Quiz study q's 353 Midterm

Often when a person with a substance use disorder becomes pregnant, this is a turning point in their disease and provides motivation for change. a. true b. false

a true This is correct. Motivation for change often occurs in pregnant persons who screen positive for substance use. Therefore, is critical we treat these patients with a new and unbiased lens with every encounter.

A patient in the third trimester of pregnancy expresses concern to the nurse about changes to her muscles, joints, and bones. Which conditions does the nurse reassure the patient are normal changes of pregnancy? Select all that apply. a. low back pain b. fractures c. severe msk aches d. waddling gait e. increased risk of falls

a, d, e a. This is correct. Low back pain is expected during pregnancy and related to increased progesterone and relaxin levels leading to softening of joints and increased joint mobility, resulting in widening and increased mobility of the sacroiliac and symphysis pubis. d. This is correct. A waddling gait is a normal change during pregnancy and related to increased progesterone and relaxin levels causing softening of joints and increased joint mobility. Widening and increased mobility of the sacroiliac and symphysis pubis result. e. This is correct. Although it is hazardous, increased risk of falls is expected during pregnancy due to a shift in the center of gravity related to the enlarged uterus. The patient needs to take precautions to avoid falls or activities requiring balance.

A patient with pregestational diabetes mellitus delivers a neonate who is diagnosed with macrosomia. The nurse is aware that the neonate is at risk for additional long-term conditions related to maternal diabetes mellitus. Which long-term effects may occur? Select all that apply. a. Changes in genetic expression b. Increased risk for chronic illnesses c. Development of metabolic syndrome d. Shoulder injury related to birth size e. Impaired intellectual development

a. Changes in genetic expression This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for changes in genetic expression related to exposure to hyperglycemia in utero. b. Increased risk for chronic illnesses This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for an increase in chronic illnesses in later life. This change is related to the previously listed changes in genetic expression. c. Development of metabolic syndrome This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for the development of metabolic syndrome. e. Impaired intellectual development This is correct. Long-term risks for a newborn whose mother has pregestational diabetes is for impaired intellectual development. There can also be an impairment of psychomotor development.

The nurse at the pregnancy center is providing care to a 27-year-old patient with a history of frequent heroin use. The nurse understands when prescribed at proper doses, Methadone can: Select all that apply a. Manages pain effectively for patients with chronic use by blocking receptors b. Decreases opioid relapse and manages symptoms of withdrawal c. Provide physiologic stability and increase personal accountability d. Decreases crime and the transmission of infectious diseases

b. Decreases opioid relapse and manages symptoms of withdrawal --This is correct. When prescribed properly, Methadone decreases withdrawal symptoms and lowers the rate of opioid relapse. c. Provide physiologic stability and increase personal accountability d. Decreases crime and the transmission of infectious diseases --This is correct. Methadone provides physiological stability, and thereby decreases illicit opioid use which impacts crime and decreases needle use - leading to lower transmission of infectious diseases.

A patient is confirmed to be pregnant. Obstetric history includes two sets of twins born at 30 and 32 weeks gestation, respectively, a singleton birth born at 39 weeks gestation, and two pregnancies lost in the first trimester. In which way will the nurse define the patient's obstetrical history? a. G4, T3, P2, A2, L3 b. G6, T1, P4, A2, L5 c. G6, T4, P0, A4, L3 d. G5, T1, P2, A2, L5

b. G6, T1, P4, A2, L5

The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia? Select all that apply. a. There is a higher rate of spontaneous vaginal delivery. b. There is a higher rate of fever and sepsis. c. When using an epidural, women are less likely to sweat with a fever. d. Labor may be longer with an epidural. e. There is a higher rate of instrumental vaginal delivery.

b. There is a higher rate of fever and sepsis. --This is correct. Epidurals are associated with higher rates of fever and sepsis. c. When using an epidural, women are less likely to sweat with a fever. d. Labor may be longer with an epidural. e. There is a higher rate of instrumental vaginal delivery.

The nurse is collecting the urine of a postpartum patient who is passing large clots. For which reason does the nurse examine the large collected clots? a. To validate the presence of clotting b. To determine the presence of tissue c. To document the number of clots d. To obtain an accurate description

b. To determine the presence of tissue - This is correct. The nurse collects the large clots in order to examine them for the presence of tissue, which indicates retained placenta tissue. Retained placental tissue can interfere with uterine involution and lead to excessive bleeding.

The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply. a. Christa received butorphanol (Stadol) within 3 hours of delivery and the infant experienced neonatal depression. b. Local anesthesia in the perineal area was used in conjunction with the epidural throughout labor and delivery. c. The medication Christa wants is an epidural. After she receives the epidural, the FHR tracing is within normal limits. d. Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. e. Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief.

c. The medication Christa wants is an epidural. After she receives the epidural, the FHR tracing is within normal limits. - This is correct. Medication should provide relief to the mother with minimal risk to the baby. d. Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. -- This is correct. Labor must be well established before administration of an analgesic is begun. e. Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief. -- This is correct. Women with a history of drug abuse may have a lessened effect from pain medication and require higher doses.

The nurse is assessing a newborn's reflexes. Which response will cause the nurse concern? a. Absence of rooting or sucking reflexes b. A fencing position when the head is turned c. Strong Babinski reflex d. Asymmetrical Moro reflex

Asymmetrical Moro reflex This is correct. The nurse is concerned if an asymmetrical response is noted when checking for a Moro reflex. This response may be related to temporary or permanent birth injury to clavicle, humerus, or brachial plexus. This reflex disappears by age 6 months.

A patient at 34 weeks gestation is undergoing an ultrasound. The nurse notes that the amniotic fluid is estimated at between 500 and 600 mL. Which deduction does the nurse make from this finding? a. Polyhydramnios has formed. b. Follow-up ultrasound is warranted. c. Oligohydramnios is present. d. Fluid is normal for gestation age.

Oligohydramnios is present. This is correct. The volume of amniotic fluid at 34 weeks gestation should peak at 800 to 1,000 mL. The current volume indicates oligohydramnios, which is indicative of a decrease in placental function. The newborn is at increased risk for congenital renal problems.

The nurse is providing care to a postpartum patient after an emergency cesarean due to eclampsia. The patient received spinal anesthesia prior to delivery. Magnesium sulfate is infusing 2 g/hr in 100 mL of IV fluid. Which assessment finding will cause the nurse to administer calcium gluconate to the patient via IV push? Patella reflexes are rated at zero. Respiratory rate is 18 breaths/min. Serum magnesium level is 10 mg/dL Urinary output remains at 30 mL/hr.

Serum magnesium level is 10 mg/dL This is correct. The therapeutic serum level of magnesium sulfate is 5 to 7 mg/dL, and the patient's laboratory result is 10 mg/dL. The nurse will give the antidote of calcium gluconate (5 to 10 mEq) by IV over a period of 5 to 10 minutes.

The nurse is preparing a postpartum patient for discharge. For which reasons does the nurse instruct the patient to call the primary care provider? Select all that apply. a. hot, red painful breasts b. Frequent, painful urination c. mild headache d. not sleeping well e. Foul-smelling lochia

a Hot, red, painful breasts b. Frequent, painful urination e. Foul-smelling lochia these are all signs of infection

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient? a. Wider outlet b. Shorter diameter between her coccyx and ischium c.Narrower pubic arch d. Smaller inlet

a. Wider outlet This is correct. A gynecoid pelvis has a wider outlet than an android pelvis.

The nurse is planning an assessment on a patient in the second trimester of pregnancy. For which assessments will the nurse plan? Select all that apply. a. presence of dependent edema b. urine testing with a dipstick c. antibody screening for Rh- patient d. determine EDD by Naegele's rule e. check for chromosomal abnormalities

a, b, c a. This is correct. During the second trimester, the nurse should be checking the patient for slight, dependent edema in the lower extremities due to decreased venous return. Upper body edema is abnormal and requires additional evaluation. b. This is correct. During the second trimester, it is common for the nurse to perform urine testing with a dipstick to check for glucose, albumin, and ketones. Mild proteinuria and glycosuria are expected. c. This is correct. In the second trimester, the nurse will perform screening needed to determine if the Rh- patient has produced antibodies. If so, the patient will receive the first dose of Rhogam. The patient's Rh factor is determined in the first trimester.

After counseling with an obstetrician about infertility, a couple is advised to undergo testicular sperm aspiration. The nurse is aware that the procedure may be recommended for which infertility? a. Unsuccessful vasectomy reversal b. Diminished sperm motility c. Blocked fallopian tubes d. Poor cervical mucus production

a, unsuccessful vasectomy reversal This is correct. An unsuccessful vasectomy reversal is treated with testicular sperm aspiration. Other reasons for this infertility treatment are the absence of a vas deferens, an extremely low sperm count, or absence of sperm in ejaculated semen.

The nurse is preparing to perform a visual assessment of the perineum of a postpartum patient. The nurse will use the REEDA acronym. Which specific assessments are covered by REEDA? Select all that apply. a. Suture line appearance b. Perineal coloration c. Amount of swelling d. Description of pain e. Soft tissue trauma

a. Suture line appearance --This is correct. The acronym REEDA stands for redness, edema, ecchymosis, discharge, approximation of edges of episiotomy or laceration. Suture line appearance is indicative of approximation of edges of episiotomy or laceration. b. Perineal coloration --Redness is indicative of perineal coloration. c. Amount of swelling e. Soft tissue trauma --Soft tissue trauma is frequently accompanied by bruising and is indicative of ecchymosis.

A patient arrives for her fourth month prenatal visit and expresses concern because of a leakage of yellow fluid from her breasts. Which topic does the nurse discuss during this visit? a. breast changes b. support bras c. a change in EDD d. signs of infection

a. breast changes This is correct. The leakage of yellow fluid from the patient's breasts is a normal change during pregnancy. The patient is experiencing a leakage of colostrum, which is rich in antibodies for the neonate. This manifestation can begin as early as 16 weeks.

The nurse is counseling a patient regarding pregnancy. The patient lost her first two pregnancies in the second trimester of gestation for undetermined reasons. Which initial advice does the nurse provide for this patient? a. Seek genetic studies. b. Consider adoption. c. Attend grief counseling. d. Plan for fertility tests.

a. seek genetic studies

A postpartum patient calls the OB office 8 days following a vaginal delivery. The patient reports concern regarding vaginal bleeding. Which patient-reported symptom causes the nurse concern? a. Bleeding that is described as scant b. A description of the lochia as being red in color c. Increased flow noticed with physical activity d. Discharge that is noted to have a fleshy odor

b. A description of the lochia as being red in color --This is correct. The lochia during the period of 4 to 10 days is described as lochia serosa (pink or brown color). The nurse will be concerned if the patient reports lochia that is red in color, which is indicative of bleeding.

The nurse is providing care for a patient who is 8 hours postpartum after a vaginal delivery. The patient reports severe perineal pain unaffected by pain medication. The nurse notices a 4 cm area of discoloration on the labia that is tender to the touch. Which action does the nurse take? a. Relieve pressure by placing patient in a side-lying position b. Contact the primary care provider for further evaluation c. Monitor vital signs and report any abnormal readings d. Continue to apply ice to the area for 24 hours

b. Contact the primary care provider for further evaluation This is correct. The primary care provider needs to be contacted about assessment findings; the hematoma may need to be evaluated further and/or evacuation of the hematoma performed.

A patient who is pregnant asks the nurse when her baby is due to be born. The patient reports her last menstrual period (LMP) date as April 14. Using Naegele's rule, the nurse will set the estimated date of delivery (EDD) as what date? a. July 14 b. January 7 c. January 21 d. July 21

c. January 21 This is correct. Naegele's rule requires counting back 3 months from the LMP and adding 7 days. This is the correct calculation and EDD.

A patient at 36 weeks gestation reports a constant dull backache, regular frequent contractions that are painless, and lower abdominal pressure. Physical examination reveals intact membranes and cervical dilation of 3 cm. Which order by the health care provider is unexpected by the nurse? a. Beta-adrenergic agonist therapy b. Administer antenatal steroids c. Obtain fetal fibronectin levels d. monitor blood glucose levels

c. Obtain fetal fibronectin levels This is correct. Fetal fibronectin is a previously used test, which has a low positive predictive value but a high negative predictive value, thereby making it a useful test to predict those women who will not deliver preterm. The test is considered to be unsuitable for wide-spread testing; the nurse would not expect the health care provider to prescribe this test.

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring strip. How would the nurse assess this? a. Palpate the maternal abdomen right after a contraction ceases. b. Time the amount of time in between the ending of one contraction and the beginning of another. c. Palpate the maternal abdomen during a contraction. d. Monitor the patients' vocalizations and facial expressions.

c. Palpate the maternal abdomen during a contraction. This is correct. Intensity is evaluated by palpating the fingertips on the maternal abdomen.

Genomic medicine is an emerging medical discipline that involves using genomic information about an individual as part of the individual's clinical care. Which example does the nurse associate with genomic medicine? a. conducting trial studies to determine how drugs effect individuals b. creating drugs specifically for the treatment of cancer c. screening of neonates for inherited, treatable genetic diseases d. treating and gaining knowledge about how genetic mutations occur

c. screening of neonates for inherited, treatable genetic diseases

A patient who is pregnant shares details of being in a physically and psychologically abusive relationship with her baby's father. Which statement by the nurse is indicative of AWHONN's standing regarding intimate partner violence (IPV)? a. "If you are all alone, you need to make arrangements for someone to stay with you."s standing regarding intimate partner violence (IPV)? b. "Your partner needs to come to the office so that we can confront his behavior." c. "I will call a women's shelter to make arrangement for you to move in immediately." d. "Let's explore ways to protect you and stop the abuse you have been enduring."

d. "Let's explore ways to protect you and stop the abuse you have been enduring." This is correct. AWHONN promotes safety, support, education, and confidentiality as part of the interventions to protect the woman who is experiencing partner abuse; this statement covers the patient's needs.

The nurse works in a labor and delivery facility with new protocols for estimating postpartum blood loss. Which method for estimating blood loss is implemented in the delivery room is most accurate? a. Place a basin at the foot of the delivery table to catch any blood b. Rely on the primary health care provider's estimate of blood loss c. Ask the patient how many peripads she considered to be "soaked." d. Collect blood in calibrated, under-buttocks drapes for vaginal birth.

d. Collect blood in calibrated, under-buttocks drapes for vaginal birth. - This is correct. Collecting blood in calibrated, under-buttocks drapes for vaginal birth and then weighing the drapes is the easiest way to estimate blood loss in the delivery room.

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with SROM clear fluid 2 hours ago. What action should the nurse take? a. Monitor the patient's blood pressure, temperature, and respirations every 2 hours. b. Have the patient rate her pain on a scale from 1-10 roughly every hour. c. Monitor the fetal heart tones every hour. d. Help the patient change her position from side to side every 30 minutes.

d. Help the patient change her position from side to side every 30 minutes. This is correct. When the patient is in active labor, the nurse should help the woman change position every 30 minutes and as needed.

An infertile couple learns that the female is unable to produce viable eggs. The male partner suggests the use of a surrogate as a means of having a child. The female states, "I don't want your baby with another woman!" The nurse is aware of which psychosocial issue with this couple? a. The male blames the female for the infertility. b.The male needs to have a child with his genes. c. The female is jealous of the surrogate's fertility. d. The female is experiencing self-esteem issues.

d. The female is experiencing self-esteem issues. This is correct. The nurse is aware that the diagnosis and treatment of infertility can cause self-esteem issues. The female partner is likely to be feeling "less of a woman" because of the inability to conceive. She may also have feelings of shame for having a "defective" body.

The nurse in a prenatal clinic is reviewing the files of four patients scheduled for visits. Which patient does the nurse identify as having the highest-risk pregnancy? a. The patient who is 28 years of age who delivered a premature neonate 3 years prior b. The patient with preexisting hypertension who is currently pregnant with twins c. The patient who is 16 years of age just diagnosed with gestational diabetes d. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension

d. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension This is correct. The patient who is 37 years of age, obese, and experiencing pregnancy-induced hypertension has three risk factors: age over 35 years, excessive weight, and a pregnancy-related complication. This is the patient with the highest-risk pregnancy.

During an initial assessment of the neonate's skin the nurse notices the presence of red marks that darken while crying called __________ __________on the neonate's eyelid and nape of the neck.

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