Maternal-Newborn final
A 26-year-old woman at 29 weeks' gestation experienced epigastric pain following the consumption of a large meal of fried fish and onion rings. The pain resolved a few hours later. The most likely diagnosis for this symptom is: Select one: a. Cholelithiasis b. Influenza c. Urinary tract infection d. Indigestion
A
A first-time father is experiencing couvade syndrome. He is likely to exhibit which of the following symptoms or behaviors? Select one: a. Urinary frequency b. Hypotension c. Bradycardia d. Prostatic hypertrophy
A
A gravida, G4 P1203, fetal heart rate 150s, is 14 weeks pregnant, fundal height 1 cm above the symphysis. She denies experiencing quickening. Which of the following nursing conclusions made by the nurse is correct? Select one: a. The woman is experiencing a normal pregnancy. b. The woman may be having difficulty accepting this pregnancy. c. The woman must see a nutritionist as soon as possible. d. The woman will likely miscarry the conceptus. .
A
A laboratory report indicates the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid patient with preeclampsia are 2:1. The nurse interprets the result as which of the following? Select one: a. The baby's lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby's kidneys are functioning poorly. d. The mother is high risk for eclampsia.
A
A nurse is reviewing diet with a pregnant woman in her second trimester. Which of the following foods should the nurse advise the patient to avoid consuming during her pregnancy? Select one: a. Brie cheese b. Bartlett pears c. Sweet potatoes d. Grilled lamb
A
A nurse who is discussing serving sizes of foods with a new prenatal patient would state that which of the following is equal to 1 (one) serving from the dairy food group? Select one: a. 1 cup low-fat milk b. cup vanilla yogurt c. cup cottage cheese d. 1 ounce cream cheese
A
A nurse working in a prenatal clinic is caring for a woman who asks advice on foods that are high in vitamin C because "I hate oranges." The nurse states that 1 cup of which of the following raw foods will meet the patient's daily vitamin C needs? Select one: a. Strawberries b. Asparagus c. Iceberg lettuce d. Cucumber
A
For the patient with which of the following medical problems should the nurse question a physician's order for beta agonist tocolytics? Select one: a. Type 1 diabetes mellitus b. Cerebral palsy c. Myelomeningocele d. Positive group B streptococci culture
A
Identify the hallmark of placenta previa that differentiates it from abruptio placenta. Select one: a. Sudden onset of painless vaginal bleeding b. Board-like abdomen with severe pain c. Sudden onset of bright red vaginal bleeding d. Severe vaginal pain with bright red bleeding
A
Lina is an 18-year-old woman at 20 weeks' gestation. This is her first pregnancy. Lina is complaining of fatigue and listlessness. Her vital signs are within a normal range: BP = 118/60, pulse = 70, and respiratory rate 16 breaths per minute. Lina's fundal height is at the umbilicus, and she states that she is beginning to feel fetal movements. Her weight gain is 25 pounds over the prepregnant weight (110 lb), and her height is 5 feet 4 inches. The perinatal nurse's best approach to care at this visit is to: Select one: a. Ask Lina to keep a 3-day food diary to bring in to her next visit in 1 week. b. Explain to Lina that weight gain is not a concern in pregnancy, and she should not worry. c. Teach Lina about the expected normal weight gain during pregnancy (approximately 20 pounds by 20 weeks' gestation). d. Explain to Lina the possible concerns related to excessive weight gain in pregnancy, including the risk of gestational diabetes.
A
Teera is a 22-year-old woman who is experiencing her third pregnancy. Her obstetrical history includes one first-trimester elective abortion and one first-trimester spontaneous abortion. Teera is a semi-vegetarian who drinks milk and eats yogurt and fish as part of her daily intake. The perinatal nurse discusses Teera's diet with her as she may be deficient in (select all that apply): Select one or more: a. Iron b. Magnesium c. Zinc d. Vitamin B12
A
The clinic nurse includes screening for domestic violence in the first prenatal visit for all patients. An appropriate question would be: Select one: a. This is something that we ask everyone. Do you feel safe in your current living environment and relationships? b. This is something we ask everyone. Do you have any abuse in your life right now? c. Is your partner threatening or harming you in any way right now? d. I need to ask you, do you feel safe from abuse right now?
A
The clinic nurse meets with Rebecca, a 30-year-old woman who is experiencing her first pregnancy. Rebecca's quadruple marker screen result is positive at 17 weeks' gestation. The nurse explains that Rebecca may need a referral to: Select one: a. A genetics counselor/specialist for further diagnostic testing b. An obstetrician c. A gynecologist d. A social worker
A
The clinic nurse uses Leopold maneuvers to determine the fetal lie, presentation, and position. The nurse's hands are placed on the maternal abdomen to gently palpate the fundal region of the uterus. This action is best described as the: Select one: a. First maneuver b. Second maneuver c. Third maneuver d. Fourth maneuver
A
he nurse is interviewing a pregnant client who states she plans to drink chamomile tea to ensure an effective labor. The nurse knows that this is an example of: Select one: a. Cultural prescription b. Cultural taboo c. Cultural restriction d. Cultural demonstration
A
A woman at 10 weeks' gestation is diagnosed with gestational trophoblastic disease (hydatiform mole). The nurse is aware that this condition puts the woman at an increased risk for choriocarcinoma. Medical management the nurse would expect to see include: Select one: a. Immediate evacuation of hydatiform mole by aspiration/suction D&C b. Platelet transfusions c. Blood draw for hCG analysis d. Amniocentesis
A A hydatiform mole is a benign proliferating growth with formation of vascular transparent vesicles in grape-like clusters without a viable fetus. Due to the use of Ultrasound, this condition is diagnosed early in pregnancy. The mole must be immediately evacuated and hCG levels are drawn at the time of diagnosis and as follow-up for at least 6 months to detect trophoblastic neoplasia.
The perinatal nurse is providing care to Marilyn, a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks' gestation. The nurse is preparing to administer the second dose of beta-methasone prescribed by the physician. Marilyn asks: "What is this injection for again?" The nurse's best response is: Select one: a. "This is to help your baby's lungs to mature." b. "This is to prepare your body to begin the labor process." c. "This is to help stabilize your blood pressure." d. "This is to help your baby grow and develop in preparation for birth."
A Betamethasone is a corticosteroid given by injection to pregnant women at 24-34 weeks' gestation with signs of preterm labor or at risk to deliver preterm. Betamethasone stimulates the production of more mature surfactant in the fetal lungs to prevent respiratory distress syndrome in premature infants.
Which of the following signs or symptoms would the nurse expect to see in a woman with concealed abruptio placentae? Select one: a. Abrupt onset of uterine pain b. Normal vital signs c. Normal fetal heart rate (FHR) pattern d. Mild uterine tenderness
A Concealed abruptio placenta occurs when more than 1/2 of the placenta separates prematurely. Total blood loss can be >1500 ml with moderate to severe dark vaginal bleeding and abrupt onset of uterine pain described as tearing, knifelike, and continuous. The uterus may be described as hard or board-like. Significant maternal tachycardia with severe orthostatic hypotension and significant tachypnea are also seen. Fetal heart patterns show compromise and death can occur.
An example of a cultural prescriptive belief during pregnancy is: Select one: a. Remain active during pregnancy b. Coldness in any form should be avoided c. Do not have your picture taken d. Avoid sexual intercourse during the third trimester
A Feedback: The belief that the patient should remain active during pregnancy is the only example of a cultural prescriptive belief. All of the other answers are examples of cultural restrictive beliefs.
Taboos are cultural restrictions that: Select one: a. Have serious supernatural consequences b. Have serious clinical consequences c. Have superstitious consequences d. Are functional and neutral practices
A Taboos are believed to have serious supernatural consequences. Taboos are not known to have clinical or superstitious consequences and are not functional or neutral practices.
Your antepartal patient is 38 weeks' gestation, has a history of thrombosis, and has been on strict bed rest for the last 12 hours. She is now experiencing shortness of breath and you suspect pulmonary embolism (PE). What are the risk factors that may contribute to PE? Select one: a. Physiologic changes in pregnancy result in venous stasis, vasodilation, and compression of the inferior vena cava and pelvic veins, which increases the tendency to form blood clots. b. Physiologic changes in pregnancy result in vasoconstriction, which increases the tendency to form blood clots. c. Physiologic changes in pregnancy result in anemia, which increases the tendency to form blood clots. d. Physiologic changes in pregnancy result in decreased perfusion to the lungs, which increases the tendency to form blood clots.
A The patient's shortness of breath, bed rest, and history of thrombosis indicate possible pulmonary embolism. Her pregnant state also increases the potential for thrombosis resulting from increased levels of coagulation factors and decreased fibrinolysis, venous dilation, and obstruction of the venous system by the gravid uterus. Thromboembolitic diseases occurring most frequently in pregnancy include deep vein thrombosis and pulmonary embolism.
Marked hemodynamic changes in pregnancy can impact the pregnant woman with cardiac disease. Signs and symptoms of deteriorating cardiac status include (select all that apply): Select one or more: a. Orthopnea b. Nocturnal dyspnea c. Palpitations d. Irritation
A B C The correct answer is: Orthopnea, Nocturnal dyspnea, Palpitations Signs and symptoms of deteriorating cardiac status with cardiac disease include orthopnea, nocturnal dyspnea, and palpitations, but do not include irritation.
Metabolic changes during pregnancy ____ glucose tolerance. Select one: a. lower b. increase c. maintain d. alter
A Metabolic changes during pregnancy lower glucose tolerance.
Interventions for low back pain during pregnancy should include (select all that apply): Select one or more: a. Utilizing proper body mechanics b. Applying ice or heat to affected area c. Avoiding pelvic rock and pelvic tilt d. Using additional pillows for support during sleep
A, B, D Interventions for back pain during pregnancy include utilizing proper body mechanics, applying heat or ice to the area, using additional pillows during sleep, and not avoiding pelvic rock/tilt, but encouraging pelvic rock/tilt.
The clinic nurse is assessing the complete blood count results for Kim-Ly, a 23-year-old pregnant woman. Kim-Ly's hemoglobin is 9.8 g/dL. This laboratory finding places Kim-Ly's pregnancy at risk for (select all that apply): Select one or more: a. Preterm birth b. Placental abruption c. Intrauterine growth restriction d. Thrombocytopenia
A, C
The perinatal nurse talks to the prenatal class attendees about guidelines for exercise in pregnancy. Recommended guidelines include (select all that apply): Select one or more: a. Stopping if the woman is tired b. Bouncing and slowly arching the back c. Increasing fluid intake throughout the physical activity d. Maintaining the ability to walk and talk during exercise
A, C D
Asking the pregnant woman about her use of recreational drugs is an essential component of the prenatal history. Harmful fetal effects that may occur from recreational drugs include (select all that apply): Select one or more: a. Miscarriage/spontaneous abortion b. Low birth weight c. Macrosomia d. Postterm labor/birth
A,B
The clinic nurse describes the respiratory system changes common to pregnancy to the new nurse. These changes include (select all that apply): Select one or more: a. An increased tidal volume b. A decreased airway resistance c. An increased chest circumference d. An increased airway resistance
A,B
An overweight or obese pre-pregnancy weight increases the risk for which poor maternal outcomes? (Select all that apply.) a. Preeclampsia b. Hemorrhage c. Difficult delivery d. Vaginal infections
A,B Being overweight or obese can substantially increase perinatal risk; however, no data support an increase in vaginal infections for the obese pregnant population.
The perinatal nurse teaches the student nurse about the physiological changes in pregnancy that most often contribute to the increased incidence of urinary tract infections. These changes include (select all that apply): Select one or more: a. Relaxation of the smooth muscle of the urinary sphincter b. Relaxation of the smooth muscle of the bladder c. Inadequate emptying of the bladder d. Increased incidence of bacteriuria
A,B, C, D
Kerry, a 30 year old G3 TPAL 0110 woman presents to the labor unit triage with complaints of lower abdominal cramping and urinary frequency at 30 weeks' gestation. Appropriate nursing actions include (select all that apply): Select one or more: a. Fetal and uterine monitoring for well being and contractions b. Obtain urine for analysis and dipstick c. Assess Kerry's temperature, blood pressure, and pulse d. Start an IV
A,B,C
The clinic nurse describes possible interventions for the pregnant woman who is experiencing pain and numbness in her wrists. The nurse suggests (select all that apply): Select one or more: a. Elevating the arms and wrists at night b. Reassessment during the postpartum period c. The use of "cock splints" to prevent wrist flexion
A,B,C
The clinic nurse discusses normal bladder function in pregnancy with a 22 year old pregnant woman who is now in her 29th gestational week. The nurse explains that at this time in pregnancy, it is normal to experience (select all that apply): Select one or more: a. Urinary frequency b. Urinary urgency c. Nocturia d. Incontinence
A,B,C
The clinic nurse encourages paternal attachment during pregnancy by including the father in (select all that apply): Select one or more: a. Prenatal visits b. Ultrasound appointments c. Prenatal class information d. History taking and obtaining prenatal screening information
A,B,C
The perinatal nurse provides a hospital tour for couples and families preparing for labor and birth in the future. Teaching is an important component of the tour. Information provided about preterm labor and birth prevention includes (select all that apply) Select one or more: a. Encouraging regular, ongoing prenatal care b. Reporting symptoms of urinary frequency, abdominal cramping, and low back pain to the health-care provider c. Coming to the labor triage unit if back pain or cramping persist or become regular contractions d. Stay at home on bedrest with restricted fluid intake until contractions are 5 minutes apart
A,B,C
The perinatal nurse screens all pregnant women early in pregnancy for maternal attachment risk factors, which include (select all that apply): Select one or more: a. Adolescence b. Low educational level c. History of depression d. A strong support system for the pregnancy
A,B,C
The perinatal nurse describes for the new nurse the various risks associated with prolonged premature preterm rupture of membranes (PPROM). These risks include (select all that apply): Select one or more: a. Chorioamnionitis b. Fetal/neonatal sepsis c. Operative birth d. Cord compression
A,B,C,D Feedback; Even though maintaining the pregnancy to gain further fetal maturity can be beneficial, prolonged PPROM has been correlated with an increased risk of maternal infection such as chorioamnionitis, fetal/neonatal sepsis, increased rates of cesarean/operative birth, and cord compression causing fetal hypoxia or asphyxia.
During the initial antenatal visit, the clinic nurse asks questions about the woman's nutritional intake. Specific questions should include information pertaining to (select all that apply): Select one or more: a. Preferred foods b. The presence of cravings c. Use of herbal supplements d. Aversions to certain foods and odors
A,B,C,D The nurse should obtain a nutritional history on all pregnant patients and patients of childbearing age to gain specific information related to the pregnancy, including foods that are preferred while pregnant (which may provide information about cultural and environmental dietary factors), special diets (which will assist the nurse in planning for education or interventions for risk factors associated with dietary practices), cravings or aversions to specific foods, and use of herbal supplements.
Presumptive signs of pregnancy include (select all that apply): Select one or more: a. Nausea b. Fatigue c. Ballottement d. Amenorrhea
A,B,D
The clinic nurse encourages all pregnant women to increase their water intake to at least 8 to 10 glasses per day in order to (select all that apply): Select one or more: a. Decrease the risk of constipation b. Decrease the risk of bile stasis c. Decrease their feelings of fatigue d. Decrease the risk of urinary tract infections
A,C,D
A woman presents to a prenatal clinic appointment at 10 weeks' gestation, in the first trimester of pregnancy. Which of the following symptoms would be considered a normal finding at this point in pregnancy? Select one: a. Occipital headache b. Urinary frequency c. Diarrhea d. Leg cramps
B
At the end of her 32-week prenatal visit, a woman reports discomfort with intercourse and tells you shyly that she wants to maintain a sexual relationship with her partner. The best response is to: Select one: a. Reassure woman/couple of normalcy of response b. Suggest alternative positions for sexual intercourse and alternative sexual activity to sexual intercourse c. Recommend cessation of intercourse until after delivery due to advanced gestation d. Suggest woman discuss this with her care provider at her next appointment
B
During pregnancy, poorly controlled asthma can place the fetus at risk for: Select one: a. Hyperglycemia b. Hypoxia c. Hypoglycemia d. Macrosomia
B
Jane's husband Brian has begun to put on weight. What is this a possible sign of? Select one: a. Culturalism syndrome b. Couvade syndrome c. Moratorium phase d. Attachment
B
The clinic nurse reviews the complete blood count results for a 30-year-old woman who is now 33 weeks' gestation. Tamara's hemoglobin value is 11.2 g/dL, and her hematocrit is 38%. The clinic nurse interprets these findings as: a. Normal adult values b. Normal pregnancy values for the third trimester c. Increased adult values d. Increased values for 33 weeks' gestation
B
The clinic nurse talks with Kathy about her possible pregnancy. Kathy has experienced amenorrhea for 2 months, nausea during the day with vomiting every other morning, and breast tenderness. These symptoms are best described as: Select one: a. Positive signs of pregnancy b. Presumptive signs of pregnancy c. Probable signs of pregnancy d. Possible signs of pregnancy
B
The clinic nurse visits with Wayne, a 32-year-old man whose partner is pregnant for the first time and is at 12 weeks. Wayne describes nausea and vomiting, fatigue, and weight gain. His symptoms are best described as: a. Influenza b. Couvade syndrome c. Acid reflux d. Cholelithiasis
B
The nurse who is assessing a G2 P1 palpates the fundal height at the location noted on the picture below. The nurse concludes that the fetus is equal to which of the following gestational ages? Select one: a. 12 weeks b. 20 weeks c. 28 weeks d. 36 weeks
B
What is the most common expected emotional reaction of a woman to the news that she is pregnant? Select one: a. Jealousy b. Acceptance c. Ambivalence d. Depression
B
Which of the following findings, seen in pregnant women in the third trimester, would the nurse consider to be within normal limits? Select one: a. Diplopia B. Epistaxis c. Bradycardia d. Oliguria
B
Which of the following would be a priority for the nurse when caring for a pregnant woman who has recently emigrated from another country? Select one: a. Help her develop a realistic, detailed birth plan. b. Identify her support system. c. Teach her about expected emotional changes of pregnancy. d. Refer her to a doula for labor support.
B
Your pregnant patient is having maternal alpha-fetoprotein (AFP) screening. She does not understand how a test on her blood can indicate a birth defect in the fetus. The best reply by the nurse is: Select one: a. "We have done this test for a long time." b. "If babies have a neural tube defect, alpha-fetoprotein leaks out of the fetus and is absorbed into your blood, causing your level to rise. This serum blood test detects that rise." c. "Neural tube defects are a genetic anomaly, and we examine the amount of alpha-fetoprotein in your DNA." d. "If babies have a neural tube defect, this results in a decrease in your level of alpha-fetoprotein."
B
Your pregnant patient is in her first trimester and is scheduled for an abdominal ultrasound. When explaining the rationale for early pregnancy ultrasound, the best response is: Select one: a. "The test will help to determine the baby's position." b. "The test will help to determine how many weeks you are pregnant." c. "The test will help to determine if your baby is growing appropriately." d. "The test will help to determine if you have a boy or girl."
B
A labor nurse is caring for a patient, 39 weeks' gestation, who has been diagnosed with placenta previa. Which of the following physician orders should the nurse question? Select one: a. Type and crossmatch her blood. b. Sterile vaginal exam c. Administer an oral stool softener to reduce straining. d. Assess her complete blood count.
B A sterile vaginal exam is contraindicated in all pregnant women with extensive vaginal bleeding until the source of bleeding is identified. Due to the possibility of massive hemorrhage, ensure adequate IV access is established and blood/blood products are readily available. Straining at stool is also contraindicated as this can cause cervical dilation and increased risk of hemorrhage; stool softeners are often given to prevent straining.
Ms. M is 38 weeks' gestation and is a G1 P0. At 10 pm Ms. M has just been informed by the nurse that she is 3 to 4 cm dilated, cervix is 100% effaced, and contractions are every 4 to 5 minutes. When the nurse tells her the findings from the sterile vaginal exam (SVE), Ms. M states that she had been contracting since early that morning and she becomes extremely frustrated stating "I should have had this baby by now." Knowing that this is the latent phase of labor for this primiparous woman, what is the best response by the nurse? Select one: a. Tell her she probably has many hours of labor ahead of her and not to worry. b. Provide emotional support, verbal encouragement, teach and reinforce relaxation techniques. c. Discuss various analgesic options d. Tell Ms. M that the provider will be contacted immediately about the slow progress of labor
B Discuss labor progress in latent phase of labor especially with first babies. Women in the latent phase of labor may be frustrated with lack of progress or slow progress of labor and desire companionship and encouragement. The other responses are inappropriate. The nurse should first encourage breathing and relaxation methods as well as provide reassurance, and then contact the provider.
Which of the following laboratory values is most concerning in a client with pregnancy-induced hypertension? Select one: a. Proteinuria of 2.0 g in a 24-hour urine collection period b. Total platelet count of 40,000 mm c. AST <41 units/L; ALT < 30 units/L d. Low serum creatinine
B In hypertensive disorders of pregnancy, evaluation of lab values includes findings of elevated serum creatinine, low platelet count, and and elevated liver enzymes
A 34-weeks' gestation multigravida, G3 P1 is admitted to the labor suite with contractions, fever, and low back pain. The woman has several medical problems. Which of the following of her comorbidities is most consistent with the clinical picture? Select one: a. Kyphosis b. Urinary tract infection c. Congestive heart failure d. Cerebral palsy
B Risk factors for preterm labor include infection, especially genitourinary and periodontal. The other comorbidities listed are not generally associated with preterm labor risk.
The mechanisms of labor include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. These mechanisms are also referred to as: Select one: a. Stages of labor b. The cardinal movements of labor c. First stage of labor d. Fetal lie
B The cardinal movements of labor allow passage of the fetus through the birth canal. These include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
The perinatal nurse knows that tocolytic agents are most often used to (select all that apply): Select one or more: a. Prevent maternal infection b. Suppress uterine contractions c. Prolong pregnancy to facilitate administration of antenatal corticosteroids d. Allow for transport of the woman to a tertiary care facility prior to delivery
B,C,D
A nurse is performing an assessment on a pregnant woman during a prenatal visit. Which of the following findings would lead the nurse to report to the obstetrician that the patient may be experiencing intrauterine growth restriction (IUGR)? Select one: a. Leopold's maneuvers: Hard round object in the fundus, flat object on left of uterus, small parts on right of uterus, soft round object above the symphysis b. Weight gain: 6-pound increase over 4-week period c. Fundal height measurement: 22 cm at 26 weeks' gestation d. Alpha-fetoprotein assessment: level is one-half normal, accompanied by complaints of severe nausea and vomiting
C
A woman who is admitted to labor and delivery at 30 weeks' gestation, is 1 cm dilated, and is contracting q 5 minutes. She is receiving magnesium sulfate IV piggyback. Which of the following maternal vital signs is most important for the nurse to assess each hour? Select one: a. temperature b. pulse c. respiratory rate d. blood pressure
C
Sally is in her third trimester and has begun to sing and talk to the fetus. Sally is probably exhibiting signs of: Select one: a. Mental illness b. Delusions c. Attachment d. Crisis
C
The clinic nurse is aware that the pregnant woman's blood volume increases by: Select one: a. 20% to 25% b. 30% to 35% c. 40% to 45% d. 50% to 55%
C
The nurse has taken a health history on four multigravida patients at their first prenatal visits. It is high priority that the patient whose first child was diagnosed with which of the following diseases receives nutrition counseling? Select one: a. Development dysplasia of the hip b. Achondroplastic dwarfism c. Spina bifida d. Muscular dystrophy
C
The nurse is providing prenatal teaching to a group of diverse pregnant women. One woman, who indicates she smokes two to three cigarettes a day, asks about its impact on her pregnancy. The nurse explains that the most significant risk to the fetus is: Select one: a. Respiratory distress at birth b. Severe neonatal anemia c. Low neonatal birth weight d. Neonatal hyperbilirubinemia
C
The nurse is working in a prenatal clinic caring for a patient at 14 weeks' gestation, G2 P1001. Which of the following findings should the nurse highlight for the nurse midwife? Select one: a. Body mass index of 23 b. Blood pressure of 100/60 c. Hematocrit of 29% d. Pulse rate of 76 bpm
C
Which statement best exemplifies adaptation to pregnancy in relation to the adolescent? Select one: a. Adolescents adapt to motherhood in a similar way to other childbearing women. b. Social support has very little effect on adolescent adaptation to pregnancy. c. The pregnant adolescent faces the challenge of multiple developmental tasks. d. Pregnant adolescents of all ages can be capable and active participants in health-care decisions.
C
A woman at 32 weeks' gestation is diagnosed with severe preeclampsia with HELLP (Hemolysis, elevated Liver enzymes, Low Platelets) syndrome. The nurse will identify which of the following as a positive patient care outcome? Select one: a. Rise in serum creatinine b. Drop in serum protein c. Resolution of thrombocytopenia d. Resolution of polycythemia
C With HELLP, hemolysis is a result of red blood cell destruction as the cells travel through constricted vessels. Elevated liver enzymes result from decreased blood flow and damage to the liver. Low platelets (thrombocytopenia) result from aggregation at the site of damaged vascular endothelium causing platelet consumption. Medical management includes replacement of platelets; a resolution of thrombocytopenia would indicate successful treatment.
When providing a psychosocial assessment on a pregnant woman at 21 weeks' gestation, the nurse would expect to observe which of the following signs? Select one: a. Ambivalence b. Depression c. Anxiety d. Happiness
C The correct answer is: Anxiety The maternal tasks of pregnancy include acceptance of pregnancy and generally happy feelings during this time. Adaptation to pregnancy in the second trimester, more specifically, includes anxiety regarding body changes, and the presence of fears and phobias. Feelings of anxiety in addition to changes in body image include loss of old life, changing relationships with friends and family, changes in sexual activity and "tuning in" to the fetus in terms of movement, etc.
The clinic nurse explains to Margaret, a newly diagnosed pregnant woman at 10 weeks' gestation, that her rubella titer indicates that she is not immune. Margaret should be advised to (select all that apply): Select one or more: a. Avoid contact with all children b. Be retested in 3 months c. Receive the rubella vaccine postpartum d. Report signs or symptoms of fever, runny nose, and generalized red rash to the health-care provider
C, D
Strategies for culturally responsive care include (select all that apply): Select one or more: a. Practicing ethnocentrism b. Applying stereotyping c. Examining one's own biases d. Learning another language
C,D
A 37-year-old woman who is 17 weeks pregnant has had an amniocentesis. Before discharge, the nurse teaches the woman to call her doctor if she experiences which of the following side effects? Select one: a. Pain at the puncture site b. Macular rash on the abdomen c. Decrease in urinary output d. Cramping of the uterus
D
A type 1 diabetic patient has repeatedly experienced elevated serum glucose levels throughout her pregnancy. Which of the following complications of pregnancy would the nurse expect to see? Select one: a. Postpartum hemorrhage b. Neonatal hyperglycemia c. Postpartum oliguria d. Neonatal macrosomia
D
A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? Select one: a. Serum potassium level increases b. Diarrhea c. Urticaria d. Tachycardia
D
Jenny, a 21-year-old single woman, comes for her first prenatal appointment at 31 weeks' gestation with her first pregnancy. The clinic nurse's most appropriate statement is: Select one: a. "Jenny, it is late in your pregnancy to be having your first appointment, but it is nice to meet you and I will try to help you get caught up in your care." b. "Jenny, have you had care in another clinic? I can't believe this is your first appointment!" c. "Jenny, by the date of your last menstrual period, you are 31 weeks and now that you are finally here, we need you to come monthly for the next two visits and then weekly." d. "Jenny, by your information, you are 31 weeks' gestation in this pregnancy. Do you have questions for me before I begin your prenatal history and information sharing?"
D
The nurse is caring for two laboring women. Which of the patients should be monitored most carefully for signs of placental abruption? Select one: a. The patient with placenta previa b. The patient whose vagina is colonized with group B streptococci c. The patient who is hepatitis B surface antigen positive d. The patient with eclampsia
D
The perinatal nurse is assessing a woman in triage who is 34 + 3 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats per minute. A vaginal examination performed by the health-care provider reveals that the cervix is closed, long, and posterior. The most likely diagnosis would be: Select one: a. Preterm labor b. Term labor c. Back labor d. Braxton-Hicks contractions
D
The perinatal nurse knows that the term to describe a woman at 26 weeks' gestation with a history of hypertension prior to pregnancy and who now presents with a new onset proteinuria (by dipstick) is: Select one: a. Preeclampsia and eclampsia syndrome b. Chronic hypertension c. Gestational hypertension d. Preeclampsia superimposed on chronic hypertension
D
The primary complications of amniocentesis are: Select one: a. Damage to fetal organs b. Puncture of umbilical cord c. Maternal pain d. Infection
D
Which of the following information regarding sexual activity would the nurse give a pregnant woman who is 35 weeks' gestation? Select one: a. Sexual activity should be avoided from now until 6 weeks postpartum. b. Sexual desire may be affected by nausea and fatigue. c. Sexual desire may be increased due to increased pelvic congestion. d. Sexual activity may require different positions to accommodate the woman's comfort.
D
Which of the following statements is most appropriate for the nurse to say to a patient with a complete or total placenta previa? Select one: a. "During the second stage of labor you will need to bear down." b. "You should ambulate in the halls at least twice each day." c. "Your provider will likely induce your labor with oxytocin." d. "Please promptly report any vaginal bleeding or if you feel any lower back discomfort.
D
Your patient is a 37-year-old pregnant woman who is 5 weeks pregnant and is considering genetic testing. During your discussion, the woman asks the nurse what the advantages of chorionic villus sampling (CVS) are over amniocentesis. The best response is: a. "You will need anesthesia for amniocentesis, but not for CVS." b. "CVS is a faster procedure." c. "CVS provides more detailed information than amniocentesis." d. "CVS can be done earlier in your pregnancy, and the results are available more quickly."
D
The nurse is caring for a woman at 28 weeks' gestation with a history of preterm delivery. Which of the following laboratory data should the nurse carefully assess in relation to this diagnosis? Select one: a. Human relaxin levels b. Amniotic fluid levels c. Alpha-fetoprotein levels d. Fetal fibronectin levels
D Fetal fibronectin (fFN) is a biochemical marker used in the assessment of preterm labor. A negative fFN (<50 ng/mL) has a high negative predictive value that the woman will not deliver in 7-14 days.
A client on 2 gm/hr of magnesium sulfate has decreased deep tendon reflexes. Identify the priority nursing assessment to ensure client safety. Select one: a. Assess uterine contractions continuously. b. Assess fetal heart rate continuously. c. Assess urinary output. d. Assess respiratory rate.
D Magnesium sulfate is a central nervous system depressant and has been proven to help reduce seizure activity without documentation of long-term adverse effects to the woman and fetus. Care of the woman on Magnesium sulfate includes assessment of vital signs every 5-15 minutes during loading dose and then every 30-60 minutes until stabilization. Assess deep tendon reflexes (DTRs) every 2 hours; decreasing DTRs may be a sign of impending respiratory depression. Respiratory depression, <14 breaths/minute, is the primary complication of Magnesium sulfate use.
Your patient is 34 weeks pregnant and during a regular prenatal visit tells you she does not understand how to do "kick counts." The best response by the nurse would be to explain: Select one: a. "Here is an information sheet on how to do kick counts." b. "It is not important to do kick counts because you have a low-risk pregnancy." c. "Fetal kick counts are not a reliable indicator of fetal well-being in the third trimester." d. "Fetal movements are an indicator of fetal well-being. You should count twice a day, and you should feel 10 fetal movements within 2 hours."
D Maternal assessment of fetal movement by counting fetal movements in a period time can identify potentially hypoxic fetuses. Fetal activity is diminished in the compromised fetus. The pregnant woman is instructed to palpate her abdomen and track fetal movements daily for 1-2 hours. Ten distinct fetal movements within 2 hours is considered normal. Once movement is achieved, counts can be discontinued for the day.
The single most important risk factor for preterm birth is: Select one: a. Uterine and cervical anomalies b. Infection c. Increased BMI d. Prior preterm birth
D The single most important factor is prior preterm birth with a reoccurrence rate of up to 40%.
The nurse working in a prenatal clinic is providing care to three primigravida patients. Which of the patient findings would the nurse highlight for the provider? Select one: a. 15 weeks, denies feeling fetal movement b. 20 weeks, fundal height at the umbilicus c. 25 weeks, complains of excess salivation d. 30 weeks, states that her vision is blurry
D Visual disturbances may be an indication of preeclampsia. The other responses are normal findings for the various stages of pregnancy.
The perinatal nurse explains to the new nurse that ptyalism is a condition more acute than the normal nausea and vomiting of pregnancy and is often associated with dehydration, hypokalemia, and weight loss. Select one: True False
False
The perinatal nurse explains to the student nurse that the most frequent fetal risk associated with the use of forceps is cord compression. select one: True False
False
Women with gestational diabetes (GDM) do not need to be monitored for type 2diabetes after the birth. Select one: True False
False
The clinic nurse understands the meaning of the following terms related to pregnancy care. Match these terms with the definitions listed below: Passive movement of the unengaged fetus: Ballotement Curvature of the spine: Lordosis Verbalizing someone else's wishes if he or she is unable to do so: Advocacy Absence of menses: Amenorrhea Stretch marks: Striae gravidarum
Lordosis Advocacy Amenorrhea gravidarum
Cecilia, a pregnant woman at 30 weeks' gestation, has her vital signs assessed during a routine prenatal visit. Cecilia's blood pressure has remained at 110/70 for the last few visits, and her pulse rate has increased from 70 to 80 beats per minute. These findings would be considered normal at this time in pregnancy. Select one: True False
True
The perinatal nurse recommends strengthening exercises during pregnancy, as this can improve posture and increase energy levels. Select one: True False
True
Question 2 You are caring for a woman in the 4th stage of labor and birth. Fundal massage reveals a firm, well-contracted uterus but you note unusual swelling of the perineum. This might indicate formation of a hematoma. Select one: True False
True During the 4th stage of labor and birth, the nurse closely monitors the perineum for unusual swelling which may indicate internal bleeding and hematoma formation.
You are caring for a patient who was admitted to labor and delivery at 32 weeks' gestation and diagnosed with preterm labor. She is currently on magnesium sulfate, 2 gm per hour. Upon your initial assessment you note that she has a respiratory rate of 8 with absent deep tendon reflexes. What will be your first nursing intervention? Select one: a. Elevate head of the bed b. Notify the provider c. Discontinue magnesium sulfate and notify the provider d. Draw a serum magnesium level
c Initial nursing intervention needs to be discontinuing magnesium sulfate because the patient is exhibiting signs of magnesium toxicity with absent deep tendon reflexes and decreased respiratory rate.
A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner? Select one: a. Presence of cholasma b. Presence of severe heartburn c. 10-pound weight gain in a month d. Patellar reflexes +1
c Some of the normal cardiac changes during pregnancy can exacerbate cardiac disease including increase in total blood volume, increase in cardiac output, increased heart rate, and slight enlargement of the heart. Usual signs of deteriorating cardiac function include fluid retention which leads to weight gain above that expected of normal pregnancy. Chloasma, heartburn, and patellar reflexes are not related to cardiac disease.
The labor patient you are caring for is ambulating in the hall. Her vaginal exam 1 hour ago indicated she was 4 cm dilated/70% effaced/-1 station. She tells you she has fluid running down her leg. Your priority nursing intervention is to: Select one: a. Assess the color, odor, and amount of fluid. b. Assist your patient to the bathroom. c. Assess the fetal heart rate (FHR). d. Call the care provider.
c When rupture of membranes (ROM) is suspected, the first nursing action is to assess the fetal heart rate (FHR) as there is an increase risk of umbilical cord prolapse with ROM especially if the fetal head is not well engaged.
When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is: Select one: a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact. b. True labor contractions result in increasing anxiety and discomfort, and false labor does not. c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.
d
Question 6 Ms. P has delivered her first baby 30 minutes ago and the placenta delivered 15 minutes ago. She is attempting to breastfeed her newborn daughter for the first time. Which action by the nurse would NOT be appropriate? Select one: a. The nurse is checking the BP every 15 minutes b. The nurse is massaging the fundus vigorously c. The nurse is auscultating the infant's heart and lungs while on the mother's chest d. The nurse is leaving the patient unattended for 30 minutes to bond with her newborn
d During the fourth stage of labor the mothers should not be left unattended as maternal bleeding needs to be closely monitored.
The perinatal nurse knows that the laboring diabetic patient's blood glucose level should be maintained at 70-110 mg/dL. Select one: True False
true
