2011, which includes how nursing education should evolve from 2010 to 2020. State Board of Nursing Each state has a board of nursing which is responsible for the Nurse Practice Act governing the education, licensure, regulation, and the scope of practice for nurses within that state. The Nurse Practice Act defines the rules and regulations governing nursing. American Association of Colleges of Nursing The American Association of Colleges of Nursing recommended that the Doctor of Nursing Practice (DNP) become the next step for advanced practice registered nurses. It is not responsible for publishing the IOM Future of Nursing report.

A nursing student expresses a desire to become more involved with the nursing profession on a national level. Which of the following organizations should the student join? The National League for Nursing The National Student Nurses' Association The National Academy of Medicine The International Council of Nurses

The National League for Nursing The National League for Nursing is a professional nursing organization that promotes nursing education through education of nurse faculty, and the promotion of policies and nursing education research. Individual memberships are available to nurse educators, graduate students and nurses who are interested in nursing education. However, it is not an organization for nursing students to join. ✅The National Student Nurses' Association MY ANSWER The National Student Nurses' Association is an organization for students to join to become involved with initiatives and issues, and to connect with other student nurses across the nation. The National Academy of Medicine The National Academy of Medicine works to develop and integrate scientific, evidence-based approaches to health and is not an organization for nursing students to join. The International Council of Nurses The world's first and most far-reaching nursing organization is the International Council of Nurses (ICN). Since 1899, this organization for nurses, run by nurses, is committed to the excellence of nursing care and the advancement of the profession globally. However, it is not an organization for nursing students to join.

A nurse is reviewing the medical history of a client who is to start a new prescription for cefaclor. Which of the following findings should indicate to the nurse the need for further assessment? The client has a BUN of 15 mg/dL. The client has a history of asthma. The client is allergic to amoxicillin. The client has hyperthyroidism.

The client has a BUN of 15 mg/dL. A BUN of 15 mg/dL is within the expected reference range of 10 to 20 mg/dL. Clients who have kidney disease should use cefaclor with caution. The client has a history of asthma. Asthma is not a contraindication to taking cefaclor. A client who has asthma should not take beta blockers, such as propranolol, because these medications can cause bronchoconstriction. ✅The client is allergic to amoxicillin. Cephalosporin antibiotics, such as cefaclor, should be used with caution in clients who are allergic to penicillin antibiotics, such as amoxicillin. The nurse should obtain further information to determine the severity of the client's reaction and contact the provider to clarify this prescription. The client has hyperthyroidism. Hyperthyroidism is not a contraindication to taking cefaclor. However, a client who has diabetes mellitus should use cefaclor with caution.

A nurse is reviewing the medical record of an older adult male client. The nurse should identify that which of the following findings places the client at risk for developing a urinary tract infection (UTI)? The client has a history of a left-sided stroke. The client is currently taking metoprolol. The client has prostate disease. The client admits to drinking six alcoholic beverages each day.

The client has a history of a left-sided stroke. A client who has a history of a stroke may be at increased risk for aspiration pneumonia due to an impaired gag reflex; however, it is not associated with an increased risk of developing a UTI. The client is currently taking metoprolol. A client who is taking metoprolol has a history of hypertension, which can increase the risk of stroke; however, it is not associated with an increased risk of developing a UTI. ✅The client has prostate disease. MY ANSWER A client who has prostate disease is at an increased risk for developing a UTI due to the enlarged prostate causing reduced bladder capacity and delayed bladder emptying. The client admits to drinking six alcoholic beverages each day. A client who drinks six alcoholic beverages daily may be at an increased risk for alcohol use disorder; however, it is not associated with an increased risk of developing a UTI.

A nurse is reviewing the health history of a client during a routine office visit. Which of the following observations by the nurse is an example of the client demonstrating health literacy? The client states they want to improve their current knowledge about their health. The client asks for information that will help them improve their eating habits. The client states they understand their health care information and treatments. The client requests a meeting with the nurse, the physical therapist, and the provider

The client states they want to improve their current knowledge about their health. This is an example of the client participating in lifelong learning. Nurses also participate in lifelong learning by obtaining continuing education hours and staying abreast of evidence-based practices. The client asks for information that will help them improve their eating habits. This is an example of the client desiring information about health promotion information. Health promotion is a way that nurses can empower clients to address and improve their health, such as educating themselves about healthy choices, regular exercise, and making dietary changes. ✅The client states they understand their health care information and treatments. Health literacy can be described as the capacity to obtain, communicate, and understand basic health information and services in order to make appropriate health decisions. This client is demonstrating health literacy by being knowledgeable about and understanding their health care information and treatments. The client requests a meeting with the nurse, the physical therapist, and the provider. This is an example of collaborative health care. With collaborative health care, all members of the client's health care team work together to obtain positive outcomes for the client.

6. A woman is seeking counseling regarding tubal ligation. Which of the following should the nurse include in her discussion? 1. The woman will no longer menstruate. 2. The surgery should be done when the woman is ovulating. 3. The surgery is easily reversible. 4. The woman will be under anesthesia during the procedure.

The surgery can be performed at any time except between 2 days and 6 weeks postpartum. Although BTLs have been reversed, the pregnancy success rate after reversals is variable. This response is correct. BTL surgery, usually performed laparoscopically, is done under general anesthesia. TEST-TAKING TIP: Because scar tissue forms at the site of the BTL, it can be difficult to have a successful reversal of the procedure. Even though a sperm may be able to traverse the tube after reconstructive surgery has taken place, the fertilized egg is often too large to migrate through the tube to the uterus for implantation. Women are at high risk for ectopic pregnancies after tubal reconstructive surgery. CHAPTER 12 COMPREHENSIVE EXAMINATION

6.A nurse researcher studies the effects of genomics on current nursing practice. Which statements identify genetic principles that will challenge nurses to integrate genomics in their research, education, and practice? Select all that apply. A. Genetic tests plus family history tools have the potential to identify people at risk for diseases. B. Pharmacogenetic tests can determine if a patient is likely to have a strong therapeutic response to a drug or suffer adverse reactions from the medication. C. Evidence-based review panels are in place to evaluate the possible risks and benefits related to genetic testing. D. Valid and reliable national data are available to establish baseline measures and track progress toward targets. E. Genetic variation can either accelerate or slow the metabolism of many drugs. F. It is beyond the role of the nurse to answer questions and discuss the impact of genetic findings on health and illness.

a, b, e. In the very near future, all health care providers will be challenged to integrate genomics into their research, education, and practice (Healthy People 2020, 2018). Genetic tests plus family history tools have the potential to identify people at risk for diseases. Pharmacogenetics is the study of how genetic variation affects a person's response to drugs. Pharmacogenetic tests can determine if a patient is likely to have a strong therapeutic response to a drug or suffer adverse reactions from the medication. Genetic variation can either accelerate or slow the metabolism of many drugs (see Chapter 29). Two emerging challenges exist related to genomic discoveries: (1) the need for evidence-based review panels to thoroughly evaluate the possible benefits and harms related to the expanding number of genetic tests and family health history tools; and (2) the need for valid and reliable national data to establish baseline measures and track progress toward targets (Healthy People 2020, 2018). Nurses must be prepared to answer questions and discuss the impact of genetic findings on health and illness. CHAPTER 21 Developmental Concepts

2. A nurse caring for older adults in a skilled nursing home observes physical changes in patients that are part of the normal aging process. Which changes reflect this process? Select all that apply. Fatty tissue is redistributed. The skin is drier and wrinkles appear. Cardiac output increases. Muscle mass increases. Hormone production increases. Visual and hearing acuity diminishes.

a, b, f. Physical changes occurring with aging include these: fatty tissue is redistributed, the skin is drier and wrinkles appear, and visual and hearing acuity diminishes. Cardiac output decreases, muscle mass decreases, and hormone production decreases, causing menopause or andropause.

2.The nurse caring for infants in a hospital nursery knows that newborns continue to grow and develop according to individual growth patterns and developmental levels. Which terms describe these patterns? Select all that apply. A. Orderly B. Simple C. Sequential D. Unpredictable E. Differentiated F. Integrated

a, c, e, f. Growth and development are orderly and sequential, as well as continuous and complex. Growth and development follow regular and predictable trends, and are both differentiated and integrated. CHAPTER 21 Developmental Concepts

4. A nurse is teaching parents of preschoolers what type of behavior to expect from their children based on developmental theories. Which statements describe this stage of development? Select all that apply. A. According to Freud, the child is in the phallic stage. B. According to Erikson, the child is in the trust versus mistrust stage. C. According to Havighurst, the child is learning to get along with others. D. According to Fowler, the child imitates religious behavior of others. E. According to Kohlberg, the child defines satisfying acts as right. F. According to Havighurst, the child is achieving gender-specific roles.

a, d, e. According to Freud, the child is in the phallic stage. According to Fowler, the child imitates religious behavior of others. According to Kohlberg, the child defines satisfying acts as right. According to Erikson, the child is in the initiative versus guilt stage. According to Havighurst, the child is learning sex differences, forming concepts, and getting ready to read. According to Havighurst, the adolescent, not the preschooler, is achieving gender-specific social roles. CHAPTER 21 Developmental Concepts

8.A school nurse is studying Kohlberg's theory of moral development to prepare a parent discussion addressing the problem of bullying. According to Kohlberg, which factor initially influences the moral development of children? A. Parent/caregiver-child communications B. Societal rules and regulations C. Social and religious rules D. A person's beliefs and values

a. A child's beginnings of moral development result from caregiver-child communications during the early childhood years, as the young child tries to please his or her parents and other caregivers. Kohlberg's stages of moral development begin in childhood but may develop well into adolescence and adulthood. Rules and regulations established by society are eventually challenged and evaluated as a person either accepts societal rules into his or her own internal set of values or rejects them. CHAPTER 21 Developmental Concepts

1. A nurse performing an assessment of a newborn in the neonatal unit records these findings: heart rate 85 bpm, irregular respiratory rate, normal muscle tone, weak crying, and bluish tint to skin. Using the APGAR scoring chart (Table 22-1 on page 529) what would be the score for this newborn? A.5 B.,7 C.,8 D.,10

a. A newborn with a heart rate less than 100 bpm (rated 1), irregular respiratory effort (rated 1), normal muscle tone (rated 2), weak cry (rated 1), and bluish tint to the skin (rated 0) scores a 5 on the APGAR chart. CHAPTER 22 Conception Through Young Adult

9.A nurse is caring for an 80-year-old patient who is living in a long-term care facility. To help this patient adapt to the present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? "Tell me about how you celebrated Christmas when you were young." "Tell me how you plan to spend your time this weekend." "Did you enjoy the choral group that performed here yesterday?

a. Asking questions about events in the past can encourage the older adult to relive and restructure life experiences. Asking about a recent event, upcoming plans, or feelings would be unlikely to encourage reminiscence. CHAPTER 23-The Aging Adult

3. A 2-year-old grabs a handful of cake from the table and stuffs it in his mouth. According to Freud, what part of the mind is the child satisfying? A. Id B. Superego C. Ego D. Unconscious mind

a. Freud defined the id as the part of the mind concerned with self-gratification by the easiest and quickest available means. CHAPTER 21 Developmental Concepts

10. A nurse is teaching new mothers about infant care and safety. What would the nurse include as a teaching point? A. Keep infants younger than 6 months out of direct sunlight. B. Use honey instead of sugar in homemade baby food. C. Place the baby on his or her stomach for sleeping. D. Keep crib rails down at all times.

a. Nurses should teach parents to keep infants younger than 6 months out of direct sunlight and cover them with protective clothing and hats. The nurse should also teach parents not to add honey or sugar to homemade baby food, to place the baby on the back for sleeping to prevent SIDS, and to keep the crib rails up at all times. CHAPTER 22 Conception Through Young Adult

6. A mother tells the nurse that she is worried about her 4-year-old daughter because she is "overly attached to her father and won't listen to anything I tell her to do." What would be the nurse's best response to this parental concern? A. Tell the mother that this is normal behavior for a preschooler. B. Tell the mother that she and her family should see a counselor. C. Tell the mother that she should try to spend more time with her daughter. D. Tell the mother that her child should be tested for autism.

a. Preschoolers, according to Freud, are in the phallic stage, with the biologic focus primarily genital. The child has a sexual desire for the opposite-sex parent, but as means of defense strongly identifies with the same-sex parent. This is normal behavior for a preschooler, and the family does not need counseling or autism testing. Spending more time with the child is always a good idea, but is not the solution to this concern. CHAPTER 22 Conception Through Young Adult

5. A nurse caring for older adults in a long-term care facility encourages an older adult to reminisce about past life events. This life review, according to Erikson, is demonstrating what developmental stage of the later adult years? A. Ego integrity B. Generativity C. Intimacy D. Initiative

a. Reminiscence during the older years of a person's life provides a sense of fulfillment and purpose (ego integrity). Generativity is a developmental stage of the middle adult years. Intimacy is a developmental task of the adolescent to adult years, and initiative is a task of the preschooler to early school-age years. CHAPTER 21 Developmental Concepts

6.A nurse is caring for older adults in a senior adult day services (ADS) center. Which findings related to the normal aging process would the nurse be likely to observe? Select all that apply. Patients with wrinkles on the face and arms due to increased skin elasticity A patient with skin pigmentation caused by exposure to sun over the years A patient with thinner toenails with a bluish tint to the nail beds A patient healing from a hip fracture that occurred due to porous and brittle bones Bruising on a patient's forearms due to fragile blood vessels in the dermis Decreased patient voiding due to increased bladder capacity

b, d, e. Exposure to sun over the years can cause older adults' skin to be pigmented. Bone demineralization occurs with aging, causing bones to become porous and brittle, making fractures more common. The blood vessels in the dermis become more fragile, causing an increase in bruising and purpura. Wrinkling and sagging of skin occur with decreased (not increased) skin elasticity. Older adults' toenails may become thicker (not thinner), with a yellowish tint (not a bluish tint) to the nail beds. Voiding becomes more frequent in older adults because bladder capacity decreases by 50% CHAPTER 23-The Aging Adult

10. Following a fall that left an older adult temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply. S—Senility P—Problems with feeding I—Irritability C—Confusion E—Edema of the legs S—Skin breakdown

b, d, f. The SPICES acronym is used to identify common problems in older adults and stands for: S—Sleep disorders P—Problems with eating or feeding I—Incontinence C—Confusion E—Evidence of falls S—Skin breakdown CHAPTER 23-The Aging Adult

2. The nurse records an APGAR score of 4 for a newborn. What would be the priority intervention for this newborn? A. No interventions are necessary; this is a normal score. B. Provide respiratory assistance. C. Perform CPR. D. Wait 5 minutes and repeat the scoring process

b. A newborn who scores a 4 on the APGAR chart requires special assistance such as respiratory assistance. Normal APGAR scores are 7 to 10. Neonates who score between 4 and 6 require special assistance, and those who score below 4 are in need of life-saving support CHAPTER 22 Conception Through Young Adult

3.A nurse caring for patients in a primary care setting refers to Erikson's theory that middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which patient statement is an example of this finding? "I am helping my parents move into an assisted-living facility." "I spend all of my time going to the doctor to be sure I am not sick." "I have enough money to help my son and his wife when they need it." "I earned this gray hair and I like it!"

b. According to Erikson (1963), the middle adult is in a period of generativity versus stagnation. The tasks are to establish and guide the next generation, accept middle-age changes, adjust to the needs of aging parents, and reevaluate goals and accomplishments. Middle adults who do not reach generativity tend to become overly concerned about their own physical and emotional health needs. CHAPTER 23-The Aging Adult

8. A nurse working with adolescents in a group home discusses the developmental tasks appropriate for adolescents with the staff. What is an example of a primary developmental task of the adolescent? A. Working hard to succeed in school B. Spending time developing relationships with peers C. Developing athletic activities and skills D. Accepting the decisions of parents

b. Adolescence is a time to establish more mature relationships with both boys and girls of the same age. CHAPTER 22 Conception Through Young Adult

4. The nurse encourages parents of hospitalized infants and toddlers to stay with their child to help decrease what potential problem? A. Problems with attachment B. Separation anxiety C. Risk for injury D. Failure to thrive

b. Separation anxiety, as evidenced by crying initially and then appearing depressed, is common during late infancy in infants who are hospitalized. CHAPTER 22 Conception Through Young Adult

3.A school nurse is preparing a talk on safety issues for parents of school-aged children to present at a parent-teacher meeting. Which topics should the nurse include based on the age of the children? Select all that apply. A. Child-proofing the home B. Choosing a car seat C. Teaching pedestrian traffic safety D. Providing swimming lessons and water safety rules E. Discussing alcohol and drug consumption related to motor vehicle safety F. Teaching child how to "stop, drop, and roll"

c, d, f. Important safety topics for school-aged children include pedestrian traffic safety, water safety, and fire safety. Childproofing a home would be appropriate for parents of a toddler, choosing a car seat would be an appropriate topic for parents of an infant or toddler, and teaching drug and alcohol as it relates to motor vehicle safety would be a more appropriate topic for parents of adolescents. CHAPTER 22 Conception Through Young Adult

1. A nurse caring for adults in a provider's office researches aging theories to understand why some patients age more rapidly than others. Which statements describe the immunity theory of the aging process? Select all that apply. Chemical reactions in the body produce damage to the DNA. Free radicals have adverse effects on adjacent molecules. Decrease in size and function of the thymus results in more infections. There is much interest in the role of vitamin supplementation. Lifespan depends on a great extent to genetic factors. Organisms wear out from increased metabolic functioning.

c, d. The immunity theory of aging focuses on the functions of the immune system and states that the immune response declines steadily after younger adulthood as the thymus loses size and function, resulting in more infections. There is much interest in vitamin supplements (such as vitamin E) to improve immune function. The cross-linkage theory proposed that a chemical reaction produces damage to the DNA and cell death. The free radical theory states that free radicals—molecules with separated high-energy electrons—formed during cellular metabolism can have adverse effects on adjacent molecules. The genetic theory of aging holds that lifespan depends to a great extent on genetic factors. According to the wear-and-tear theory, organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion from adapting to stressors. CHAPTER 23-The Aging Adult

7.A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? Most older adults live in their own homes. Healthy older adults enjoy sexual activity. Old age means mental deterioration. Older adults want to be attractive to others

c. Although response time may be longer, intelligence does not normally decrease because of aging. Most older adults own their own homes. Although sexual activity may be less frequent, the ability to perform and enjoy sexual activity lasts well into the 90s in healthy older adults. Older adults want to be attractive to others CHAPTER 23-The Aging Adult

8.A nurse is helping to prepare a calendar for an older adult patient with cognitive impairment. What is the leading cause of cognitive impairment in old age? Stroke Malnutrition AD Loss of cardiac reserve

c. Dementia, AD, depression, and delirium may occur and cause cognitive impairment. AD is the most common degenerative neurologic illness and the most common cause of cognitive impairment. It is irreversible, progressing from deficits in memory and thinking skills to an inability to perform even the simplest of tasks. The leading causes of death in adults aged 65 and older are heart disease, cancer, chronic respiratory disease, stroke, AD, and diabetes. CHAPTER 23-The Aging Adult

7.A nurse who is working with women in a drop-in shelter studies Carol Gilligan's theory of morality in women to use when planning care. According to Gilligan, what is the motivation for female morality? A. Law and justice B. Obligations and rights C. Response and care D. Order and selfishness

c. In Gilligan's theory, men and women have different ways of looking at the world. Men are more likely to associate morality with obligations, rights, and justice, whereas women are more likely to see moral requirements emerging from the needs of others within the context of a relationship. This moral orientation of women is called the ethic of care, which develops through three levels: Level 1—Preconventional: Selfishness, Level 2—Conventional: Goodness, Level 3—Postconventional: Nonviolence. CHAPTER 21 Developmental Concepts

10.A nurse is interviewing a 42-year-old patient who is visiting an internist for a blood pressure screening. The patient states: "I'm currently a sales associate, but I'm considering a different career and I'm a little anxious about the process." According to Levinson, what phase of adult life is this patient experiencing? Entering the adult world Settling down Midlife transition Entering middle-adulthood

c. Midlife transition (ages 40 to 45) involves a reappraisal of goals and values. The established lifestyle may continue, or the person may choose to reorganize and change careers. This is an unsettled time, with the person often anxious and fearful. The years of the middle to late 20s (ages 22 to 28) are a time to build on previous decisions and choices and to try different careers and lifestyles. In the settling-down phase (ages 33 to 40), the adult invests energy into the areas of life that are most personally important. The years of entering middle adulthood (ages 45 to 50) revolve around having made choices and having formed a new life structure, and committing to new tasks. CHAPTER 21 Developmental Concepts

1. A nurse examining a toddler in a pediatric office documents that the child is in the 90th percentile for height and weight and has blue eyes. These physical characteristics are primarily determined by which of the following? Socialization with caregivers Maternal nutrition during pregnancy Genetic information on chromosomes Meeting developmental tasks

c. Physical appearance and growth have a predetermined genetic base in inheritance patterns carried on the chromosomes. CHAPTER 21 Developmental Concepts

5.A nurse is teaching parents of toddlers how to spend quality time with their children. Which activity would be developmentally appropriate for this age group? A. Playing video games B. Playing peek-a-boo C. Playing in a sand box D. Playing board games

c. Playing in a sand box with toys that emphasize gross motor skills and creativity is a developmentally appropriate activity for a toddler. Video games are appropriate for school-aged children and adolescents, but should be monitored. Playing peek-a-boo is developmentally appropriate for an infant, and playing board games usually begins with preschool and older children. CHAPTER 22 Conception Through Young Adult

9. The school nurse uses the principles and theories of growth and development when planning programs for high school students. According to Havighurst, what is a developmental task for this age group? A. Finding a congenial social group B. Developing a conscience, morality, and a scale of values C. Achieving personal independence D. Achieving a masculine or feminine gender role CHAPTER 21 Developmental Concepts

d. According to Havighurst, it is the role of the adolescent to achieve a masculine or feminine gender role. Developing a conscience, morality, and a scale of values and achieving personal independence are roles of middle childhood. Finding a congenial social group is a role of young adulthood.

9. Following assessment of an obese adolescent, a nurse considers nursing diagnoses for the patient. Which diagnosis would be most appropriate? A. Risk for injury B. Risk for delayed development C. Social isolation D. Disturbed body image

d. Adolescents who are obese are at high risk for a disturbed body image. Risk for injury would be appropriate for a risk taker, a risk factor for delayed development may be ADHD, and social isolation may occur with low self-esteem. CHAPTER 22 Conception Through Young Adult

5.An experienced nurse tells a less-experienced nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have "outlived their usefulness." What is the term for this type of prejudice? Harassment Whistle blowing EA Ageism

d. Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their age group. Harassment occurs when a dominant person takes advantage of or overpowers a less dominant person; it may involve sexual harassment or power struggles. Whistle blowing involves reporting illegal or unethical behavior in the workplace. EA is an intentional act or failure to act by a caregiver that causes or creates a risk of harm to an older adult. CHAPTER 23-The Aging Adult

4. A nurse providing health services for a 55 plus community setting formulates diagnoses for patients. Which of the following nursing diagnoses would be most appropriate for many middle adults? Risk for Imbalanced Nutrition: Less Than Body Requirements Delayed Growth and Development Self-Care Deficit Caregiver Role Strain

d. Many middle adults help care for aging parents and have concerns about their own health and ability to continue to care for an older family member. Caregivers often face 24-hour care responsibilities for extended periods of time, which creates physical and emotional problems for the caregiver. Risk for Imbalanced Nutrition: Less Than Body Requirements would be most appropriate for an adolescent with an eating disorder or an older adult who has conditions (such as ill-fitting dentures, financial restraints, or GI issues) preventing proper nutrition. Delayed growth and development would be most appropriate for infancy to school-age patients, and self-care deficit would be most appropriate for older adults whose health prevents them from performing ADLs. CHAPTER 23-The Aging Adult

A nurse is discussing culturally competent care with another nurse. Which of the following statements should the nurse include? "Use a medical interpreter for a client who does not speak the same language." "Provide the client with information in print only so they can have it as a resource." "Provide standard educational materials to all clients for continuity." "Limit communication with the client if there is a language barrier

✅"Use a medical interpreter for a client who does not speak the same language." The nurse should provide a medical interpreter for a client who speaks a different language than the nurse when providing culturally competent care. The interpreter should be able to translate in the client's native language so that the information is clear and understandable. "Provide the client with information in print only so they can have it as a resource." The nurse should provide the client with information through multiple modalities including discussion, print, video, and the use of images. It is important for the client to understand the information and have the opportunity to ask questions. "Provide standard educational materials to all clients for continuity." The nurse should provide individualized information to each client that is culturally and spiritually sensitive. "Limit communication with the client if there is a language barrier." Limiting communication with a client is detrimental to the client's health and to the nurse-client relationship. Learning about a client's personal and culturally sensitive preferences is a first step in establishing trust and is a part of effective communication for that client. RN Nursing Foundations Assessment

A nurse is teaching a client who has a new diagnosis of a severe allergy to penicillin. Which of the following instructions should the nurse include in the teaching? "You should wear a medical alert bracelet." "You can keep an epinephrine auto-injector in your refrigerator." "You should premedicate with acetaminophen before taking antibiotics." "You can take cephalosporin antibiotics in place of penicillin."

✅"You should wear a medical alert bracelet." The nurse should instruct the client to wear a medical alert bracelet at all times to alert emergency health care workers of this allergy. "You can keep an epinephrine auto-injector in your refrigerator." The client should have an epinephrine auto-injector available to promote bronchodilation, reduce edema, and increase blood pressure during an anaphylactic reaction. However, the nurse should instruct the client to store epinephrine auto-injectors in a dark room at room temperature. "You should premedicate with acetaminophen before taking antibiotics." The nurse should instruct the client to use caution when taking antibiotics. Acetaminophen will not reduce the risk for an adverse reaction to antibiotics. "You can take cephalosporin antibiotics in place of penicillin." The nurse should instruct the client to avoid cephalosporin antibiotics to reduce the risk for a cross-hypersensitivity reaction. Clients that have a severe penicillin allergy should not take cephalosporin antibiotics.

1 cup of pasta 1 medium apple 1 cup of steamed mixed vegetables 1 cup of bran flakes

✅1 cup of pasta The nurse should provide the client, who is on a low residue diet, with a snack that is low in fiber and easy to digest, such as pasta. One cup of cooked pasta contains 1.9 g of fiber. 1 medium apple MY ANSWER For a client on a high fiber diet, the nurse should provide raw fruits, such as a medium apple which contains 4.4 g of fiber. 1 cup of steamed mixed vegetables For a client on a high fiber diet, the nurse should provide steamed mixed vegetables. One cup of steamed mixed vegetables contains 4.0 g of fiber. 1 cup of bran flakes For a client on a high fiber diet, the nurse should provide bran flakes. One cup of bran flakes contains 5.5 g of fiber.

84. A client is receiving terbutaline (Brethine) IV for preterm labor. Which of the following maternal findings would warrant stopping the infusion? 1. Cardiac arrhythmias. 2. Respiratory rate 24 rpm. 3. Blood pressure 90/60. 4. Hypocalcemia.

✅1. The presence of cardiac arrhythmias warrants termination of the medication. 2. A respiratory rate of 24 does not warrant termination of the medication. The blood pressure may rise. 3.A blood pressure of 90/60 does not warrant termination of the medication. 4. Hypocalcemia does not warrant termination of the medication. TEST-TAKING TIP: Terbutaline is a beta agonist used to treat preterm labor. Tachycardia is an expected side effect of the medication, but its use is contraindicated in clients with dysrhythmias or with a heart rate over 140 bpm. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

57. The nurse is caring for a baby whose blood type is A+ (positive) and direct Coombs test is + (positive) and whose mother's blood type is O+ (positive). Which of the following nursing diagnoses is appropriate for this baby? 1. Risk for injury to the central nervous system. 2. Risk for fluid volume deficit. 3. Risk for interrupted family processes. 4. Risk for impaired parent-infant attachment.

✅1.This is an appropriate nursing diagnosis because this child is at high risk for developing hyperbilirubinemia. 2. This baby is not at high risk for fluid volume deficit. 3.This baby is not at high risk for interrupted family processes. 4.This baby is not at high risk for impaired parent-infant attachment. TEST-TAKING TIP: The baby in the scenario is exhibiting signs of ABO incompatibility. The mother's blood type is O+ while the baby's type is A+. Because the baby's direct Coombs test is positive, the nurse should conclude that the baby has anti-A antibodies in the bloodstream against the A antigen. If the baby's blood should start to hemolyze, high levels of bilirubin will be released into the baby's bloodstream. Because bilirubin is neurotoxic, high blood levels of the substance can damage the baby's central nervous system. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

80. A pregnant woman and her partner have the following genotypes for an autosomal dominant disease: Aa and Aa. If asked, which of the following should the nurse say is the probability of their child having the disease? 1. 25% probability. 2. 50% probability. 3. 75% probability. 4. 100% probability.

✅3. There is a 75% probability that their child will have the disease. TEST-TAKING TIP: The test taker should create and analyze a Punnett square: Because only 1 dominant gene need be present for a dominant disease to be exhibited, each child has a 3⁄4, or 75%, probability of having the disease. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

A nurse is caring for four clients who are 4 days postoperative following abdominal surgery. The nurse should further assess which of the following clients for a wound evisceration? A client who reports feeling his incision separate when he sneezed A client who states that he is passing flatus A client who has serous drainage on the wound dressing A client who has bruising around the incision

✅A client who reports feeling his incision separate when he sneezed The nurse should assess this client for wound dehiscence or evisceration. A wound evisceration can occur 4 to 5 days postoperatively following an increase in strain on the incision, such as from forceful coughing, sneezing, or vomiting. Client's often report feeling something has "popped" or opened in the wound. A client who states that he is passing flatus The nurse should assess the client for active bowel sounds and return of intestinal activity. A client who has serous drainage on the wound dressing The nurse should assess the client to identify the amount of drainage to monitor for infection and excessive bleeding. A client who has bruising around the incision The nurse should assess the client for excessive bruising and inflammation to monitor for infection and excessive bleeding.

A nurse is assessing a client who is postoperative following abdominal surgery and discovers bowel protruding from the client's incision. Which of the following actions should the nurse take first? Contact the rapid response team. Check the client for shock. Document the incident. Prepare the client for surgery.

✅Contact the rapid response team. MY ANSWER The greatest risk to this client is compromised blood supply to the bowel resulting in necrosis; therefore, the first action the nurse should take is to contact the rapid response team for immediately for assistance. Check the client for shock. The nurse should check the client for manifestations of shock, such as tachycardia and hypotension; however, it is not the first action the nurse should take. Document the incident. The nurse should document the incident to communicate the sequence of events to other members of the health care team to ensure comprehensive and effective care for the client; however, it is not the first action the nurse should take. Prepare the client for surgery. The nurse should prepare the client for surgery to repair the evisceration; however, it is not the first action the nurse should take.

A nurse is performing the role of case manager for a client. Which of the following actions demonstrates this nursing role? Coordinating and overseeing the care the client is receiving Helping to develop nursing knowledge for clinical interventions Providing knowledgeable and compassionate care to promote health and address illness Instructing the client on specialized topics such as diabetes care

✅Coordinating and overseeing the care the client is receiving A case manager is an RN who coordinates and oversees client care, working with their family and the health care team, usually when clients need a variety of services. Helping to develop nursing knowledge for clinical interventions This describes the role of a nurse researcher. The nurse researcher plans and implements research studies involving the collection and analysis of data which may involve trials of a new procedure, medication, or diagnostic test. Providing knowledgeable and compassionate care to promote health and address illness This describes the role of a care provider. Nurses have been trained to provide knowledgeable and compassionate care to promote health and address illness. Instructing the client on specialized topics such as diabetes care This describes the role of an educator. Providing information on selected topics such as diabetes care empowers the client and helps the client improve their quality of life. RN Nursing Foundations Assessment

A nurse is caring for a client who has been placed on a full liquid diet. Which of the following foods should the nurse offer the client? Cream of chicken soup Scrambled eggs Cottage cheese Mashed potatoes with gravy

✅Cream of chicken soup The nurse should identify that cream of chicken soup is a clear liquid with a smooth-textured dairy product added. Full liquid foods are foods that are in a liquid state at body temperature, such as ice cream, pudding, and yogurt. Therefore, cream of chicken soup is part of a full liquid diet. Scrambled eggs The nurse should identify that scrambled eggs is part of a pureed diet. These foods are blended, with liquid if necessary, for a smooth consistency. Cottage cheese The nurse should identify that cottage cheese is part of a mechanical soft diet. Mechanical soft diet foods are foods that are finely chopped and have a smooth consistency. Mashed potatoes with gravy The nurse should identify that mashed potatoes with gravy is part of a pureed diet. These foods are blended, with liquid if necessary, for a smooth consistency.

A nurse is reviewing the contributions made by various nursing organizations that have impacted the nursing profession. The nurse should identify that which of the following are contributions made by The American Nurses Association (ANA)? (Select all that apply.) Providing a definition of nursing Lobbying for whistle blower protection Providing objective data to improve the health of society Providing all registered nurses with competency expectations Providing the nursing magazine Imprint

✅Providing a definition of nursing is correct. The ANA defined nursing through The Nursing Scope and Standards of Practice, which provides a clear definition of what nursing involves and the responsibilities of the professional nurse. ✅Lobbying for whistle blower protection is correct. The ANA provides support to registered nurses through lobbying for major issues including whistle blower protection and improving safety in the workplace. Providing objective data to improve the health of society is incorrect. It is the role of the National Academy of Medicine to provide objective data to improve the health of society. ✅Providing all registered nurses with competency expectations is correct. The ANA provides the nursing profession with The Nursing Scope and Standards of Practice, which defines the actions RNs are expected to perform competently. Providing the nursing magazine Imprint is incorrect. The NSNA produces the nursing magazine Imprint for nursing students to keep current on trends and issues.

Report of tightness in the chest Dilated pupils Report of metallic taste in client's mouth Brown colored urine

✅Report of tightness in the chest A report of tightness in the chest, the presence of wheezing, and hypotension are manifestations of a severe allergy. Treatment requires the application of oxygen and the administration of epinephrine. The medication should be discontinued Dilated pupils Dilated pupils are an adverse reaction to cholinergic blocking agents, such as benztropine. Report of metallic taste in client's mouth A metallic taste in the mouth is an adverse reaction to certain antibiotics, such as metronidazole Brown colored urine Brown colored urine is a manifestation of a hemolytic transfusion reaction to a blood product.

A nurse is reviewing the contributions of various nursing organizations that provide support in caring for clients. The nurse should identify that which of the following agencies provides The Nursing Scope and Standards of Practice? The American Nurses Association (ANA) The American Academy of Nursing The National Student Nurses Association (NSNA) The National Academy of Medicine

✅The American Nurses Association (ANA) The ANA is an organization responsible for establishing a set of nursing standards that are contained within The Nursing Scope and Standards of Practice. This document provides a clear definition of what nursing involves and the responsibilities of the nurse as a professional. The American Academy of Nursing The American Academy of Nursing is an organization whose goals include advocating for local, state, and national health care reform. The National Student Nurses Association (NSNA) The NSNA supports nursing students by providing scholarships, leadership opportunities, and networking among other nursing professionals. The National Academy of Medicine The National Academy of Medicine is a non-profit private business that provides objective data to improve the overall health of society.

Nursing Actions to Promote Health in Older Adults

Physical Changes in the Middle Adult Years Fatty tissue is redistributed; men tend to develop abdominal fat, women thicken through the middle. The skin is drier. Wrinkle lines appear on the face. Gray hair appears, and men may lose hair on the head. Cardiac output begins to decrease. Muscle mass, strength, and agility gradually decrease. There is a loss of calcium from bones, especially in perimenopausal women. Fatigue increases. Visual acuity diminishes, especially for near vision (presbyopia). Hearing acuity diminishes, especially for high-pitched sounds (presbycusis). Hormone production decreases, resulting in menopause or andropause. ⏺Cognitive Function Slow pace of activity and wait for responses. Be sure eyeglasses and hearing aids are used; ensure that lenses are clean and batteries are strong. ⏺Psychosocial Needs Be aware that illness, hospitalization, or changes in living arrangements are major stressors. Assess and support sources of strength, including cultural and spiritual values and rituals. Encourage use of support systems: family, friends, community resources, and pets. Set mutual goals and encourage the patient's role in making decisions about care. Encourage life review and reminiscence. Encourage self-care. Consider the patient's background, interests, capabilities, values, culture, and lifestyle when planning care. ⏺Nutrition Assess for lost or damaged teeth; ensure that dentures fit properly. Provide foods appropriate to the patient's ability to chew. Assess height, weight, eating patterns, and food choices. Assess for malnutrition, especially in older adults impacted by cognitive, psychological, or social factors such as the 3Ds, isolation, limited income or access to nutritious food, and the need for assistance with food preparation or eating (Mangels, 2018). Assess swallowing ability. Consider using supplements. ⏺Sleep and Rest Discourage excessive napping. Assess normal bedtime, time for rising, bedtime rituals, effects of pain, medications, anxiety, and depression. ⏺Elimination Assess frequency of bladder elimination as well as problems with incontinence. Assess normal times for bowel movements while considering changes in activity, privacy, and medications. Ensure that the floor is not cluttered, the toilet is easily accessible, lighting is adequate, and privacy is provided. Suggest having safety bars installed in the bathroom. Review diet for necessary fluid and fiber content. Activity and Exercise Assess ability to walk; ensure that assistive devices (such as a walker or cane) are available. Consider effects of illness, surgery, medications, and changes in diet and fluid intake on strength and motor function. Ensure an uncluttered environment with good lighting; suggest using a night light and removing rugs. Slow the pace of care, allowing extra time to carry out activities. ⏺Sexuality Assist as necessary with hygiene, hair care, oral care, clean clothing and bedding, makeup, and shaving. Maintain a clean, odor-free environment. Demonstrate genuine caring: ask preferred name, listen carefully, and respect belongings. Discuss safer sex if appropriate. Discuss water-soluble lubricants with women; refer men for evaluation if erectile dysfunction is a concern. ⏺Meeting Developmental Tasks Promote continued development and maintenance of functional health by identifying unmet tasks, feelings of isolation, and physical or sensory limitations. Assist in finding creative solutions to developmental tasks. Collaborate with other health care providers to provide information and referral to community resources for the patient and family. NOTE- Concept Mastery Alert Social isolation is different from ineffective coping. Social isolation is the feeling of being alone; ineffective coping refers to difficulty in adapting or responding to the changes associated with the situation. Ineffective coping can lead to social isolation. NOTE- Concept Mastery Alert Nurses working with older adults must understand that many changes that are seen are the result of normal interactions and processes of the body. This knowledge is broader than just having knowledge of illness and the older adult. NOTE- QSEN POLYPHARMACY Polypharmacy, the use of many medications at the same time, requires careful monitoring to minimize the risk for adverse effects, toxicities, and drug-drug interactions.

A nurse is caring for a client who has metabolic alkalosis. As the client compensates for this acid-base imbalance, which of the following mechanisms should the nurse expect the client's body to use? Hypoventilation Hyperventilation Increased renal acid excretion Decreased renal acid excretion

✅Hypoventilation Hypoventilation is the mechanism that helps clients compensate for metabolic alkalosis. As a result, the client's PaCO2 and HCO3- will increase. Hyperventilation Hyperventilation is the mechanism that helps clients compensate for metabolic acidosis. Increased renal acid excretion Increased renal acid excretion is the mechanism that helps clients compensate for respiratory acidosis. Decreased renal acid excretion Decreased renal acid excretion is the mechanism that helps clients compensate for respiratory alkalosis. RN Acid-Base Imbalances Case Study Test

A nurse manager is providing education to a group of newly licensed nurses about various nursing organizations. Which of the following information should the nurse manager include? The American Nurses Association's The Code of Ethics for Nurses with Interpretive Statements guides nurses through difficult decisions. The National Academy of Medicine developed the Healthy People campaign to improve the health of all Americans The American Academy of Nursing requires members to have a doctorate degree in nursing to join. The National Student Nurses' Association is an organization created to encourage students to enter nursing.

✅The American Nurses Association's The Code of Ethics for Nurses with Interpretive Statements guides nurses through difficult decisions. The American Nurses Association created The Code of Ethics for Nurses with Interpretive Statements to help nurses work through ethical issues that can be complicated and sensitive in nature. The National Academy of Medicine developed the Healthy People campaign to improve the health of all Americans The National Academy of Medicine works collaboratively with other organizations to find the answers to global health problems; however, the National Academy of Medicine did not develop the Healthy People campaign. The Healthy People campaign was developed by the U.S. Office of Disease Prevention and Health Promotion. The American Academy of Nursing requires members to have a doctorate degree in nursing to join. Although most of the members of the American Academy of Nursing do hold a doctorate degree, it is not a requirement for membership. The National Student Nurses' Association is an organization created to encourage students to enter nursing. The National Student Nurses' Association is an organization created for undergraduate nursing students to provide them with a voice and introduce them to leadership and networking within nursing practice. RN Nursing Foundations Assessment

A nurse is teaching a client who is postoperative following abdominal surgery. Which of the following instructions should the nurse include to reduce the risk for wound evisceration? "Perform leg exercises at frequent intervals." "Use an incentive spirometer every hour while awake." "Turn side to side every 2 hours." "Support your abdomen with a pillow when coughing."

"Perform leg exercises at frequent intervals." The nurse should instruct the client to perform leg exercises frequently to promote venous return and reduce venous stasis. "Use an incentive spirometer every hour while awake." The nurse should instruct the client to use an incentive spirometer every hour when awake to promote lung expansion and reduce the risk for pulmonary complications, such as pneumonia. "Turn side to side every 2 hours." The nurse should instruct the client to turn side to side every 2 hr to improve lung expansion, increase circulation and venous return, and maintain skin integrity. ✅"Support your abdomen with a pillow when coughing." The nurse should instruct the client to support his abdomen with a pillow when coughing to provide support to the incision and reduce the risk for wound evisceration.

58. Which of the following complications of labor and delivery may develop when a baby enters the pelvis in the LMP position? Select all that apply. 1. disproportion. 2. Placental abruption. 3. Breech presentation. 4. Prolapsed cord. 5. Severe pre-eclampsia.

1 and 4 are correct. ✅1. Because a larger diameter of the fetal head is presenting to the pelvis in the LMP position, cephalopelvic disproportion is possible. 2. Placental abruption does not occur more frequently during the labor and delivery of a baby in LMP position than it does when the baby is in any other position. 3. LMP is a vertex, not a breech, position. ✅4. Prolapsed cord does occur more frequently when babies are in malpresentations. 5. Women are not at higher risk for pre- eclampsia when the baby is in the LMP position than it is for a baby in any other position. TEST-TAKING TIP: When a baby's mentum is presenting to the birth canal, the baby's head has failed to flex during descent. As a result, rather than the smallest diameter of the fetal head presenting to the pelvis, a larger diameter is presenting. Cephalopelvic disproportion is a possible consequence. In addition, the fetal cord can become prolapsed more easily when the fetal face is presenting. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

18. Which of the following electronic fetal monitor tracings shown would the nurse interpret as indicating umbilical cord compression?

1. This fetal heart tracing shows a healthy fetus with good variability and accelerations. 2. This fetal heart tracing indicates that the fetus is experiencing head compression— early decelerations. 3. This fetal heart tracing indicates the presence of uteroplacental insufficiency—late decelerations. ✅4. This fetal heart tracing indicates the presence of cord compression—variable decelerations. TAKING TIP: One way to remember why variable decelerations indicate cord compression is the fact that the cord is a free-flowing object in the uterine cavity. It can be compressed, therefore, at a variety of times. For example, if the baby moves a certain way, the cord can be compressed. Or when the mother moves to a new position, the cord can be compressed. The decelerations seen, therefore, occur at times independent of timing of the contractions CHAPTER 12 COMPREHENSIVE EXAMINATION

30. A client complaining of frequency, urgency, and burning on urination is seen by her healthcare practitioner. Which of the following factors in the client's history places her at risk for these complaints? 1. The client urinates immediately after every sexual encounter. 2. The client uses the diaphragm as a family planning method. 3. The client wipes from front to back after every toileting. 4. The client changes her peripads every two hours during her menses.

1. Voiding after each sexual encounter decreases women's chances of developing a urinary tract infection. ✅2. Clients who use the diaphragm as a family planning device are at high risk for urinary tract infections. 3.To prevent the introduction of rectal flora into the urinary tract, it is important for women to wipe from front to back after toileting. 4. Because blood is an ideal medium for bacterial growth, it is recommended that women change their peripads frequently. TEST-TAKING TIP: Women are much more at high risk for UTI than men because of the close proximity of the urethra to the vagina and rectum. Women should be counseled on ways to prevent UTI, and women who are prone to UTI should consider changing their family planning method from the diaphragm to another method. CHAPTER 12 COMPREHENSIVE EXAMINATION

20. A client has been admitted with a diagnosis of threatened abortion. She is wearing a pad that weighed 15 grams when it was clean. It now weighs 30 grams. How many mL of blood can the nurse estimate that the client has lost? Calculate to the nearest whole. __________ mL.

15 mL. 30 grams − 15 grams = 15 grams The client has lost approximately 15 mL of blood. EST-TAKING TIP: The test taker must remember that 1 mL of fluid = 1 gram of fluid. This is true of blood, water, breast milk, or any other natural fluid CHAPTER 12 COMPREHENSIVE EXAMINATION

4. A fetus is in the LOA position in utero. Which of the following findings would the nurse observe when doing Leopold maneuvers? 1. Hard, round object in the fundal region. 2. Flat object above the symphysis pubis. 3. Soft, round object on the left side of the uterus. 4. Small objects on the right side of the uterus.

2. If the nurse had noted a flat object—the fetal back—above the symphysis, he or she would have concluded that the fetus was in a horizontal lie. 3. If the nurse had noted a soft, round object— the fetal buttocks—on the left side of the uterus, he or she would have concluded that the fetus was in a horizontal lie. 4. A nurse could conclude that a fetus is in the LOA when feeling small objects—the fetal arms and legs—on the right side of the uterus. TEST-TAKING TIP: This is a difficult question. The test taker must clearly understand that in the LOA position the occiput of a fetus is presenting. The back of the baby would be felt on the left side of the uterus and the small parts of the baby would be felt on the right side of the uterus. CHAPTER 12 COMPREHENSIVE EXAMINATION

65. Which of the following features would the nurse expect to be absent in an 8-week- gestation embryo? 1. Four-chambered heart. 2. Fingers and toes. 3. Fully formed genitalia. 4. Facial features.

65. 1. The four-chambered heart is present by 8 weeks' gestation. 2. Although webbed and short, fingers and toes are visible by 8 weeks' gestation. ✅3. The genitalia are not fully formed until about 12 weeks' gestation. 4. The facial features are all present by 8 weeks' gestation. TEST-TAKING TIP: By the time the embryo reaches 8 weeks' gestation virtually all organ systems are present. Male genitalia will be differentiated by 12 weeks if testosterone is produced. If no testosterone is produced, female genitalia develop. Maturation continues in all organ systems through the remainder of the pregnancy. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

A newly licensed nurse is reviewing Benner's Novice to Expert Model for nursing competence. At which of the following stages does the nurse first develop the ability to prioritize tasks by drawing on experience? Advanced beginner Proficient Competent Novice

Advanced beginner The nurse in the advanced beginner stage requires the support of more advanced nurses to set priorities for optimal delivery of client care. Proficient The nurse in the proficient stage can understand the desired outcomes of a situation and can respond to changing situations. This nurse has already developed the ability to prioritize tasks. ✅Competent The nurse in the competent stage is able to prioritize tasks by drawing on past experience. The competent nurse does not prioritize as quickly as a proficient nurse, but they do have mastery in multiple areas. Novice The nurse in the novice stage is a nursing student or a new nurse who does not have previous experience, so they are not able to draw on their own judgement. RN Nursing Foundations Assessment

Assessment of Delirium and Dementia

BOX 23-Online Tool ⏺Confusion Assessment Method (CAM) Identifies delirium quickly. Long and short versions are available. ⏺Delirium Observation Screening (DOS) Consists of 13 items focused on routine observation of verbal and nonverbal behaviors. ⏺Mini-Cog Two-part test to determine if dementia or cognitive impairment is present (even in early stages). Takes 3 to 5 minutes to administer. ⏺Mini-Mental Status Exam (MMSE) The original MMSE contains 30 questions and screens for cognitive impairment, estimates the severity of cognitive impairment, and documents changes over time with respect to decline or response to treatment. ⏺MMSE Second Edition The second edition may be useful in populations with milder forms of cognitive impairment. ⏺Neecham Confusion Scale Consists of nine items and is used to detect early stages of delirium; does not differentiate between dementia and delirium ⏺Physiologic Function Maintain physiologic reserves. Maintain ongoing assessments for early detection of problems. Review perceptions of current health status, health problems, and prescribed or over-the-counter medications. Include nursing care that maintains physical status, such as skin care and planned rest and activity. NOTE- QSEN MULTIDISCIPLINARY TEAMS The U.S. Department of Justice provides a guide designed to facilitate the development and growth of multidisciplinary teams (MDTs) dedicated to the review of EA cases. This living document is designed to provide a structure for case review that any community can use (available online at https://www.justice.gov/elderjustice/mdt-toolkit).

A nurse educator is planning a presentation for nurses about the opioid epidemic. Which of the following is a strategy promoted by the U.S. Department of Health and Human Services to address this epidemic? Continue to evaluate to determine if the use of opioids improves on its own. Educate nurses and other health care personnel about naloxone. Keep the issue private to avoid embarrassment. Reduce efforts to explore alternative pain management practices until the opioid epidemic is over.

Continue to evaluate to determine if the use of opioids improves on its own. Continuing to evaluate the incidence of opioid use is not one of the five strategies promoted by the U.S. Department of Health and Human Services. The five strategies are proactive and involve taking action to address the epidemic. ✅Educate nurses and other health care personnel about naloxone. Promoting the use and administration techniques of overdose-reversing medications is one of the five priority strategies for the opioid epidemic. Naloxone is a medication that is promoted because it is widely available and can be administered by laypersons with minimal training. Keep the issue private to avoid embarrassment. Keeping the issue private to avoid embarrassment will not assist to address the opioid use disorder epidemic. The nurse should work to increase awareness and understanding of the epidemic through better communication and education. Reduce efforts to explore alternative pain management practices until the opioid epidemic is over. Promoting the use of alternative practices for pain management is one of the strategies to address the opioid epidemic.

A nurse is assisting a client who is at risk for aspiration following a stroke with eating. Which of the following actions should the nurse take? Lay the client down flat on the bed 20 min after meals. Place 1 tbsp of food on the unaffected side of client's mouth. Elevate the head of the client's bed to a 45° angle during meals. Palpate the client's throat while she is swallowing food.

Lay the client down flat on the bed 20 min after meals. The nurse should maintain the client in an upright position in bed or in a chair for at least 30 min to 1 hr following meals to prevent the client from aspirating. This allows time for the client's food to digest in the stomach properly. Place 1 tbsp of food on the unaffected side of client's mouth. The nurse should place ½ to 1 tsp of food on the unaffected side of the client's mouth. Giving too much food at one time places the client at risk for aspiration. Elevate the head of the client's bed to a 45° angle during meals. The nurse should elevate the head of the client's bed to a 90° angle for meals to prevent aspiration. ✅Palpate the client's throat while she is swallowing food. The nurse should palpate the client's throat while she is swallowing food to evaluate the client's swallowing effort. Pocketing food indicates impaired swallowing and places the client at risk for aspiration

5. A woman is being interviewed by a triage nurse at a medical doctor's office. Which of the following signs/symptoms by the client would warrant the nurse to suggest that a pregnancy test be done? Select all that apply. 1. Amenorrhea. 2. Fever. 3. Fatigue. 4. Nausea. 5. Dysuria.

Pregnancy is the most common cause of amenorrhea. Although a client's temperature is slightly elevated (about 0.2 ̊C above normal) during pregnancy, a nurse would not associate a fever with pregnancy. A common complaint of women in early pregnancy is fatigue. A common complaint of women in early pregnancy is nausea. Although gravidas complain of urinary frequency early in pregnancy, they should not complain of dysuria. TEST-TAKING TIP: This question is easily answered if the test taker is familiar with the presumptive signs of pregnancy—that is, the subjective complaints of pregnancy

A nurse is caring for a client whose ABG results are pH 7.30, PaCO2 32 mm Hg, and HCO3- 19 mEq/L. The nurse should identify that the client has which of the following acid-base imbalances? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory acidosis With respiratory acidosis, the pH is low, the PaCO2 is high, and the bicarbonate is high or within the expected reference range. Respiratory alkalosis With respiratory alkalosis, the pH is high, the PaCO2 is low, and the bicarbonate is low or within the expected reference range. ✅Metabolic acidosis With metabolic acidosis, the pH is low, the PaCO2 is low or within the expected reference range, and the bicarbonate is low Metabolic alkalosis With metabolic alkalosis, the pH is high, the PaCO2 is high or within the expected reference range, and the bicarbonate is high. RN Acid-Base Imbalances Case Study Test

7. A high school nurse is counseling parents of teenagers who are beginning high school. Which issues would be priority topics of discussion for this age group? Select all that apply. A. The influence of peer groups B. Bullying C. Water safety D. Eating disorders E. Risk-taking behavior F. Immunizations

a, b, d, e. Appropriate topics of discussion for parents of adolescents include peer groups, bullying, eating disorders, and risk-taking behaviors. Discussing immunizations would be appropriate for parents of children from infants to school-age. Water safety should be taught in the preschool and school-age years. CHAPTER 22 Conception Through Young Adult

A nurse is caring for a client who reports experiencing chills and not feeling well. The nurse informs the client that they will need to have their temperature taken to monitor the manifestations. Which of the following terms describes that the nurse's action is grounded in research? Evidence-based practice Competencies Lifelong learning Change agent

✅Evidence-based practice The nurse should identify that obtaining the temperature of a client who is not feeling well and experiencing chills is grounded in research and is referred to as evidence-based practice. This type of practice indicates that actions the nurse takes have been tested with a scientific rationale for meaning, purpose, and importance. Competencies Competencies are nursing skills that require demonstrated proficiency to indicate the nurse can provide safe care. Lifelong learning Lifelong learning is a commitment nurses make to demonstrate a dedication to the profession and toward maintaining licensure as a nurse. It involves continuing education that the nurse can obtain through independent learning, attendance at workshops or seminars, and through the workplace. Change agent A change agent is a nursing role in which a nurse recognizes the need for a change in practice and takes the steps necessary to integrate credible and reliable changes into nursing practice.

A nurse is caring for a male client who has an upper urinary tract infection. The nurse should identify that the infection is in which of the following portions of the urinary tract? Kidney Bladder Prostate Urethra

✅Kidney MY ANSWER The nurse should identify that pyelonephritis, or inflammation of the kidney, is an infection of the upper urinary tract. Bladder Cystitis, or inflammation of the bladder, is an infection of the lower urinary tract. Prostate Prostatitis, or inflammation of the prostate gland, is an infection of the lower urinary tract. Urethra Urethritis, or inflammation of the urethra, is an infection of the lower urinary tract.

53. A breastfeeding client asks the nurse to make sure that her newborn is positioned and latched well at the breast. Which of the following assessments would indicate that the baby is poorly latched? 1. The baby swallows after every suckle. 2. The baby's body is facing the mother's body. 3. The baby's lower lip is curled under. 4. The baby is lying at the level of the mother's breasts.

. 1. Babies who swallow after every suck usually are latched well. 2. To latch well, babies should face their mother's body. ✅3. When babies' lips are curled under, they are unable to create a satisfactory suck. In addition, it is usually painful for the mother. 4. Neonates should be placed at the level of their mother's breasts to breastfeed. TEST-TAKING TIP: To create a good latch, babies should have a large quantity of breast tissue in their mouth, lips should be well flanged at the breast, and their tongue should cup around their mother's breast. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

69. Young pregnant adolescents have increased nutritional needs as compared with pregnant adults. Which of the following foods would meet those needs? 1. Banana. 2. Cheeseburger. 3. Strawberries. 4. Rice.

1. A banana is an excellent fruit choice, but it does not meet the young woman's iron or calcium needs. ✅2. Cheeseburgers meet both iron and calcium needs. 3. Strawberries are an excellent fruit choice, but they do not meet the young woman's iron or calcium needs. 4. Rice is high in protein and does contain some calcium, but it is not a good iron source. TEST-TAKING TIP: The best way to remember the special nutritional needs of young pregnant adolescents is to remember that they are still growing themselves. As a result, they need the minerals, calcium and iron, as well as protein for their own growth and development and to meet the needs of the growing fetus. Of the choices, only cheeseburgers meet all those needs. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

59. A 36-week-gestation client is having an amniocentesis. For which of the following reasons is the test likely being conducted? 1. Genetic evaluation. 2. Assessment of intrauterine growth restriction. 3. Assessment of fetal lung maturation. 4. Hormonal studies.

1. A genetic amniocentesis is performed between 12 and 16 weeks' gestation. 2. Intrauterine growth restriction is detected via ultrasound. ✅3. A lecithin/sphingomyelin ratio and/or a shake test can be performed on amniotic fluid to determine whether the fetal lung fields are mature. These tests are performed during the third trimester. 4. Hormonal studies would not be conducted on the amniotic fluid. TEST-TAKING TIP: To answer this question correctly, the test taker must attend carefully to the gestational age when the test is being conducted. Even though amniocenteses are performed to obtain fetal cells for genetic analysis, those tests are not performed during the third trimester. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

39. The doctor has ordered a nonstress test for a 39 weeks' gestation gravida. The nurse should interpret which of the following as a reactive test? 1. The fetal heart remains stable throughout the test period. 2. The uterine contractions last longer than 90 seconds. 3. The mother reports a pain level that is less than 5 on a 10-point scale. 4. The baby moves spontaneously 3 times in 20 minutes.

1. A nonreactive nonstress test result is characterized by a stable fetal heart rate throughout the test period. 2. The length of contractions is not considered when a non-stress test is performed. 3. The mother's pain level is not considered when a non-stress test is performed. ✅4. A reactive nonstress test is characterized by 3 spontaneous fetal movements in a 20-minute time period. TEST-TAKING TIP: A nonstress test is performed to assess the well-being of the fetus during pregnancy. Very little can be deduced from a fetal heart rate that remains stable throughout the test period. A healthy result—reactive test—is noted when the heart rate accelerates spontaneously 3 times during the 20-minute test period.MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

96. A client with type 1 diabetes mellitus is 6 weeks pregnant. Her fasting glucose and hemoglobin A1C are noted to be 168 mg/dL and 12%, respectively. Which of the following nursing diagnoses is appropriate for the nurse to make at this time? 1. Altered maternal skin integrity. 2. Deficient maternal fluid volume. 3. Risk for fetal injury. 4. Fetal urinary retention.

1. A nursing diagnosis of altered skin integrity (maternal) is not related to the clinical scenario. 2. A nursing diagnosis of maternal deficient fluid volume is not related to the clinical scenario. ✅3. A nursing diagnosis of risk for fetal injury is an appropriate nursing diagnosis. 4. A nursing diagnosis of fetal urinary retention is not related to the clinical scenario. TEST-TAKING TIP: The client in the scenario has an elevated fasting blood glucose level as well as an elevated glycohemoglobin level. The nurse knows, therefore, that the client is currently hyperglycemic and has been hyperglycemic over the past 3 months. Because hyperglycemia is teratogenic, the fetus is at high risk for injury or, in other words, at high risk for birth defects. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

85. A breastfeeding client, 6 days postdelivery, calls the postpartum unit stating, "I think I am engorged. My breasts are very hard and hot and they really hurt." Which of the following questions should the nurse ask at this time? 1. "Have you taken a warm shower this morning?" 2. "Do you have an electric breast pump?" 3. "How much did you have to drink yesterday?" 4. "When was the last time you fed the baby?"

1. A warm shower may help to promote the milk ejection reflex, but this is not the question the nurse should ask at this time. 2. The client may need to pump her breasts to soften them enough for the baby to latch well, but this is not the question the nurse should ask at this time. 3. Unless a client has a very low intake, the quantity of fluids that the client consumes is not related to the quantity of milk she will produce. ✅4. The nurse should ask the client when she fed the baby last. TEST-TAKING TIP: Engorgement rarely develops if a mother breastfeeds frequently. Breastfeeding mothers should be encouraged to feed every 2 to 3 hours. Plus, it is especially important to encourage them never to skip a feeding. If they must give the baby a bottle in place of a breastfeeding, they should pump their breasts at the same time as the missed feeding. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

46. The nurse is teaching a woman how to do the pelvic tilt exercise. In the teaching session, which of the following should the nurse tell the woman to do? 1. Stand with the back of her heels and shoulders touching a wall. 2. Bend laterally back and forth from one side to the other. 3. Move so that her back alternately is concave and convex. 4. Lie flat on her back and move her hips from side to side.

1. A woman should be encouraged to stand erect to improve her posture but this action is not related to the pelvic tilt. 2. This can be a valuable exercise but it is not the pelvic tilt. ✅3. The woman successively changes her back from a concave to a convex posture when doing the pelvic tilt. 4. It is recommended that pregnant women not lie flat on their back. TEST-TAKING TIP: The pelvic tilt is an excellent exercise for pregnant women. It helps to strengthen as well as to relax the muscles of the lower back. The test taker should be familiar not only with the name of exercises or other procedures but also with the precise way each is performed. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

88. The nurse has identified the following nursing diagnosis for a postpartum (PP) client: Potential for fluid volume deficit. Which of the following goals for the mother is appropriate? 1. Minimal perineal pain. 2. Normal lochial flow. 3. Normal temperature. 4. Weight reduction.

1. Although minimal perineal pain is a goal for the PP client, it is not related to the nursing diagnosis of potential for fluid volume deficit. ✅2. Normal lochial flow is a goal related to the nursing diagnosis of potential for fluid volume deficit. 3. Although a normal temperature is a goal for the PP client, it is not related to the nursing diagnosis of potential for fluid volume deficit. 4. The PP client is expected to have some weight reduction, but that goal is not related to the nursing diagnosis of potential for fluid volume deficit. TEST-TAKING TIP: The nursing process is an important tool used by nurses to provide care. To provide needed care, the nurse must determine goals for his or her clients. The goals are related to the nursing diagnoses. When fluid volume deficit is of concern, the nurse must consider loss of fluids through bleeding, excessive voiding, or other means. The nursing goal is that the client not bleed heavily. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

42. The triage nurse is interviewing a client, 19 years old, unmarried, who states, "I felt a hard thing on the lip of my vagina this morning. It doesn't hurt." Which of the following questions is most important for the nurse to ask at this time? 1. "Have any of your partners ever hurt you?" 2. "Do you ever have unprotected intercourse?" 3. "Have you ever had a baby?" 4. "Do you think you may be pregnant?"

1. Although this question is important, it is not the best question to ask at this time. In addition, an injury would be painful. ✅2. This is the best question to ask at this time. 3. Although this question is important, it is not the best question to ask at this time. 4. Although this question is important, it is not the best question to ask at this time. TEST-TAKING TIP: This is an unmarried woman who may be having intercourse with men and/or women who are intimate with others. The young woman may be feeling a lesion caused by a sexually transmitted infection, such as a syphilis chancre or a perineal wart. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

75. A male baby is born with scant amounts of vernix caseosa in his axillae and groin, scant amounts of lanugo on his shoulders, testes in his scrotum, and a strong suck. The nurse would estimate that the baby is which of the following gestational ages? 1. 22 weeks. 2. 28 weeks. 3. 32 weeks. 4. 38 weeks.

1. At 22 weeks, testes are not yet descended, the suck is weak, and lanugo and vernix are present. 2. At 28 weeks, testes may begin to descend, the suck is weak, and lanugo and vernix are abundant. 3. At 32 weeks, testes may have descended, the suck is improving but still poor, and lanugo and vernix are abundant. ✅4. At 38 weeks, testes are fully descended, the suck is strong, and the amount of lanugo and vernix is minimal. TEST-TAKING TIP: The test taker should be familiar with major fetal development milestones. Preterm babies are born covered in lanugo and vernix, have weak sucks, and, if male, have not developed sufficiently to have their testes present in their scrotal sacs. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

99. A nurse has just received report on 4 neonates in the newborn nursery. Which of the babies should the nurse assess first? 1. Neonate whose mother is HIV positive. 2. Neonate whose mother is group B streptococcus (GBS) positive. 3. Neonate whose mother's labor was 12 hours long. 4. Neonate whose mother gained 45 pounds during her pregnancy.

1. Babies whose mothers are HIV positive are not at high risk during the immediate neonatal period. ✅2. This is the correct response. Babies who are born to mothers who are GBS positive are at high risk for sepsis. The incidence of sepsis is reduced, however, when the mother receives IV antibiotics during labor. 3. Twelve hours is not an abnormal length for a patient's labor. 4. Although 45 pounds is higher than the recommended weight gain for pregnancy, this baby is not the highest priority. TEST-TAKING TIP: Each of the responses includes either a number or a disease process. To answer the question, the nurse must determine which of the answer options is a high-risk state during the immediate neonatal period. Even though babies born to women who are HIV positive may acquire the infection, the baby will not be adversely affected by the virus immediately after birth. (In fact, if mothers and babies are treated, transmission rates are almost zero.) Babies born to mothers who are GBS positive, however, may develop sepsis while in the neonatal nursery. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

93. A nurse has provided a young woman with preconception counseling. Which of the statements by the woman indicates that the teaching was successful? Select all that apply. 1. "As soon as I think I may be pregnant, I should stop drinking alcohol." 2. "It is important for me to see my medical doctor for a complete physical." 3. "I should make sure that my daily multivitamin contains folic acid." 4. "When I go to my dentist for a checkup I should state that I may be pregnant." 5. "From now until I deliver I should refrain from eating sushi and rare meat."

1. Because the majority of fetal development occurs during the embryonic period, and many women are unaware that they are pregnant until well into that period, it is too late to stop drinking alcohol when the woman "thinks" that she may be pregnant. ✅2. To make sure that a woman is not suffering from a disease that could adversely affect a pregnancy, or that pregnancy would adversely affect a woman's health, it is important for a woman to have a complete medical checkup prior to becoming pregnant. ✅3. Because folic acid supplementation has been found to reduce the incidence of some birth defects, women should begin taking a daily multivitamin that includes folic acid when they are trying to become pregnant. ✅4. Because dental x-rays could injure the developing embryo, a woman should tell her dentist that she is trying to become pregnant so that the dentist can shield her abdomen during the x-ray. ✅5. Pregnant women are especially at high risk for contracting listeriosis. The offending organism, Listeria monocytogenes, is found in sushi and rare meat as well as in a number of other foods. TEST-TAKING TIP: Embryogenesis often occurs before a woman is aware that she is pregnant. Because teratogenic insults can injure the developing embryo, it is essential that women plan their pregnancies and avoid teratogens when attempting to become pregnant. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

94. A client who had a vaginal delivery 2 hours earlier has just been transferred to the postpartum unit from labor and delivery. Which of the following nursing care goals is of highest priority? 1. The client will breastfeed her baby every 2 hours. 2. The client will consume a nutritious diet. 3. The client will have a moderate lochial flow. 4. The client will ambulate in the hallways every shift.

1. Breastfeeding every 2 hours is an important nursing care goal for a postpartum client, but it is not the highest priority. 2. A nutritious diet is an important nursing care goal for a postpartum client, but it is not the highest priority. ✅3. The nursing care goal of a moderate lochial flow for a postpartum client is of highest priority. 4. Walking in the hallways every shift is an important nursing care goal for a postpartum client, but it is not the highest priority. TEST-TAKING TIP: The test taker should consider the acronym CAB (circulation, airway, breathing) to determine which nursing care goal is of highest priority. The care goal related to lochial flow is directly related to circulation (C). If the client were to bleed heavily, her circulation would be compromised. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

12. A 42-week-gestation neonate is being assessed. Which of the following findings would the nurse expect to see? 1. Folded and flat pinnae. 2. Smooth plantar surfaces. 3. Loose and peeling skin. 4. Short pliable fingernails.

1. Folded and flat pinnae are seen in preterm newborns, not postmature babies. 2. Smooth plantar surfaces are seen in preterm newborns, not postmature babies. 3. The skin of the post-term baby is loose because the baby has depleted most of the subcutaneous fat stores and is peeling because of dehydration and the advanced age of the baby. 4. The nurse would expect to see long fingernails that may be tinged green from exposure to meconium. TEST-TAKING TIP: If the test taker were unsure of the answer to this question, an educated response could have been made. Post-term babies are in utero beyond the normal life of the placenta. They are deprived of nourishment, hydration, and oxygenation because of this. Loose skin often connotes a loss of weight, and peeling skin is seen in poorly nourished and hydrated individuals. The test taker could deduce that choice 3 is the correct response. CHAPTER 12 COMPREHENSIVE EXAMINATION

61. A client asks the nurse to explain what luteinizing hormone (LH) does in the body. The nurse should make which of the following statements? 1. "It accelerates the growth and maturation of an egg in your ovary." 2. "It enhances the potential for the sperm to fertilize the mature egg." 3. "It promotes the movement of the egg through the fallopian tube." 4. "It stimulates the monthly release of a mature egg from your ovary."

1. Follicle-stimulating hormone (FSH), not LH, accelerates the growth and maturation of an egg in the ovary. 2. This response is untrue. LH does not enhance the potential of the sperm to fertilize an egg. 3. This response is untrue. LH does not facilitate the egg's movement through the fallopian tube. 4. This response is correct. LH stimulates the release of a mature egg from the ovary each month. TEST-TAKING TIP: FSH stimulates the growth and maturation of the egg, while LH stimulates its release from the ovary. The woman's temperature will drop slightly when she experiences the LH surge. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

52. A fetal fibronectin assessment of the cervicovaginal fluids of a 28-week gravida is positive. Based on the results, which of the following complaints should the nurse advise the client to report immediately to the healthcare provider? 1. Headache. 2. Visual disturbances. 3. Uterine cramping. 4. Oliguria.

1. Headache is associated with pre-eclampsia, not preterm labor. 2. Visual disturbances are associated with pre-eclampsia, not preterm labor. ✅3. The nurse should advise the client immediately to report any uterine cramping. 4. Oliguria is associated with pre-eclampsia, not preterm labor. TEST-TAKING TIP: A positive fetal fibronectin assessment between 22 and 37 weeks' gestation puts a client at high risk for preterm labor. All of the other symptoms—headache, visual disturbance, and oliguria—are associated with pre- eclampsia. The test taker could have made an educated guess regarding the correct response to the question had he or she noted the relationship among the three other options. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

87. A G1 P0000 gravida whose labor was uneventful delivered 1 minute ago. The baby's Apgar score at this time is 3. Which of the following actions is appropriate for the nurse to make? 1. Administer ophthalmic prophylaxis. 2. Place the baby on the abdomen of the mother. 3. Obtain assistance for neonatal resuscitation. 4. Repeat the score to confirm its accuracy.

1. It is inappropriate to insert eye prophylaxis when the baby needs resuscitation. 2. This action is inappropriate. The baby needs to be resuscitated. ✅3. An Apgar score of 3 is an indication for neonatal resuscitation. 4. There is no need to repeat the score until 5 minutes after birth. The score of 3 at 1 minute is enough evidence to warrant resuscitation. TEST-TAKING TIP: An Apgar score of 8 or above indicates that the baby is making a smooth transition into extrauterine life. A score of 3 indicates a baby who is severely compromised. Resuscitation should be instituted as quickly as possible. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

34. A doula is working with a laboring woman who is 6 cm dilated and is contracting every 3 min × 60 sec on an oxytocin drip. Which of the following interventions should the nurse suggest the doula perform? 1. Regulate the oxytocin drip rate. 2. Check the vaginal dilation of the client. 3. Encourage the woman to use breathing techniques. 4. Monitor the client for uterine hyperstimulation.

1. It is not appropriate for the nurse to delegate the regulation of the oxytocin drip rate to the doula. 2. It is not appropriate for the nurse to delegate the monitoring of the client's vaginal dilation to the doula. ✅3. The doula is an expert in assisting laboring clients to work with their labors. 4. It is not appropriate for the nurse to delegate the monitoring for hyperstimulation to the doula. TEST-TAKING TIP: The role of the doula is as a labor support. Doulas intervene to help clients to relax and work with their labors. It is inappropriate for doulas to perform any professional nursing care such as evaluating electronic monitor tracings, administering medications, performing physical assessments, and the like. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

74. Without doing a vaginal examination, a nurse concludes that a primigravida who has received no medications during her labor is in transition. Which of the following signs/symptoms would lead a nurse to that conclusion? 1. The woman fell asleep during a contraction. 2. The woman yelled at her partner and vomited. 3. The woman laughed at something on the television. 4. The woman began pushing with each contraction.

1. It is very unlikely that a woman in transition would fall asleep during contractions. ✅2. These are characteristic actions of laboring women who are in transition. 3. It is very unlikely that a woman in transition would be watching television. 4. Pushing is characteristic of stage 2 of labor. TEST-TAKING TIP: Transition is the most forceful phase of the first stage of labor. The contractions are strong and frequent and mothers, especially primigravidas, are usually fatigued and very uncomfortable during the phase. Vomiting is commonly seen during this phase. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

22. A woman is in the "taking-hold phase" of the postpartum period. Which of the following behaviors would the nurse expect to see? 1. The woman is on the telephone relating her experiences to family and friends. 2. The woman asks for a meal tray and eats a variety of foods brought from home. 3. The woman is interested in learning baby-care skills from the nurse. 4. The woman takes a nap after each breastfeeding and each meal.

1. Mothers who discuss their labor and delivery experiences are exhibiting a characteristic of the "taking-in" postpartum phase 2. Mothers who eat quantities of food are exhibiting a characteristic of the "taking-in" postpartum phase. ✅3. When mothers are interested in learning baby-care skills from the nurse, they are exhibiting signs of the "taking-hold" postpartum phase. 4. Mothers who express intense fatigue and take naps throughout the day are exhibiting a characteristic of the "taking-in" postpartum phase. TEST-TAKING TIP: The "taking-hold" phase is the postpartum period when mothers regain their independence and express interest in caring for their neonate. Prior to that time, mothers express the need to be cared for while they internalize their labor and delivery experience. CHAPTER 12 COMPREHENSIVE EXAMINATION

47. A 6-month-old child has been diagnosed with a significant hearing loss. Which of the following complications that occurred immediately after delivery could have resulted in this condition? 1. Necrotizing enterocolitis. 2. Hypoglycemia. 3. Bronchopulmonary dysplasia. 4. Kernicterus.

1. Necrotizing enterocolitis does not result in hearing loss. 2. Hypoglycemia does not result in hearing loss. 3. Bronchopulmonary dysplasia does not result in hearing loss. ✅4. A baby who has had kernicterus can develop hearing loss. TEST-TAKING TIP: Kernicterus occurs when bilirubin in the bloodstream reaches toxic levels. Bilirubin is neurotoxic. Early signs of kernicterus are lethargy, sleepiness, and poor feeding. Severe kernicterus, when babies develop seizures and opisthotonus, can result in a number of neurological problems, including cerebral palsy, sensory deficits, and behavioral disorders. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

67. A baby is exhibiting signs of neonatal abstinence syndrome. Which action would be appropriate for the nursery nurse to make? 1. Cover the baby with at least two blankets. 2. Stimulate the baby with rattles. 3. Play soft classical music in the nursery. 4. Attach a mobile to the crib.

1. Neonates who are exhibiting signs of neonatal abstinence syndrome are not at high risk of becoming hypothermic. In addition, neonates should be swaddled rather than covered with blankets. When a baby is covered, the blankets may inadvertently cover the baby's face, obstructing the baby's nasal passages. 2. Neonates who are exhibiting signs of neonatal abstinence syndrome should be kept in a low-stimulation environment. ✅3. Neonates who are exhibiting signs of neonatal abstinence syndrome are often soothed by the playing of soft classical music. 4. Neonates who are exhibiting signs of neonatal abstinence syndrome should be kept in a low-stimulation environment TEST-TAKING TIP: Neonatal abstinence syndrome is the title given to the signs and symptoms exhibited by babies during the drug or alcohol withdrawal period. The babies are hyperreflexic and agitated during this period; therefore, keeping them in a soothing, low-stimulation environment is optimal. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

81. The nurse is providing patient teaching to a client who plans to bottle feed her newborn infant. Which of the following information should be included in the education session? 1. The baby should be burped after every 3 ounces of formula. 2. If the bottle nipple is not filled throughout the feeding, the baby may take in a large amount of air. 3. The best way to heat formula for the baby is in the microwave. 4. If the mother is busy with her other children, she can prop the baby bottle up on a blanket or towel.

1. Newborn babies should be burped after consuming every 1/2 to 1 ounce of formula. ✅2. This statement is true. To prevent ingestion of air, the bottle nipple should be filled with formula throughout the feeding. 3. Formula should never be heated in the microwave. 4. Because of the potential for aspiration, baby bottles should never be propped. TEST-TAKING TIP: Mothers who decide to bottle feed their babies must be educated regarding safe bottle feeding practices. Not only is propping unsafe but it also decreases the amount of quality time the mother has with her baby. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

51. A nurse should monitor a client who is postpartum from a forceps delivery for which of the following complications? 1. Placental abruption. 2. Seizure. 3. Idiopathic thrombocytopenia. 4. Infection.

1. Placental abruption occurs before the delivery of the baby. 2. Clients who have had forceps deliveries are no more at high risk for seizures than other postpartum clients. 3. Clients who have had forceps deliveries are no more at high risk for idiopathic thrombocytopenia than other postpartum clients. ✅4. Clients who have had forceps deliveries are at high risk for infection. TEST-TAKING TIP: The vagina is not a sterile space. Because the forceps are applied through the vagina into the sterile uterine cavity, there is a possibility of bacteria ascending into the upper gynecological system. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

41. A woman who is in pain from a diagnosis of mastitis has abruptly weaned her baby to a bottle. Her actions place the woman at high risk for which of the following? 1. Mammary rupture. 2. Postpartum psychosis. 3. Supernumerary nipples. 4. Breast abscess.

1. She is not at high risk for mammary rupture. 2. She is not at high risk for postpartum psychosis. 3. She is not at high risk for supernumerary nipples. ✅4. The client is at high risk for the development of a breast abscess. TEST-TAKING TIP: When clients wean abruptly, the breasts become engorged with milk. Mastitis is a breast infection usually caused by Staphylococcus aureus. When the milk is not removed from the breast, an abscess, or collection of pus, can develop in the breast. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

23. A client's amniocentesis results are reported as 45, X. How should the nurse interpret these findings? 1. The fetus is nonviable. 2. The fetus is a normal female. 3. The baby will be a hermaphrodite. 4. The girl will be short and sterile.

1. The amniocentesis results indicate Turner syndrome—45, X, a genetic anomaly—but the fetus is viable. 2. This is not a normal female, although the child will be phenotypically female. 3. The child will be phenotypically female. ✅ 4. Turner syndrome girls are characterized by short stature, broad chests, and the inability to conceive. TEST-TAKING TIP: The genetic anomaly 45, X is one of the few monosomies that are viable. There is no intellectual disability associated with Turner syndrome. CHAPTER 12 COMPREHENSIVE EXAMINATION

89. An infant of a diabetic mother, 40 weeks' gestation, weight 4,500 grams, has just been admitted to the neonatal nursery. The neonatal intensive care nurse will monitor this baby for which of the following? Select all that apply. 1. Hyperreflexia. 2. Hypoglycemia. 3. Respiratory distress. 4. Opisthotonus. 5. Nuchal rigidity.

1. The baby is no more at high risk for hyperreflexia than other neonates. ✅2. The nurse should monitor the baby for respiratory distress and hypoglycemia. ✅3. The nurse should monitor the baby for respiratory distress and hypoglycemia. 4. The baby is no more at high risk for opisthotonus than other neonates. 5. The baby is no more at high risk for nuchal rigidity than other neonates. TEST-TAKING TIP: Babies of diabetic mothers are at high risk for respiratory distress because their lung fields develop more slowly than the lung fields of babies of normoglycemic mothers. Even full- term infants of diabetic mothers sometimes have respiratory difficulties MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

68. A mother, 39 weeks' gestation, is admitted to the labor suite with rupture of membranes 15 minutes earlier and contractions q 8 minutes × 30 seconds. On vaginal exam, the cervix is 4 cm dilated and 80% effaced and the station is −2. The baby is found to be in the LSP position. The fetal heart rate is 144 with average variability and variable decelerations. Which of the following complications of labor must the nurse assess this client for at this time? 1. Precipitous delivery. 2. Chorioamnionitis. 3. Uteroplacental insufficiency. 4. Prolapsed cord.

1. The baby is not yet engaged. It is very unlikely that the client will experience a precipitous delivery. 2. The membranes have been ruptured a very short time. The client is not at high risk for infection at this time. 3. The fetal heart rate is showing variable decelerations, the baby is not postdates, and there is no evidence of other placental issues. The client is not at high risk for uteroplacental insufficiency. ✅4. The membranes are ruptured, the baby is not engaged, the baby is in the sacral position, and the fetal heart rate is showing variable decelerations. The nurse should assess this client carefully for prolapsed cord. TEST-TAKING TIP: The test taker must methodically consider the many factors in the scenario before determining the correct answer to this question. The key items that must be considered are fetal heart rate, time since rupture of membranes, fetal position, fetal station, and gestational age. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

45. The nurse documents a woman's gravidity and parity as G6 P3214. Which of the following obstetric histories is consistent with this notation? 1. The woman is currently pregnant, has 3 living children. 2. The woman is currently pregnant, had 2 full-term pregnancies. 3. The woman is not currently pregnant, had 4 preterm babies. 4. The woman is not currently pregnant, had 1 abortion.

1. The client is not currently pregnant and has 4 living children. 2. The client is not currently pregnant and has had 3 full-term pregnancies. 3. The client is not currently pregnant and has had 2 preterm deliveries. ✅4. The client is not currently pregnant and has had 1 abortion. TEST-TAKING TIP: Gravidity (G) is defined as the total number of pregnancies a woman has had, including a current pregnancy. Parity (P) refers to deliveries. The four numbers following the P refer to the following: full-term pregnancies, preterm pregnancies, abortions, living children. The client in the scenario, therefore, has been pregnant 6 times, had 3 full-term deliveries, 2 preterm deliveries, 1 abortion, and has 4 living children. Since 3 + 2 + 1 = 6, the client has delivered all of her pregnancies MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

13. A 39-week-gestation client is admitted to the labor and delivery unit for a scheduled cesarean delivery. The nurse should inform the surgeon regarding which of the following admission laboratory findings? 1. Potassium 4.9 mEq/L. 2. Sodium 136 mEq/L. 3. Platelet count 75,000 cells/mm3. 4. White blood cell count 15,000 cells/mm3.

1. The client's potassium level is normal. 2. The client's sodium level is normal. 3. The platelet count is well below normal. 4. The white blood cell count is normal for a 38-week-gestation woman. TEST-TAKING TIP: The normal platelet count is 150,000 to 400,000 cells/mm3. This client's cell count is well below normal. Clients with low platelet counts are at high risk for bleeding spontaneously. Although thrombocytopenia could be the client's sole problem, the nurse should also assess the client for any other signs of HELLP syndrome. Although the white blood cell count is elevated for a nonpregnant woman, it is normal for a perinatal client. CHAPTER 12 COMPREHENSIVE EXAMINATION

86. A client's vital signs during labor and delivery were: BP 100/58-110/66, T 98.6°F-98.8°F, P 72-80 bpm, R 20-24 rpm. The client's vitals 2 hours postpartum from a spontaneous vaginal delivery are BP 100/56; TPR 99.4°F, P 70 bpm, R 20 rpm; her fundus is firm and her lochia is scanty. Which of the following actions should the nurse perform at this time? 1. Massage the client's uterus. 2. Ask the client if she is having chills. 3. Encourage the client to drink fluids. 4. Assess the client's lung fields.

1. The fundus is firm and the lochia is scanty. There is no need for the nurse to massage the client's uterus, that is her fundus. 2. The client's temperature, although higher than during labor, is not elevated significantly. This is not the appropriate action to take at this time. ✅3. The only significant change in vitals is a rise in temperature to 99.4°F. Because the client has recently delivered, it is likely that the elevation is related to dehydration. The nurse should encourage the client to drink fluids. 4. There is nothing in the scenario that indicates that the client may have a pulmonary problem. This is not the appropriate action to take at this time. TEST-TAKING TIP: The only significant change in the client's vital signs from the intrapartum period to the postpartum period is the elevation in the temperature. Since the temperature is not high enough to signal an infection, it is likely related to dehydration. She should drink fluids. If the client were becoming hypovolemic from blood loss, the nurse would have noted a marked elevation in pulse rate but likely no change in blood pressure. Because the blood volume of women rises dramatically during pregnancy, their bodies are able to compensate for an extended period of time before hypotension is noted. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

73. A nurse sees an overweight woman looking at the babies through the nursery window. The woman asks the nurse when the babies go to their mothers for feedings and about the location of the nearest stairwell. Which of the following replies by the nurse is most appropriate at this time? 1. "The babies go to their mothers whenever they seem hungry." 2. "Please let me escort you to the mother's room you are here to visit." 3. "The babies are in the mothers' rooms for the majority of the day." 4. "Most of our visitors prefer to use the elevator to return to the lobby."

1. The nurse should refrain from giving any information to the woman regarding the babies' schedules. ✅2. The nurse should politely escort the woman to a postpartum room, if appropriate, or off the unit if she is not visiting a patient. 3. The nurse should refrain from giving any information to the woman regarding the babies' schedules. 4. The nurse should politely escort the woman to a postpartum room, if appropriate, or off the unit if she is not visiting a patient. TEST-TAKING TIP: The physical characteristics and actions of the woman in the scenario are consistent with those of women who abduct neonates. By asking the client which patient the woman wishes to visit, the nurse will be able to determine whether the woman is a legitimate visitor. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

62. The nurse is obtaining the first postpartum meal for a client who has stated that she practices Mormonism (the Church of Jesus Christ of Latter-Day Saints). Which of the following items should the nurse remove from the client's food tray? 1. Caffeinated coffee. 2. Cheeseburger. 3. Fried fish. 4. Pork sausage.

1. The nurse should remove the caffeinated coffee from the food tray. 2. The nurse need not remove the cheeseburger from the food tray. 3. The nurse need not remove the fried fish from the food tray. 4.The nurse need not remove the pork sausage from the food tray. TEST-TAKING TIP: Mormons are forbidden from drinking caffeinated beverages, such as coffee and colas, and are forbidden from smoking and from drinking alcohol. To show respect, the nurse should remove the offending beverage from the woman's food tray. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

64. A client, 6 cm and 80% effaced, has just received Sublimaze (fentanyl citrate) 50 micrograms IV for pain. Which of the following fetal heart changes would the nurse expect to observe on the internal fetal monitor tracing? 1. Drop in baseline heart rate. 2. Increase in number of variable decelerations. 3. Decrease in variability. 4. Rise in number of early decelerations.

1. The nurse would not expect to see a drop in the baseline fetal heart rate. 2. The nurse would not expect to see an increase in variable decelerations. ✅3. The nurse would expect to see a decrease in the baseline variability. 4. The nurse would not expect to see an increase in early decelerations. TEST-TAKING TIP: Fentanyl is a narcotic analgesic. Narcotics are central nervous system (CNS) depressants. The baseline variability is an expression of the interaction between the parasympathetic and sympathetic nervous systems of the fetus. Because the narcotic enters the fetal vascular system through the placenta, the fetal CNS is depressed. As a result, the variability drops. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

40. A nurse who is creating a pedigree of a woman's family tree includes the following symbols. The symbols represent which of the following relationships? female (circle)—————-(square) 1. A healthy sister and brother. 2. A couple who has mated. 3. A grandmother and her grandson. 4. A father and his daughter.

1. The symbol represents a couple who has mated, not a healthy sister and brother. ✅2. The symbol represents a couple who has mated. 3. The symbol represents a couple who has mated, not a grandmother and her grandson. 4. The symbol represents a couple who has mated, not a father and his daughter. TEST-TAKING TIP: When a female (circle) and a male (square) are connected with single line on a pedigree, a couple has mated is represented. A circle and square connected by a double line indicates a consanguineous couple (blood relatives) who has mated. CHAPTER 12 COMPREHENSIVE EXAMINATION

38. A 32-week-gravid client presents in the emergency department with severe abdominal pain, rigid abdomen, and scant dark red bleeding. The nurse should assess this client for which of the following? 1. Signs of pulmonary edema. 2. Enlarging abdominal girth measurements. 3. Hyporeflexia and confusion. 4. Signs of diabetic coma and ketosis.

1. The symptoms in the scenario are related to placental abruption, not pulmonary edema. ✅2. The nurse should observe for enlarging abdominal girth measurements. 3. Hyporeflexia and confusion are not symptoms of placental abruption. 4. The symptoms in the scenario are related to placental abruption, not diabetic coma and ketosis. TEST-TAKING TIP: When a nurse suspects placental abruption, he or she should monitor the gravida for enlarging abdominal girth, a board-like abdomen, and unrelenting pain. The nurse should also monitor the fetal heart rate for dysrhythmias. Placental abruption is an obstetric emergency. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

92. A 4-day-old breastfeeding neonate whose birth weight was 2,678 grams has lost 286 grams since the baby's cesarean birth. Which of the following actions should the nurse take? 1. Nothing, because this is an acceptable weight loss. 2. Advise the mother to stop breastfeeding and give formula. 3. Notify the neonatologist of the excessive weight loss. 4. Give the baby dextrose water between breast feedings.

1. The weight loss is excessive. This response is not acceptable. 2. It is inappropriate to recommend that the woman stop breastfeeding. It may be appropriate to add supplementation, however. ✅3. The nurse should notify the neonatologist of the excessive weight loss. 4. It is inappropriate for the baby to receive dextrose water between feedings. TEST TAKING TIP: Babies can lose between 5% and 10% of their birth weights in the first few days of life. Instead of calculating the exact weight loss for this baby, however, the test taker can determine what a 10% weight loss would be for the baby and compare that figure to the child's actual weight loss: 2678 × 0.1 = 267.8. Because the baby has lost more than 10% of his or her birth weight (286 is greater than 267.8), it is easy to determine that the weight loss is excessive. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

50. A postpartum client who delivered her baby vaginally 2 hours earlier just voided 100 mL in the bathroom. After returning to bed, the nurse makes the following assessment: fundus 4 cm above the umbilicus and deviated to the right with moderate lochia rubra. Which of the following nursing diagnoses is appropriate at this time? 1. Impaired skin integrity. 2. Fluid volume deficit. 3. Impaired urinary elimination. 4. Toileting self-care deficit.

1. There is nothing in the scenario that indicates that the client's skin integrity is impaired. 2. Although the woman's bladder is full, at this time the client is not bleeding heavily. ✅3. This answer is correct. The client has not emptied her bladder. 4. The client is able to walk back and forth to the toilet on her own. Her problem is related to an inability to empty her bladder. TEST-TAKING TIP: Postpartum clients eliminate large quantities of fluids through their kidneys. When only 100 mL is voided and the uterus is displaced, the nurse must conclude that the client has not emptied her bladder.MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

29. A woman contracting every 3 min × 60 seconds suddenly develops an amniotic fluid embolism. Which of the following signs/symptoms would the nurse observe? 1. Sudden gush of fluid from the vagina. 2. Intense and unrelenting uterine pain. 3. Precipitous dilation and expulsion of the fetus. 4. Chest pain with dyspnea and cyanosis.

1. These signs are evident when the amniotic sac ruptures, not when a client experiences an amniotic fluid embolism. 2. Intense, unrelenting uterine pain is seen with placental abruption and uterine rupture, not with amniotic fluid embolism. 3. Precipitous dilation and expulsion of the fetus describes a precipitous delivery. ✅4. Chest pain with dyspnea and cyanosis are the classic signs of amniotic fluid embolism TEST-TAKING TIP: When amniotic fluid enters the vascular tree, it acts like any foreign body. When it reaches the lung fields, gas exchange is adversely affected. The woman experiences the same symptoms as if a thrombus had migrated to her lungs CHAPTER 12 COMPREHENSIVE EXAMINATION

70. The nurse is caring for a client and her partner who just birthed a 33-week fetal demise. Which of the following actions by the nurse is appropriate at this time? 1. Recommend that the woman be moved to a medical unit. 2. Refrain from discussing the loss with the couple. 3. Ask the couple if they would like to hold their baby. 4. Obtain an order for a milk suppressant for the mother.

1. This action is not advisable unless the woman requests the move. 2. This action is inappropriate. The nurse must acknowledge the loss of the baby. ✅3. This action is appropriate. The nurse should offer the couple the opportunity to hold their baby. 4. This action is inappropriate. The administration of milk suppressants is not recommended because of the adverse side effects of the medications. TEST-TAKING TIP: Unless the couple view and hold their baby, they will have no tangible person to mourn. Nurses should take pictures of the baby. Then in the future if they should want to, the couple can look at the pictures to remember their loss. In addition, clients who have had a fetal loss should be forewarned that they may lactate. This can be very stressful for a grieving woman if she is unprepared. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

48. During a vaginal delivery of a macrosomic baby, the nurse midwife requests nursing assistance. Which of the following actions by the nurse would be appropriate? 1. Estimate fetal length and weight. 2. Assess intensity of contractions. 3. Provide suprapubic pressure. 4. Assist woman with breathing.

1. This action will not assist the midwife with the delivery of the baby. 2. This action will not assist the midwife with the delivery of the baby. ✅3. Suprapubic pressure can help to dislodge the shoulders of a macrosomic baby and facilitate the delivery. 4. This action will not assist the midwife with the delivery of the baby. TEST-TAKING TIP: Macrosomia can lead to shoulder dystocia during a delivery. Suprapubic pressure helps to dislodge the shoulders and enable the baby to be delivered. Nurses must not apply fundal pressure in this situation. Rather than facilitating delivery of the shoulders, fundal pressure can actually worsen the dystocia. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

82. The nurse has received change of shift report on the following four clients. Which of the clients should the nurse assess first? 1. G1 P0000, 9 weeks' gestation, hyperemesis gravidarum, vomited twice during the last shift. 2. G2 P0101, 24 weeks' gestation, receiving terbutaline PO q 2 h for preterm labor, no complaints of cramping during last shift. 3. G1 P0000, 1 day postpartum, vacuum extraction, for bilateral tubal ligation during this shift. 4. G2 P0101, 2 days postpartum, spontaneous delivery, had asthma attack during last shift.

1. This client did vomit twice last shift, but she is not the highest risk of the nurse's patients. 2. This client is at high risk for preterm labor, but she is not the highest risk of the nurse's patients. 3. This client does need to be given preoperative teaching and prepared for surgery, but she is not the highest risk of the nurse's patients. ✅4. This client should be seen first. Although obstetrically she is not at high risk, her care must take priority because she had a pulmonary episode during the prior shift. TEST-TAKING TIP: When taking a comprehensive examination, the test taker should be prepared to answer complex questions. This question requires the test taker to consider a variety of issues including antepartum clients versus postpartum clients, obstetric complications versus medical complications, and preoperative issues versus standard care issues MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

90. A nurse has just inserted an orogastric gavage tube into a preterm baby. When would the nurse determine that the tube is in the proper location? 1. When gastric aspirate is removed from the tube. 2. When the baby suckles on the tubing. 3. When respirations are unlabored during tube insertion. 4. When the tubing can be inserted no farther.

1. ✅ The tube is placed through the mouth into the baby's stomach. When gastric juices are aspirated, the nurse knows that the tubing is in the stomach. 2. Babies will often suckle on items in their mouths. This does not mean, however, that the tubing is in place. 3. Even if the tubing is inserted correctly into the stomach, the baby may exhibit some respiratory difficulties. 4. Even though the nurse meets resistance when inserting the tube, this does not mean that it has been inserted into the stomach. TEST-TAKING TIP: When a tube is inserted into a baby for a gavage feeding, the nurse must be certain that the tube has entered the stomach and not the lung fields. There are a number of actions the nurse can take to ensure the tube's placement, including injecting air into the tubing and listening with a stethoscope for the "rush" as it enters the stomach as well as aspirating the stomach contents. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

98. A woman who states that she smokes 2 packs of cigarettes each day is admitted to the labor and delivery suite in labor. The nurse should monitor this labor for which of the following? 1. Delayed placental separation. 2. Late decelerations. 3. Shoulder dystocia. 4. Precipitous fetal descent.

1.Delayed placental separation is not associated with maternal cigarette smoking. ✅2. The nurse should carefully monitor the labor for late decelerations. 3. Shoulder dystocia is not associated with maternal cigarette smoking. 4. Precipitous fetal descent is not associated with maternal cigarette smoking. TEST-TAKING TIP: Smoking affects the oxygenation ability of the placenta. Indeed, the placentas of women who smoke are often small, infarcted, and/or calcified. During labor, therefore, there is a strong likelihood that uteroplacental insufficiency will be evident. Late decelerations are indicative of uteroplacental insufficiency MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

14. A mother questions the nurse about when the newborn screening tests for inborn diseases will be performed. Which of the following is an appropriate response by the nurse? 1. The doctor took blood from the baby's umbilical cord at birth. 2. The pediatrician will take a blood sample at the baby's first visit. 3. A vial of blood was drawn and sent when the baby was admitted to the nursery. 4. Blood from the baby's heel was sent after the baby had been fed a few times.

14. 1. A sample of cord blood is taken but it is not used to check for inborn diseases. Rather, the baby's blood type and Coombs test are assessed from the cord blood sample. 2. The blood must be obtained prior to the baby's discharge from the hospital. 3. This answer is incorrect. Admission blood is not used to check for inborn diseases. 4. This answer is correct. Because many of the inborn diseases are related to metabolism of foods, the baby must be fed a few times before the blood can be drawn. TEST-TAKING TIP: The genetic disease phenylketonuria (PKU) is one of the many metabolic illnesses that babies are assessed for. Babies with PKU lack the enzyme needed for fully metabolizing phenylalanine, an essential amino acid. To accurately assess whether the baby lacks the enzyme or not, the baby must have consumed the proteins that are present in breast milk or formula before the blood test is performed CHAPTER 12 COMPREHENSIVE EXAMINATION

11. The healthcare practitioner caring for a pregnant client diagnosed with gonorrhea writes the following order: ceftriaxone 250 mg IM × one dose. The medication is available in 1-gram vials. The nurse adds 8 mL of normal saline to the vial. How many mL of the medication should the nurse administer? Calculate to the nearest whole. __________ mL.

2 mL. The standard formula for this question is: Known dose = Desired dose Known volume = Desired volume 1 gram/8 mL = 250 mg/x mL 1,000 mg/8 mL = 250 mg/x mL 1,000 x = 2,000 x = 2 mL TEST-TAKING TIP: If the test taker always uses the formula—inserting the correct values into the respective locations—he or she will be unlikely to make any calculation errors. The known dosage and volume are given; that is, 1 gram in 8 mL. CHAPTER 12 COMPREHENSIVE EXAMINATION

83. Using the graph that follows, of the following weights, how many grams would a 34-week neonate need to weigh to be labeled appropriate for gestational age? 1. 500 grams. 2. 1,700 grams. 3. 2,900 grams. 4. 4,100 grams.

GO LOOK AT PHOTO 1. A 34-week baby weighing 500 grams would be classified as small for gestational age. 2. A 34-week baby weighing 1,700 grams would be classified as small for gestational age. ✅3. A 34-week baby weighing 2,900 grams would be classified as appropriate for gestational age. 4. A 34-week baby weighing 4,100 grams would be classified as large for gestational age. TEST-TAKING TIP: The test taker must be prepared to interpret simple graphs. Appropriate for gestational age babies are babies who weigh between the 10th and 90th percentile for a specific gestational age. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

16. The nurse would be concerned that a 26-week-gravid client is carrying an unwanted pregnancy when the client makes which of the following statements? 1. "The baby hasn't started to move yet." 2. "My back aches every night when I get home from work." 3. "I am finding it very hard always to eat the right things." 4. "I am no longer able to wear my old clothes."

Quickening should be felt by 20 weeks' gestation at the latest. The nurse, therefore, should be concerned that this pregnancy is unwanted. Backaches are normal, expected complaints of pregnancy. This comment shows the frustration that the mother is feeling about maintaining a nutritious diet for her child. It does not indicate a rejection of the pregnancy. This comment shows the frustration that the mother is feeling about her changing body image. TEST-TAKING TIP: When women whose pregnancies are beyond 20 weeks' gestation state that they have yet to feel the baby move, the nurse must consider the possibility that the woman is rejecting her pregnancy. The nurse should attempt to intervene during the pregnancy rather than waiting until the baby is delivered CHAPTER 12 COMPREHENSIVE EXAMINATION

2. The nurse is caring for a client in labor and delivery with the following history: G2 P1000, 39 weeks' gestation in transition phase, FH 135 with early decelerations. The client states, "I'm so scared. Please make sure the baby is OK!" Which of the following responses by the nurse is appropriate? 1. "There is absolutely nothing to worry about." 2. "The fetal heart rate is within normal limits." 3. "How did your first baby die?" 4. "Did your first baby die during labor?"

TEST-TAKING TIP: Clients who have experienced fetal loss or the loss of a newborn are often very anxious during pregnancy, labor and delivery, and the early newborn period. The nurse must accept the client's concern and acknowledge the client's grief. It is also important for the nurse to keep the client well informed of all assessments and interventions related to the baby. CHAPTER 12 COMPREHENSIVE EXAMINATION

3. A certified nursing assistant (CNA) is working with a registered nurse in the neonatal nursery. It would be appropriate for the nurse to delegate which of the following actions to the assistant? 1. Admission assessment on a newly delivered baby. 2. Patient teaching of a neonatal sponge bath. 3. Placement of a bag on a baby for urine collection. 4. Hourly neonatal blood glucose assessments.

TEST-TAKING TIP: Nursing assistants do not have the education to perform sophisticated client care skills. An initial assessment, patient teaching, and invasive neonatal procedures all should be performed by a skilled professional. The placement of a drainage bag is a task that the CNA could be taught to perform. CHAPTER 12 COMPREHENSIVE EXAMINATION

7. A woman is admitted to the labor and delivery unit with active tuberculosis. She has not been under a physician's care and is not on medication. Which of the following actions should the nursery nurse perform when the neonate is delivered? 1. Isolate the baby from the other babies in a special care nursery. 2. Keep the baby in the regular care nursery but separated from the mother. 3. Isolate the baby with the mother in the mother's room. 4. Obtain an order from the doctor for antituberculosis medications for the baby.

TEST-TAKING TIP: Tuberculosis is transmitted via respiratory droplets. Because the mother has not been given medication, she is communicable. This is one of the few instances when mothers and babies must be kept apart. Only after it has been determined that the mother has been on medication a sufficient period of time should she and the baby have physical contact. If the mother wishes to breastfeed and she has been prescribed standard anti-TB medications, she can pump her milk to be fed to her baby while they are separated then begin to feed the baby at the breast once the quarantine is lifted (see www.cdc.gov/tb/publications/factsheets/ specpop/pregnancy.htm) MCHAPTER 12 COMPREHENSIVE EXAMINATION

1. The nurse is caring for a client, 37 weeks' gestation, who was just told that she is group B streptococci + (positive). The client states, "How could that happen? I only have sex with my husband. Will my baby be OK?" Based on this information, which of the following should the nurse communicate to the client? 1. The client's partner must have acquired the bacteria during a sexual encounter. 2. The bacteria do not injure babies, but they could cause the client to have a bad sore throat. 3. The client is at high risk for developing pelvic inflammatory disease from the bacteria. 4. Antibiotics

TEST-TAKING TIP: Vertical transmission refers to the transmission of disease from the mother to the baby. Group B strep is called the "baby killer." If a mother is colonized with the bacteria, the baby may be exposed if the membranes rupture or when the baby passes through the birth canal. CHAPTER 12 COMPREHENSIVE EXAMINATION

10. A patient is placed on bedrest at home for mild pre-eclampsia at 38 weeks' gestation. Which of the following must the nurse teach the patient regarding her condition? 1. Eat a sodium-restricted diet. 2. Check her temperature 4 times daily. 3. Report swollen hands and face. 4. Limit fluids to 1 liter per day.

The client should be encouraged to have a normal sodium intake. 2. It is unnecessary for the client to assess her temperature. 3. The client should call her primary caregiver to report swollen hands and face. 4. The client should not limit her intake of fluids. TEST-TAKING TIP: Clients with mild pre-eclampsia who progress to severe pre-eclampsia usually develop swollen hands and face. The symptoms occur as a result of the third spacing of fluid, which, in turn, occurs as a result of the reduced colloidal pressure in the vascular tree. CHAPTER 12 COMPREHENSIVE EXAMINATION

9. The triage nurse in an obstetric clinic received the following four messages during the lunch hour. Which of the women should the nurse telephone first? 1. "My section incision from last week is leaking a whitish yellow discharge and I have a fever. What should I do?" 2. "I am 39 weeks pregnant with my first baby. I am having contractions about every twenty minutes." 3. "My boyfriend and I had intercourse this morning and our condom broke. What should we do?" 4. "I started my period yesterday. I need some medicine for these terrible menstrual cramps."

The nurse should call the postoperative cesarean client back first. It sounds from her description that she has a wound infection. This client is a primigravida and if she is in labor, she is in the early phase of the first stage. Her call must be returned, but it can wait. This client should be offered emergency contraception. Although the medicine must be taken within 72 hours of intercourse, the nurse can wait to return her call. This client is complaining of menstrual pain. Although she needs pain medicine, the nurse can wait to return her call. TEST-TAKING TIP: To answer this question, the test taker must prioritize care. The woman who is most vulnerable at this time is the woman with a wound infection. If she truly does have a wound infection, she will need to be seen by the healthcare practitioner, have a culture of the wound taken, and be put on antibiotics. CHAPTER 12 COMPREHENSIVE EXAMINATION

15. On vaginal examination it is noted that the fetus is in the LSA position and −2 station. Place an "X" on the diagram in the quadrant where the fetal heart would best be assessed. Upper right quadrant Upper left quadrant Lower right quadrant Lower left quartrant

The test taker should place an "X" in the diagram's left upper quadrant. TEST-TAKING TIP: The best way for the test taker to remember the placement of the fetal heart electrode is to remember that the heartbeat is best heard through the fetal back. Because the baby is in the breech position and is not yet engaged, the heart would be located in an upper quadrant, and because the baby is in the LSA position, the electrode should be placed in the left upper quadrant. CHAPTER 12 COMPREHENSIVE EXAMINATION

8. A client has just received synthetic prostaglandins for the induction of labor. The nurse plans to monitor the client for which of the following side effects? 1. Nausea and uterine tetany. 2. Hypertension and vaginal bleeding. 3. Urinary retention and severe headache. 4. Bradycardia and hypothermia.

hypertension and vaginal bleeding are not associated with prostaglandin administration. Urinary retention and severe headache are not associated with prostaglandin administration. Bradycardia and hypothermia are not associated with prostaglandin administration. TEST-TAKING TIP: The test taker must be familiar with the side effects of commonly administered medications. Prostaglandins are frequently administered to women who are to be induced but who have low Bishop scores. CHAPTER 12 COMPREHENSIVE EXAMINATION

71. A woman asks the nurse to recommend the best douche for use after menstruation. Which of the following responses by the nurse is appropriate? 1. "Tap water with white vinegar is most refreshing and least allergenic." 2. "It is really best for women not to douche." 3. "Any of the over-the-counter douches is satisfactory." 4. "It is best to douche during menstruation rather than after it is over."

✅ 2. It is recommended that women not douche. TEST-TAKING TIP: Douching not only adversely affects the vaginal environment, it also can force endometrial tissue into the tubes and onto the ovaries, resulting in endometriosis, especially when performed during the menses. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

78. The nurse in the obstetrician's office is caring for four 25-week-gestation prenatal clients who are carrying singleton pregnancies. With which of the following clients should the nurse carefully review the signs and symptoms of preterm labor? 1. African American, 15 years old, with newly diagnosed gestational diabetes. 2. Asian American, 23 years old, with five-year-old twins who were born at term. 3. Jewish, 25 years old, working as a certified public accountant. 4. Mormon, 33 years old, who recently moved into a new apartment.

✅. 1. This client is high risk for preterm labor because she is African American, under 17 years of age, and has been diagnosed with gestational diabetes, a vascular disease. 2. Although twin pregnancies are at high risk for preterm labor, this client currently is carrying a single fetus. Plus, Asian American women are not at high risk for preterm labor. 3. Neither Jewish clients nor clients who work as certified public accountants are at high risk for preterm labor. 4. Clients who follow the Mormon religion are not at high risk for preterm labor. Simply because a client has had a recent move does not place her at high risk for preterm labor. TEST-TAKING TIP: It has been shown that there are many risk factors for preterm labor, including non-white race, age over 35 or under 17, and maternal medical disease. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

97. A client who is 8 weeks' gestation has been diagnosed with a hydatidiform mole (gestational trophoblastic disease). In addition to vaginal loss, which of the following signs/symptoms would the nurse expect to see? 1. Hyperemesis and hypertension. 2. Diarrhea and hyperthermia. 3. Polycythemia. 4. Polydipsia.

✅1. Hyperemesis and hypertension are often seen in clients with hydatidiform mole. Neither diarrhea nor hyperthermia is associated with hydatidiform mole. Polycythemia is not associated with hydatidiform mole. Polydipsia is not associated with hydatidiform mole. TEST-TAKING TIP: Because the levels of human chorionic gonadotropin are markedly elevated with hydatidiform mole, women often experience excessive vomiting. In addition, signs of pre- eclampsia, such as hypertension, appear before 20 weeks' gestation in clients with molar pregnancies. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

79. A woman has been diagnosed with chlamydia. The nurse would expect the client to complain of which of the following signs/symptoms? 1. No signs or symptoms. 2. Painful lesions on the labia. 3. Foul-smelling discharge. 4. Severe lower abdominal pain.

✅1. Most women have no complaints. TEST-TAKING TIP: Chlamydia is known as a "silent" disease because about 75% of infected women and about 50% of infected men have no symptoms. If symptoms do occur, they usually appear within a few weeks of the exposure (see www.cdc.gov/std/chlamydia/STDFact -Chlamydia.htm). MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

24. The nurse is teaching a new mother about the physical characteristics and needs of her baby. Which of the following statements should the nurse include in her discussion? 1. "The anterior fontanelle will close by the time the baby is 18 months of age." 2. "The grasp reflex will last until the baby is about 10 months old." 3. "Your baby can see shapes but will not be able to see colors clearly for about 6 months." 4. "Your baby will likely be started on solid foods when he is 2 to 3 months of age."

✅1. The anterior fontanelle will close by the time the baby is about 18 months of age. 2. The grasp reflex will disappear when the baby is about 3 months of age. 3. Babies see colors at birth. And they see quite well when they are about 12 to 18 inches away from an object. 4. Babies are usually started on solids at 4 to 6 months of age. TEST-TAKING TIP: The obstetric nurse must be familiar with normal growth and development. It is essential that nurses provide parents with anticipatory guidance regarding their child's normal growth and development milestones. CHAPTER 12 COMPREHENSIVE EXAMINATION

43. A breastfeeding mother and her baby are being discharged home after delivery. The nurse is providing anticipatory guidance about what signs the mother should expect the baby to exhibit every 24 hours by the end of the first week. Which of the following should the nurse include in his/her instructions? 1. The baby should have at least 6 wet diapers. 2. The baby should have at least 6 pasty stools. 3. The baby should breastfeed at least 6 times. 4. The baby should gain at least 6 ounces.

✅1. The baby should have a minimum of 6 wet diapers during each 24-hour period. 2. The baby should have 3 to 4 loose, bright yellow stools during each 24-hour period. Babies who consume formula often have pasty, brownish-colored stools. 3. The baby should breastfeed a minimum of 8 times in a 24-hour period. 4. Neonates gain, on average, about 5 oz per week, not 6 oz in a 24-hour period. TEST-TAKING TIP: Breastfeeding mothers often worry whether their babies are receiving enough to eat. It is important, therefore, to provide the mothers with objective assessments that inform them that their babies are receiving enough fluids and nutrition: at least 6 wet diapers per day and 3 to 4 loose, bright yellow stools per day. In addition, if the mother is still concerned about her baby's health, she can take the baby to the pediatrician's office for periodic weight evaluations. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

27. When providing contraceptive counseling to a woman, which of the following factors should the nurse consider? Select all that apply. 1. Age. 2. Obstetric history. 3. Religious beliefs. 4. Employment. 5. Body structure.

✅1. The client's age should be considered by the nurse. ✅2. The client's obstetric history should be considered by the nurse. ✅3. The client's religious beliefs should be considered by the nurse. 4.The client's employment is not usually relevant in relation to her choice of family planning method. 5.The client's body structure is not usually relevant in relation to her choice of family planning method. TEST-TAKING TIP: Many issues will determine a client's willingness and ability to use family planning methods. For example, if a client is a devout Catholic or an Orthodox Jew, she may refuse to use any method other than a natural family planning method. If a client states that she feels she has completed her family, she may be interested in a permanent family planning method. A woman over 35 who smokes should be advised not to use a hormonally based method for health considerations. CHAPTER 12 COMPREHENSIVE EXAMINATION

72. During a postpartum examination, the nurse notes that a client's left calf is warm and swollen. Which of the following actions by the nurse is appropriate at this time? 1. Notify the client's physician. 2. Teach the client to massage her leg. 3. Apply ice packs to the client's leg. 4. Encourage the client to ambulate.

✅1. The client's physician should be notified. 2. It is inappropriate to massage the client's leg. 3. It is inappropriate to apply ice packs to the leg. 4.It is inappropriate to encourage the client to walk. TEST-TAKING TIP: Clients who exhibit any or all of the following symptoms— erythema, warmth, edema, pain—in one or both calves may have a deep vein thrombosis. The physician should be notified so that diagnostic tests can be ordered. If the woman were to ambulate or if she were to massage her leg, the thrombus could become dislodged. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

26. A birth plan is being developed by a pregnant couple. Which of the following items should be included in the plan? 1. The method of infant feeding the mother plans on using. 2. The name and address of her healthcare insurance company. 3. The couple's baby name preferences. 4. The couple's cell phone numbers.

✅1. The couple should include in the birth plan whether the mother plans to breastfeed or bottle feed the baby. 2. It is unnecessary to include in the birth plan the name and address of the woman's health insurance company. 3. It is unnecessary to include in the birth plan the couple's baby name preferences. 4. It is unnecessary to include in the birth plan the couple's cell phone numbers. TEST-TAKING TIP: If the test taker remembers the rationale for the birth plan, he or she will easily be able to choose the correct response to this question. The birth plan is a document that a couple creates to facilitate communication between themselves and healthcare professionals in relation to the couple's wishes for the birth CHAPTER 12 COMPREHENSIVE EXAMINATION

28. A baby is born addicted to crack cocaine. Which of the following signs/symptoms would the nurse expect to see? 1. Hyperreflexia. 2. Anorexia. 3. Constipation. 4. Hypokalemia.

✅1. The nurse would expect that the baby would be hyperreflexic 2. Babies who are showing signs of addiction often repeatedly mouth for food rather than showing signs of anorexia. 3. Babies who are showing signs of addiction often have diarrhea, not constipation. 4. Hypokalemia is not related to neonatal cocaine addiction. TEST-TAKING TIP: Babies who are withdrawing from crack cocaine as well as most other addictive substances exhibit agitated behaviors, including hyperreflexia, high-pitched crying, and disorganized behavioral states. CHAPTER 12 COMPREHENSIVE EXAMINATION

95. The nurse who has just performed a vaginal examination notes that the fetus is in the LOP position. Which of the following clinical assessments would the nurse expect to note at this time? 1. Complaints of severe back pain. 2. Rapid descent and effacement. 3. Irregular and hypotonic contractions. 4. Rectal pressure with bloody show

✅1. The nurse would expect the client to complain of severe back pain. 2. Descent is often slowed when the baby is in a posterior position. 3. The nurse would not expect to see hypotonic or irregular contractions. The nurse would not expect rectal pressure or an increase in bloody show. TEST-TAKING TIP: When the fetus is in a posterior position, the occiput of the baby's head presses against the coccyx during every contraction. This action is very painful. None of the other responses is directly linked to a posterior fetal position. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

25. A laboring woman, G4 P3003, who was 6 cm dilated 1 hour ago cries, "Hurry. I have to go to the bathroom to have a bowel movement." The nurse notes that there is an increase in bloody show. Which of the following actions by the nurse is appropriate? 1. Assess cervical dilation. 2. Help the woman to the bathroom. 3. Ask the woman if she needs pain medicine. 4. Check the fetal heart rate.

✅1. This action is appropriate. It is very likely that this client is fully dilated because she is complaining of the urge to push. 2. This action is appropriate only if the nurse, after examining the woman, determines that she is not fully dilated. 3. This action is inappropriate. Not only has the client not complained of pain, she is likely fully dilated and ready to push. 4. There is nothing in the scenario that indicates that the fetus is in danger at this time. TEST-TAKING TIP: This client is a multipara. Even though her last vaginal examination indicated that she was in active labor 1 hour ago, the test taker must remember that the transition phase of labor on average lasts only 10 minutes in multiparas. It is very likely that this client has experienced very rapid cervical change and is now in the second stage of labor. The urge to push, a classic sign of the second stage of labor, feels very similar to the urge to have a large bowel movement. CHAPTER 12 COMPREHENSIVE EXAMINATION

33. A nurse notes that a baby is lying in a crib in the tonic neck position. In which of the following positions is the baby lying? 1. One of the baby's arms and one of its legs are extended to the same side the baby's head is facing. 2. When the baby faces straight ahead, the baby's head tilts toward one side. 3. Both the baby's back and head are sharply arched backward and resist being moved to midline. 4. When the baby lies prone, the baby's body arches to one side.

✅1. This is an accurate description of the tonic neck position. 2.This is a description of a child with torticollis. 3.This is a description of a child with opisthotonus. 4.This is a description of a baby exhibiting the trunk incurvation reflex. TEST-TAKING TIP: Tonic neck position is one of the neonatal reflexes. The reflex usually disappears between 3 and 4 months. It has been suggested that the reflex developed to prevent babies from rolling over onto their bellies, a high-risk position that predisposes babies to sudden infant death syndrome. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

17. A young man is planning to use the condom as a contraceptive device. The nurse should teach him that which of the following actions is needed to maximize the condom's effectiveness? 1. Use only water-soluble lubricants. 2. Use only natural lambskin condoms. 3. Apply the condom to a flaccid penis. 4. Apply it tightly to the tip of the penis.

✅1. This response is correct. Only water- based lubricants should be used with the condom. 2. Natural lambskin condoms do not protect the wearer from viral sexually transmitted illnesses. Latex condoms do protect the wearer. 3. The condom should be applied to an erect penis. 4. A small reservoir should be left in the condom at the tip of the penis. TEST-TAKING TIP: The condom is an excellent birth control and infection control device if it is used properly. The nurse must be prepared to educate clients, both male and female, in its correct use. CHAPTER 12 COMPREHENSIVE EXAMINATION

35. A pregnant woman is complaining of ptyalism. The nurse should teach the woman to try which of the following self-care measures? 1. Use an astringent mouthwash. 2. Elevate her legs frequently. 3. Eat high-fiber foods. 4. Void when the urge is felt.

✅1. This response is correct. Women who complain of ptyalism should be advised to use an astringent mouthwash. 2. Elevating one's legs will not alleviate a woman's complaint of ptyalism. 3. Eating high-fiber foods will not alleviate a woman's complaint of ptyalism. 4. Voiding when the urge is felt will not alleviate a woman's complaint of ptyalism. TEST-TAKING TIP: Some women complain of ptyalism during pregnancy. The excessive salivation is caused by the increase in vascularity of the mucous membranes as a result of elevated estrogen levels in the bloodstream. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

21. A school nurse is discussing the male reproductive system with the students in a high school health class. Which of the following information about the hormone testosterone should be included in the discussion? 1. "Testosterone is what makes boys more muscular than girls." 2. "The level of testosterone in boys changes every month like female hormones do." 3. "Testosterone is produced by the male prostate gland." 4. "The production of testosterone usually stops by the time a man is 50 years old."

✅1. This response is true. Testosterone is responsible for the development of the male secondary sex characteristics. 2.This response is incorrect. Unlike the monthly hormonal fluctuations seen in the female, testosterone levels are relatively constant at all times. 3. This response is incorrect. Testosterone is produced by the testes. 4. Although the level of testosterone does drop slightly with age, the testes will produce the hormone throughout life. TEST-TAKING TIP: Even though the female carries the fetus, the male reproductive system is also essential to procreation. It is important, therefore, for the test taker to be familiar with the anatomy and physiology of both the male and the female reproductive systems. CHAPTER 12 COMPREHENSIVE EXAMINATION

36. The nurse is counseling a woman who has been diagnosed with mild osteoporosis. Which of the following should be included in the counseling session? 1. Begin a regimen of walking each day. 2. Refrain from drinking chocolate milk. 3. Increase her daily intake of red meat. 4. Only wear shoes with rubber soles.

✅1. Walking is an excellent preventive exercise for women who are at high risk for osteoporosis. 2.Chocolate milk contains calcium and vitamin D. The intake of both substances is important in the prevention of osteoporosis. 3.Red meat is not high in calcium or vitamin D. 4The type of shoe worn by a woman will not affect her bone density. TEST-TAKING TIP: A woman's bone health is positively affected by her participation in exercise. Weight-bearing exercises, such as walking, jogging, running, and weight lifting, provide the most benefit for women who are at high risk for osteoporosis. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

56. When caring for a woman whom a nurse suspects is being abused by her partner, the nurse should do which of the following? 1. Ask the client directly about how she sustained her injuries. 2. Counsel the client on how her behavior probably provoked the attack. 3. Inform the client that the police must arrest her partner. 4. Give the client a pamphlet with the names of matrimonial attorneys.

✅1.This action is appropriate. The client must be asked about her injuries. 2. This is inappropriate. No one deserves to be abused. 3. This is inappropriate. Although the nurse can recommend to the client that the police arrest her partner, they can only do so if there is sufficient evidence that the injuries were inflicted by the partner and/or the client presses charges against her partner. 4. This is inappropriate. TEST-TAKING TIP: Clients rarely discuss domestic violence issues unless they are asked directly about them. Even if the nurse does not see evidence of injury, he or she should inquire about the client's relationship during each nurse-patient encounter. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

31. On the third postpartum day a client tells the nurse that she feels sad and that she cries easily. The nurse should explain about which of the following? 1. These feelings are normal and should diminish when the baby is a week or so old. 2. The physician will likely order an antidepressant for the client to take at home. 3. If the client focuses on the fact that she has a healthy baby, the feelings will cease. 4. When the client is home with her family and friends, her sad feelings will disappear.

✅1.This statement is true. The client's feelings are normal. 2. Because the postpartum blues usually last less than 2 weeks, it is unlikely that the physician will order antidepressants for the client. 3.This statement is incorrect. It is not possible to change one's feelings by merely "thinking" positive thoughts. This statement is inappropriate. The blues may continue for up to 10 days, well after the client returns home. TEST-TAKING TIP: Postpartum blues are considered normal. About 80% of women experience them. They are related to the hormonal shifts that occur after delivery as well as fatigue and the emotional stress of having full responsibility for the care and well-being of a neonate. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

54. A fetus descending through the birth canal is going through the cardinal moves of labor. Please place the following moves in chronological order. 1. External rotation. 2. Flexion. 3. Extension. 4. Internal rotation. 5. Expulsion.

✅2, 4, 3, 1, 5 is the correct order. TEST-TAKING TIP: For the fetus to traverse the birth canal, the baby must flex the head so that the chin is on the chest and then must rotate through the pelvis. When the baby's head is flexed, the smallest diameter of the fetal head will present to the pelvis. As the baby proceeds through the moves—descent, internal rotation, extension, external rotation, and expulsion—the baby will progress from the intrauterine environment to the external environment. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION

66. A client who is 6 hours post-vaginal delivery has a BP of 150/110. Her last 4 BP readings were: 114/88, 120/80, 134/86, 140/90. Which of the following questions should the nurse ask the client at this time? 1. "Have you had a bowel movement since delivery?" 2. "Is there anything that is making you anxious about the baby?" 3. "When you last went to the bathroom were you bleeding heavily?" 4. "Do you have a headache or blurring of your vision?"

✅4. This question is important for the nurse to ask at this time. TEST-TAKING TIP: Even though the client is postdelivery, her blood pressures are rising. It is likely that she is developing pre-eclampsia. Among the symptoms that clients with severe pre-eclampsia experience are headache, blurred vision, and epigastric pain. MATERNAL AND NEWBORN SUCCESS CHAPTER 12 COMPREHENSIVE EXAMINATION